pediatric Nurse Midwife

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    Hello

    Can anyone elaborate on this type of position and following career? I understand you can work both as a CNM and PNP and take care of both women at all stages of life and all pediatric populations- which is quite interesting. University of Michigan has such a program. Any others? Anyone out there that works in both roles or each role separately at different practices? I think this is an interesting field.

    Thanks for all your insight!
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    bump...anyone have any thoughts? I think this might be really useful in a women's and children's clinic, etc.
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    U Mich's pediatric nurse midwife program in pretty new and, to the best of my knowledge, is the only formal program which combines PNP and CNM preparation. I've never meet anyone who had these two specialties. It does sound like an interesting combination to do women's health/pregnancy and follow the kids as well. I'm currently a student in one of the dual specialty FNP/CNM programs and I know there are a quite a few of us around (FYI - Francis Likis, the editor-in-chief of the Journal of Midwifery and Women's Health is a dually certified FNP/CNM). At my program, about half of the midwifery student are dual specialty (with the FNP) and I know quite a few who have earned each credential separately. We are trained to do primary care throughout the lifespan including full-scope women's health and maternity care, just like the old fashion family doctor. Many of the student, like myself, have interests in community-oriented primary care with underserved populations. I really wanted the dual specialties since in community health, there is such a pressing need for comprehensive primary care for all ages as well as pregnancy-related care. Uninsured or underinsured women are much more likely to have bring their children to a healthcare provider yet often will not seek post-partum care for themselves so having a provider who can do both as a "one stop shop" would cut down on one barrier to care. Pediatric providers (regardless of preparation) are also expected to provide care for a breastfeeding mother of one of their patients since complications (maternal nutrition, latching problems, mastitis, etc...) can have disastrous consequences for the infant. Most PNPs have minimal, if any, experience in this area. This is another area where CNM credentialing would come in handy. The dually credentialed midwife + primary care specialty is nothing new but the peds-only version is not something I've heard about before. This would be an appealing combination if you wanted to have a scope of practice but didn't want to treat adult men.
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    Hi pro-student,
    How long do the dual FNP/CNM programs take to complete? I'm interested in doing something like this and would probably want to get one degree first and then complete the other part time while I'm working under my first degree. I'm sure it varies by school which courses they will waive for the post masters part, but I'm just looking for an estimate. I'm going to be entering an accelerated/masters entry NP program this fall (either a 2 year or 3 year program) but was also accepted to med school so could accomplish these career goals in family practice as well. Would getting a dual cert FNP/CNM be a similar time/tuition committment as med school (4 yrs school and 3 residency)?

    Thanks!
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    I like the FNP/CNM model (which was not offered at my school, I am CNM only). I'm not sure about the usefulness of the CNM/PNP model though. I am sure there are some places it would work well or the program wouldn't exist! It is within the scope of practice of a CNM to provide well newborn care. But routine pediatric care would be difficult, office not set up for it, stocking childhood vaccines, ped size equipment, different scale, etc. Not to say it wouldn't be done anywhere. It would be nice for job opportunities to have both options though. Has anyone worked in a combined CNM/PNP role?
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    Quote from km446
    Hi pro-student,
    How long do the dual FNP/CNM programs take to complete? I'm interested in doing something like this and would probably want to get one degree first and then complete the other part time while I'm working under my first degree. I'm sure it varies by school which courses they will waive for the post masters part, but I'm just looking for an estimate. I'm going to be entering an accelerated/masters entry NP program this fall (either a 2 year or 3 year program) but was also accepted to med school so could accomplish these career goals in family practice as well. Would getting a dual cert FNP/CNM be a similar time/tuition committment as med school (4 yrs school and 3 residency)?

    Thanks!
    My dual specialty FNP/CNM program is two years (5 semesters, including one summer) full-time. I think this pretty much the norm (off the top of my health, Emory is the same length and so is U Mich, I believe). Many people do one specialty and then another as a post-masters however, just a heads up, federal financial aid will not cover a post-masters program (no grants, sub or unsub loans) so you’d be on your own to foot the bill. Scholarships and private loans can certainly be used if you can get them but just something to bear in mind. It’s one of the many reasons I choose to do the dual-specialty right away.

    As far a going the physician vs. APN route, it really should be about more than time and money. A really good friend of mine and I were both pre-med as undergrads. We both also ended up back in nursing school after we had our first degrees and were both enrolled in advanced practice nursing programs. She dropped out of hers to go to med school and I’m obviously still in mine. She decided to leave her graduate nursing program just after she was awarded a full-ride scholarship for the entire program but it was the right decision for her. She was much more into the scientific basis of clinical practice than nursing offers. Not to say that there isn’t a rigorous scientific aspect in nursing but we both came from backgrounds in the hard sciences and, comparatively, nursing science seems like finger painting to us. I was talking to her after her advanced patho final which most nursing students abhor. She was frustrated at what she felt was the lack of rigor commenting, “Really? They’re going to let me diagnose and prescribe after THIS?” Med school is two years of just hard sciences whereas in nursing you get usually two classes with some science in clinical context. I’m not bashing nursing at all, I actually passed on med school because the nursing model was the right fit for me personally.

    Financially speaking, med school vs. nursing school would really depend on which programs they are. My MSN will cost more than many med schools would cost for 4 years. Some med schools cost next to nothing whereas others will set you back quite a bit. Consider, though, that almost no one works during med school (certainly not nursing M3 or M4) but most people are able to work at least part-time through nursing school. Many nursing programs are specifically designed with the understanding that most students will still be working as an RN while in school. Med school + family med residency will take 7 years while a direct-entry MSN with a dual-specialty could be done in 3. One last point, while family medicine residencies are all required to prepare physicians in OB and women’s health, there is a very wide range in how well they do so. A lot of FP’s who want to really do OB do one of the fellowships available around the country (usually 1 year focusing solely on OB/women’s health). But then again, some unopposed family med programs have excellent OB content in the normal residency program.

    I know this response is probably much longer than you were looking for but hopefully I could offer some thinking points. Best of luck with your decision and your career in healthcare, whatever it ends up looking like.
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    @pro-student-may i ask what school you are at? Are you worried having no LD experience will leave you with few options after graduation? What has your experience been like in this climate doing a direct entry type program? Do you feel you will be prepared to manage birth once you graduate no problem?

    Do you personally know if CNMs can opt only to do in office/clinic OB care but opt of out doing deliveries or make a concession to a private practice or clinic that they don't necessarily have to allow "me" to deliver (intrapartum) if its too much to ask (malpractice or whatever)---instead of hiring say a WHNP or FNP that wouldn't have the expertise in OB? Have you seen this during your clinicals or experience in the field thus far?

    you've been extremely helpful in your comments, thank you!
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    danceluver, I'm at Vanderbilt. I'm actually not a direct-entry nurse (I did an ADN after my bachelor's instead). But I don't have any L&D experience as an RN and probably won't be landing a job while in school. This doesn't really concern me all that much. Yes, L&D experience would be great for being a midwife but I don't think it is in any way necessary. We have a number of direct-entry CNM and CNM/FNP students who, I don't think, are really at a disadvantage. The role and scope of a CNM/FNP are so much different than what and L&D nurse do. They don't do prenatal care, GYN or well-woman, suture lacs, manage contraception or STIs much less the family practice side of things. In terms of finding a job once I graduate, I'm not too concerned that lack of RN experience will be such a detriment. I think a lot of employers who hire APNs are very aware just how different their jobs are from RNs even in a similar field. I feel completely confident in my program and the faculty to give me the tools I need to be an excellent provider and I know they have the confidence in me that I can be an excellent provider without the RN experience (otherwise they wouldn't have admitted me or my direct-entry colleagues).
    There are CNM's that do full-scope midwifery and every flavor of "partial-scope" you could imagine including not catching. I know of one clinic in particular which only uses CNMs for clinic and contracts with an OB/GYN practice for 24/7/365 on-call coverage (done exclusively by physicians). Personally, I would never want to work like that. If I wanted to only do clinic women's health I would have done WHNP (actually my FNP scope covers women's health including prenatal and postpartum care). I wouldn't short-change yourself though. I know the job situation is bleak but if you want to be a midwife, then be one! Prove your competence to potential employers. They'll only think less of you if you try and pass your skill set off as a liability rather than an asset. My FNP advisor always tells new students (many of whom choose FNP just because they think it will make them more marketable than other specialties), "You should only be here if family practice is what gets you excited. If you don't want to see kids, you need to be an ANP. No one wants to hire someone who's scared of their own scope of practice. If it's peds you're into then don't waste your time learning how to manage adult problems. Peds clinics are going to want a peds practitioner anyway." There are tons of CNMs who have not worked a day of L&D in their lives and are no worse in their role because of it.
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    Hey Pro-Student!

    I work at Vandy on 4E. I'm set to graduate from nursing school in May 2014. I have toyed with the idea of bridging and doing the duel program. I really feel torn about it. I have 4 children, my husband and I both work full time at Vandy, and we're both in school. I've had two of my children at home with a midwife, and through that process I fell in love with the art. With the recent tuition benefit changes, I estimate it will cost me somewhere around 50K to complete the program. I would need to take out student loans. By the time I finish the program, I'll have one daughter close to starting college. I'm just not sure it's worth the financial pay off. I'm not doing it for the money, but I wouldn't be a good steward of my finances if I invested in something that wouldn't pay off. Make sense? Especially with 4 children to put through college (even though Vandy does pay for that). I'm not sure I would stay there forever....you never know where life will take you. Our charge nurses top out at $40 and hour (even the ADNs). Short of flat out asking the midwives when they're on the floor what they make (something I would never do!) I haven't found any reliable stats on what they are ACTUALLY bringing home these days. If I don't do the duel program I will definitely get my Masters....probably in nurse education, but I have a love for midwifery. I attend home births now as an assistant. I'm not interested in being a CPM. I just do it as a service. Plus, it's good experience to observe a seasoned midwife practicing her art.

    Thoughts?


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