Modern Challenges in Midwifery
“I really hate it when a nurse-practitioner is called a mid-level provider. Mid-level provider is not a legal or academic term. It is slang developed to demean or minimize a health professional who is not an MD. The term “mid-level provider” is aimed at nurse-practitioners (NP’s), as well as physician assistants (PAs), and certified nurse-midwives. It is insulting to health professionals and to the patients they serve. Mid-level implies that he or she provides middle-of-the-road or average care. Who then delivers high-level care? It must be the MD, of course. So who delivers the lowest level of care? Nurses?
Patti Brito
It is insulting to anyone who has decided to pursue higher education that he or she has finally achieved mid-level competence. Maybe the term originated from the number of years of training. I understand that physicians have more years of school than practitioners. But most of us know that we define ourselves as we begin working on our own and take responsibility for our own decisions.[1]
Hierarchies of Care
Vertical hierarchies in obstetrical care feature the physician on top, nurse-midwives/nurse practitioners in the middle, and labor and delivery nurses at the bottom. Instead of promoting a teamwork approach to care, where one provider is not more valuable than another, vertical hierarchies devalue and disregard the contributions of those considered to be in lower tiers. Decisions and plans for care tend to flow in one direction, top-down. With this dynamic, effective teamwork is nearly impossible, and ultimately, the patient suffers.
Luis Melendez
Best care can flourish when all team members are equally involved, and everyone cooperates and contributes within their individual scope of practice.
Critical Events Team Training
Visualize a horizontal model where all providers contribute equally. Optimal care fails when a segment of this model is not allowed to contribute or is missing. Unfortunately, the scope of practice is not well understood between provider specialties. Before engaging in critical events team training, members envisioning a well-functioning/productive team should take time to understand each specialty’s scope of practice; {nursing, labor and delivery} - {nurse-midwifery} - {obstetrics} (these positions on the horizontal model can be shuffled) Defining and understanding the scopes of practice for each team specialty will take some effort but the information shared can only enhance team functioning Respect and responsibilities will flow side-to-side, and everyone can potentially benefit, particularly the patients.
1. KevinMD.com. Michael D. Pappas, MD/Physician/July 14, 2014. http://www.kevinmd.com/blog/2014/stop-calling-nurse-practitioners-mid-level-providers
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