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queenanneslace

queenanneslace ADN, MSN, APRN, CNM

Nurse-Midwife
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queenanneslace is a ADN, MSN, APRN, CNM and specializes in Nurse-Midwife.

queenanneslace's Latest Activity

  1. queenanneslace

    Most successful way to find a preceptor

    I see a lot of questions about finding preceptors, and not a lot of responses. First (maybe this is obvious) - making online requests to the universe at large for a preceptor is probably not very effective. This is what I'd suggest: NETWORKING - in person. Go to local midwifery meetings. Go to midwifery seminars. Go to midwifery/nursing conferences - AWHONN, ACNM, ACOG. Attend Frontier case days in person. I cannot overemphasize the importance of making connections IN PERSON. If there is a doula meeting and there are going to be nurse-midwives there, GO. If a hospital is hosting a 'Meet the Midwives' day for their CNMs. GO. If there is a movie night about something birthy in the community and CNMs will be there. GO. When you get there, be friendly, ask the midwives about themselves and their practices. Be social. Let them know that you are looking for a clinical site, and ask if they have any ideas or suggestions. Preceptors are going to want to get a feel for you - and that is virtually impossible to do with online or email requests. My advice is to do whatever you can do - IN PERSON - to interface with CNMs. That is probably the best way to secure a clinical site.
  2. queenanneslace

    Course work @ Frontier

    Your plan is very realistic. I enrolled in courses part-time, and had a part-time FTE during the non-clinical portion of the program. During clinicals I went to per diem. When I completed my program, and passed the CNM boards, I could seamlessly pick up more hours and an L&D RN while I was applying for midwife jobs.
  3. queenanneslace

    Frontier CNM Program hours of study per week

    I worked 24-32 hours per week on average. I had to do a lot of networking - and way ahead of time - to secure a site. Ideally, I wanted more sites, but it worked out that the practice was large enough and diverse enough that I got good experience. Also - my work experiences in L&D helped round out my experiences. I would not recommend precepting with only one CNM. That's just my opinion -you learn so much from working with multiple different providers.
  4. queenanneslace

    Frontier CNM Program hours of study per week

    I enrolled part-time for a couple of reasons. - My workplace had tuition reimbursement if I maintained my work schedule at a certain FTE. It was fairly generous - $3500-4000/year toward a graduate degree program if I remember correctly. -Working part-time along with the tuition reimbursement allowed me to pay outright for my tuition while I went through the program. I graduated with $0 in student loan debt. Studying wasn't excessive - and it was manageable to have a part-time work schedule and a part-time school schedule. 20 hours a week? I supposed it depended on the week. There were some classes that were more self-paced than others - I think I finished some weeks before the term was done. There was some flexibility. When I started clinicals, I had to travel outside of my community, and went to a per diem schedule at work. Clinicals were essentially full-time - or more - due to taking lots of call. But overall, I graduated in less than 3 years doing the part-time track at Frontier. Hope this information helps!
  5. queenanneslace

    39 IOL

    I've never worked at a hospital where IOL without indication at 39+0 weeks is the norm. It might be your hospital, or the culture of your geographic area.
  6. queenanneslace

    Are Certified Midwifes still Prevelent in the U.S?

    ChiefFaith The questions you ask will have different answers depending upon the state and the area where you work. Some places have lots of CNM practices. Others have very few. The way practices are structured vary from practice to practice - and also depending on the size/volume of the clinic/hospital where you work. Getting experience as a nurse will help you feel out different APRN professions, and help you decide where you want to land in your nursing career. I'm not Allison, but I'm a CNM. I used to think that gaining experience as an RN was completely unnecessary - but that was until I got a job as an RN in a very busy tertiary L&D unit. I can say that my RN experience was hands-down the most important part of my training as a midwife. Especially the experience in the high-volume, high risk center. I would not have even close to the experience and knowledge that I have with my midwifery training alone. There are plenty of people who will minimize the necessity of RN experience in L&D. BUt it's worth it. Even if the job isn't midwife-y (and the place I was wasn't! At All!) The skills and intuition and knowledge and experience you will gain will be vital to you being ready to practice when you start as a CNM on your own.
  7. queenanneslace

    Just how busy is an online NP master program?

    I entered an MSN program with a non-nursing Bachelor's degree and ADN. I enrolled part-time (6-8 credits per term), and worked part-time (24-30 hrs/week) until clinicals. I was at Frontier, so the clinicals come after the coursework - this would be different with concurrent academic coursework and clinicals. When clinicals started, I went per diem at work. Though I could have maintained my work schedule and done clinicals, I just didn't want to be that insane, and my family life and finances were such that I didn't have to. Most people have to make adjustments to their work schedules - especially if they're working full-time - to accommodate clinicals. Since I was in a midwifery program, I needed to be both on-call for births in the hospital, as well as clinic days. The clinic days were easiest and most reliable to incorporate into my schedule. So that is another thing to take into account. There were many FNP students enrolled at Frontier, and most seemed to be working throughout their academic studies.
  8. queenanneslace

    gnosis

    I would study the ACOG document Hypertension in Pregnancy - (sorry if that is not the exact title). Thanks for the memory jog as to what Gnosis is, NRSKarenRN. It seems that when my institution required these trainings, we had an opportunity to go back, review and update our answers. It was a learning process. Also, Gnosis identified areas where we needed more review and pointed us in that direction. Maybe I'm thinking of a different program - but what I remember is that it was not about acheiving a grade, but about learning current best practices, and reviewing and updating our knowledge base.
  9. queenanneslace

    ARRIVE trial results - elective induction of labor at 39 weeks

    "Mother Nature is, indeed, a terrible obstetrician, but that's not a bad thing because she's a great midwife." It seems like she's mixing metaphors a little bit. What do you think this means?
  10. queenanneslace

    Insight into CNM career

    CNM positions are going to vary depending on your geographic location, the local birth 'culture', and by employer. Where are you planning on working when you finish nursing school? One of the best things about having an RN license is your employablity in many different areas of health care. It's a great way to get experience and also to observe first-hand how CNMs WHNPs are practicing - if you can find a position where these providers are practicing. I would suggest trying out some work experiences in areas that interest you before making a decision about CNM vs WHNP or other advance practice nursing role.
  11. queenanneslace

    ARRIVE trial results - elective induction of labor at 39 weeks

    "The multicenter ARRIVE study involved 6106 women who were randomly assigned in their 38th gestational week to induction or expectant management at 39 weeks, 0 to 4 days. The women, from 41 hospitals across the United States, were nulliparous with a live singleton fetus in vertex position in an uncomplicated pregnancy and without contraindications for a vaginal delivery." This is from a Medscape article regarding the ARRIVE study (where I could pull it up the most quickly).
  12. queenanneslace

    ARRIVE trial results - elective induction of labor at 39 weeks

    Thanks for all your comments and perspectives. I realize that I must be living in an area where induction practices have been modified to allow for longer onset of labor, diagnoses of 'failed induction' and stricter criteria for Bishop scores prior to initiating oxytocin. It is pretty uniformly practiced in my area that a nullip must have a Bishop of >10 before starting oxytocin. There are only a few providers that try to circumvent this - so yes, labors (well, cervical ripening) take a loooooooong time, but no one is put on a clock and sectioned after 24 or even 48 hours of ripening. That is just not happening. It is also more universally practiced in my local hospitals/medical centers to diagnose active labor at 6 cm dilatation, and not before. I haven't worked in a facility that worships the Friedman curve, or anything close to it. There's a random provider (physician) here and there who might be doing this - but they are usually in solo or private practice, kind of out there on their own, they are becoming few and far between. I have to be careful to not assume that this is true elsewhere, because I'm hearing from many others that induction of labor is still in the dark ages in many places. If I worked in a freestanding birth center I would probably not see any reason to change the way I practiced, either! Birth center clients are usually committed to natural, physiologic, spontaneous labor and birth - and very motivated to acheive that. I work in a hospital-based practice, and have patients requesting inductions all the time. Our midwifery practice is not restricted to patients who only desire natural birth, so this creates a lot of diversity in desires for a labor and birth experience. The hospital system discourages elective IOL - in fact our guidlelines effectively prohibit it - no cervical ripening until 40+6. Medically indicated IOLs can be performed at various gestional ages based on clinical criteria. For me, I want to accommodate choices that my patients make for themselves, based on shared decision making and informed consent. One of the hardest things for me to have learned is to accept and support choices made by my patients that I would not make for myself. Some of the choices they make come with increased risks, some with decreased risks, some just conflict with my own ideas of what an ideal birth experience is **for me**. Example: I never wanted an epidural for labor - but I work with patients all the time who opt for epidurals, and are happy they made that choice for themselves. (There are patients who dislike the epidural experience, usually when it doesn't work, but that's a method failure in a way.) I'm delighted to work with patients who get the experience they want. Same with patients who want to give birth underwater, I'm happy to support that, if that is what they are opting for themselves. I induce patients with medical necessity, and I support the labor process and promote a positive labor and birth experience to the best of my ability when induction is indicated. I don't know any midwifery practice that functions in that old school 24-hours-to-birth after starting IOL - it seems that a midwifery managed IOL would result in lower cesearean rates, just as spontaneous labors do. (Maybe another study is indicated?) I'm getting long-winded. Do any of you have patients requesting induction of labor by 39 weeks? How would you counsel them? I'm having a hard time not supporting this choice - it appears to not increase risk for cesarean birth. I really like that. 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.
  13. queenanneslace

    ARRIVE trial results - elective induction of labor at 39 weeks

    Thanks. I'd love to hear more of your questions. As far as acheiving 'vaginal delivery at all costs' do you believe this was an intervention employed in the experimental group (IOL at 39 weeks) versus the control group? Or do you believe both groups were subject to the same treatment? This trial occurred in something like 40 hospitals, do you believe what your friend experienced was true at every site? It's true, it is hard to control for a lot of potentially confounding factors.
  14. Hey. Let's talk about the ARRIVE trial and results. Thoughts? Questions? Concerns? Were you surprised? Do you anticipate a change in guidelines for elective IOL at the facilities where you attend births? Will this impact the way you practice? Will this impact how you counsel women requesting IOL? Practice Advisory: Clinical guidance for integration of the findings of The ARRIVE Trial: Labor Induction versus Expectant Management in Low-Risk Nulliparous Women - ACOG ACNM Responds to Release of ARRIVE Trial Study Results
  15. queenanneslace

    Attending births with a CPM

    I attended births with CPMs, and at one point was apprenticing to become a CPM. I had chosen that route because I felt pulled toward that model of care, and wanted to provide midwifery services in out-of-hospital settings. I concur with the other posters here who have concerns about the education and training of CPMs. So I won't repeat myself. I will say that the last birth I attended with a CPM (in a home setting) was during nursing school. Once I had my RN license, I was very reluctant (resistant) to jeopardizing my license by even being present with a CPM at a home birth. And they ask me... because I think it lends legitimacy to what they're doing: "My birth assistant is an RN!" I know how the board of nursing regulates nursing in my state, and I know how midwifery is *not* really regulated in my state (despite CPMs being licensed), I do not want to take the chance of being present at a home birth gone wrong. No question in my mind that I would be subject to scrutiny for my professional actions (or inactions), and held to a higher standard than the CPM.
  16. queenanneslace

    New grad in L&D. Are these things normal?

    When I read the title of your post I was all prepared to say: "Hmpf, yeah, it's that bad." Because L&D can be ... eye-opening ... in the way things are done. But after reading the content in your post. NOPE. Nuh-uh, get outta there, that is not a good place for patients, for nurses or for living things in general. A side note - do nurses employ dark humor to cope with work and challenging patient situations? Yes. Will I defend this behavior? Nope. Never. I will not normalize this or justify it. I will work hard every day to exemplify professionalism in the workplace. I have colleagues who are nothing short of stellar human beings - both in earshot and out of earshot of patients. It is a pleasure to work with these individuals, and patients are served well by not only their skills as a nurse, but their committment to professionalism. So yeah, you can get into an environment where this kind of boneheaded behavior is tolerated, and you will even find people who will justifiy and normalize this type of behavior. It is something I will not stand for. There are excellent nurses, clinicians and providers out there. They employ team work, the provide respectful and patient-centered care, and they prioritize safety of their patients. And they'll even call out their doofus coworkers for making demeaning comments about their patients. I can't say all work environments are perfect - of course they're not - but you can find much better. Don't compromise your standards!