Quote from cass1320
If a CM and CNM's scope of practice is the same, why would you bother going into nursing at all?
I am going to try
to answer this. I claim no authority on the subject.
Here's how I look at it.
1. Many OB patients today have all sorts of co-morbidities or yet-to-be-expressed/evolving co-morbidities. It, to me, would be important to have a practitioner with a good foundation for these things, and there is nothing like the didactic and strong clinical to make a practitioner ready to identify and effectively deal with such issues. You gain expertise, insight, and strong clinical judgment through strong and frequent clinical experiences. There is NO replacement for them--NONE. Yes some practitioners make the most out of such experiences, while others just endure or get through them. People that practice excellence make the most out of all those experiences, regardless of their specialization.
2. Yes, certain clients/pts would be farmed out to the appropriate specialists, depending on what their issues are; but things can so EASILY get missed
. Happens all the time. Happens enough with advanced practice nurses, such as NPs, that just want to zip right into the advanced practice programs without getting strong clinical experiences. (Until nursing can get stronger residency-practice programs and requirements w/ appropriate oversight, much like physicians, we will see more NPs held accountable through lawsuits and such.) The clinical experiences, over time, make the difference, if one is committed to becoming an expert. OK, so I am veering a bit off target, but hopefully my point about having a good foundation and good didactics coupled with strong clinical experiences over time, and also with appropriate oversight and mentoring is highlighted.
3. Lawsuits--see above. This is a huge area for malpractice. Malpractice insurance for OBGYNs in Florida, PA, NJ, just to name a few, is outrageous, and it has caused OBGYNs to move out of state or stop practicing. NY is up there too. This should be an indicator to you, regardless of whether or not a person is an OBGYN.
4. An advanced practice Nurse midwife has a better hope for professional sustainability and marketability. Many people--would be patients/clients today are more educated, and they have higher expectations when it comes to meeting their needs or those of their developing children.
5. You never know what will happen, and it's to the OP's advantage to be eligible to gain licensure in any state.
6. The best overall approach for OP, if you look at things in terms of economics 101--i.e., counting opportunity costs, would be to gain acceptance into a reputable RN program with strong clinical, pass the boards, get experience in OB/ L&D, and continue into an advanced practice program for Nurse Midwives. OP would then have more opportunites all the way around--independent or co-independent practice, as well as for employment with in-hospital opportunities and education. The nursing profession is weilding a good amount of power nowadays, as compared to days past.
OP, do the opportunity cost calculations and compare Loss/Gain for either scenario.
The other alternative would be gaining entrance to a PA program and then moving into OBGYN or apply to medical school. Depends upon what you want and your particular life situation.
Personally, and this is just me, I wouldn't waste my time with a CM program--only to go back through Excelsior for RN. It's limiting, and you will NOT gain the same experiences in terms of putting it all together with the clinicals and didactics as if you went to a reputable Brick and Mortar program. This is why Excelsior RN is not accepted everywhere. I think it can work for say paramedics with strong and wide variety of clinical scenario-experiences--even then, they may struggle with appplying other aspects of nursing. LPNs with strong clinical experience may also do OK in such a program. Overall though, I personally would that RN would require the same clinical hours/exposure as B&M programs. I already had a lot of clinical exposure before entering the RN program I attended. I stilled gained many valuable experiences and insights through the whole process of combining the didact with the direct clinical, and having many a good clinical professors guide me.
OB can get very tricky& scary, very fast. There are a number of reasons why it is a high litigation area. And people that are younger have more issues today--not just the women waiting to have children. Obesity and all the co-morbidities that go along with obesity--with or without pregnancy are a huge factor today. Young pregnant women are finding things tougher with their pregnancies IMHO (would have to procure research to support this for you--though I have read of it--don't have time for this now, but perhaps later I will). I think this is due to poor health practices prior to, not just during pregnancy.
I wish you the best in whatever you decide.