A 2014 article in Providence Business News reported that nurse-midwives in Rhode Island are becoming increasingly popular. The nurse-midwife featured in this piece attributed this phenomenon to the fact that women report having a more individualized experience when working with nurse-midwives during pregnancy and beyond. The growing interest in having nurse-midwives present in conventional delivery settings was also reflected in a 2014 article from the Newport Patch, which reported that Newport Hospital had just hired a CNM to augment the antepartum, intrapartum, and postpartum services the hospital provides.
Nurse midwives will likely cross paths with Providence’s Women and Infants Hospital of Rhode Island. In 2013, Providence Business News reported that certified nurse-midwives attended 1,200 births at this location. Nurse-midwives and expectant mothers alike are drawn to the Women and Infants Hospital because of the comprehensive care programs offered, which include preconception counseling, neonatal intensive care, high-risk obstetrics, maternal fetal medicine, and a prenatal diagnosis center.
Rhode Island allows its certified nurse midwives (CNMs) to practice independently, without establishing a collaborative practice agreement with a physician. In 2013, the American College of Nurse-Midwives reported that of the 10,809 children born in Rhode Island that year, 1,203 (11.1 percent) were brought into the world with the help of a certified nurse-midwife. As the number of new opportunities for nurse-midwives in Rhode Island continues to grow, so will the number of women who entrust these medical professionals with their primary, long-term care needs.
Steps to Becoming a Certified Nurse-Midwife in Rhode Island
The Rhode Island Department of Health licenses qualified certified nurse-midwives, allowing them to legally provide nurse-midwifery care in the state.
Rhode Island RNs with unencumbered, unrestricted licenses in good standing may become certified nurse-midwives by completing these four steps:
Step 1. Complete an Approved Graduate Program in Nurse-Midwifery
To qualify for CNM certification through the American Midwifery Certification Board, candidates must earn a master’s or higher degree in nurse-midwifery through a program approved by the Accreditation Commission for Midwifery Education (ACME).
Nurse-midwifery graduate students can choose from 39 accredited programs around the nation, including a number of flexible online programs. With so few campus locations, many nurse-midwifery graduate students opt for schools that offer online graduate programs, which are designed to accommodate the busy schedules of working RNs.
Nurse-midwifery graduate programs often offer students the option to pursue a dual focus in women’s health. Completing an approved Nurse Midwife/Women’s Health NP (NM/WHNP) graduate program will fulfill the education requirements for dual certification and dual licensure in Rhode Island:
- Certified Nurse Midwife (CNM)
- Board Certified Women’s Health Nurse Practitioner (WHNP-BC) (Women’s health NPs fall within the advanced practice registered nurse (APRN) licensure classification)
Graduate School Admission Standards
Common admission standards for nurse-midwife graduate programs include:
- Minimum GPA of 3.0
- Current RN license
- BSN or completion of nursing prerequisite courses
- Letters of recommendation
- Prior experience in a healthcare setting
- GRE General Test
- Personal essay, video essay, or statement of purpose
Although most candidates for nurse-midwife graduate programs hold a BSN, ACME does accredit RN-to-MSN bridge programs in midwifery for RNs enrolling with an associate’s degrees in nursing.
Structure of the Graduate Program
Graduate programs in nurse-midwifery include two important elements:
- Didactic education – between 40-60 semester credits
- Clinical education – around 1,000 hours
Nurse midwife students begin their studies with advanced theoretical concepts in nurse-midwifery and women’s health:
- Advanced physiology and pathophysiology
- Health promotion and disease prevention
- Psychology for pregnancy
- Reproductive health of Women
- Labor, birth, and newborn care procedures
- Ethical and legal issues in midwifery
- Advanced health assessments
- Biostatistics for mothers and infants
- Pharmacology for midwifery
Students learn the practical application of their didactic studies in the clinical education segment. Students who are completing their education online work with faculty advisors from an early stage to identify potential clinical education sites throughout Rhode Island and the wider region. Online colleges and universities strive to establish local partnerships with hospitals and other healthcare facilities in an effort to maximize coverage and minimize commuting or relocation.
Examples of potential clinical sites in Rhode Island include:
- Memorial Hospital of Rhode Island in Pawtucket
- Newport Hospital
- South County Hospital in Wakefield
- Women and Infants Hospital of Rhode Island in Providence
- Kent Hospital in Warwick
With a master’s degree in nurse-midwifery or women’s health/nurse-midwifery, graduates can apply to take the national exams required to become certified nurse midwives or dually certified as nurse midwives/women’s health nurse practitioners.
Step 2. Pass the National Nurse-Midwife Certification Exam
Prospective nurse midwives must become nationally certified through the American Midwifery Certification Board (AMCB), as required by the Rhode Island Department of Health. AMCB certification results in the nationally-recognized Certified Nurse-Midwife (CNM) credential.
Nurse midwives seeking a secondary certification as women’s health nurse practitioners must become nationally certified through the National Certification Corporation (NCC). NCC certification results in the nationally-recognized Women’s Health Nurse Practitioner-Board Certified (WHNP-BC) credential.
Certification exam candidates can start by registering with the appropriate organization. After this they can sign up for a testing date, location, and time with Applied Measurement Professional (APM). APM administers both examinations at the H&R Block Center in Warwick near Providence.
Certified Nurse Midwife Exam
Detailed information about this examination is available in the AMCB’s Candidate Handbook. The test itself is given over the course of four hours and is comprised of 175 questions. Subjects covered on this exam are:
- 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
Candidates can apply for the National Certification Examination in Nurse-Midwifery by sending an application to:
849 International Drive, Suite 120
Linthicum, MD 21090
Women’s Health Care Nurse Practitioner (WHNP) Exam
Detailed information about this exam is available through the NCC’s WHNP Candidate Guide. Testing takes place over the course of three hours, and is comprised of 150 scored test questions with up to 25 additional unscored pretest questions.
Topics covered on the exam 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, examinees will earn the NCC’s WHNP-BC credential. Candidates can register for this exam online through the NCC’s website.
Step 3. Apply for Licensure as a certified Nurse-Midwife with the Rhode Island Department of Health
With a master’s education and national certification, candidates will be prepared to apply for certified nurse-midwife licensure through the Rhode Island Department of Health – License Application for Certified Nurse Midwife.
Candidates that have also earned the WHNP-BC credential may choose to apply for advanced practice registered nurse (APRN) licensure as a women’s health NP– License Application for APRN Status as a Certified Nurse Practitioner (CNP) in Women’s Health.
Prospective CNMs can send their application to:
Rhode Island Department of Health
Advisory Council on Midwifery
Room 103, 3 Capitol Hill
Providence, RI 02908-5097
Prospective women’s health nurse practitioners can send their application to:
Rhode Island Department of Health
Board of Nursing Registration and Nursing Education
Room 103, 3 Capitol Hill
Providence, RI 02908-5097
All applications for licensure take at least eight weeks to be processed, and significantly longer if applicants have a criminal or malpractice record.
Nurse-midwives and women’s health NPs can write prescriptions if they submit a completed Rhode Island Uniform Controlled Substance Act Registration (included with the respective license applications). Once this has been processed they can apply for a prescribing number from the Drug Enforcement Agency (DEA).
Step 4. Explore Career Opportunities in Nurse-Midwifery and Maintain Credentials
The Rhode Island Department of Health allows applicants to query themselves on its license verification portal. Once applicants have received their license number they can start actively pursuing career opportunities in nurse-midwifery.
New nurse midwives may be interested in searching for job opportunities at their current place of practice or at the location where they completed their clinical education. Others will want to start their own practice or join colleagues to open a local women’s clinic or birth center.
Shown here are significant employers and noteworthy practice models for nurse midwives in Rhode Island:
- Memorial Hospital of Rhode Island’s Birthing Center in Pawtucket
- Newport Hospital’s Noreen Stonor Drexel Birthing Center
- South County Hospital Maternity Services in Wakefield
- Women and Infants Hospital of Rhode Island’s Neonatal Intensive Care Unit or Alternative Birthing Center in Providence
- Kent Hospital’s Women’s Care Center in Warwick
- Women’s Health Care Specialists in Pawtucket
The following list shows examples of job vacancies that were listed throughout Rhode Island in December 2015. (Listings are provided here as illustrative examples only and do not constitute a job offer or assurance of employment):
- Certified Nurse Midwife with Newport Hospital
- Women’s Health Nurse Practitioner with Women and Infants Hospital of Rhode Island in Providence
- Certified Nurse Midwife with a healthcare organization in Northern Rhode Island
- Women’s Health Nurse Practitioner with Memorial Hospital of Rhode Island in Pawtucket
- Women’s Health Nurse Practitioner with the VA Medical Center in Providence
Maintaining Licensure with the Rhode Island Department of Health
Each category of advanced nurse has its own requirements for renewal:
- Certified Nurse Midwife Licenses – expire on October 31st of odd-numbered years; to renew candidates must complete 20 hours of continuing education, including four hours in pharmacology
- Women’s Health NP Licenses – expire every two years on February 14th; to renew candidates must maintain their national certification with the NCC
Prescriptive authority can be renewed each time a nurse midwife or women’s health NP license is renewed.
Renewing National Certification with the American Midwifery Certification Board (AMCB)
Maintaining the CNM credential through AMCB would fulfill Rhode Island’s continuing education requirements for license renewal.
Maintaining AMCB certification requires nurse midwives to enroll in the organization’s Certificate Maintenance Program. This involves completing one of the following during each five-year renewal cycle:
- Retake the Certified Nurse Midwife Examination
- Completion of 20 hours of continuing education and three certificate maintenance modules
Renewing National Certification with the National Certification Corporation (NCC)
WHNP-BC certification maintenance through the NCC is done on a three-year cycle and involves completing the organization’s maintenance program. This starts with the Continuing Competency Assessment, which determines how many hours of continuing education (minimum 10, maximum 50) are required for certification renewal.
Salaries for Certified Nurse-Midwives in Rhode Island
In 2013, the American College of Nurse-Midwives reported that the average salary among certified nurse-midwives employed in hospitals and birthing centers in Rhode Island was $83,450. In 2014, the Rhode Island Department of Labor and Training reported average earnings that included the CNMs that work in clinical partnerships or who have independent practices. The average salary jumped to $101,837 when factoring in these independent practitioners.
According to the Rhode Island Department of Labor and Training, employment opportunities for nurse-midwives in Rhode Island are expected to increase by 28% in the 10-year period between 2012 and 2022. About 14% of that growth will be due to changes in healthcare demand and increasing numbers of women choosing the services of nurse-midwives, while the other 14% will result from more experienced nurse-midwives leaving the workforce in favor of retirement.
The Many Factors Contributing to a Strong Job Outlook for CNMs in Rhode Island
In March of 2010, the Centers for Disease Control and Prevention released the National Vital Statistics Report detailing the status of out-of-hospital birthing trends in the United States. Between 2005 and 2006, approximately 0.3% of all births in Rhode Island were out-of-hospital births. The majority of those births, about 0.26%, were home births.
There is an interesting trend happening in Rhode Island revealing an increased interest in home birthing. In fact, the National Vital Statistics Report indicated that between 2003 and 2006 the number of home births in Rhode Island increased by 36.8%, which was the largest percentage increase of any state in the nation.
Since that time, the shift toward incorporating nurse-midwives into women’s healthcare has continued in Rhode Island. In 2014, the American College of Nurse-Midwives published a report examining the prevalence of midwifery services throughout the United States, which found that CNMs attended 11.44% of all births in Rhode Island, including both in-hospital and out-of-hospital births. Statistics such as these underscore the continuous integration of nurse-midwives into women’s healthcare, and bodes well for the career outlook of nurse-midwives in Rhode Island.
Salary Offers for Certified Nurse Midwives through Rhode Island’s Top Employers
Data published by the Rhode Island Department of Labor and Training in 2014 revealed that the average salary for certified nurse-midwives in Rhode was $101,837 that year. The median salary was about 6.7% less at $94,994. There was a gap of about 30% between starting salary and experienced salary at $81,120 and $115,024 respectively.
In addition, the salary aggregator site SimplyHired offers supplemental salary data by location throughout Rhode Island. It’s important to mention, though, that SimplyHired’s salary methodology is based on current job advertisements, and so published salary figures are not general averages but rather specific to an individual job opening. The salaries below are provided by SimplyHired and are included for illustrative purposes only:
- Providence: $82,000
- Warwick: $59,000
- Cranston: $59,000
- Pawtucket: $59,000