LibraSunCNM, BSN, MSN, CNM 23,360 Views
Joined: Jan 24, '08;
Posts: 1,006 (69% Liked)
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Thank you for responding to the article.
Or like me, trying desperately to fill out applications and write my cover letters at the last minute in January while simultaneously studying for my nursing exams and attending clinicals. I wish I'd gotten a head start way earlier than I did, and I definitely encourage current nursing students to learn from my mistakes.
I politely disagree; I actually missed out on applying to a couple of major hospitals that I was very interested in because I didn't realize that their application cycles for May graduates had closed in mid-January, and I was going to have to wait for the next application/graduation cycle to be considered (so with a May graduation I wouldn't be able to start until February with the December graduates). The timelines can vary quite widely by region; it doesn't hurt to start looking into the timelines for your local hospitals now so that you can make an informed decision.
Also, many hospitals will have a specific timeframe for when their new grad applications are open. Unlike experienced RN jobs, which are often filled on a rolling basis, usually the new grad applications are only open for a specific period of time. Therefore, even if you tried to apply right now you'd probably find that the applications are closed (except to nurses who have already graduated, or are graduating in December).
If you're graduating in May, it's too early to apply for jobs now, for sure. I also had a May graduation and around February or March of that year, I started calling around to the nurse recruitment departments of all of the hospitals I was interested in, and asked when they thought I should apply as a new grad planning on taking boards sometime in June. Most were very willing to help and most told me to apply right after graduation but not before. Only one hospital told me to wait until after taking and passing the NCLEX. This may vary depending on your area, but start reaching out a few months before graduation and you should be fine.
General Hospital- the program that had a woman fall in love with her rapist. Also- McGyver as a cardiac surgeon who was so dense he did not recognize his own child with a CV surgical scar! The list goes on.
Um, I would say no way? But that all depends on how desperate you are for food and shelter.
Jesus H. Christ. I have said this many times on this board...I don't know how you guys do it!!! I tried unsuccessfully to potty-train my 22 month old over the summer, she started getting her molars all at once and the process crashed and burned, she was too cranky and overwhelmed. I know we will try again in a few months and she will be fine, but dang...stories like a 5 year old in diapers make me terrified for my future!
Better poll: who knew General Hospital was still on the air???
Also, I don't think swarms of women will be requesting elective IOL - only a few. And actually, after describing the risks and the process (this will take DAAAAAAYS), probably fewer. But right now I have no way to provide that option to any patient, due to institutional protocols against it.
I just saw this on Facebook and thought it was pretty helpful:
As a CNM working in a freestanding birth center, we do not plan on changing our practice in any way because of these results. My (limited so far, I haven't gotten a chance this week to dive deeply into it) understanding of the analysis is that the study participants were only women cared for by physicians in academic medical centers. As such, it's almost like comparing apples to oranges when trying to apply it to midwifery care, because the entire philosophy around midwifery care is to avoid a lot of the things that are routine in OB/GYN physicians' practice. True comparison of the risks/benefits of elective induction of labor, to me, would involve some comparison to women of equal risk in a much lower intervention setting than a hospital, such as a birth center or home.
I just can't understand how rational human beings can think that the process of labor and birth needs to be interfered with this drastically to provide better outcomes for moms and babies. If we truly want to make a difference in the disgustingly high rates of maternal and infant morbidity and mortality rates in this country, we should be looking to the practices of other countries who spend less and have better outcomes. This involves:
-midwifery care for all low risk women
-midwife/physician co-management for moderate risk women
-judicious use of interventions in labor and delivery
-robust postpartum support for mothers
-careful tracking of obstetric outcomes throughout the country with dedicated interdisciplinary groups who study poor outcomes and work together to find solutions
As a side note, a midwife I work with at my current job was working as an L&D nurse at one of the ARRIVE study hospitals a couple of years ago and did state that she personally witnessed a nurse researcher whose job it was to recruit participants for the study behaving in a grossly unethical manner, saying things like, "Come on, don't you want to meet your baby sooner?" to women who declined to participate, not taking no for an answer. Just one person's experience, but overall, I don't really take the results seriously for that, as well as the other reasons I mentioned above. What makes me sad is what klone described, that some MDs will truly apply this to their practice and start inducing all of their patients at 39 weeks. I try to keep my head down when crap like this pops up, maligning the idea that normal birth has a place in this world anymore, and know that I still believe in the midwifery model of care and will keep fighting for it.
Thanks for the clarification. Your words came across strongly to me, and it's rough hearing such negativity when I do not feel that I embody such negativity in that way.
Anyway - I don't remember stating anything about giving up on midwifery because of ob rotation. But I recently did reply to someone else that spoke that way and my response was very positive.
I'm happy to side step the vaccine stuff, and I wasn't trying to start a debate of any kind at all. I am not against vaccines. Nor for them. They are a tool.
I did not mean to imply that I thought CPMs and CNMs were "completely equal in their education" and I do not really think that I did imply that. My point was that their scopes are different entirely. They [I]are[I] trained differently because their scopes are different. CPMs do not require the training that CNMs are required because their scope is not that of a CNMs, similarly, the scope of CNM does not require the hours/education of that of an OB. The message I was trying to put across is that a CPM isn't "less than" because her training is not the training of a CNM. She has a different scope and does not need the training - just like a CNM does not need the training of a OB/GYN. Different scope = different training requirements.
Speaking of training requirements. NARM regulates the CPM and the CPM requirements are all the same. If the candidate does not graduate from a MEAC accredited program then the process is different, but is (supposed to be) equal to a MEAC accredited schools education. I wasn't in any way trying to insinuate that CNM programs are not good enough or something. Not sure how I came across that way - possibly because I was trying to say that CPMs are a safe option - everything else was clouded up... I don't know. I felt that the response I was replying to was pretty negative toward CPMs and that is where I was coming from. Doctors and CNMs have poor outcomes too. CPMs aren't the lone ranger there. I believe their training is all adequate (between professions) - it is the responsibility of the patient to hire competent care. We place trust in the licensing bodies to have strict requirements, and we have trust that people that have passed their licensing exams are safe practitioners, but that is not always the case. I have trust in our licensing and accrediting agencies. I have less trust in the people that pass the exams, and that is where education, information and interviewing comes in. Women have the right to choose how they birth and with whom.
I also do not have a closed mind about the world of OB - what makes you think I do? I really would like to know, because I can't imagine what lead you to think/say that to me. I do NOT view "anything remotely medicalized as somehow the enemy of women." I do not believe that in any way whatsoever. I have been a doula for a long time. I have seen the most natural birth to the most medicalized. I stated plainly that I believe women most certainly have the right to choose how they birth, whatever that means to them. Do I want them to be informed? Yes, yes, yes. I wish all women could have amazing care providers that give them awesome information and education so they can make truly informed decisions for themselves. If that means in a hospital with an epidural and continuous monitoring, with induction, AROM, and anything else on top - so be it. We all have our own paths and choices to make in life and we do the best we can with what we have, and when we know better we do better.
Sorry, but you don't want her to "come out thinking that Vit K is not really necessary," or that "routine vaccination is dangerous,"..? It is really sad that nursing school teaches that Vitamin K is 100% necessary and that vaccines are PERFECTLY safe. Both assumptions are false. This is one huge problem with our standard education, and it is a much larger problem of an unthinking population. I am not over here to say no one needs vaccines or Vit K - but please do not ever say they are completely without ill effect because it is not true.
Vitamin K and vaccines are choices just like taking any drug is a choice, and parents should be made understood all the implications of the drugs they and their infants/children are prescribed. THAT is what we were taught in nursing school. Do patients refuse medications? Yes they do. Do we as nurses always agree? No we do not. Are we our patients' advocate? Yes, yes we are. We teach them, and explain and educate again. We explain what we know - but yes, we tell them side effects, and there are side effects and poor outcomes for every single drug available. In the end, it is a parent decision. Not a nurses or a CPMs.
CPMs do not need "medical experience" because they are experts in normal/healthy pregnancy and birth. Once the norm has left the room, the midwife should leave the room too (i.e.: transfer to hospital). CPMs are trained in "standard science-based care." Not sure why you think they are not. OB/GYNs have a different scope than CNMs, and CNMs have a different scope than CPMs, in that, each expertise is different. Some skills and knowledge overlaps, and some does not.
The training of CPMs is widely variable just like the training of a CNM is widely variable, just like the training of a OB/GYN is widely variable. Do all professionals have boxes to check, numbers to meet and hours to accrue? Yes. Do all CPMs have the same boxes to check, numbers to meet? Yes. Do all CNMs? Probably not - there is probably a minimum number of clinical hours for the national examination, but schools all have different requirements here. Same for OB/GYN. BUt all CPMs take the same test and have the same minimum hour requirement and experience requirements. So - maybe their preceptors could be good or bad but that is the same for doctors and CNMs too. Allll that to say.....all medical professionals go through similar processes to learn their expertise, and they all come out with variable education. CPMs are not unique in that. I just graduated nursing school with 29 other people and I am certain that we are not all qualified equally, yet we all went through the same process.
I also want to say that it is legal to practice midwifery as a CPM in 33 states (because you said they are unregulated in "most states"). 5 states currently have legislation for legality happening now, and 6 more are in planning stages. So really - in MOST states, CPMs are regulated. Some states "license" CPMs, some do not, but the CPM cert is usually what is used to "license" the midwife anyway (in my state) without other contingencies. So I am curious as to what the difference is to you - that "CPMs are not licensed"? I do not understand why you say they are unregulated - CPMs are regulated - in the states that regulate them.
To Original Poster:
That being said - I do not disagree that you should be very careful and contact your state board of nursing before you do observe (even if you are ONLY observing). Read your state Nurse Practice Acts. I would also familiarize yourself with all the CPM bylaws for your state. But thats just me and I tend to be very thorough.
I also would not want anyone at the birth to know I am a nurse. I also would be careful not to perform any nursing specific skills (IV placement for example).
I (obviously) am a CPM sympathetic. I am not against them in any way. I fully believe people can and should choose with whom they give birth and how they give birth. I believe we should all have freedom to choose our way of life - including birth to death - and everything in between. Sometimes that means we hire a crappy midwife - but you know what? Sometimes that means we hire a crappy doctor that spent 10 years in school. Crappy birth professionals are not limited to licensed midwives. Far from it. I have been a doula for 17 years, and I have seen so many really unprofessional doctors and even unprofessional CNMs. I have also seen unprofessional CPMs, but I've seen way more poor ob's.
Do your research, cover your tail, be professional, and you'll be good to go. Birth is beautiful and homebirth is an amazing experience.
I had multiple RNs work as birth assistants for me when I was a CPM, because I was licensed. However most states do not license CPMs (for good reason IMO). So yes, the RN would be the licensed provider in that scenario and it would be inappropriate to act in a birth assistant role. Even doula is pushing it. I wouldn't do it if the midwife herself wasn't licensed, no way.
There's also the factor of all of the zillions of lovely bugs he could pick up during a hospital stay to treat his own bug. The healthcare system royally sucks on a lot of levels.
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