Midwifery is a practice founded on the philosophy of protecting, supporting, and enhancing the normal process of birth, but has evolved to include much more as nurse-midwives provide advanced care to women and infants before, during and after childbirth. Today’s expectant mothers are increasingly choosing nurse-midwives in favor of traditional OB-GYN care, the latter of which tends to focus on the abnormal or pathological aspects of childbearing and birth.
According to the American College of Nurse-Midwives, there were 53 certified nurse-midwives practicing in Hawaii as of 2015. In 2013 alone, Hawaii’s CNMs attended nearly 1,700 births—or about 12 percent of all vaginal births in the state that year.
Hawaii CNMs enjoy a broad scope of practice, providing direct and indirect care, teaching and counseling, consulting, establishing collaborative relationships and referral networks with other healthcare professionals, developing and implementing community programs, conducting research, and participating in policy analysis and development.
Hawaii is an independent practice state, meaning that CNMs may enjoy relationships with other physicians or providers without the need for a contractual agreement.
Steps to Becoming a Nurse-Midwife in Hawaii
RNs in Hawaii seeking to become primary healthcare providers in nurse-midwifery must meet specific education and certification requirements to achieve an APRN license through the Hawaii Board of Nursing (part of the Professional and Vocational Licensing Division, Department of Commerce and Consumer Affairs):
|Earn a Qualifying Degree in Nurse Midwifery|
|Take and Pass the National Certification Examinations|
|Apply for APRN Recognition through the Hawaii Board of Nursing|
|Maintain Certification and Advanced Practice RN Licensure in Hawaii|
Step 1. Earn a Qualifying Degree in Nurse Midwifery
Hawaii’s RNs seeking nurse-midwife recognition and APRN licensure are required to complete a master’s degree or other graduate-level program accredited by the Accreditation Commission for Midwifery Education (ACME).
Because many institutions now offer online programs, RNs in Hawaii enjoy a multitude of options for earning their master’s degree in nurse-midwifery, even though no campus-based programs are available through the state’s nursing schools. Many institutions also offer part-time programs, thus accommodating today’s busy, working professionals.
In addition to the MSN degree with a focus in nurse-midwifery, many institutions offer students the opportunity to choose a dual focus of nurse-midwifery/women’s health, thus expanding their practice options and professional pursuits.
Master’s Degree Programs in Nurse-Midwifery and Nurse-Midwifery/Women’s Health
MSN degrees (sometimes structured as Master of Science programs) in nurse-midwifery prepare RNs to serve as advanced practice nurse practitioners that provide healthcare to women of all ages, including prenatal, birth, and gynecological care.
Graduates of these programs are positioned to achieve national certification in nurse-midwifery through the American Midwifery Board, earn state licensure as an APRN, and work in an array of settings, including clinics, hospitals, and birth centers.
Graduates of MSN programs in nurse-midwifery/women’s health are positioned to achieve nurse-midwifery certification through the American Midwifery Board, as well as the Women’s Health Care Nurse Practitioner (WHNP) designation through the National Certification Corporation.
RNs may choose from a number of master’s degree programs based on their current educational status. For example:
- Master of Science in Nursing (MSN) degrees: Designed for RNs with a bachelor’s degrees in nursing
- RN-to-MSN programs: Designed for RNs with an associate’s degree in nursing
- Post-graduate certificates: Designed for APRNs seeking to add a CNM designation to their license or for master’s prepared RNs seeking initial APRN licensure
Qualifying candidates for MSN degree programs in nurse-midwifery typically posses a Bachelor of Science in Nursing (BSN) degree along with the following:
- Minimum undergraduate GPA as specified by the school
- Minimum GRE scores
- Letters of recommendation
- Admissions essay
The Elements of an MSN in Nurse-Midwifery
The typical MSN program in nurse-midwifery for the bachelor’s-prepared RN in Hawaii consists of about two years of full-time study. Many institutions also offer students the option of completing the program through a part-time format, which takes about three years to complete.
All programs consist of a mixture of didactic study and clinical experiences. The clinical portion of an MSN degree in nurse-midwifery may consist of up to 1,000 hours.
The program components of an MSN in Nurse-Midwifery or Nurse-Midwifery/Women’s Health prepare students to provide healthcare to women of all ages in rural and urban settings and in underserved communities throughout Hawaii. Graduates of these programs are poised to provide effective nurse-midwifery care that takes into account a women’s physical, mental, and spiritual health throughout the lifespan.
Core coursework in an MSN in Nurse-Midwifery or Nurse-Midwifery/Women’s Health includes study in:
- Midwifery Perspectives
- Advanced Health Assessment
- Advanced Pharmacology
- Healthcare for Women and Primary Care
- Global Perspectives of Health
- Antepartum Care
- Intrapartum and Postpartum Care
Students complete the clinical component of an MSN in Nurse-Midwifery through a variety of approved clinical sites selected by the university. In a predominately-online program, universities partner with clinical sites throughout the U.S., thus allowing students to complete this critical part of their MSN degree in settings close to home.
Clinical sites in Hawaii for students of master’s degrees in nurse-midwifery may include:
- Hawaii Pacific Health, Honolulu
- Kapiolani Medical Center for Women and Children, Honolulu
- Castle Medical Center, Kailua
- Straub Clinic and Hospital, Honolulu
- The Queen’s Medical Center, Honolulu
Step 2. Take and Pass the National Certification Examinations
Graduates of master’s degrees in nurse-midwifery are eligible to take AMCB certification examination through the American Midwifery Certification Board and receive certification as a nurse-midwife (CNM credential).
Graduates of master’s degrees with a focus on nurse-midwifery and women’s health are eligible to take the AMCB examination, as well as the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation. RNs who pass both examinations can apply for dual APRN recognition through the Hawaii Board of Nursing so as to be recognized as Certified Nurse Midwives (CNM) and Women’s Health Care Nurse Practitioners (WHNP).
In addition to successfully completing a master’s degree in nurse-midwifery or nurse-midwifery/women’s health, candidates for certification must take and pass the appropriate certification examinations. Candidates must complete an application, receive approval to take the certification examination, and then schedule the examination at one of the more than 150 Applied Measurement Professionals (AMP) testing centers throughout the U.S. In Hawaii, individuals may take their examination(s) in Honolulu.
Step 3. Apply for APRN Recognition through the Hawaii Board of Nursing
After successfully passing the appropriate certification examination(s), candidates must apply for APRN recognition through the Hawaii Board of Nursing.
To qualify for APRN licensure, candidates must possess an unencumbered RN license in Hawaii, complete the Application for APRN Recognition, and provide the Board with the following:
- Verification of current certification as a CNM and WHNP (if applicable), sent directly to the Board from the national certifying body
- Official transcript of the master’s degree in nursing, sent directly to the Board from the nursing school
Only those licensed APRNs in Hawaii with prescriptive authority may prescribe and administer over-the-counter drugs, legend drugs, and controlled substances; prescribe, order, and dispense medical devices and equipment; and plan and institute a therapeutic regimen that includes nutritional, diagnostic, and supportive services through home healthcare, hospice, and physical and occupational therapy.
The Board of Nursing grants prescriptive authority to qualified APRNs. CNMs in Hawaii interested in seeking prescriptive authority may contact the Department of Commerce and Consumer Affairs at 808-586-3000 for an application.
Step 4. Maintain Certification and Advanced Practice RN Licensure in Hawaii
APRN Recognition – Hawaii Board of Nursing
All RN licenses and APRN Recognitions, regardless of their issue date, expire on June 30 of all odd-numbered years. Nurse-midwives in Hawaii must complete a separate renewal form and pay a separate fee to renew their RN license and APRN Recognition. Hawaii nurses cannot renew their APRN recognition without renewing their RN license.
The Board requires Hawaii nurses to submit their renewal through the Department of Consumer Affairs’ online service, MyPVL.
The Board does not require APRNs in Hawaii with a current, national certification to complete continuing education, instead deferring continuing education to the national certification organizations:
CNM – American Midwifery Certification Board
Features a Certification Maintenance Program, which allows CNMs to complete their continuing education requirements by completing one of the following:
- Option 1: Complete at least 3 AMCB Certificate Maintenance Modules during each five-year certification cycle and at least 20 contact hours of approved continuing education units; pay annual fees
- Option 2: Retake the AMCB Certification Examination and pay the $500 examination fee in lieu of annual fees
WHNP – National Certification Corporation
WHNPs must take a continuing competency assessment at the beginning of each three-year maintenance cycle and complete a specific number of continuing education credits hours based on the results of the assessment.
Resources for CNMs and WHNPs in Hawaii
CNMs in Hawaii interested in starting or advancing their careers in nurse-midwifery may find plenty of opportunities through hospitals, women’s clinics, and OB-GYN offices, such as:
- Kapiolani Medical Center for Women and Children, Honolulu
- Bay Clinic Family Health Center, Hilo
- Pali Women’s Health Center, Laie
- Hawaii Women’s Healthcare, Honolulu
- North Hawaii Community Hospital, Waimea Women’s Center, Waimea
- University Women’s Health, Waipahu
- Hawaii Pacific Health, Obstetrics and Gynecology
For many of Hawaii’s CNMs, gaining APRN recognition as a nurse-midwife provides the opportunity to branch out and start their own practice. Professional associations in Hawaii may be a valuable resource for nurse-midwives looking to get independent women’s clinics and birthing centers off the ground:
- Midwives Alliance of Hawaii
- American College of Nurse-Midwives, Hawaii State Affiliate
- Hawaii Association of Professional Nurses
- Hawaii Small Business Development Center
Salaries for Certified Nurse-Midwives in Hawaii
As of 2013, the average salary among Hawaii’s certified nurse-midwives was $96,780 according to the American College of Nurse Midwives (ACNM). An indication of the starting salaries for Hawaii’s CNMs can be found by looking at job vacancy announcements in the state. One position advertised for a certified nurse midwife travel assignment available in Hawaii in November 2015 showed a starting salary of $58,000. The considerable difference between starting salaries and the reported statewide average helps illustrate the earning potential for CNMs as they gain experience and pursue more advanced positions.
Location and Employment Patterns of Certified Nurse-Midwives in Hawaii
Just forty certified nurse-midwives were licensed to practice in Hawaii as of 2012 according to the Hawaii Department of Labor and Industrial Relations. However, as the demand for less invasive perinatal and general gynecological services increases, the number of jobs for nurse midwives in the state is also expected to increase. In fact, during the ten-year period leading up to 2022, the Department expects the number of licensed nurse midwives in the state to increase by 20%.
The results of an extensive survey conducted by the Hawaii State Center for Nursing entitled Hawaii’s Nursing Workforce Supply examined the practice settings for advanced practice registered nurses including certified nurse-midwives. According to the 2013 report, certified nurse-midwives in academic settings were only found in Oahu, while nurse midwives employed in hospitals were found in both Oahu and the Big Island of Hawaii. In addition, CNMs worked in physician’s offices in Oahu and Maui. Kauai was the only island in which certified nurse-midwives were identified as being self-employed.
How Hawaii has Helped Revolutionize Advanced Practice Nursing
A 2015 editorial in the Honolulu Star-Advertiser by Laura Reichhardt, the interim director of the Hawaii State Center for Nursing, described how the state is at the forefront of responding to nursing needs. The advance in the scope of practice for advanced practice registered nurses including nurse midwives has been particularly notable in Hawaii, as the state was among the first to grant prescriptive privileges and full practice autonomy.
In 2010, Hawaii became one of the first eight states in the country to enable APRNs to practice to the fullest extent of their training and education. This legislative change improved access to comprehensive healthcare for both rural and urban residents of Hawaii, since APRNs can now provide direct services in all healthcare settings without physician oversight.