The landscape of healthcare delivery is constantly changing, bringing with it a unique set of challenges for today’s healthcare professionals. Although the future of our nation’s healthcare remains unclear in many ways, we do understand the undeniable value of practitioners who can meet the challenges of an evolving healthcare environment, particularly now when the demand for healthcare has never been greater. The education programs that prepare today’s practitioners are also evolving to better fit the changing shape of healthcare in the 21st century, offering students new opportunities for interdisciplinary study that will prepare them to specialize in multiple areas and serve more than one patient population group.
In the field of nurse-midwifery, master’s degree programs that offer dual specialization have become prevalent. One such popular option is the dual-focus Certified Nurse-Midwife (CNM)/Women’s Health Nurse Practitioner (WHNP), available through a number of institutions as a Master of Science in Nursing (MSN), Master of Science (MS), or as a post-graduate certificate program.
For many prospective nurse-midwives, completing a dual-focus advanced practice program that encompasses both nurse-midwifery and women’s health may have a host of benefits; both for their future careers and for the women they will serve. Here’s why:
Why a Dual Specialty? Understanding the Similarities and Differences between Nurse-Midwives and Women’s Health Nurse Practitioners
Although it has been fairly commonplace for practicing nurse-midwives to also pursue an APRN specialization as a women’s health nurse practitioner, it wasn’t until recently that a number of institutions began offering combined nurse-midwife/women’s health nurse practitioner programs. These graduate-level programs allow RNs to complete all courses and clinical sequences required for national certification in both APRN specializations, through one comprehensive course of study.
These programs allow graduates their choice of credentialing options, qualifying them to earn either the Certified Nurse-Midwife (CNM) credential or board certification as a Women’s Health Nurse Practitioner (WHNP-BC), or both if they so choose.
The CNM/WHNP degree program is a natural combination program, as the scope of practice of a nurse-midwife is often closely related to that of a women’s health nurse practitioner. This combination of inter-related knowledge and skills make earning a dual specialization degree a smart choice for APRNs interested in providing comprehensive care for women throughout their lifespan:
Women’s Health Nurse Practitioner (WHNP): A women’s health nurse practitioner provides primary health care services to women, from adolescence and beyond. WHNPs specialize in gynecology, providing well-woman care and treating women with both chronic and acute illnesses.
WHNP’s provide a gender-focused approach to health concerns affecting women so as to improve women’s health outcomes, reduce health disparities, and enhance the quality and efficiency of the delivery of women’s healthcare services.
The WHNP Guidelines for Education and Practice provides a comprehensive clarification of the WHNP role to include providing specialty services related to
- Sexual health
- Reproductive cancers
They generally provide care in:
- Community clinics
- Private practices
Nurse-Midwife (NM): A nurse-midwife provides primary healthcare services, including gynecologic and family planning services, as well as preconception care, childbirth services, and care during the post-partum period. These healthcare providers are also qualified to provide care for the newborn during the first 28 days of life and for male partners as it relates to sexually transmitted infections.
Nurse-midwives provide initial and ongoing comprehensive assessment, diagnosis, and treatment of women. The scope of their services includes health promotion, disease prevention, and individualized wellness education and counseling. They provide these services in diverse settings such as:
- Ambulatory care clinics
- Private offices
- Community and public health systems
- Birth centers
Although both nurse-midwives and women’s health nurse practitioners are recognized as advanced practice RNs in all 50 states and are able to provide primary care to women from adolescence through menopause, there are distinct differences between these two APRN specialties:
- Women’s health nurse practitioners are qualified to treat women with both chronic and acute illnesses, while the primary focus of the nurse-midwife is on well-woman care.
- The major focus of nurse-midwives has long been management of the antepartum, intrapartum, and postpartum woman. Nurse-midwives attend births in any number of settings, including hospitals, birth centers, and private home births. The scope of women’s health nurse practitioners does not include care of the childbearing woman, aside from prenatal visits.
- Nurse-midwives are qualified to provide care to newborns during the first 28 days of life.
Nurse-midwives also certified as WHNPs may enjoy a broader scope of practice, providing care to women during their reproductive years to include diagnosing and treating acute and chronic illnesses and injuries, thus providing them with complete and comprehensive care.
The Nurse-Midwifery/Women’s Health Nurse Practitioner (NM/WHNP) Master’s Program
A dual focus NM/WHNP master’s program prepares students to serve as competent nurse-midwives and women’s health nurse practitioners, capable of providing family-centered clinical practice and primary care.
Students of an NM/WHNP master’s degree program can expect a rigorous academic load and more than 1,000 hours of clinical practice to meet the curriculum and experience requirements of this combined specialty track.
Students of an NM/WHNP master’s degree program must possess a current and unencumbered RN license, a Bachelor of Science in Nursing (BSN), and often:
- Minimum undergraduate GPA
- Minimum GRE scores
- Letters of recommendation
- RN experience/resume
- Professional statement of purpose/admissions essay
Program Structure and Accreditation
The Accreditation Commission for Midwifery Education (ACME) accredits nurse-midwifery programs in the U.S. Students must graduate from an ACME-accredited program to qualify to sit for the Certified Nurse-Midwife Exam through the American Midwifery Certification Board.
Students of CNM/WHNP programs accredited by ACME are also qualified to sit for the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation if they choose.
The majority of ACME-accredited programs are designed as MSN or MS programs, although a number of programs exist to accommodate students with differing levels of education. For example:
- RN-to-MSN degree programs: Often called bridge programs, these programs allow RNs with associate’s degrees to earn both their BSN and MSN degrees in one, accelerated program.
- Post-graduate certificate programs: These post-graduate programs appeal to master’s prepared RNs seeking initial APRN licensure as a CNM/WHNP, or to APRNs seeking to add additional specialties to their APRN license.
Other options found throughout many NM/WHNP master’s programs include:
- Part-time/Full-time: While full-time NM/WHNP programs take about two years to complete, students often have the option of completing them on a part-time basis over the course of three years.
- Partially/Fully Online: A number of NM/WHNP programs offer students the option of completing part or all of their didactic requirements through online study. Web-based study is particularly useful given the select number of institutions that offer the CNM/WHNP master’s degree. Students of online programs would complete their clinical requirements at approved sites close to home.
Because the core curriculum of a nurse-midwife program is closely related to that of a women’s health nurse practitioner program, a dual focus master’s program eliminates the need to complete these courses twice:
- Advanced health assessment
- Clinical pharmacology
- Healthcare ethics
- Physiology and pathophysiology
- Research methods for healthcare providers
The specialty coursework of these programs includes study in:
- Women’s reproductive health
- Ambulatory care of women
- Primary care of women
- Antepartum care
- Nurse-midwifery management of complications
- Intrapartum and postpartum care
- Care of the newborn
Clinical practice in a dual focus CNM/WHNP master’s degree program takes place across a variety of healthcare settings in which collaborative management, medical consultation, and referrals take place. All clinical rotations are in line with the National Organization of Nurse Practitioner Faculties Competencies for WHNPs and the Standards for Nurse-Midwifery Practice of the American College of Nurse-Midwives.
Clinical experiences for these programs may include ambulatory care settings, private practice, triage, hospitals, birth centers, and home birth settings. Students can expect to complete about 1,000 hours of clinical rotations.