Legal Foundations For Certified Nurse-Midwifery Practice
Certification, Regulation, Legislated Practice Environments, Scope of Practice, and Facility Credentialing for CNM/CM Practice
American College of Nurse-Midwives (ACNM)
CNMs and CMs must demonstrate compliance with the Core Competencies for Basic Midwifery Practice of the ACNM upon completion of their midwifery education programs and must practice according to the ACNM Standards for the Practice of Nurse-Midwifery. The Core Competencies define baseline midwifery practice; the collection of skills which every Certified Nurse-Midwife must have. American College of Nurse-Midwife competencies and standards are consistent with or exceed the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives. To maintain the designation of CNM or CM, midwives must be recertified every five years through the American Midwifery Certification Board (AMCB) and must also meet specific continuing education requirements.[1]
CNMs and CMs require specialized Midwifery Boards for licensing and discipline. Not Boards of Nursing.
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State Regulation and Power of the Nursing Board
Certified nurse-midwives and certified midwives are licensed and regulated at the individual State level. Professional practice rules vary among the States but, typically, they are found in State Statutes, Boards of Nursing, Medical Boards and Midwifery Boards. State regulatory boards are made up of experts who are obliged to be members of the field of practice that is being regulated. Unfortunately for CNMs, there are very few Boards of Midwifery.
In the majority of States, CNMs and CMs are regulated by Boards of Nursing which may not include them as members or staff. It is potentially problematic and unfair when governing boards and disciplinary panels, devoid of CNM representation, are drafting regulations and voting on disciplinary actions specific to Nurse-Midwifery practice. In their decision-making capacity, Boards of Nursing may lack critical information related to care models, standards of practice, core competencies and ethical considerations specific to CNMs. Women’s Healthcare Nurse-Practitioners or Adult Nurse-Practitioners, for example, do not have the education, experience, or capacity to judge the CNM model of care and vice versa.
Disciplinary Boards may not be the same specialty of those accused of wrong-doing
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Necessity of CNMs on Nursing Board Disciplinary Panels
Although nurse-practitioners and CNMs are frequently lumped into one category of Advanced Practice Providers (APP) or Advanced Practice Registered Nurses (APRN) under Board jurisdiction, it is inappropriate, at best, to allow an APP or APRN (outside of midwifery) to investigate, evaluate, or pass judgment on the alleged misdeeds of a CNM/CM. Yet, this disciplinary issue affects CNMs all over the country.
It is crucial for midwives, involved in State Board of Nursing actions against them, to determine whether their State Board has CNMs on the disciplinary panel that will hear their case. If these panels lack CNM representation, nurse-midwives must consider seeking independent, legal representation from independent counsel that can be versed in CNM standards of practice. A nurse-practitioner sitting on a State Nursing Board disciplinary panel could adversely affect the career of a Certified Nurse-Midwife without ever determining or understanding the practice standards of a CNM.
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Beware of Punitive Employment Contracts As APRN/CNM/APP
Although the care models, education, and standards of practice among APRNs/APPs are diverse and unique, it is increasingly common for governmental agencies and corporate health care systems to treat non-MD professional providers of care as one indistinguishable mass. Of particular concern, hospital corporate entities are presenting employment contracts to varied-specialty nurse-practitioners, CRNA’s, physician’s assistants, and CNMs under the auspices of an “APP” contract.
Without meaningful delineation o f the distinct and separate backgrounds, education, and duties of individual practitioners, these generic, mostly punitive, contracts will eventually be challenged and found unenforceable. Drawing up vague, barely intelligible contracts is, doubtless expedient, but likely to result in watered-down legal documents that will inevitably fail all parties involved.
APRN/APPs not distinguished by gov’t agencies or hospital corporations
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Nursing Boards Are Not Advocates For Those They License
Boards of nursing, along with other regulatory boards, exist for one reason, only: to ensure safe practice and protect consumers of health care. Regulatory boards do not advocate for those that they license. Never forget this fact. From the moment you are licensed as a CNM/CM, it is in your best interest to conduct yourself responsibly and professionally, keeping up with all of the requirements to maintain the integrity of your license. Other than obligatory licensing needs, it is advisable to avoid any negative attention from the Board. If the board receives a consumer or other legal complaint against you, seek immediate legal advice.
Consider Legal Counsel If Serious Complaint to Board of Nursing
Many legal professionals will provide first consultations free. If you are unfortunate and become involved in professional negligence litigation, remember that the Boards have a vested interest in supporting these actions which attach to their duty to protect the consumer.
If a complaint is filed against your license, do not expect sympathy or support from your regulatory Board. One of the first things that a trial lawyer may do following trial or settlement of a professional negligence case, will be to inform the relevant State Board that has issued your license. The board will request, and receive, the pertinent legal documents from the litigation so that they can form an independent assessment of your conduct and the original legal complaints against you.
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Legal Claims and Involvement of Board of Nusring
You may end up settling your lawsuit or having the claims against you dismissed but the regulatory board will have the opportunity to weigh-in and decide if there is any action that they need to take against your license. Of course, the board will be aware of trial proceedings and verdicts returned, for or against you.
For any Board case deemed particularly strong, the State’s attorney general’s office may be summoned to represent the Board and will handle your prosecution in what amounts to a professional negligence trial before an Administrative Law Judge. If your case reaches this point, and you haven’t already retained your own personal defense counsel, now is the time to do it.
1 American College of Nurse-Midwives. Definition of Midwifery, Scope of Practice of Certified Nurse-Midwives.
CNM Contractual Relationships with Other Healthcare Providers
Certified Nurse-Midwifery association with other healthcare providers, such as physicians, is varied among States in regard to the existence of mandatory contractual relationships that involve physician supervision or oversight of nurse-midwifery practice. Most States have abolished strict, supervisory language in legislation related to the physician-nurse-midwifery relationship.
Physicians do not directly supervise CNMs and can be located off-site from where nurse-midwives are practicing. Typical State legislation may or may not require a “collaborative agreement”, either written or oral, which includes mutually agreed-upon emergency plans in the event that physician services are required. Certain State statutes may contain supervisory language, but in practice it rarely means that physicians are required to be physically present with a nurse midwife during a routine vaginal delivery.
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