Experience to Enter CNM Program

[MUOStudentNurse]

Hello!

I'm a senior nursing student in a BSN program and graduating :mortarboard: this coming May (Woo HOO!). I am planning on entering the CNM program at The Ohio State University in the coming year after my graduation from the BSN program. I feel that my lifestyle and personal goals might stand in the way of me going back to school if I don't do it right away.

The OSU program does not have a qualification for years of experience but I was wondering if anyone had any input on the importance of experience before entering a program. I am quite nervous that my peers will have so much more experience than me that I will find it hard to keep up or compete with them. Other people tell me it can be just the opposite where I have the advantage due to the freshness of my schooling. Any input would be well appreciated! Thanks so much!!

[nizhoni]

Hi Lovingpecola, I should clarify . . . . While it is legal in every state for parents to have a homebirth, the legalities of *direct-entry midwifery practice* vary from state to state. In some states it is clearly legal, in others it is clearly not legal. In some states it is legal by judicial or statutory inference and in other states it is not prohibited but not regulated either. Nebraska is an example of the latter category. For more information, see this link:

Direct-Entry Midwifery State-by-State Legal Status

Unregulated midwifery practice might seem like a plus to some people, but it actually poses a significant problem--I know, since I lived for several years in Utah, a state which also did not regulate midwifery until the midwives finally succeeded in getting legislation passed in 2005. The problem that midwives in unregulated states have is that, without legal status, midwives can (and are!) prosecuted for the practice of medicine or nursing or nurse-midwifery. This can (and does!) occur even without a bad maternal or fetal outcome. In Utah, the case that finally mobilized the midwives was one in which a well-known midwife was charged with 3 felony counts of practicing medicine without a license (5-10 years per count). In one case, she had performed an emergency episiotomy. In another she had administered Pitocin to a woman who was hemorrhaging. And in the third instance, she had administered O2 during a transport to the hospital for fetal heart tones that were problematic. There were no bad outcomes, and indeed she had acted according to the standard of care in midwifery practice. Unfortunately, since midwifery practice was not defined, all of her actions *were* definable as the practice of medicine. Certainly she was hung out to dry by carrying and giving Pit without having the authority to do so; and since oxygen is technically a drug, that was likewise a problem. Ultimately she plea bargained, but hers was the case that finally got the midwives to realize that any one of them could be the next case.

Nebraska has a reputation as being a "tough" state where midwifery is concerned. Perhaps the midwives can create the same success that Utah did, with what is widely considered to be one of the most favorable midwifery laws in the U.S. (It took four or five tries at the legislature and constant work in between sessions, but they did it!)

Having moved from Utah back to San Diego in late 2002, I can tell you that working in a state where midwives are licensed is much easier in a lot of ways. There are still some hassles, but overall it's a big improvement over the challenges we were having in Utah.

The biggest challenge we are facing in California currently is that licensed midwives are required by law to have "physician supervision." The California Medical Association insisted on this proviso in 1993 as the means of removing their opposition to the Licensed Midwifery Practice Act. However, the California Association of Professional Liability Insurers (a major trade association) has threatened any MD who provides LM supervision with revocation of their malpractice insurance . . . retroactive three years! Because of this interesting Catch-22, the Medical Board of California has thus far agreed not to pursue midwives who are practicing without physician supervision. An attempt was made by the MBC to redefine the term "supervision" but CAPLI threatened to sue the Medical Board of California (!!!) if they allowed that to occur. The MBC backed right down and turfed the matter to the Attorney General's office for further consideration. (I was at the meeting where that occurred.) That was about three years ago. Interesting, eh? So midwives considering legislative remedies need to make sure they avoid these pitfalls.

I would like to see greater cooperation between CNMs and LMs/DEMs where legislation is concerned. CNMs and direct-entry midwives often share many more commonalities than differences and it would be terrific if we could embrace that fact and work more unitedly. It has been my experience from 30+ years involvement in midwifery that CNM practices are also frequently targeted for elimination by those with whom they are in competition. While there are, of course, challenges to deal with in creating more unity between midwives, having a unified force would help to meet the survival issues faced by all types of midwives (and not only in the United States). You know, the more experience we gain politically, the more adept we become! Hat tip to those intrepid ones who take it on!

[hebamme]

Dear midwifeinthemaking,

I have both, nursing education, and I'm a UK midwifery graduate.

I worked as a nurse on and off for several years before becoming

a midwife, and I never liked nursing as much as midwifery.

Go for it,

hebamme

[NPs4health]

I am getting very frustrated at the constant comments and advice to those considering advanced practice with no experience. While I do not for one minute doubt that 1 or more years of experience as an RN is a good thing, or even that they probably do have an advantage over those of us with no experience.

However, I just graduated with about 20 GM students with no experience in a Family Nurse Practitioner program. We have 100% pass rate on the exam and I believe just about 100% hiring rate after graduation. Many of us did clinicals with NP's with no RN experience (nor interest in it, nor felt anything missing).

I think the area you work in makes a difference. If planning to work in acute care or ER, probably experience as an RN in such a fast pace environment probably helps.

My only point is that more and more of us are joining the ranks with no RN experience (I had almost a year, but am SO thankful to skip any more - I think nurse managers have an obligation to treat new nurses like sh&*^, looking only for what you do wrong - heaven forbid a compliment for a rough, busy night spend successfully helping very sick patients). I am SOOO much happier working directly for a doctor - feel like I am being treated like a professional with a lot left to learn, versus a peon with no brains.

Some of my class got the NP (finished school and passed test), but are choosing to keep jobs as RN to continue getting the experience for their area, but at least dont have to worry about going back to school later.

I am sure I will be blasted for this, but I think we all need to get to the end of the journey in our own way. I just hate to see anyone motivated to move on stop and quit now. So many people find it hard to go back to school later - people get married, have kids, life happens. If you have the means and motivation to go on, go for it.

It is similar to getting your MBA. When I got mine, after several years of experience, it frustrated me to meet those who had the nerve to go for it with no work experience. How dare they! I had to work hard before I went - why shouldnt they? Well, I got over it. Yes, I brought a lot of experience to the table due to real world experience first, but you know what? Those I kept in touch with did alright. Just took a different route than I did.

SebagoLaurel, I am graduating this December with my BSN and planning to apply for FNP program following one year of working as a telemetry RN. I really do feel like new RN's aren't treated so well and the workload is just crazy so I want to get back to school and get an NP as soon as possible. But my concern is, how do I convince the admissions committee when I don't have the 10+ yrs of work experience everyone else does? I would appreciate any advice you have to offer!

[midwife2b]

So that's it in a nutshell. It's also the reason I feel qualified to say that, while it's terrific for RNs to have clinical experience prior to entering a nurse-midwifery program, it's not really necessary in order to develop competency since it's within the ability of non-RNs to do so.

I agree with this post. What is learned in midwifery school is not what is learned in an undergrad BS program.

My new partner had absoluely NO L&D experience prior to her acceptance at an IVY LEAGUE CNM program. It doesn't seem to have hindered her ability to find a job or be clinically competent.

I had 24 years of L&D/PP/NBN experience before I even thought about applying. We have a lot of dialog about our patients; while I believe I have an advantage because of my years of L&D I do have to remember a lot of that was high risk and preterm experience. SHe has current experience in normal, low risk births. It all evens out in the end.

Experience is nice but not necessary.

[midwife97]

Don't worry about it. Do doctors have experience before they go to medical school?????? Not! This is just an area where I think there is a misconception and possibly some sex stereotyping. While every bit of experience will help, you can do fine without it AND maybe even do better without it. Go for it!