Nature and scope of certified nurse-midwifery practice: A workforce study.

AIMS AND OBJECTIVES: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN: Mixed methods research utilising prospective descriptive survey and interview. METHODS: An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. RESULTS: The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. CONCLUSIONS: An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. RELEVANCE TO CLINICAL PRACTICE: Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.

Looking Back While Looking Ahead.

This year marks the 25th year of publication for Nursing for Women's Health.

Wishes.

In her final editorial, Nursing for Women's Health editor Mary Brucker has some wishes for readers.

The Evolution of Language.

Using clear, unbiased language can help all individuals who present for health care to feel welcome and acknowledged.

Back to Normal?

The massive upheaval that the COVID-19 pandemic has brought to all our lives has caused many of us to think long and hard about what kind of future we want and need.

Change, Anxiety, and Resilience.

Change is a defining characteristic of the times we are living in.

The Power of Images.

Images have the power to inform us, surprise us, and move us.

Goodbye to an Unusual Year.

This year has brought challenges many of us never imagined, but the importance of nursing care for women, newborns, and families remains constant.

Tarnished Silver Linings.

The SARS-CoV-2 pandemic may have many of us feeling distraught, but there are still reasons to be hopeful about the future of health care.

Novel Viruses, Zoonotic Infections, and Travel Health.

Novel viruses and zoonotic infections pose global health risks.

Nursing When the World Is Upside Down.

Nurses are at the forefront of the COVID-19 pandemic.

In the Same Storm but Different Boats.

People's experiences of the COVID-19 pandemic vary widely, with some groups suffering disproportionately.

A Year to Celebrate.

This year has been officially proclaimed by the World Health Organization as the Year of the Nurse and the Midwife.

Nursing the Planet.

Nurses have a vital role to play regarding environmental issues and associated health implications.

Weaving All the Threads to Prevent Maternal Mortality.

The etiology of maternal mortality is multifactorial and requires a concerted and comprehensive effort to address the problem.

The Value of Evidence.

We strive to put evidence into action to promote optimal nursing care, regardless of whether those care practices are brand new or decades old.

Monoliths and Millennials.

Typifying all members of a particular age group as having specific characteristics is as deleterious as doing it with members of any other population, such as racial, ethnic, gender, and geographic groups.

What Does the Future Hold for Nurses?

Studying today's data on health trends can give us a glimpse into what the future might hold for the nursing profession.

Hands.

Healthy hands are integral to nurses' practice.

A Comparative Workforce Study of Midwives Practicing in the State of Texas.

INTRODUCTION: Access to quality care is a problem in Texas, an ethnically diverse state with large birth numbers. The state has over 300 areas designated as medically underserved, and a severe lack of obstetricians and midwives. Minimal data exist on midwifery's contribution, and no known study compares the work environment and clinical practice of the 2 state-recognized midwifery paths, licensed midwives (LMs) and certified nurse-midwives (CNMs). The purpose of this study was to determine the differences in practice by CNMs and LMs, the latter of whom are generally certified professional midwives. The specific aims were to 1) describe the differences in demographic and employment characteristics of CNMs and LMs, 2) identify the geographic areas and population groups served by CNMs and LMs, and 3) compare the nature and scope of CNM and LM clinical practices. METHODS: Online parallel surveys of Texas LMs and CNMs were conducted in December 2015 and January 2016. The REDCap data management system housed the 123- and 125-item surveys for LMs and CNMs, respectively, addressing demographics, populations served, and clinical practice. A comparative statistical analysis, using Fisher's exact test, Pearson's chi-squared test, and Independent Samples t-tests, was performed. RESULTS: The survey response rates of LMs and CNMs were 35.4% (n = 75) and 31.9% (n = 143), respectively. Differences in demographics, employment status, workload, scope of practice, risk assessment, time-based care management, and technology use were observed. DISCUSSION: Findings represent the first attempt to describe the Texas midwifery workforce. In a large state with health care provider shortages, this step is pivotal in addressing strategies for providing services for women and infants. This groundwork can provide the foundation for including midwifery in a state health plan.