North Dakota’s certified nurse-midwives (CNMs) enjoy the freedom to practice independently without needing to establish a collaborative or supervisory agreement with a physician.
The American College of Nurse-Midwives reports that although more women in North Dakota are seeking the services of nurse-midwives thanks to the gentler, less invasive approach to obstetric and gynecologic care they offer, the total number of certified nurse-midwives in the state remains low, at just 16, as of 2015. The limited number of nurse-midwives in North Dakota may mean plenty of opportunities for RNs who want to expand their nursing careers to become advanced practice registered nurses (APRN) specialized in nurse-midwifery.
CNMs enjoy a broad scope of practice and work in a wide array of settings, including hospitals, private OB/GYN or midwifery practices, women’s health clinics, and birthing centers, among others.
As APRNs, North Dakota’s nurse-midwives provide women with a full range of primary healthcare services, from adolescence, to the childbearing years, to menopause and beyond. Their services encompass gynecologic, primary care, family planning, preconception, pregnancy, childbirth, and postpartum care. Nurse-midwives are also qualified to treat the healthy newborn within the first 28 days of life.
Steps to Becoming a Certified Nurse-Midwife in North Dakota
All nurse-midwives in North Dakota must achieve state licensure as an APRN in nurse-midwifery, which involves the completion of the following steps as required by the North Dakota Board of Nursing:
Step 1. Earn a Master’s Degree in Nurse-Midwifery
Nurse-midwives—both in North Dakota and throughout the U.S.—must successfully complete a graduate or post-graduate program in nurse-midwifery accredited by the American Commission for Midwifery Education (ACME). There are currently no accredited nurse-midwifery programs in North Dakota; however, a number of accredited schools offer online programs that allow students to complete the didactic portion of their nurse-midwifery program through web-based study.
In addition to partially and fully online nurse-midwifery programs, many of today’s ACME-accredited programs offer part-time study, which allow working RNs to complete their nurse-midwifery graduate degree at a slower pace.
Types of Nurse-Midwife Degree Programs
Although all nurse-midwifery programs require enrolling students to possess current and unencumbered registered nurse (RN) licenses, not all RNs possess the same educational background. Institutions with nurse-midwifery programs often offer them in a number of formats designed to accommodate students at different stages of their education:
Master of Science in Nursing (MSN) with a focus on nurse-midwifery/Master of Science (MS) in Nurse-Midwifery:
Both the MSN and MS in nurse midwifery are designed for conventional RN graduate students that possess a Bachelor of Science in Nursing (BSN). These traditional graduate programs take about two years to complete.
The RN-to-MSN program in nurse-midwifery is designed specifically for the RN that possesses an associate’s degree, as it includes the BSN requirements necessary to complete an MSN in nurse-midwifery. These accelerated programs take about three years to complete.
A post-graduate certificate in nurse-midwifery is designed for RNs that possess an MSN and are seeking initial APRN licensure as a nurse-midwife or an additional APRN specialty in nurse-midwifery.
Dual Specialization Program:
Dual specialization nurse-midwife/women’s health nurse practitioner degree programs have become increasingly popular in recent years. This dual specialization allows nurse-midwives to also complete a comprehensive course of study in women’s health. Due to the overlapping areas of study in nurse-midwifery and women’s health, a dual specialization degree makes sense to many nurse-midwife students.
Graduates of these dual specialization programs are eligible to pursue dual certification and a dual APRN license as both a certified nurse-midwife (CNM) and board certified women’s health nurse practitioner (WHNP-BC). This allows them to treat women across the lifespan and provide care related to chronic and acute illnesses.
What to Expect in a Nurse-Midwifery Degree Program
A typical nurse-midwifery degree program consists of two components: a didactic component and a clinical component. The didactic component consists of all coursework, seminars, and lectures within the program, while the clinical component consists of all clinical rotations conducted at predetermined clinical sites.
The coursework of a nurse-midwifery degree program includes a core of classes in the following areas:
- Advanced Health and Physical Assessment
- Advanced Physiology and Pathophysiology
- Advanced Pharmacology for Primary Care
Nurse-midwifery-specific courses often include:
- Primary care of women
- Antepartum care
- Perinatal care
- Advanced midwifery role development
- Postpartum care
- Care of the newborn
Program directors of nurse-midwifery programs arrange clinical rotations for students at sites near the institution’s campus. However, online nurse-midwifery programs often partner with clinical sites across the country to allow students to complete the clinical component of their nurse-midwifery program at sites close to home.
Some of the clinical sites in North Dakota where nurse-midwife students may complete a portion of their clinical requirements include:
- CHI St. Alexus Health, Bismarck
- CHI St. Joseph’s Health Clinic, Dickinson
- Mid Dakota Clinic Center for Women, Bismarck
- Mercy Medical Center, Williston
- Sanford Birth Center, Bismarck
Admission into a nurse-midwife degree program requires a current and unencumbered RN license, a Bachelor of Science in Nursing (BSN) and, often times, one or more of the following:
- Minimum undergraduate GPA
- Minimum GRE scores
- Letters of recommendation
Step 2. Take and Pass the National Certification Examination in Nurse-Midwifery
North Dakota nurse-midwifery graduates must take and pass the CNM Certification Examination through the American Midwifery Certification Board. State licensure in North Dakota as a nurse-midwife is conditional upon passing the CNM Certification Examination.
Graduates of nurse-midwife/women’s health nurse practitioner programs may also apply to take the Women’s Health Care Nurse Practitioner (WHNP) examination through the National Certification Corporation (NCC), if desired.
Upon graduating from an ACME-accredited program of nurse-midwifery, candidates must apply with the American Midwifery Certification Board and receive approval before scheduling their examination with Applied Measurement Professionals (AMP), a third party exam provider.
AMP has testing centers located throughout the U.S. In North Dakota, candidates may take their CNM exam in Bismarck and Fargo.
Step 3. Apply for APRN Licensure as a Certified Nurse-Midwife in North Dakota
RNs applying for APRN licensure in North Dakota as a nurse midwife must complete an Initial Practice License with or without Prescriptive Authority Initial Application and send it to the Board, along with:
- Evidence of current CNM certification through the American Midwifery Certification Board
- Completed transcripts with nurse-midwifery degree posted (only official transcripts sent by the institutions are accepted) by submitting a Request for Release of Transcript form
- Completed Criminal History Record Check (and a $20 processing fee) if a criminal history record check has not been completed in the past 90 days
- Completed portion of the application if applying for prescriptive authority
- $100 application fee
- Additional $50 fee if applying for prescriptive authority
Step 4. Explore Opportunities Available to Certified Nurse-Midwives in North Dakota and Keep Credentials Current
Nurse-midwives in North Dakota may work in a variety of settings, such as hospitals, birthing centers, private OB/GYN clinics, and midwifery clinics, among others. Just a few of the settings where North Dakota’s nurse-midwives may start or advance their nurse-midwifery careers include:
- Trinity Health, Minot
- Trinity Community Clinic – Western Dakota, Williston
- Great Plains Women’s Health, Williston
- Trinity Hospital OB/GYN, Minot
- Mid Dakota Clinic, Minot
- Trinity Community Clinic, Kenmare
- Family Healthcare Center, Fargo
APRN Renewal Requirements
Nurse-midwives in in North Dakota must renew their APRN license on a biennial basis upon completion of at least 15 contact hours of pharmacotherapy continuing education. The completion of these continuing education hours also fulfills the RN renewal requirements. The cost of renewal with prescriptive authority for nurse-midwives in North Dakota is $210.
All renewals are completed online.
American Midwifery Certification Board (CNM Credential)
Nurse-midwives in North Dakota must renew their CNM certification every five years to maintain their APRN nurse-midwife license. The American Midwifery Certification Board features the Certification Maintenance Program, which allows CNMs to satisfy 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
National Certification Corporation (WHNP-BC Credential)
Nurse-midwives that also hold WHNP-BC certification must maintain the credential by taking the National Certification Corporation’s continuing competency assessment at the beginning of each three-year maintenance cycle. The number of required continuing education hours varies according to the results of the assessment.
Salaries for Certified Nurse-Midwives in North Carolina
The 160 certified nurse midwives who practiced in North Carolina in 2015 earned an average salary of $89,100 according to the state’s Department of Commerce. Experienced nurse midwives earned an averaged of $95,980 that year, while new certified nurse midwives earned an average starting salary of $75,340.
Job Prospects are Promising For Certified Nurse-Midwives in North Carolina
The North Carolina Department of Commerce expects the number of jobs for certified nurse-midwives to increase by 28.3% between 2012 and 2022. This rate is more than two-fold higher than the average job growth rate in North Carolina.
The diverse array of jobs posted online in December 2015 for certified nurse-midwives throughout North Carolina help illustrate the growing number of employment opportunities in the state. These postings are featured to showcase the variety of providers who hire CNMs in North Carolina and should not be interpreted as a guarantee of employment:
- Carolinas HealthCare System – Charlotte
- Novant Health – Charlotte
- Duke University and Duke University Health System – Durham
- Cape Fear Valley Health System – Fayetteville
- Maria-Parham Medical Center – Henderson
- Physicians East PA – Greenville
- S. Army 2nd Medical Recruiting Battalion – Raleigh
While North Carolina has enough physicians to meet the needs of the state’s population, they are not distributed well according to a medical education brief by the Cecil G. Sheps Center for Health Research from 2015. This brief noted that North Carolina’s physicians are concentrated in urban areas and counties with academic medical centers. Fourteen counties have had a critical shortage of primary-care physicians since 2004, and Camden and Tyrell Counties currently have no physicians.
Certified nurse-midwives are in a good position to provide obstetric and gynecological care in areas that lack OB-GYN physicians. According to a fact sheet published by the American Congress of Obstetricians and Gynecologists, 31 counties in North Carolina totally lacked OB-GYN physicians in 2014.
Location Dramatically Affects the Salaries of Nurse Midwives in North Carolina
The average salary for certified nurse-midwives in 2015 differed by more than 1.5-fold depending on their location according to the North Carolina Department of Commerce:
- Experienced – $112,090
- Average – $104,160
- Entry-level – $88,310
- Experienced – $104,461
- Average – $97,151
- Entry-level – $82,530
- Experienced – $104,160
- Average – $95,990
- Entry-level – $$82,530
- Experienced – $75,500
- Average – $68,340
- Entry-level – $54,020
Shown below for comparison is an expanded profile of the salaries of certified nurse-midwives in Charlotte-Gastonia-Rock Hill as of 2014 (US Bureau of Labor Statistics):