In 2013, former Nevada Governor Brian Sandoval signed a new legislative bill that grants the state’s advanced practice registered nurses (APRN), including certified nurse-midwives, the freedom to practice independent of physician. As a result of the change, CNMs are no longer required to have a collaborative practice agreement in place with a physician.
Additionally, CNMs would earn prescriptive authority after just 200 hours of practice after graduating from a qualifying master’s program in nurse-midwifery. These changes have only added to the growth of nurse-midwifery in the state, giving certified nurse-midwives more opportunities to establish independent woman’s clinics and birthing centers.
According to the Centers for Disease Control and Prevention (CDC), the number of out-of-hospital births within birthing centers is on the rise in Nevada. In fact, 1.47% of all births in Nevada in 2012 took place outside of the hospital settings, a notable increase from the 1.29% figure in 2004. This rise is due in large part to the recent resurgence of midwifery, a time-tested practice that women are embracing in the modern era.
In 2018, less than 7% of births in Nevada were attended by midwives, according to the U.S. Department of Health & Human Services, Centers for Disease Control and Prevention and the National Center for Health Statistics.
While some nurse midwives in Nevada open their own practices, many are employed by the state’s hospitals and birth centers. Two such hospitals are Mountain View Hospital and Centennial Hills Hospital in Las Vegas. The two hospitals, each a subsidiary of WellHealth Medical Group, share the same team of CNMs, who provide contraception education, gynecologic care, as well as antepartum, intrapartum and postpartum care.
Steps to Become a Certified Nurse-Midwife in Nevada
RNs interested in becoming certified nurse-midwives must becoming nationally certified through the American Midwifery Certification Board and licensed as advanced practice registered nurses (APRN) through the Nevada State Board of Nursing by completing these steps:
Step 1. Earn a Qualifying Degree in Nurse-Midwifery
The Nevada State Board of Nursing requires all APRNs licensed as certified nurse-midwives to hold a master’s degree or higher in nurse-midwifery recognized by the Accreditation Commission for Midwifery Education (ACME).
Nevada, like many other states, does not have any schools with campus locations that offer master’s degrees in nurse-midwifery. Just like in much of the rest of the country, RNs in the state would pursue their degree through an accredited online program.
Admissions Standards
For bachelor’s prepared RNs, earning a conventional Master of Science in Nursing (MSN) with a focus in nurse-midwifery or a dual focus in nurse-midwifery and women’s health would satisfy educational requirements for a career in nurse-midwifery.
Associate’s prepared RNs must complete an accredited RN-to-MSN bridge program with a focus in nurse-midwifery to earn both their BSN and MSN.
Nurses eligible for admission to these programs are evaluated on a variety of factors such as their admissions essay, their undergraduate GPA, and their GRE score.
Dual Focus Options and Program Structure
Among nurse midwife programs, those offering a dual specialization option in nurse midwifery and women’s health are becoming increasingly popular. RNs who complete these programs are eligible to pursue board certification as a women’s health nurse practitioner (WHNP-BC) in addition to their certified nurse-midwife (CNM) credential.
Master’s programs in nurse-midwifery and dual focus nurse-midwife/woman’s health nurse practitioner programs are designed to give RNs a comprehensive education though both didactic coursework and clinical experience.
Classroom courses typically consist of 40-60 credits and cover the key areas of nurse-midwifery:
- Midwifery care during labor
- Newborn care
- Midwifery care during pregnancy
- Pharmacology
- Nursing research
- Physiology & pathophysiology
- Women’s reproductive healthcare
- Ambulatory care of women
- Biostatistics for health care providers
- Family crisis care
Clinical work takes place in nearby birth centers or the maternity divisions of hospitals. Under the guidance of a physician or APRN, RNs are typically required to work between 700-1,000 hours to meet their program’s clinical requirements. Clinical sequences for nurse-midwife programs typically take place in one of these facilities:
- Banner Churchill Community Hospital in Fallon
- Carson Tahoe Regional Medical Center in Carson City
- Centennial Hills Hospital in Las Vegas
- Dignity Health – St. Rose Dominican Hospitals in Henderson
- MountainView Hospital in Las Vegas
- Northeastern Nevada Regional Hospital in Elko
- Northern Nevada Medical Center in Sparks
- Renown Regional Medical Center in Reno
- Saint Mary’s Regional Medical Center in Reno
- Southern Hills Hospital & Medical Center in Las Vegas
- Summerlin Hospital Medical Center in Las Vegas
- Sunrise Hospital & Medical Center in Las Vegas
- University Medical Center of Southern Nevada in Las Vegas
- Well Rounded Momma in Las Vegas
Graduate students pursuing their master’s degree in nurse-midwifery online must consult with their school’s program director about placement in a nearby clinical setting.
Step 2. Pass the National Nurse-Midwife Certification Examination
To ensure candidates are prepared for a career in nurse-midwifery, the American Midwifery Certification Board (AMCB) administers the Certified Midwife Exam, which serves as the final step before Board certification and advanced practice licensure through the Nevada State Board of Nursing.
Upon graduating from a qualifying master’s degree program, RNs must send their completed application to the following address:
AMCB
849 International Drive, Suite 120
Linthicum, MD 21090
The Certified Midwife Exam is a 175-question test that RNs must complete within four hours. The exam is divided into the following sections, which nurses may prepare for by studying the online Candidate Handbook:
- 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
To take the exam, RNs must schedule a testing time with an AMP testing center. Nevada is home to two AMP centers, one in Henderson and the other in Reno.
Graduates of dual-focus nurse-midwife/women’s health nurse practitioner programs may also choose to achieve certification as a Women’s Health Care Nurse Practitioner (WHNP-BC) by taking the Women’s Health Care Nurse Practitioner (WHNP) Exam administered by the National Certification Corporation (NCC).
Consisting of 150 multiple-choice questions, the WHNP exam covers topics including:
- Pharmacology – 5-10 percent
- Primary Care – 10-15 percent
- Diagnostic testing and physical assessment – 10-15 percent
- Obstetrics – 25-30 percent
- Gynecology – 35-40 percent
The NCC offers a WHNP Candidate Guide as a resource for RNs to prepare for the exam.
Step 3. Apply for Advanced Practice Licensure through the Nevada State Board of Nursing
With their national nurse-midwife certification in hand, candidates may begin the process of applying for APRN licensure through the Nevada State Board of Nursing.
First, nurses must call 1-888-590-6726 to receive instructions on obtaining and documenting their fingerprint cards. Nurses must pay a $51.25 fee to the Nevada State Board of Nursing to be fingerprinted. Complete fingerprint instructions may be found on the board’s website.
Next, nurses must complete their APRN application form. When completed, the form should be sent along with the following documentation to the Board:
- Finger print form
- A $200 fee in the form of a money order, cashier’s check, or personal check, or through a MasterCard, Visa, or Discover Card. The fee should be made payable to “NSBN”.
- A copy of your national certifications
Additionally, nurses instruct their graduate program to send a copy of the nurse’s official college transcript. The transcript must show that the nurse completed courses in the following areas:
- Advanced health assessment
- Advanced pathophysiology
- Advanced role preparation
- Concentration of courses in a specific role and population focus
- Clinical preceptorship
If the transcript does not suffice in demonstrating completion of courses in those topics, a school official must send either a letter verifying the courses have been completed or send a copy of the school course catalog.
All materials should be sent to the following address:
Nevada State Board of Nursing
5011 Meadowood Mall Way, Suite 300
Reno, NV 89502-6547
Step 4. Explore Career Opportunities in Nurse-Midwifery and Maintain Credentials
Upon receiving their APRN license, certified nurse-midwives may begin exploring career opportunities.
Nevada is home to a number of hospitals and medical centers that employ the services of CNMs. Hospitals remain the top employers of certified nurse-midwives in Nevada:
- Banner Churchill Community Hospital in Fallon
- Carson Tahoe Regional Medical Center in Carson City
- Centennial Hills Hospital in Las Vegas
- Dignity Health – St. Rose Dominican Hospitals in Henderson
- MountainView Hospital in Las Vegas
- Northeastern Nevada Regional Hospital in Elko
- Northern Nevada Medical Center in Sparks
- Renown Regional Medical Center in Reno
- Saint Mary’s Regional Medical Center in Reno
- Southern Hills Hospital & Medical Center in Las Vegas
- Summerlin Hospital Medical Center in Las Vegas
- Sunrise Hospital & Medical Center in Las Vegas
- University Medical Center of Southern Nevada in Las Vegas
- Well Rounded Momma in Las Vegas
Maintaining APRN Licensure with the Nevada State Board of Nursing
Nevada’s CNMs must renew their APRN license with the board every two years at the same time as their RN license renewal. APRN license renewal may be completed online on the Nevada State Board of Nursing website. CNMs must complete 15 contact hours in their specialty as well as an additional 30 Continuing Education credits (CEs) to maintain their license. The Board must approve all continuing education. Nurse-midwives should keep documents showing proof of their continuing education for four years in case of a Board audit.
Maintaining CNM Certification through the American Midwife Certification Board
To maintain their certification with the AMCB, CNMs must complete one of two continuing education options every five years. The first option is to pass the AMCB Certification Examination. CNMs who choose this option must pay a one-time $500 fee. Alternatively, CNMs may complete three AMCB Certificate Maintenance Modules and 20 AMCB-approved contact hours of Continuing Education. Those who choose this option will be subject to annual fees.
Maintaining WHNP-BC Certification through the National Certification Corporation
APRNs with the WHNP-BC credential must meet additional continuing education requirements through the National Certification Corporation (NCC). In addition to having to complete an NCC-administered continuing competency assessment, nurses must complete the continuing education requirements as part of their education plan, which is mailed to them directly by the NCC.
Salaries for Certified Nurse-Midwives in Nevada
Twenty-three certified-nurse midwives were licensed to practice in Nevada as of 2013 according to the American Association of Colleges of Nursing (AACN). However, this number is expected to increase dramatically during the 10-year period between 2018 and 2028, with the U.S. Department of Labor projecting a job growth rate of 29% for nurse practitioners in Nevada.
The U.S. Bureau of Labor Statistics didn’t publish data for nurse midwives in Nevada, but the annual average salary nationally for nurse midwives in 2019 was $108,810. For more experienced nurse midwives in the 75th and 90th percentiles, the national average salaries are $127,110 and $158,990, respectively.
Shortage of OB/GYN Physicians in Nevada Leads to Increased Demand for CNMs
Nevada had the 7th lowest ratio of physicians to residents in the country in 2010 according to the USA Today “24/7 Wall St.” analysis. Physicians who specialize in obstetrics and gynecology are in especially short supply in Nevada. Increasing the number of certified nurse-midwives licensed to practice in Nevada is widely recognized as the best way to ensure that Nevada’s residents continue to have access to high-quality obstetric and gynecological care in the face of this shortage.
According to a fact sheet on Nevada published by the American Congress of Obstetricians and Gynecologists, 11 of the 17 counties in Nevada did not have a single OB/GYN physician in 2014. Counties with the highest ratio of OB/GYN physicians on a population basis included Elko, Washoe and Storey counties and Carson City. These counties each had a ratio of three OB/GYNs for every 10,000 women. In contrast, Clark and Churchill counties only had 2.0-2.4 OB/GYNs per 10,000 women.
(Salary data for nurse-midwives reported by the U.S. Bureau of Labor Statistics in May 2019. Figures represent state data, not school-specific information. Job growth data provided by Projections Central, a resource funded by the U.S. Department of Labor’s Employment and Training Administration. Conditions in your area may vary. Information accessed March 2021.)