Certain about midwifery, uncertain about nursing

blackbird singing · Aug 10, 2011

Yeah, I though it was missing a few schools, too. But isn't Emory set up to where you get your ABSN, then you have to apply to get the CNM? idk though...

I'm looking at Vandy, ohio state, seattleu and marquette. I'm all over the place. haha

MaineMan88 · Aug 10, 2011

Lilacs,

I am currently a student in one of the aforementioned "bridge" programs. I just finished my pre-specialty year, and therefore, will sit for my RN licensure exam very soon and will being my nurse-midwifery courses this month.

I can sympathize with your situation because I have been there before. I had no interest in being a nurse and viewed nursing as a mere "stepping stone" to bigger and better things.

However, I think you will soon find that nursing is not a stepping-stone, but rather the foundation of who you will become as a nurse-midwife. They are one in the same--there is no separating the two. You would not be a good nurse-midwife if you were first not a good nurse, or at least believed in the nursing philosophy.

You mention that you don't want to be wiping poop off of the tooshes of angry and frustrated patients. True, you probably won't have to do this often as a nurse-midwife. But many of your patients will defecate as they "push" during labor. How will you respond? Will you call in a nurse and let the patient sit in her own feces until the RN arrives to wipe her butt? Let's say you need a nurse to start an IV and hang a bag of fluids, insert a Foley catheter for a laboring patient, and give an IM Rhogam injection. But let's also say that you are working in a rural area with a nursing shortage. There aren't any nurses to delegate these activities to. As a nurse-midwife, you are ALSO A REGISTERED NURSE. You have been trained to perform in this role and have proved yourself competent. Do you get what I'm getting at here? To be a competent nurse-midwife, you sure as hell need to be a competent nurse. And oh yeah--if you've spent a few years wiping poop off of the butts of elderly men in ICU pods or post-op cardio floors, or at least spent a year doing so in clinical rotations, wiping a little smear of poop away from your laboring patient's toosh will be no big deal.

Consider this, keep doing your research, and keep gaining multiple perspectives. If after thorough reflection you still have the same aversion to nursing, I would suggest that you pursue a career other than nurse-midwifery.

Best of Luck,

Nate

lilacs101 · Aug 10, 2011

Nate, thanks so much for your thoughts. You know, when I was originally typing out the poop example, I had also typed something in parenthesis about how somehow it seems different to me if the expectation is to clean up a client occasionally, rather than be expected to do it all the time, essentially acting as both a CNA and an RN (which seems to be surprisingly common, based on experiences I've heard about here). Then I decided that my post was getting too long, and I deleted that parenthetical aside. I probably should have picked a better example, but a year of wiping butts due to a messed up, overtaxed medical system and a failing economy was the first thing that came to mind. For the record: I would wipe my daughter's butt, I don't mind wiping someone else's daughter's. :-)

I'm going to go out on a limb with something--I haven't even been to nursing school, yet, so bear with me. I think there is a distinction between "being a nurse" and "having nursing skills." To me, "being a nurse" means placing myself squarely within a medical model of care for women in the childbearing year ("Just lay back, sweetie, and do what the OB tells you to do. No don't worry about the episiotomy, no you can't get up and walk around because I can't read the monitor if you move," etc). Yes, I realize that I'm both exaggerating and generalizing, and I also understand that, as a CNM, I'll probably end up working within the medical system (what, like 96% of CNMs work in hospitals?). But. As a CNM/ WHNP/ FNP, I feel that I will have more latitude to tailor my care to the clients' needs and wishes, more independent decision-making ability, more responsibility, and yes, more risk exposure than the average bedside RN. That is what I want for my career.

Which brings me to the reason that I've decided to put my career within the medical system and not to pursue the CPM credential: because I believe that "nursing skills" and a standardized education will make me a better care provider. Not only for the clinical skills--e.g. placing an IV with steady, practiced hands into a tricky vein--but also to work with women as part of their family and social system. I currently live in a rural area and expect to stay here, so your point really hit home. Eventually, I'd love to work abroad, perhaps in the developing world, so scope of practice is important to me. For these reasons, I would re-write your point as follows: "To be a competent midwife, you sure as hell need to be totally competent with your nursing skills."

In short, I'm hoping that a miserable year in nursing school plus a crappy first job in a crappy job market will be worth it: that it will give me a start on the clinical skills that I'll need and a bit of experience to start me on my way. I don't know, maybe this is all semantics, maybe I'm over-thinking things, but this is important to me and my motivations. I guess I want to prepare for the worst and hope for the best.

Having said that...

A traveler came upon an old farmer hoeing in his field beside the road. Eager to rest his feet, the wanderer hailed the countryman, who seemed happy enough to straighten his back and talk for a moment.

"What sort of people live in the next town?" asked the stranger.

"What were the people like where you've come from?" replied the farmer, answering the question with another question.

"They were a bad lot. Troublemakers all, and lazy too. The most selfish people in the world, and not a one of them to be trusted. I'm happy to be leaving the scoundrels."

"Is that so?" replied the old farmer. "Well, I'm afraid that you'll find the same sort in the next town.

Disappointed, the traveler trudged on his way, and the farmer returned to his work.

Some time later another stranger, coming from the same direction, hailed the farmer, and they stopped to talk.

"What sort of people live in the next town?" he asked.

"What were the people like where you've come from?" replied the farmer once again.

"They were the best people in the world. Hard working, honest, and friendly. I'm sorry to be leaving them."

"Fear not," said the farmer. "You'll find the same sort in the next town."

EDIT: Nate, are you doing a direct-entry CNM program? As in, you didn't have your RN before the program? If so, I wonder if your perspective might be different if you had to BE a nurse/ work as a nurse for a year (and not just work on your nursing skills within an academic context). If I were doing a direct-entry program (i.e. straight through RN to CNM), I wouldn't have ANY of these worries.

danceluver · Aug 11, 2011

Yeah, I though it was missing a few schools, too. But isn't Emory set up to where you get your ABSN, then you have to apply to get the CNM? idk though...
I'm looking at Vandy, ohio state, seattleu and marquette. I'm all over the place. haha

Those are some great choices....i'll be looking into Vandy as well, but not a big fan of the whole distance education and or massive traveling involved in this program.

And no i don't think Emory is a two step program....you can applying to a direct entry program or do a segue program (which makes the BSN a regular BSN program instead of a ABSN program). I'm sure you'll get into a program this year. Its going to be an exciting journey!

**LibraSunCNM, BSN, MSN, CNM** · Aug 12, 2011

I'm going to go out on a limb with something--I haven't even been to nursing school, yet, so bear with me. I think there is a distinction between "being a nurse" and "having nursing skills." To me, "being a nurse" means placing myself squarely within a medical model of care for women in the childbearing year ("Just lay back, sweetie, and do what the OB tells you to do. No don't worry about the episiotomy, no you can't get up and walk around because I can't read the monitor if you move," etc). Yes, I realize that I'm both exaggerating and generalizing, and I also understand that, as a CNM, I'll probably end up working within the medical system (what, like 96% of CNMs work in hospitals?). But. As a CNM/ WHNP/ FNP, I feel that I will have more latitude to tailor my care to the clients' needs and wishes, more independent decision-making ability, more responsibility, and yes, more risk exposure than the average bedside RN. That is what I want for my career.
I think this is where your logic is going wrong, and it's only something you can understand as you get into nursing school, are exposed to different medical environments, and then mostly when you work as a nurse. I became a nurse to become a CNM, and have been working as an RN, first in med/surg, now in mother/baby, for 3 years. I too felt reluctant to have to get nursing experience before starting my program--I wanted to go straight through, and come out the other end an advanced practice nurse. But all I can say is that you don't know what you don't know right now. You won't understand how necessary your time, however brief, working as an RN will provide a necessary foundation for being a CNM, until you do it. NOT just in the skill sets, but in having a greater understanding of caring for the patient. I promise! I know there are good advance practice nurses who went through direct-entry programs, but I just don't agree with that educational path. If you're going to be an advanced practice nurse, you HAVE to have nursing experience to be able to relate to both your patients and the nurses you may work with in a more complete way. And no, being a nurse is not comprised of "Oh, lay back and listen to the doctor." Some nurses may work that way, but that does not align with the philosophies of nursing practice in this country, and it is not how they will teach you to practice in school. As MaineMan said, and I mean this as respectfully as possible, if your aversion to nursing still persists after contemplating all of these factor, becoming a CNM might not be the best path to take. Just my

danceluver · Aug 14, 2011

Lilacs,
I am currently a student in one of the aforementioned "bridge" programs. I just finished my pre-specialty year, and therefore, will sit for my RN licensure exam very soon and will being my nurse-midwifery courses this month.
I can sympathize with your situation because I have been there before. I had no interest in being a nurse and viewed nursing as a mere "stepping stone" to bigger and better things.
However, I think you will soon find that nursing is not a stepping-stone, but rather the foundation of who you will become as a nurse-midwife. They are one in the same--there is no separating the two. You would not be a good nurse-midwife if you were first not a good nurse, or at least believed in the nursing philosophy.
You mention that you don't want to be wiping poop off of the tooshes of angry and frustrated patients. True, you probably won't have to do this often as a nurse-midwife. But many of your patients will defecate as they "push" during labor. How will you respond? Will you call in a nurse and let the patient sit in her own feces until the RN arrives to wipe her butt? Let's say you need a nurse to start an IV and hang a bag of fluids, insert a Foley catheter for a laboring patient, and give an IM Rhogam injection. But let's also say that you are working in a rural area with a nursing shortage. There aren't any nurses to delegate these activities to. As a nurse-midwife, you are ALSO A REGISTERED NURSE. You have been trained to perform in this role and have proved yourself competent. Do you get what I'm getting at here? To be a competent nurse-midwife, you sure as hell need to be a competent nurse. And oh yeah--if you've spent a few years wiping poop off of the butts of elderly men in ICU pods or post-op cardio floors, or at least spent a year doing so in clinical rotations, wiping a little smear of poop away from your laboring patient's toosh will be no big deal.
Consider this, keep doing your research, and keep gaining multiple perspectives. If after thorough reflection you still have the same aversion to nursing, I would suggest that you pursue a career other than nurse-midwifery.
Best of Luck,
Nate

@ Maineman88 Great post! Just curious, does your program require you or encourage you to work as an RN after you obtain your license during your cnm program? Do you think as a current student it being something all midwife students who do direct entry programs should pursue? I fully grasp the train of thought you are highlighting in your post, and fully support it, but as a CNM, after graduation, does your program tell you that you will be well prepared to work as a CNM without say having worked as an RN for years in between? I'd like your input :)

MaineMan88 · Aug 14, 2011

DancingNurse,

In one of the posts above you mention that Vandy is a distance program with massive amounts of traveling. The last part may be true, depending on where you are placed; faculty make it clear that you will likely travel outside of Nashville for at least one of your rotations. However, Vandy's midwifery program is not a distance program--or at least not yet. Most of Vandy's specialty programs offer the distance option, including FNP. However, it is my understanding that there are a number of students in each specialty that have classroom spots. If you were to do the NMW/FNP dual-program, you would NOT be a distance student, unless you opted for that in your last semester which focuses only on FNP courses and clinical.

In response to your questions, no, Vanderbilt does not require or suggest that students work as RNs after graduation. I know that a lot of the ACNP students have to work as a RN in order to get a job, but from my understanding, this does not hold true for any of the other specialties. The pre-specialty (RN) faculty are supportive of this route and even provide literature that suggests that NPs who start out as non-RN students are better prepared than those with RN experience (although I'm not sure if I completely buy into this). I can send you the article if you wish, just for a different perspective. Here's a blurb from the discussion portion of the article:

"Based on the data collected in this study, duration of practice experience as an RN was not correlated with level of competency in NP practice skills, as determined by NP self report. An unexpected finding was that there was a significant negative correlation between years of experience as a RN and NP clinical practice skills as assessed by the NPs' collaborating physicians. Longer experience as a RN was associated with lower rankings of NP skills competency by the physicians.This information can lead us to question longstanding biases that claim that those with little or no experience as RNs are poorly prepared for advanced NP practice."

citation: Rich, E.R. (2005). Does RN experience relate to NP clinical skills? The Nurse Practitioner, 30(12), 53-56.

My point is not to prove that NPs who enter nursing school without a nursing degree are "better" than those with RN experience--rather, just to reinforce that there are many entry options into advanced practice nursing and that one path is not necessarily better than any other.

So to answer your other question, no, I do not think that working as a RN is something that all new graduate CNMs should do or need to do. It might be necessary for some graduates--maybe not for others. I may have done a poor job articulating exactly what I wanted to say in my previous post. I don't necessarily believe that having RN experience correlates to having better NP skills (which goes along with the article I cited)--rather, I would say that having RN experience likely correlates to having RN skills, which will likely by utilized by the NP constantly throughout her career. I guess what I was trying to say is this: To become a NP or CNM, you will first need to become a RN in one way or another. Regardless of the path you take to obtain your RN licensure, that experience will be valuable both in forming your nursing skills and building a foundation of the nursing process and model--both of which will need to be strong in order for you to be a successful advanced practice nurse.

Lilacs, I agree with LilyRoseRN that most RNs do not work within the medical model. While there are always those unfortunate exceptions, I think your assumptions are based on outdated stereotypes. In the clinical experiences I have logged working toward my RN, nearly all of the nurses I have worked with have been stellar--intelligent, as autonomous as policies allow, and excellent patient advocates. In other words, most modern RNs do a wonderful job upholding the nursing model.

Peace,

Nate

lilacs101 · Aug 15, 2011

First, I'd like to thank Lily, Nate, and DN for contributing to this conversation. The thoughtful discussion on the role of previous RN experience as an advanced practice nurse has been very helpful in my thinking.

To throw out a few more thoughts on the intersection of nursing and midwifery...

I considered some of the Certified Midwife (CM) programs in NY/ NJ/ PA. These programs are accredited through ACME, the accreditation arm of ACNM. So, yes, it's possible to become a midwife without becoming a nurse in a way that's sanctioned by the American College of NURSE-Midwives.

And what was all of that recent discussion on changing the name from ACNM to American College of MIDWIVES?

Anyway!

After doing some soul-searching, I've realized that my concerns really centers around that first year out of school. My first and primary concern is related to finding work after nursing school graduation, and, if I'm so lucky as to find a job after graduation, being stuck in a job that I hate that is not advancing my skills or my life path. It seems that the direct-entry programs would address this concern for me; I just can't justify taking on that much debt. So I've made my decision (to get a BSN, then work for a year), and I need to find peace with it.

I have both nurses and midwives in my family and circle of friends. I know what they face on a daily basis. Not a career change to be taken lightly.

**LibraSunCNM, BSN, MSN, CNM** · Aug 15, 2011

i considered some of the certified midwife (cm) programs in ny/ nj/ pa. these programs are accredited through acme, the accreditation arm of acnm. so, yes, it's possible to become a midwife without becoming a nurse in a way that's sanctioned by the american college of nurse-midwives.
you're right, and i didn't even think to get into that particular path toward midwifery!
so i've made my decision (to get a bsn, then work for a year), and i need to find peace with it.
i'm glad
i have both nurses and midwives in my family and circle of friends. i know what they face on a daily basis. not a career change to be taken lightly.

very, very true. i hope your journey towards midwifery is a happy one.

ischialspines · Aug 21, 2011

just going to chime in here - I worked with homebirth midwives for years off and on as I was pursuing CPM licensure before going to nursing school (I was about complete with that route when family issues meant I needed to go back to work full time). I graduated recently from an ADN program and now work in L&D, and hope to put in a couple of years before moving forward to a CNM program. Absolutely everything is valid that I learned in nursing school as an L&D nurse and as a midwife. I just kept constantly thinking about how I could apply x thing that I was learning to midwifery. Nursing is not the medical model, as mentioned before. It is the nursing model. And once I moved on to nursing school- definitely not rote memorization (like anatomy) but lots of concepts and critical thinking.

There are days (weeks -- semesters, maybe) that I was stressed to my eyeballs in nursing school. I did my fair share of crying. But I also turned into a nurse. And I identify as a nurse. There are days that I am absolutely overwhelmed at work, as an orienting new grad L&D nurse, and days that are great. The amount of charting sucks. There are days when I am completely frustrated with the medical model of childbirth (especially coming from the "other" side!). But above all, I love being a nurse and patient advocate. And OBs, at least at my facility, work well with the nurses - we have a great relationship because they know how much they depend on us.

coffee and toast · Sep 3, 2011

OP, many have advised you on your RN year.... but here is some advice for your BSN year.......There is acceptance and coping necessary for that year too, and here is how I'm surviving it:

The SUNY accelerated BSN program you are considering will go very fast. It will have happy moments that you can see your future in -- your first newborn assessment -- but it promises angry/bored/frustrated/strained times too.

If your experience is anything like mine, you will find wonderful faculty in the midst of a program that is - as you said - memorization (or worse, multiple choice recognition) being sold to you as critical thinking. You will find some faculty that annoy you - but you'll realize that they are actually great people, it's just hard to tell when they are standing in front of awful powerpoints all the time!

Don't let the powerpoints disillusion you.

Consider these spoon-feeding-esque lectures the clear liquid diet phase of hospital food post surgery - barely palatable, unavoidable, and best not argued with.

When you think you can't take another word-laden powerpoint slide, in the fall, you will begin to drive all over CNY to get your clinical hours. Fear not, you will continue to sit endlessly in large lecture halls in the evening. It will be more painful than the summer, but less memorable because you will be far too tired to process. Your butt will hurt so much from said sitting it may have pressure ulcers - but you'll know how to stage those pressure ulcers!

No program is perfect. The faculty are trying hard to give us a great experience in one short year. There is some ridiculousness and much disorder - but - at the end of the day I try and be appreciative for what the faculty does for us. They care, even if some can't teach, they care, and that says a lot.

I don't condone the crappy parts of the program - but I truly believe they have a special collection of teachers. This program has been criticized on All Nurses before - it's not for everyone - but if you go, try and see the good.

Also, despite it being a year about nursing not midwifery, the faculty are very pro-midwifery - and there are many midwives on staff to inspire and guide you. But, this would be my advice: Try and let yourself indulge in the nursing school experience from general interest perspective.

Pretend you are an anthropologist and try it all to really see whats its about, analyze it for the sake of entertaining yourself. Give yourself the freedom to hate some of the ideas and to love some, and then you'll actually gain something more meaningful than the requisite BSN for your midwifery application.

I promise, there are building blocks in a BSN to make you a great CNM. Even when it seems tedious, there is a lesson to be learned...somewhere. There are also things you'll learn that you'll want to reject - great - avoid the memorization game and think about why you are opposed to part of the nursing model, process, or culture. Articulate yourself, and figure out ways to build something better.

There is so much to do in so little time if you think of it that way!

And while I'm at it...accept now that you'll learn lots for the NCLEX that you'll forget down the road as a midwife. You'll learn to pick a faulty answer because its the 'best answer', and you'll be angry that 'best answer' seems to be scapegoat for 'crappy question' :)

But the process of learning and forgetting is part of every certification, and part of every path to specialization. Think of all the Psych NPs, or Peds NPs, or any specialist... will forget. But also think of all they will remember....Interventions, Medications, Suggestions, Lifestyle Choices, Diets....it all connects, it connects in life and it connects in child-bearing years no differently. You know that. And so some themes, philosophies, and of course pathophysiology will become a part of you and your thinking -- part of you as an RN and part of you as a CNM. You'll keep the good and weed out the bad.

Your BSN may indeed feel frustrating when you are trying to be marching towards your midwifery goals at steady pace. Don't worry - no matter how frustrated you feel, you will be too tired to dwell much on it. It is a whirlwind year, with too little time to get upset.

You sound passionate about what you want to do. Don't lose that, it's admirable. Don't let anyone make you feel bad about having goals. Not desiring bedside nursing is a personal choice. There are many ways to establish your RN street cred. - home nursing, clinics, etc...you'll find what works for you. Your BSN will help you filter through these options, there are more options than you may event think :)

**mya612, BSN, RN** · Sep 10, 2011

Check out Frontier School of Midwifery. Entire program is $29,700. East Carolina University (ECU) is about the same price. Both are completely on line. I will probably attend ECU when it's time for me to become a CNM because I live in NC and for me its half the price of Frontier.