Of the 215,407 children born in the state of Florida in 2013 as reported by the Centers for Disease Control and Prevention (CDC), 22,424 were brought into the world with the help of the state’s dedicated certified nurse-midwives. This represented 10.4 percent of all deliveries that occurred in the state that year.
Even with the fourth-highest number of certified nurse-midwives of all states in the nation, the Florida Department of Economic Opportunity expects the number of licensed CNMs practicing in the state to increase by 36 percent during the ten-year period leading up to 2022– significantly faster than the national average job growth rate of 29 percent for these skilled healthcare professionals.
As advanced practice RNs, certified nurse-midwives provide comprehensive well-woman and gynecological care, in addition to the minimally-invasive whole-person centered antepartum, intrapartum, and postpartum care they have come to be known for. More and more, women are turning to certified nurse-midwives for more individualized maternal and neonatal care, especially as physicians continue to deal with the time constraints that come with managing a growing number of patients.
A 2012 article in the Merced Sun-Star brought to light the increasing popularity and growing demand for nurse-midwifery services in the midst of Florida’s physician shortage. Even though most nurse-midwives work in the same hospital obstetrics departments as obstetricians, the article revealed how CNMs are often in a better position to connect with patients and develop long-term relationships as primary care providers. Describing her experience working with a nurse midwife, one woman interviewed for the feature explained how she felt like an important individual participating in the pregnancy and birth process.
Steps to Becoming a Nurse-Midwife in Florida
The Florida Board of Nursing is responsible for licensing certified nurse-midwives as advanced registered nurse practitioners (ARNP). To obtain an ARNP license as a nurse-midwife, candidates must already hold an unencumbered Florida RN license in good standing and complete these steps:
Step 1. Earn a Master’s or Higher Degree in Nurse-Midwifery
The Florida Board of Nursing requires its nurse midwives to complete a master’s degree or post-master’s program in nurse midwifery before going on to earn national certification through the American Midwifery Certification Board (AMCB). Furthermore, to be eligible for national certification candidates must complete a nurse-midwife graduate program that has been approved by the Accreditation Commission for Midwifery Education (ACME).
There is one such program at a school with a campus location in Jacksonville, and several other schools throughout the nation offering ACME-accredited graduate degrees through online programs that admit Florida residents. These flexible online programs are ideal for working RNs interested in pursuing graduate study in nurse-midwifery while maintaining their professional commitments.
More and more, graduate schools with master’s programs in nurse-midwifery are choosing to offer an additional focus in women’s health, structuring them as dual specialization Nurse Midwife/Women’s Health NP (NM/WHNP) degree programs. A graduate of this type of accredited dual specialization program would be eligible to become dually certified as a Certified Nurse-Midwife (CNM) and Women’s Health Nurse Practitioner (WHNP).
Admission Standards
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 students enrolling in nurse-midwife graduate programs hold a BSN, ACME does accredit RN-to-MSN bridge programs in nurse-midwifery for those that hold an associate’s degree in nursing. These accelerated bridge programs confer both a BSN and qualifying master’s degree in nurse-midwifery
Graduate Program Structure
Graduate programs in nurse midwifery can be divided into two parts:
- Didactic education – between 40 and 60 semester credits
- Clinical education – around 1,000 hours
Didactic Education
The in-depth study of nurse midwifery practice and theory takes place as part of the didactic education, covering such key subjects as:
- Complicated deliveries and pregnancies
- Integrated midwifery
- Multicultural midwifery
- Advanced pharmacology for pregnancies and women who may become pregnant
- Advanced health assessments
- Ethics and legal issues in maternal healthcare
- Advanced pathophysiology and physiology
- Disease prevention and health promotion
- Women’s reproductive health
- Labor, birth, and newborn care procedures
- Prevention of medical errors – at least two hours on this subject required in Florida
Clinical Education
The clinical segment provides graduate students with the opportunity to put their didactic education into practice. Online graduate schools assign a faculty advisor to help students find local partners to serve as clinical education sites. Online colleges and universities strive to develop clinical partnerships throughout Florida and the nation with the goal of minimizing relocation and commuting.
Examples of potential clinical sites located in Florida include:
- West Florida Hospital Family Birthplace in Pensacola
- Heart of Florida Regional Medical Center’s Center for Women’s Health in Davenport
- Florida Hospital OB/Labor and Delivery Departments within:
- Florida Hospital Altamonte in Altamonte Spring
- Florida Hospital Celebration Health in Celebration
- Florida Hospital DeLand
- Florida Hospital Flagler in Palm Coast
- Florida Hospital Heartland Medical Center in Sebring
- Florida Hospital Memorial Medical Center in Daytona Beach
- Florida Hospital Orlando
- Florida Hospital Tampa
- Florida Hospital Waterman in Tavares
- Florida Hospital Wesley Chapel
- Florida Hospital Zephyrhills
- Winter Park Memorial Hospital
Upon earning a master’s degree in nurse-midwifery or nurse-midwifery/women’s health graduates can then apply to take the national exams required to become a certified nurse-midwife exclusively, or if they so choose, dually certified as a certified nurse-midwife/women’s health nurse practitioner.
Step 2. Earn National Certification in Nurse-Midwifery
The Florida Board of Nursing recognizes the American Midwifery Certification Board (AMCB), sponsor of the Certificate in Nurse Midwifery (CNM), as being qualified to grant national certification to nurse midwives.
Graduates of dual-focus nurse-midwife/women’s health nurse practitioner programs may additionally choose to test with the National Certification Corporation (NCC) to become eligible for the Women’s Health Care Nurse Practitioner (WHNP-BC) credential.
To earn these national certifications, candidates will need to pass each organization’s exam. Candidates can register directly through the exam’s sponsoring organization.
After registering with the sponsoring organization(s), exam candidates can sign up for a testing time and date through Applied Measurement Professional (APM). This company administers both exams at testing centers throughout Florida located in the cities of:
- Casselberry
- Fort Lauderdale
- Jacksonville
- Lakeland
- Lutz
- Miami
- Ocala
- Sarasota
- Tallahassee
- Tampa
- West Palm Beach
Certificate in Nurse Midwifery (CNM)
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
Prospective nurse midwives can start preparing for this exam by reviewing the Candidate Handbook. The test is taken on a computer and comprised of 175 multiple-choice questions. The time limit is four hours, and the test covers the topics of:
- 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
Successful examinees will receive a Certificate in Nurse Midwifery (CNM) from the AMCB.
After completing a graduate program in nurse-midwifery, candidates can apply for advanced registered nurse practitioner (ARNP) licensure as a nurse-midwife through the Florida Board of Nursing up to one year before becoming nationally certified by the AMCB (if all other requirements are fulfilled).
Women’s Health Care Nurse Practitioner – Board Certified (WHNP-BC)
Candidates can register for the Women’s Health Care Nurse Practitioner Examination online through the NCC’s website.
Candidates can prepare for this exam by studying the WHNP Candidate Guide. Testing lasts three hours and is administered on a computer. The exam is comprised of 150 scored multiple-choice test questions, and up to 25 additional unscored pretest questions. Subjects covered on the test are:
- Gynecology – 35-40 percent
- Obstetrics – 25-30 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Pharmacology – 5-10 percent
Upon passing the exam nurses will earn the NCC’s nationally recognized Women’s Health Care Nurse Practitioner – Board Certified (WHNP-BC) credential.
Step 3. Apply for ARNP Licensure as a Certified Nurse-Midwife with the Florida Board of Nursing
Upon earning the Certificate in Nurse Midwifery (CNM), applicants can then submit a completed Application for ARNP Licensure to:
Department of Health
PO Box 6330
Tallahassee, FL 32314
All applicants will also need to complete a criminal background check.
Graduates of dual-focus nurse-midwife/women’s health nurse practitioner programs who have becoming dually certified (CNM/WHNP-BC) must submit a second application in order to be recognized as a women’s health nurse practitioner.
Before submitting the application, in most circumstances RNs will need to acquire liability insurance or a letter of credit, either of which must have an aggregate availability of at least $300,000.
Although the Florida Board of Nursing has a legal provision that allows graduates of nurse-midwife master’s programs to apply for advanced registered nurse practitioner (ARNP) licensure up to one year before earning the CNM credential, the standard process is for candidates to apply for licensure after becoming nationally certified.
Protocol Agreement
In Florida, ARNPs must establish a collaborative agreement with a physician, and cannot practice independently. This involves submitting a protocol agreement to the Board of Nursing within 30 days of beginning employment with a supervising physician, and biannually at the time of license renewal. This protocol establishes what ARNPs do within their professional role under the approximate supervision of a physician, and includes details about patient referrals and assessments.
Prescribing Medications
In Florida ARNPs are not allowed to prescribe controlled substances; only a physician may do this. ARNPs can dispense and write prescriptions for medication not classified as a controlled substance, and do not need a dispensing permit for this.
Additionally, with a Dispensing Permit, APRNs can sell medicinal drugs and supplements that are not classified as controlled substances.
Step 4. Explore Career Opportunities and Maintain Credentials
Prospective ARNPs can check the status of their application on the state’s Medical Quality Assurance (MQA) web portal. Once a license is activated newly licensed nurse-midwives can begin pursuing their employment goals.
Newly licensed certified nurse-midwives are often interested in pursuing advanced employment opportunities at the place where they currently work. Many also look for opportunities with the facility in which they completed the clinical sequence of their graduate program.
The following list represents significant employers as well as potential practice models for nurse midwives and women’s health NPs in Florida:
- Florida Hospital System’s OB/Labor and Delivery Departments
- Memorial Hospital Women’s Center in Jacksonville
- Family Birth Place at Baptist Hospital in Miami
- West Florida Hospital Family Birthplace in Pensacola
- Women’s Services at Saint Petersburg General Hospital
- Heart of Florida Regional Medical Center’s Center for Women’s Health in Davenport
- Beautiful Beginnings Program at Tradition Medical Center in Port Saint Lucie
- Breath of Life Birth Center in Largo
- The Birth Place in Orlando
- Baby Love Birth Center in Cape Coral
- Hollywood Birth Center
- Labor of Love Birth Center in Lutz
- Family Birth Center of Naples
The following list represents job vacancies that were posted throughout Florida in December 2015. (Shown for illustrative purposes only and not meant to imply the availability of jobs or the assurance of employment.):
- Advanced Midwife Provider with Lee Memorial Health System in Fort Myers
- Certified Nurse Midwife with Women’s Care Florida in Orlando
- Nurse Manager of Women’s Services at Baptist Medical Center South in Jacksonville
- Nurse Midwife with Munroe Health Management in Ocala
- Certified Nurse Midwife with Women’s Care Florida in Safety Harbor
- Women’s Health Nurse Practitioner with the Sarasota Memorial Health Care System
- Certified Nurse Midwife with an OB/GYN clinic in Tampa
- ARNP in Women’s Health with the Pasco County Health Department in New Port Richey
- Certified Nurse Midwife with Bayfront Health Spring Hill
- Nurse Midwife with the University of Florida Health’s Birth Center in Jacksonville
Renewing ARNP License with the Florida Board of Nursing
Nurse midwife and women’s health nurse practitioner ARNP licenses need to be renewed every two years. Candidates can renew their license online through the MQA web portal. Licensees will need to meet these requirements during each two-year renewal cycle:
- Re-file a protocol agreement
- Submit proof of national certification from the AMCB, NCC, or both
Renewing CNM Certification through the American Midwifery Certification Board (AMCB)
Maintaining CNM certification with the AMCB means enrolling in its Certificate Maintenance Program. Renewals take place every five years, and require certificate holders to complete one of the following options:
- Re-taking the Certificate in Nurse Midwifery exam
- Completing three certificate maintenance modules and 20 hours of continuing education
Renewing WHNP-BC Certification through the National Certification Corporation (NCC)
WHNP-BC certification with the NCC is renewed on a three-year maintenance cycle. This involves taking the Continuing Competency Assessment. Depending on the score, certificate holders would be required to complete between 10-50 hours of continuing education.
Salaries for Certified Nurse-Midwives in Florida
Florida was home to the fourth highest number of certified nurse-midwives in the country according to a 2014 analysis performed by the US Bureau of Labor Statistics.
A 2014 report published by the Florida Department of Economic Opportunity revealed the median salary among the certified nurse-midwives licensed to practice in the state to be $91,083. Experienced nurse midwives earned an average of $98,800, while nurse midwives who were new to the profession earned an average of $67,600.
As the demand increases for a gentler, less invasive approach to childbirth and antepartum, intrapartum and postpartum care, opportunities for certified nurse-midwives are likewise increasing, with the US Bureau of Labor Statistics expecting a 31% increase in the number of CNMs practicing in the US during the ten-year period leading up to 2022.
How Salaries for Florida’s Certified Nurse-Midwives Differ by Location
In 2015, the Florida Department of Economic Opportunity performed an analysis of salaries for certified nurse-midwives in four of the state’s largest cities, which showed significant differences in earnings according to location. The findings revealed that certified nurse-midwives entering the field in the Miami area were offered starting salaries that were, on average, $20,000 higher than the overall statewide average for CNMs entering the field:
Miami-Fort Lauderdale-Pompano Beach
- Experienced – $95,306
- Median – $91,853
- Entry-level – $87,734
Tampa-St. Petersburg-Clearwater
- Experienced – $91,728
- Median – $85,134
- Entry-level – $72,862
Orlando-Kissimmee
- Experienced – $91,749
- Median – $61,360
- Entry-level – $44,658
Gainesville
- Experienced – $75,046
- Median – $65,998
- Entry-level – $44,554
US Bureau of Labor Statistics Analysis of CNM Salaries in Miami and Tampa
For comparison, a detailed analysis of CNM salaries in the Miami and Tampa areas is shown below as reported by the US Bureau of Labor Statistics in 2014:
