Kerri D. Schuiling

Findings From the Analysis of the American College of Nurse‐Midwives' Membership Surveys: 2000–2003

Findings from the American College of Nurse-Midwives (ACNM) membership data provide descriptive information about selected characteristics of certified nurse-midwives (CNMs), certified midwives (CMs), and students enrolled in ACNM-accredited programs who are members of the organization. This article presents findings from the analysis of membership data for the years 2000 to 2003. Members remain predominantly white and female, with their age averaging in the mid-40s. Similarly, student demographics reflect little change from those reported in prior years. Students are primarily white, female, and in the mid-30s. Proportionately, there has been little increase in the diversity of members. The proportion of CNMs/CMs with a bachelors degree continues to rise, as does the proportion of CNMs/CMs holding doctoral degrees. The majority of CNMs/CMs identified a broad domain of clinical midwifery practice as their primary responsibility in their primary employment, and hospitals remain the largest employer of responding midwives. The salaries of employed midwives appear to be increasing, although the modal salary (60,000 US dollars to 69,000 US dollars ) is unchanged from prior years. The profile of the membership has remained fairly constant, with small changes in the trend over time noted for age, employment patterns, and attendance at birth sites for the 4 years analyzed.

Asking different questions: research priorities to improve the quality of care for every woman, every child

Citation for published version (APA): Kennedy, H. P., Yoshida, S., Costello, A., Declercq, E., Dias, M. A., Duff, E., Gherissi, A., Kaufman, K., McConville, F., McFadden, A., Michel-Schuldt, M., Moyo, N. T., Schuiling, K., Speciale, A. M., & Renfrew, M. J. (2016). Asking dierent questions: research priorities to improve the quality of care for every woman, every child. The Lancet Global Health, 4(11), e777-e779. https://doi.org/10.1016/S2214-109X(16)30183-8

Demographic Profiles of Certified Nurse–Midwives, Certified Registered Nurse Anesthetists, and Nurse Practitioners: Reflections on Implications for Uniform Education and Regulation

TOPIC There is wide variability in regulatory authority, basic education requirements, and titling for nurses in advanced practice roles, that is, certified nurse-midwives (CNMs), certified registered nurse anesthetists (CRNAs), and nurse practitioners (NPs). There is current advocacy for a common identity for advanced practice nurses (APNs), including uniform entry into practice requirements (the doctor of nursing practice [DNP]). METHODS Membership survey data were extracted to generate a contemporary profile of characteristics of these categories of practitioners. RESULTS The APN groups are similar in age (M = 47-48 years) and race (predominantly Caucasian), with the largest proportions of all groups clustering in the age range of 51-54 years. There are more men in the CRNA group (45%). CNMs have the highest proportion of doctoral degrees (4.7%). CRNAs command the highest annual average salary (

The Midwifery Workforce: ACNM 2012 and AMCB 2013 Core Data.

140,000). CONCLUSIONS Membership survey data can monitor progress toward implementation of proposed educational and regulatory changes. The effect of these proposals on the availability of an experienced APN mentor workforce for DPN students and the availability of an APN workforce for clients remains largely unknown. Standardized indicators of performance and client outcomes may enhance current data collection of membership demographics and enable precise evaluation of outcomes and impact of APN care.

Factors that Influence Midwives to Serve as Preceptors: An American College of Nurse-Midwives Survey

INTRODUCTION Core data are crucial for detailing an accurate profile of the midwifery workforce in the United States. The American College of Nurse-Midwives (ACNM) and the American Midwifery Certification Board, Inc. (AMCB), at the request and with support from the US Health Resources and Services Administration (HRSA), are engaged in a collaborative effort to develop a data collection strategy (the Midwifery MasterFile) that will reflect demographic and practice characteristics of certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. METHODS Two independent datasets, one collected by ACNM in 2012 and one by AMCB in 2013, were examined to determine key workforce information. ACNM data were collected from the online Core Data Survey sent to ACNM members. AMCB data were extracted from information submitted online by applicants seeking initial certification in 2013 and applicants seeking to recertify following 5 years of initial certification. RESULTS The ACNM 2012 survey was partially or fully completed by 36% (n = 2185) of ACNM members (N = 6072). AMCB respondents included 100% of new certificants (N = 539) and those applying for recertification in 2013 (n = 1323) of the total 11,682 certificants in the AMCB database. These two datasets demonstrate that midwives remain largely white, female, and older in age, with most engaged in clinical midwifery while employed primarily by hospitals and medical centers. Differences were reported between the ACNM membership and AMCB certification datasets in the numbers of midwives holding other certifications, working full-time, attending births, and providing newborn care. DISCUSSION The new collaboration among HRSA, ACNM, and AMCB, represented as the Midwifery MasterFile, provides the opportunity to clearly profile CNMs/CMs, distinct from advanced practice registered nurses, in government reports about the health care workforce. This information is central to identifying and marketing the role and contribution of CNMs/CMs in the provision of primary and reproductive health care services.

The development of a consensus statement on normal physiologic birth: a modified Delphi study.

INTRODUCTION Projected shortages in the primary care workforce underlie a need for more womens health care providers. In order to prepare more midwives to address this deficit, educators require additional clinical placement sites for students. The purpose of this study was to determine factors that influence practicing midwives to serve as preceptors. METHODS An e-mail invitation to participate in an online survey was sent to 7658 current and lapsed members of the American College of Nurse- Midwives (ACNM), who provided ACNM with a valid e-mail address. The survey assessed factors that enabled or were barriers for midwifery preceptors. Forced-choice questions were analyzed using descriptive statistics. Participant comments were analyzed using qualitative descriptive methods. RESULTS There were a total of 1517 surveys completed, for a response rate of 19.8%. Participants were primarily certified nurse-midwives (96.0%) who were in clinical practice (83.9%), with 78.0% in full-scope clinical practice. Participants represented all geographic regions of the United States. The majority of the participants indicated they or someone in their practice could precept a midwifery student. A commitment to the midwifery profession was the most commonly identified motivating factor (58.5%). Larger practices were more likely to precept midwifery students and to accept more than one student at a time. The most frequently identified barrier to precepting was the need to maintain a high patient volume (6.9%). Write-in comments were provided by approximately 500 participants and coded into 9 themes: payment, barriers to precepting, incentives, student characteristics, mechanisms for placement, communication, giving back, preceptor qualifications, and professional issues. DISCUSSION There is a strong commitment from preceptors to give back to the profession through the teaching of the future generation of midwives. Many of the barriers to precepting could be addressed by ACNM, the Accreditation Commission for Midwifery Education, and individual midwifery education programs.

Midwives and liability: results from the 2009 nationwide survey of certified nurse-midwives and certified midwives in the United States.

INTRODUCTION This article describes the process of developing consensus on a definition of, and best practices for, normal physiologic birth in the United States. Evidence supports the use of physiologic birth practices, yet a working definition of this term has been elusive. METHODS We began by convening a task force of 21 individuals from 3 midwifery organizations and various childbirth advocacy and consumer groups. A modified Delphi approach was utilized to achieve consensus around 2 research questions: 1) What is normal physiologic birth? and 2) What practices most effectively support its achievement? Answers to these questions were collected anonymously from task force members during multiple phases that included a preliminary briefing, an initial face-to-face roundtable, 9 iterative Delphi rounds, and reciprocal feedback from a wider audience of stakeholders at national and international conferences. Content analysis identified specific statements and concepts in the first Delphi round, which were subsequently ranked in following rounds. An initial draft was constructed based on the priorities that emerged and presented for feedback to peers and childbirth advocates whose comments were incorporated into the final document. RESULTS Four key themes were identified from our initial questions; these provided the framework for the document: 1) definitions of normal physiologic birth, 2) mechanisms and outcomes of normal physiologic birth, 3) factors that influence normal physiologic birth, and 4) recommendations for increasing normal physiologic birth. These areas comprised the final sections in the multi-organizational consensus statement. DISCUSSION The modified Delphi approach we employed allowed for the development of a consensus statement that will serve as a template for education, practice, and future research in maternity care. The completion of this statement marks the beginning of a project to promote systemic changes that support normal physiologic birth, and thus, have the potential to improve outcomes for mothers and infants.

Scope of Practice: Freedom Within Limits

INTRODUCTION In partnership with the American College of Nurse-Midwives (ACNM), the authors conducted a survey of ACNM members to examine the incidence of lawsuit involvement, the outcomes of the litigation in which they were involved, and coping mechanisms among midwives who had been involved in a lawsuit. METHODS In the spring of 2009, a nationwide Web-based survey was completed by ACNM members. In addition to using chi-square tests and nonparametric testing in data analysis, a logistic regression model was used to evaluate predictors of lawsuit involvement. RESULTS Among 1340 midwives responding to the survey, 32% had been named in a lawsuit at least once. The median number of years in practice when the event leading to lawsuit occurred was 6. The majority of midwifery lawsuits involved hospital births and were settled prior to going to court. Three variables were statistically significant for involvement with litigation: the midwifes age, the number of births attended, and the ACNM region of practice in the United States. DISCUSSION Lawsuits among midwives were significantly related to exposure to births over time. Practice patterns and job security were not greatly affected by the experience of a lawsuit. Future cyclic surveys are needed to track the frequency of litigation and the outcomes that lead to lawsuits and to better define the relationships between midwifery practice and medical malpractice litigation.