lilacs101

First, I'd like to thank Lily, Nate, and DN for contributing to this conversation. The thoughtful discussion on the role of previous RN experience as an advanced practice nurse has been very helpful in my thinking. To throw out a few more thoughts on the intersection of nursing and midwifery... I considered some of the Certified Midwife (CM) programs in NY/ NJ/ PA. These programs are accredited through ACME, the accreditation arm of ACNM. So, yes, it's possible to become a midwife without becoming a nurse in a way that's sanctioned by the American College of NURSE-Midwives. And what was all of that recent discussion on changing the name from ACNM to American College of MIDWIVES? Anyway! After doing some soul-searching, I've realized that my concerns really centers around that first year out of school. My first and primary concern is related to finding work after nursing school graduation, and, if I'm so lucky as to find a job after graduation, being stuck in a job that I hate that is not advancing my skills or my life path. It seems that the direct-entry programs would address this concern for me; I just can't justify taking on that much debt. So I've made my decision (to get a BSN, then work for a year), and I need to find peace with it. I have both nurses and midwives in my family and circle of friends. I know what they face on a daily basis. Not a career change to be taken lightly.

Can always spot the climbers. :-) It's sick, really. Where to move to... I'd suggest anywhere in the Cascades (Washington State), Tetons, and yes I like the Denver/ Boulder/ Colorado Springs suggestion, too. Utah, as you know, is fantastic. Have you tried moving somewhere more rural?

Nate, thanks so much for your thoughts. You know, when I was originally typing out the poop example, I had also typed something in parenthesis about how somehow it seems different to me if the expectation is to clean up a client occasionally, rather than be expected to do it all the time, essentially acting as both a CNA and an RN (which seems to be surprisingly common, based on experiences I've heard about here). Then I decided that my post was getting too long, and I deleted that parenthetical aside. I probably should have picked a better example, but a year of wiping butts due to a messed up, overtaxed medical system and a failing economy was the first thing that came to mind. For the record: I would wipe my daughter's butt, I don't mind wiping someone else's daughter's. :-) I'm going to go out on a limb with something--I haven't even been to nursing school, yet, so bear with me. I think there is a distinction between "being a nurse" and "having nursing skills." To me, "being a nurse" means placing myself squarely within a medical model of care for women in the childbearing year ("Just lay back, sweetie, and do what the OB tells you to do. No don't worry about the episiotomy, no you can't get up and walk around because I can't read the monitor if you move," etc). Yes, I realize that I'm both exaggerating and generalizing, and I also understand that, as a CNM, I'll probably end up working within the medical system (what, like 96% of CNMs work in hospitals?). But. As a CNM/ WHNP/ FNP, I feel that I will have more latitude to tailor my care to the clients' needs and wishes, more independent decision-making ability, more responsibility, and yes, more risk exposure than the average bedside RN. That is what I want for my career. Which brings me to the reason that I've decided to put my career within the medical system and not to pursue the CPM credential: because I believe that "nursing skills" and a standardized education will make me a better care provider. Not only for the clinical skills--e.g. placing an IV with steady, practiced hands into a tricky vein--but also to work with women as part of their family and social system. I currently live in a rural area and expect to stay here, so your point really hit home. Eventually, I'd love to work abroad, perhaps in the developing world, so scope of practice is important to me. For these reasons, I would re-write your point as follows: "To be a competent midwife, you sure as hell need to be totally competent with your nursing skills." In short, I'm hoping that a miserable year in nursing school plus a crappy first job in a crappy job market will be worth it: that it will give me a start on the clinical skills that I'll need and a bit of experience to start me on my way. I don't know, maybe this is all semantics, maybe I'm over-thinking things, but this is important to me and my motivations. I guess I want to prepare for the worst and hope for the best. Having said that... A traveler came upon an old farmer hoeing in his field beside the road. Eager to rest his feet, the wanderer hailed the countryman, who seemed happy enough to straighten his back and talk for a moment. "What sort of people live in the next town?" asked the stranger. "What were the people like where you've come from?" replied the farmer, answering the question with another question. "They were a bad lot. Troublemakers all, and lazy too. The most selfish people in the world, and not a one of them to be trusted. I'm happy to be leaving the scoundrels." "Is that so?" replied the old farmer. "Well, I'm afraid that you'll find the same sort in the next town. Disappointed, the traveler trudged on his way, and the farmer returned to his work. Some time later another stranger, coming from the same direction, hailed the farmer, and they stopped to talk. "What sort of people live in the next town?" he asked. "What were the people like where you've come from?" replied the farmer once again. "They were the best people in the world. Hard working, honest, and friendly. I'm sorry to be leaving them." "Fear not," said the farmer. "You'll find the same sort in the next town." EDIT: Nate, are you doing a direct-entry CNM program? As in, you didn't have your RN before the program? If so, I wonder if your perspective might be different if you had to BE a nurse/ work as a nurse for a year (and not just work on your nursing skills within an academic context). If I were doing a direct-entry program (i.e. straight through RN to CNM), I wouldn't have ANY of these worries.

This. Did you ever sleep?! Seriously, CONGRATS! That is a MAJOR accomplishment. I hope you feel like you're floating on a cloud right now.

I always wonder about this... in my current line of (non-nursing) work, my personal experience has been that immigrants tend to work hard, keep to themselves, and send money home. Generalization, yes, but it's made me wonder when I hear people say that immigrants get everything in this country... what benefits are they receiving that others are not? Where I live the majority of immigrants are refugees (who are generally invisible to the public) and migrant farmworkers (who live out in the sticks). On the other hand, our "homegrown" public assistance users... you probably don't want to get me started on that topic.

Arabianeyez, thanks so much for your enthusiastic post. It gives me hope!! To be honest, I should probably stop reading this board. I just keep hearing over and over about how desperate new nurses are for work, and how working nurses hate their supervisors and their work environments. What negativity! I'm not a rose-colored glasses wearing Pollyanna by any means (my boyfriend calls me out all the time for being cynical; I say I'm realistic)... but I'm pretty discouraged by listening to all of these negative stories with so few bright points. EmilyRose, you bring up a really good suggestion when you mentioned the direct-entry MSN midwifery programs. I do have a bachelor's degree in a completely unrelated field. :-) Unfortunately, most of the programs on my list are out of my price range, either because they're private schools or not in my state. My first B.S. was somewhere around $150,000. This time around I won't have outside help, and I'm very hesitant to take on that much debt in this economy. So, I'm limiting myself to my state schools, even if it takes a year or two longer (which are years that I can be working to support myself and save for my master's degree). The one that's in my state (SUNY Stony Brook) probably shouldn't be on that list; they do have a "direct entry" option, but it's for ADNs or non-nursing bachelors+portfolio (which I wouldn't have). Thanks again for your responses... it's helpful to talk this through. :-)

Thanks for your response! I know Ellenville. It's close to the Gunks, a rock climbing destination. :-) Working in their hospital, I imagine you'd see some injured climbers now and then. :-( Any one know about counties farther north and west?

Sounds like you know what you like, and what you hope to do. I hope it works out for you!! I'm looking at an accelerated BSN (SUNY Binghamton 2012 hopefully), then working for a bit, then starting a CNM program. I'm in NYS, so at the moment I'm thinking SUNY Stony Brook or Frontier to start in 2014 or 2015. If I don't have kid(s) in the meantime, haha! My first degree was incredibly expensive; I just can't justify the tuition at the private programs (Vanderbilt, Yale, etc).

The talk of new BSN grads being out of work for months on end down in the City and surroundings is making this upstate BSN hopeful a little nervous. So... how's the job climate upstate? Western NY, Southern Tier, 'Dacks/ North Country, Central NY, Catskills nurses... you all know there's more to New York than the City ... are there jobs for new grads? Or is the climate just as bad as downstate?

This looks very interesting. I was able to find the tuition, but I wasn't able to find out equipment/ text costs. For folks who have taken Chemistry, how much did your labpaq cost? How much was the textbook/ lab manual/ other printed materials?

OOOOPS, I just realized that there is a distance learning board. I'm sorry, mods--maybe this topic belongs there?

Hi all! I need to retake Chem I & II as a prereq for my accelerated BSN program. I took Chem AP in high school, then took Chem again as a freshman in college. But that was more than 10 years ago, so I've got to take it a third time! Argh! My school requires two semesters, doesn't require a lab. I'm considering: 1) The CLEP exam: upside is that it's cheap, downside is that it's supposedly pretty hard and my score will count toward my prereq GPA. 2) Columbia Southern University: upside is that I have no doubt I'd sail through with an A, downside is that it's another $1200 and I think (personally) that online, for-profit schools are a bit sketchy. I searched the forums to see what other people have taken, but it seems like most of the online chem classes include wet lab, which means you have to purchase equipment, which makes the class more expensive. Are there any other options for a cheap, online chemistry? I'd do a lab if I have to, but it's not required for my program. THANKS ALL!

Hello again! :-) On the subject of L&D... I've heard seasoned CNMs go both ways, that L&D experience can be useful or not useful (in that you can pick up on the obstetric model of care and have to "unlearn" some attitudes and habits). Having said that, I think that if a nurse is passionate about women's reproductive health, s/he's not going to start treating her clients like objects any time soon. Anyway, for me, I'm starting to think it might not be a bad idea to work in another type of setting right after graduation to sharpen my clinical skills and to give me a chance to either apply for L&D positions or apply for my master's degree. ALSO. I had my first nursing dream last night. Specifics are foggy... I had midwife dreams regularly when I first decided on the career change. Maybe I'm getting used to the idea of being a nurse. Here's my list (from what I remember, I don't have it with me!). In the end, though some of these ideas are cool, I'm probably going to go with 1) whatever opportunity presents itself, and 2) whatever will help me work on my clinical skills. And stick it out for a year. Without further ado... Things I Could Do the Year After I Graduate from Nursing School: L&D at our local hospital Planned Parenthood Assist some of the midwives in the community ED at our local hospital (the primary health care provider for the low-income in our community, I am interested in taking some social work classes while I'm in school so this might be a good fit, plus I do VERY well under pressure) LTC at a particular place in our community (I genuinely enjoy the company of the old folks, even the grumpy old men, and the place I have in mind is FABULOUS and not depressing) Head down to the Southwest and work in a border birth clinic there Go to the Philippines/ Indonesia and work in a birth clinic there (love traveling) Take on doula clients (though I don't want to do this full-time) University/ college health centers Shadow the travel medicine nurse in town (like I mentioned, I love traveling and I've been all over the place) Move somewhere totally random, in the middle of nowhere, and work in a rural hospital doing whatever (I'm thinking Alaska or Montana) Continue my education--CBE, lactation consultant, etc. Our local Free Clinic always needs hands on deck That's all I remember at the moment... I'll edit if I remember more. :-) How about you? What else could you consider besides L&D?

Thanks for your nice reply, dancingnurse. This weekend I made a list of jobs/ areas that I think I might like to do for a year. Too bad that travel nursing usually requires a few years experience! Anyway, the list was longer than I expected. Maybe there is hope. Plus, as long as the environment isn't totally toxic, I'm pretty sure I can stick out anything for a year. As long as I can get a job and not have it drive me crazy. Setting the bar pretty low, eh?

Hi all, I'm around 30 years old and making a career change into midwifery. I realized that I was very unhappy at a sedentary, desk-based job working on conceptual issues. I have always been very interested in women's issues and have always enjoyed science, love working with people, love working with my hands. When someone I knew had her first child with a midwife in attendance, I began reading everything I could find and talking to anyone who had any connection to maternal/neonatal health. My research phase lasted about six months, and by the end I was convinced that pursuing the CNM credential (versus CPM, or even CM) was right for me. This summer I began taking prerequisite classes for my state university's accelerated BSN program, and I hope to begin nursing school next summer. I have two concerns. 1) I am not looking forward to nursing school. I've talked to a few alumnae of the program I hope to attend, and they have universally said that it was a miserable year. From what they've told me, a lot of nursing school is rote memorization combined with learning the "correct" answers (i.e. the answer your instructor wants you to give), plus a few fluff credits here and there. With the number of credits packed into a calendar year, I'm not surprised they were miserable. Still, I did my B.S. at what's considered a very good university (I'd rather not name it) and had the highest GPA in my program (tied with another person). I've got a 98.5% average in the A&P1 class I'm taking at the local community college. I've got a great work ethic, I test well, I'm organized, I learn well in a structured setting. I'm prepared to do an INSANE amount of work, but what I'm NOT prepared to do is to turn off my brain. :-( I'm nervous that I'm not really a good fit for nursing school. 2) More importantly... I don't want to be a nurse. The programs I'm considering for my MSN in Midwifery require at least a year working as a nurse before the program. I am DREADING that year! I know I would be very happy working gyn/ women's health/ reproductive health (Planned Parenthood would be a dream job), and I could probably tolerate L&D for a year. ;-) Everything else... well, all I've read on this board is how impossible it is to get a job right out of school, and how everyone in the medical system looks down upon and abuses nurses, and how nurses are overworked, underpaid, and disrespected. I'm not interested in wiping someone's ass while they berate me. I'm not interested in listening to a physician talk to me like I'm subhuman because s/he went to med school and I didn't (I considered it about 10 years ago and decided that my ego was large enough as is ;-). In short, I've never met a nurse that loved his/her job. Oh, the horror stories I've heard! You nurses, all of you, are SAINTS, the POWERHOUSES of our medical system, I can't believe you all stick with your jobs. Why would anyone voluntarily choose this career? Unless... it were a stepping stone to something else? Having freaked myself out about all of that... CNMs out there, was it worth it? Do any of you identify as MIDWIVES instead of NURSE-MIDWIVES? If I tell my nursing school interviewers that I'm not going to be a nurse, don't see myself as a nurse, don't intend to work as a nurse, am I shooting myself in the foot? Was getting through nursing school and those first few years outside women's/ reproductive health worth it? What would you recommend to me? Words of wisdom? Help!!! I'm all ears (or eyes... or whatever :-). Yours truly, Lilacs