Of the more-than 81,000 registered nurses working in Arizona as of 2015, just 254 were certified nurse-midwives. This accounted for just .003 percent of all nurses in the state, despite the fact that Arizona is recognized as having the 13th highest fertility rate in the nation (Centers for Disease Control, 2013). Statistics from the Arizona Department of Health Services show that the number of home-births statewide increased by 80 percent over the ten-year period leading up to 2012. Combined, these factors help speak to the growing demand for the uniquely personalized service that nurse-midwives provide to women and neonates.
In May of 2014, Cronkite News published an article highlighting some of the reasons behind the growing demand for nurse midwives in Arizona. The article highlighted the case of one Tucson-area woman who described her experience giving birth in a hospital as traumatic, as doctors induced labor with pharmaceuticals and manually broke her water. The very positive experience she had delivering her next two children under the care of certified nurse midwives has led her to become an outspoken advocate for the gentle art and practice of nurse-midwifery.
Steps to Becoming a Nurse-Midwife in Arizona
Certified nurse midwives (CNM) are licensed as advanced practice nurses (APN) through the Arizona State Board of Nursing. Achieving advanced practice licensure and CNM credentials starts by completing a master’s degree at minimum in nurse-midwifery before going on to become nationally certified through the American Midwifery Certification Board (AMCB).
Follow the steps in this guide to learn how to become a certified nurse-midwife in Arizona:
|Earn a Graduate Degree in Nurse-Midwifery|
|Earn National Certification in Nurse-Midwifery|
|Apply for APN Status with the Arizona State Board of Nursing|
|Maintain Credentials and Explore New Career Opportunities|
Step 1. Earn a Graduate Degree in Midwifery
RNs interested in becoming nurse-midwives must earn a master’s degree or higher in nurse-midwifery through a graduate program accredited by the Accreditation Commission for Midwifery Education (ACME). Given the limited availability of nurse-midwife programs at campus locations in the US, working RNs typically opt for the more flexible and convenient online graduate programs available through some of the nation’s leading schools.
Even without a campus location in Arizona for nurse-midwife graduate studies, students interested in fulltime classroom based instruction will find schools with accredited campus-based nurse midwifery programs in the neighboring states of California, Utah, Colorado, and New Mexico.
Nurse-midwife graduate programs that offer a dual focus in nurse midwifery and women’s health are increasing in popularity, as they allow graduates to go on to become dually credentialed as both a certified nurse midwife (CNM) and women’s health nurse practitioner (WHNP).
Common admission standards for nurse-midwife graduate programs include:
- Current RN license
- BSN or completion of nursing prerequisite courses
- Minimum GPA
- GRE General Test
- Personal essay, video essay, or statement of purpose
- Letters of recommendation
Although most candidates for nurse-midwife graduate programs hold a BSN, ACME does accredit RN-to-MSN bridge programs in midwifery/women’s health for those that hold associate’s degrees in nursing.
Graduate Program Structure
These programs consist of two primary segments:
- Classroom education, ranging between 40-60 semester credits
- Clinical education, usually at least 1,000 hours
A range of important and pertinent topics are covered throughout a graduate student’s didactic studies, which can include:
- Legal issues and ethics in maternal healthcare
- Advanced physiology
- Women’s reproductive health
- Labor, birth, and newborn care procedures
- Advanced integrated midwifery
- Mother and infant biostatistics
- Research methods for advanced-practice nurses
- Advanced pharmacology for childbearing women
Clinical education serves as the point where classroom knowledge is put into practice under close supervision. Online students will work with a faculty advisor soon after initial enrollment to determine appropriate clinical locations. Online schools cater to graduate students across the nation, and often partner with hospitals in each state to ensure students have access to locations that support specialized clinical training in nurse-midwifery.
Examples of potential clinical sites located in Arizona include:
- Banner Desert Medical Center in Mesa
- Banner Estrella Medical Center in Phoenix
- Northwest Medical Center in Tucson
- Tucson Medical Center
- Tempe Saint Luke’s Hospital
- Kingman Regional Medical Center
- Saint Joseph’s Hospital in Tucson
- Holy Cross Hospital in Nogales
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, graduates can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners.
Step 2. Earn National Certification in Nurse-Midwifery
The Arizona State Board of Nursing stipulates that all advanced practice nurses must be nationally certified in their area of expertise. The two organizations that sponsor relevant certifications for nurse midwives and women’s health NPs, respectively, are:
- American Midwifery Certification Board (AMCB) – sponsors the national Certificate in Nurse Midwifery
- National Certification Corporation – sponsors the national Women’s Health Nurse Practitioners WHNP-BC credential
Candidates will need to apply directly with these organizations, and once an application has been approved they can sign up to sit for their exam(s), which will be proctored by the testing company, Applied Measurement Professionals (APM). Testing for both credentials is administered by APM at H & R Block Centers located throughout Arizona in the cities of:
Certified Nurse Midwife Exam
To be eligible to test with the AMCB nurses need to have a graduate degree from a midwifery school that is accredited by ACME. Upon earning this degree, candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Exam candidates can start preparing for the test by reviewing the Candidate Handbook. The exam is taken on a computer and comprised of 175 multiple-choice questions with a time limit of four hours. The topics covered on the exam are:
- Antepartum – 19-26 percent
- Intrapartum – 17-26 percent
- Postpartum – 15-18 percent
- Gynecology – 15-18 percent
- Women’s health and primary care – 8-16 percent
- Newborn – 7-16 percent
Women’s Health Care Nurse Practitioner (WHNP) Exam
To be eligible to sign up for the WHNP exam, candidates must have a current RN license and complete a graduate program for women’s health care nurse practitioners. Exam candidates can prepare for their test by studying the WHNP Candidate Guide. Testing takes place on a computer with 150 multiple-choice test questions. It may also have up to 25 unscored pretest items. Over the course of three hours the exam will cover the topics of:
- Gynecology – 35-40 percent
- Obstetrics – 25-30 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Primary Care – 10-15 percent
- Pharmacology – 5-10 percent
Step 3. Apply for APN Status with the Arizona State Board of Nursing
After completing an accredited graduate program and earning national certification(s), candidates for advanced practice licensure will be ready to submit an application for APN status with the Arizona Board of Nursing. Applicants can indicate they are applying for APN status as a nurse midwife and/or women’s health nurse practitioner at the AZBN Nurse Portal.
Within a month of submitting an application, nurses will receive notice from the state board if their application is lacking any materials. Applicants can check the progress of their application with the board’s online verification system.
Out-of-State and Temporary License
RNs who are waiting to take their certifying examination, as well as those from other states who meet the requirements for their APN area of specialization, can both apply for a temporary license to practice while waiting for their application to be processed. If a new licensee fails the national certifying exam, the temporary license becomes invalidated. Applicants can opt for a temporary license on their APN application. The license itself is valid for six months.
Step 4. Maintain Credentials and Explore New Career Opportunities
Once the Arizona State Board of Nursing indicates that a nurse’s APN status is active, new nurse midwives and/or women’s health NPs can start pursuing their career goals. Whatever career advancements new APNs make, it is important to remember to keep all necessary credentials current.
APN Renewal with the Arizona State Board of Nursing
The board encourages all APNs to register their RN license and APN status online. To maintain APN status as a certified nurse midwife and/or women’s health nurse practitioner, APNs must maintain their respective national certifications through the AMCB/NCC. APNs must also maintain their RN license, and submit proof of national APN certification when they renew their RN license.
Certificate in Nurse Midwifery with the American Midwifery Certification Board (AMCB)
This certificate is on a five-year renewal cycle, which can be completed through the AMCB’s Certificate Maintenance Program. Staying current with this credential involves either of these options:
- Re-examination with the AMCB
- Completion of three certificate maintenance modules and 20 hours of continuing education
Women’s Health Care Nurse Practitioner (WHNP-BC) with the National Certification Corporation
This credential is on a three-year maintenance cycle with the NCC. Maintaining it involves taking a Continuing Competency Assessment and then completing between 10-50 hours of approved continuing education per cycle, depending on the results of the assessment.
Employers and Practice Models for Certified Nurse Midwives
New APNs may be interested in advancing their careers where they are currently working or where they completed their clinical education. Others may envision starting their own midwifery practice or joining together to open a local women’s clinic. Potential employers and practice models can include any of the following:
- Family Birth Center in Phoenix
- Arrowhead OB GYN in Glendale
- Primeros Pasos Prenatal Clinic in Tucson
- Prescott Women’s Clinic
- Yuma Women Clinic
- Flagstaff Birth and Women’s Center
- Southern Arizona Midwives with locations in Sierra Vista and Benson
- Banner Estrella Medical Center in Phoenix, Women and Infants Services Department
- Women’s Center at Northwest Medical Center in Tucson
- Tuscon Medical Center Maternity
- Women’s Care at Tempe Saint Luke’s Hospital
- Kingman Regional Medical Center’s Obstetrics/Perinatal Unit
- Women’s Care Pavilion at Saint Joseph’s Hospital in Tucson
Nurses who are considering becoming midwives and/or women’s health NPs will be curious to learn more about the job market throughout Arizona. (Surveyed as part of a statewide analysis conducted in November 2015, the following job vacancies are provided as illustrative examples only):
- Certified Nurse Midwife with Saint Joseph’s Hospital’s Women’s Care Center in Phoenix
- Nurse Midwife with Indian Health Services in Chinle and Kayenta
- Adjunct Professor for Advanced Practice Management of Women’s Health Care Issues with Grand Canyon University’s College of Nursing and Health Care Professions in Phoenix
- Clinical Nurse in Women’s Health at Luke Air Force Base near Glendale
- Labor Room Nurse Director with the Maternal Child Health Services Department at a hospital in Cochise County
- Travel RN for Labor and Delivery in Chandler
Salaries for Certified Nurse-Midwives in Arizona
Certified nurse-midwives are recognized as some of Arizona’s best paid healthcare professionals. In fact, certified nurse-midwifery was named among the top 20 highest-paying occupations in Arizona requiring a master’s degree or higher (United States Department of Labor, 2014). At that time, nurse midwives working in the state earned an average annual salary of $102,900.
Newly licensed certified nurse-midwives entering the field in Arizona were offered an average starting salary of $67,800, however, experience continues to be the biggest factor contributing to higher earnings. With several years of experience, Arizona’s certified nurse-midwives can expect to earn salaries that fall with the 90th percentile for their field. The average among Arizona’s most experienced CNMs whose salaries fall within this range was $121,300 as of 2014..
Starting Salaries Published in Job Vacancy Announcements for CNMs in Arizona
In November 2015, the Indian Health Service located in Chinle released online job advertisements on healthjobsnationwide.com for nurse-midwife DHA and nurse midwife ESEP/MP positions. Starting salaries for these positions ranged widely based on experience, from $55,969 to $97,399.
In December of 2015 the Inline Group located in Fort Defiance posted an online job posting on physicianjobboard.com for a certified nurse midwife position. The full-time job offered a beginning monthly salary offer of $2,500. Addition benefits included a $5,000 sign-on bonus, loan repayment options, paid holidays, and a 401(k) plan.
In December 2015, the salary aggregation site indeed.com reported that certified nurse midwives in Tucson were offered an average starting salary of $86,000. Those in Phoenix were offered a slightly lower average annual salary of $85,000, while the average for CNMs in the Mesa area was $69,000.
Indeed.com is a job aggregation website that indexes salary information gathered from all available job vacancy announcements found in multiple sources. Their salary searches are automatically conducted on a daily base to ensure the most current salary data available. Salaries shown here were calculated for the period between December 2014 and December 2015.
An Overview of Certified Nurse-Midwifery in Arizona
Research published by the American College of Nurse-Midwives in February 2014 revealed:
- There were 190 licensed CNMs and CMs actively practicing in Arizona
- 69% of nurse midwives in Arizona were members of the American College of Nurse-Midwives
- 5% of births in Arizona were attended by CNMs and CMs in 2012
- There were three birth centers accredited by the Commission for Accreditation of Birth Centers (CABC) located across Arizona as of June 2014:
- The Flagstaff Birth and Women’s Center
- The Blossom Birth Center
- The Babymoon Inn