CNM vs WHNP vs Having Both

[JennaSnow]

I am interested in CNM and WHNP and would love to do a dual program in the future. I am in the NY/Long Island area. Does anyone know if there are any dual programs around here?

Also, I know CNMs can see patients for well women care......what is the real benefit of pursuing the WHNP in addition to CNM? What can the WHNP do that the CNM cannot? Is it worth the money for school to do both? I know they complement each other nicely.

Any input?

Thanks for any replies!

[Ohm108, MSN, NP, CNM]

Yeah I'm a little confused by what you consider a "CNM hat" vs. a "WHNP hat" and how they're different. I know nothing about California so you may be absolutely right about hospitals wanting both credentials, although it seems odd. As I said before it only really makes sense if you're only doing outpatient.

I will ask for some clarification about why this is the case for this one specific hospital. The only other thing I'm unclear about is why if CNM covers everything a WHNP does, why then do some schools still offer dual specialty CNM/WHNP when it might make more sense to completely switch to CNM/FNP like Vanderbilt or CNM/PNP like UofM where the dual specialty helps to expand your scope of practice? Is it just for the sake of profit and further monetarization of nursing education or is there another reason?

Would it be difficult to change the dual specialty curriculum to CNM/FNP or CNM/PNP since FNP and PNP are normally offered already as specialties along side CNM in most APRN programs?

[LibraSunCNM, BSN, MSN, CNM]

I will ask for some clarification about why this is the case for this one specific hospital. The only other thing I'm unclear about is why if CNM covers everything a WHNP does, why then do some schools still offer dual specialty CNM/WHNP when it might make more sense to completely switch to CNM/FNP like Vanderbilt or CNM/PNP like UofM where the dual specialty helps to expand your scope of practice? Is it just for the sake of profit and further monetarization of nursing education or is there another reason?

Would it be difficult to change the dual specialty curriculum to CNM/FNP or CNM/PNP since FNP and PNP are normally offered already as specialties along side CNM in most APRN programs?

I've wondered all that myself, and I really have no idea. My program didn't offer a WHNP track so I've never heard first-hand the academic justification for it.

[Ohm108, MSN, NP, CNM]

I've wondered all that myself, and I really have no idea. My program didn't offer a WHNP track so I've never heard first-hand the academic justification for it.

Okay, I asked around and according to what I was told, the reason that some of the APRN programs started offering dual specialty CNM/WHNP was that it was easier to get midwives credentialed in certain states for outpatient only births if they were also WHNPs. So to help facilitate this, some schools added the WHNP to the CNM for a combined dual specialty.

From what I have seen, based upon the conversations that I have had and the posts that I have been reading, this no longer seems to be the majority case for the profession. For myself, the important thing to keep in mind is that midwifery like all professions evolves with time and I guess as credentialing bodies understand our role better, they now understand that CNM's training encompasses all the the things that a WHNP can do in a clinical setting and the credentialing rules have now been possibly changed to reflect that.

Going into the midwifery school, I was adamant that I was going to go through the dual specialty and come out of my program as both a CNM and WHNP but with this new knowledge I see that I will have to adjust my own thinking and take a deeper look into my own future practice and see if it makes sense to be both a CNM and a WHNP in the context of credentialing in the states that I might one day want to practice in.

I will caveat this by saying that I do not know how every state credentials their midwives and how each state might be different in that respect but at least I have a better understanding of a reason why this has been done historically and might still be done in certain states.

Thank you for everyone's feedback!

[Ohm108, MSN, NP, CNM]

Okay, I asked around and according to what I was told, the reason that some of the APRN programs started offering dual specialty CNM/WHNP was that it was easier to get midwives credentialed in certain states for outpatient only births if they were also WHNPs. So to help facilitate this, some schools added the WHNP to the CNM for a combined dual specialty.

From what I have seen, based upon the conversations that I have had and the posts that I have been reading, this no longer seems to be the majority case for the profession. For myself, the important thing to keep in mind is that midwifery like all professions evolves with time and I guess as credentialing bodies understand our role better, they now understand that CNM's training encompasses all the the things that a WHNP can do in a clinical setting and the credentialing rules have now been possibly changed to reflect that.

Going into the midwifery school, I was adamant that I was going to go through the dual specialty and come out of my program as both a CNM and WHNP but with this new knowledge I see that I will have to adjust my own thinking and take a deeper look into my own future practice and see if it makes sense to be both a CNM and a WHNP in the context of credentialing in the states that I might one day want to practice in.

I will caveat this by saying that I do not know how every state credentials their midwives and how each state might be different in that respect but at least I have a better understanding of a reason why this has been done historically and might still be done in certain states.

Thank you for everyone's feedback!

Just realized I had a typo. I meant to say:

Okay, I asked around and according to what I was told, the reason that some of the APRN programs started offering dual specialty CNM/WHNP was that it was easier to get midwives credentialed in certain states for outpatient only practice (no births) if they were also WHNPs

[LibraSunCNM, BSN, MSN, CNM]

Yes, that basically goes along with the minimal reasoning I've heard for it---it lowers your malpractice costs or facilitates credentialing in some facilities if you're not doing births. I think now, though, it's just less necessary as more and more state affiliates are getting pro-midwife laws passed that involve better recognition of CNMs/CMs and what our training and scope of practice entails. Not saying there aren't states where the WHNP might be useful if you're also a CNM, but for me it's never been remotely necessary.

[cayenne06, MSN, CNM]

From my contacts with both durign the last semester...

- CNMs: do deliveries, school is more pointed, more rigorous and more difficult to get into, they are generally more busy (lots of calls, deliveries around the clock, etc), insurance costs more, usually (but not always) prefer Ob over gynecology, pre-program, "side specialties" strictly within the area (uro/gyn, gyn/onco), Ob experience is mandatory.

- WHNP (de-facto, FNPs): experience is not mandatory, schools can be easier to get into, more gynecology, no deliveries, interesting cross "side specialties" (like gyn/geri, gyn/peds, gyn/HIV clinic) are possible, less chances for call, paid (again, usually but not always) a bit less.

More than one CNM confessed that they envied me with my future FNP degree because they were either already seeking quieter waters or thinking about the time when being always on call and rushing in L&D in all hours would be too much for them.

I am a CNM and I work full time in GYN/sexual health, with a very nice 40hour m-f type schedule. There is nothing a WHNP could do that I cannot in my current role. I do everything from menopause care, colpos/biopsies, word catheters, LARC placement, sonography, abortions, PreP, management of early pg complications, trans care, smoking cessation, the list goes on.

However I will say that my clinical training was *heavily* biased towards obstetrics, and I get the sense that is representative of most students' experience. We didn't have any clinical rotations that were specifically GYN-focused. Maybe we need to draw a little from WHNP training, and provide a better balance of GYN clinical training in midwifery school.

I LOVE LOVE LOVE my work and I want more students to see for themselves that there is so much more to midwifery than prenatal care and baby catching!!!!! I do moonlight inpatient as a triage midwife to keep my skills current, but gyn/repro is where my heart is.

[klone, MSN, RN]

I am a CNM and I work full time in GYN/sexual health, with a very nice 40hour m-f type schedule. There is nothing a WHNP could do that I cannot in my current role. I do everything from menopause care, colpos/biopsies, word catheters, LARC placement, sonography, abortions, PreP, management of early pg complications, trans care, smoking cessation, the list goes on.

However I will say that my clinical training was *heavily* biased towards obstetrics, and I get the sense that is representative of most students' experience. We didn't have any clinical rotations that were specifically GYN-focused. Maybe we need to draw a little from WHNP training, and provide a better balance of GYN clinical training in midwifery school.

I LOVE LOVE LOVE my work and I want more students to see for themselves that there is so much more to midwifery than prenatal care and baby catching!!!!! I do moonlight inpatient as a triage midwife to keep my skills current, but gyn/repro is where my heart is.

When I worked clinic, I loved when we had students (we would get Frontier and students from the University of Colorado CNM program) because my clinic was very heavily Gyn, and very complex Gyn cases. Students came out of that clinical rotation with a VERY solid Gyn foundation. :)

[LibraSunCNM, BSN, MSN, CNM]

I am a CNM and I work full time in GYN/sexual health, with a very nice 40hour m-f type schedule. There is nothing a WHNP could do that I cannot in my current role. I do everything from menopause care, colpos/biopsies, word catheters, LARC placement, sonography, abortions, PreP, management of early pg complications, trans care, smoking cessation, the list goes on.

However I will say that my clinical training was *heavily* biased towards obstetrics, and I get the sense that is representative of most students' experience. We didn't have any clinical rotations that were specifically GYN-focused. Maybe we need to draw a little from WHNP training, and provide a better balance of GYN clinical training in midwifery school.

I LOVE LOVE LOVE my work and I want more students to see for themselves that there is so much more to midwifery than prenatal care and baby catching!!!!! I do moonlight inpatient as a triage midwife to keep my skills current, but gyn/repro is where my heart is.

That's too bad, I felt my program was actually pretty strong in GYN. I did have a full semester of GYN clinical in a busy inner-city family planning clinic so got good experience with contraception, pelvic exams, breast exams and STI testing. I wish I'd gotten more menopause experience just because it's such a complex topic, but thus far I've never really had to care for menopausal women. Maybe someday! A lot of midwifery programs do fall really short in exposing students to the full spectrum of midwifery care, I agree for sure.

[Ohm108, MSN, NP, CNM]

All great comments and noted with regards to GYN skill sets. I haven't started my program yet but I will see which is more heavily emphasized and try and take further courses or take clinical placements that are more GYN focused since I agree that most midwifery programs are heavily obstetrics focused just based upon syllabuses I have looked out for required coursework. I very early on decided that I wanted to be a full spectrum midwife and would like to include abortions and Nexplanon implantation services as part of my skillset (depending on which state I eventually practice in to see if this is possible). I definitely want to learn how to conduct sonograms. I believe that I do get to suggest where I would like to take some of my clinical rotations so I was planning on asking to be placed at Planned Parenthood and/or a family planning clinic. Any other suggestions for good GYN experience other then Planned Parenthood or family planning clinics so I can be ready with options when I do have to make a selections or suggestion during my program?

Thank you again for all the advice from the experienced nurses, NPs, and midwives on this board.

[cayenne06, MSN, CNM]

When I worked clinic, I loved when we had students (we would get Frontier and students from the University of Colorado CNM program) because my clinic was very heavily Gyn, and very complex Gyn cases. Students came out of that clinical rotation with a VERY solid Gyn foundation. :)

I've had NP and PA students rotate with me, but I am getting my first CNM student next spring! SO excited!!!!

[girlmama, MSN, RN, CNM]

I've had NP and PA students rotate with me, but I am getting my first CNM student next spring! SO excited!!!!

That's awesome! Where are you located?

I sent you a pm.

[DannyBoy8, RN]

From what I've heard, WHNPs are absolutely able to provide HRT to transgender patients , whereas CNMs who do so are practicing in a grey area. ACNM hasn't made an explicit position statement, but the WHNP association has - just from what I hear, could be wrong.