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Home — Essay Samples — Nursing & Health — Health Care Policy — The Role of the Midwife in the Healthcare

The Role of The Midwife in The Healthcare

• Categories: Health Care Policy

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Published: Sep 4, 2018

Words: 2381 | Pages: 5 | 12 min read

Works Cited

• Alberta Association of Midwives. (2012). Midwives in Alberta: Practice Guidelines Handbook.
• Beattie, A. (1991). Health promotion models and values. Oxford University Press.
• Bowden, S. (2006). Midwifery and the promotion of normality. Elsevier Health Sciences.
• Davis, D. (2002). Continuing professional development for midwives: Challenges, opportunities, and strategies. Midwifery, 18(1), 4-8.
• Dunkley, C. (2000). Health promotion in midwifery practice: A resource for health professionals. Elsevier Health Sciences.
• Ewles, L., & Simnett, I. (2003). Promoting health: A practical guide. Elsevier Health Sciences.
• Health Care Providers Handbook. (2010). Cultural sensitivity.
• Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance, and ethics for nurses and midwives.
• Royal College of Midwives. (2000). Vision 2000: A blueprint for the future of midwifery.

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Nursing and midwifery

• There are an estimated 29 million nurses worldwide and 2.2 million midwives. WHO estimates a shortage of 4.5 million nurses and 0.31 million midwives by the year 2030 (1) .
• That will bring the a global shortage of health workers estimated for 2030 to 4.8 million nurses and midwives, with the greatest gaps found in countries in Africa, South-East Asia and the WHO Eastern Mediterranean Region, as well as some parts of Latin America (1) . 
• Nurses and midwives play a pivotal role in improving health and contributing to the wider economy. Investing in them is imperative to achieve efficient, effective, resilient and sustainable health systems. They not only provide essential care but also play a critical role in shaping health policies and driving primary health care. Nurses and midwives deliver care in emergency settings and safeguard the sustainability of health systems globally.
• Globally, 67% of the health and social workforce are women compared to 41% in all employment sectors. Nursing and midwifery occupations represent a significant share of the female workforce.
• More than 80% of the world’s nurses work in countries that are home to half of the world’s population. And one in every eight nurses practices in a country other than the one where they were born or trained.
• Higher levels of female nurses are positively correlated with health service coverage, and life expectancy and negatively correlated with infant mortality.

Nurses and midwives are central to Primary Health Care and are often the first and sometimes the only health professional that people see and the quality of their initial assessment, care and treatment is vital. They are also part of their local community – sharing its culture, strengths and vulnerabilities – and can shape and deliver effective interventions to meet the needs of patients, families and communities.

WHO response

WHO’s work relating to nursing and midwifery is currently directed by World Health Assembly resolution WHA74.15 (2021) which calls on WHO Member States and WHO to strengthen nursing and midwifery through the Global Strategic Directions for Nursing and Midwifery (SDNM) 2021–2025 . The SDNM is an interrelated set of policy priorities  that can help countries to ensure that midwives and nurses optimally contribute to achieving universal health coverage (UHC) and other population health goals .

The SDNM comprises four policy focus areas: education, jobs, leadership, and service delivery Each area has a “strategic direction” articulating a goal for the five-year period, and includes between two and four policy priorities If enacted and sustained, these policy priorities can support advancement along the four strategic directions: 1) educating enough midwives and nurses with competencies to meet population health needs; 2) creating jobs, managing migration, and recruiting and retaining midwives and nurses where they are most needed; 3) strengthening nursing and midwifery leadership throughout health and academic systems; and 4) ensuring midwives and nurses are supported, respected, protected, motivated and equipped to safely and optimally contribute in their service delivery settings.

WHO engages ministries of health, the Government Chief Nurses and Midwives (GCNMOs) and other relevant stakeholders to enable effective planning, coordination and management of nursing and midwifery programmes in countries. The Global Forum for the Government Chief Nurses and Midwives, established in 2004, is organized by WHO and meets every two years. It is a Forum for senior nursing and midwifery officials to develop and inform areas of shared interest. WHO also engages with academic institutions specialised in nursing and midwifery. Forty-seven academic centres are designated as Collaborating Centres for Nursing and Midwifery with WHO. The academic centres are affiliated to the Global Network of WHO Collaborating Centres for Nursing and Midwifery.

WHO has established a Nursing and Midwifery Global Community of Practice (NMGCoP). This is  a virtual network created to provide a forum for nurses and midwives around the world to collaborate and network with each other, with WHO and with other key stakeholders (e.g WHO collaborating centres for nursing and midwifery, WHO Academy, Nursing and Midwifery Associations and Institutions.) The network will provide discussion forums, a live lecture programme, opportunities to develop and share policies, WHO documents and tools, and facilitated innovation workshops, masterclasses and webinars.

The Nursing and Midwifery Global Community of Practice is free to join and available to nurses and midwives everywhere. From May 2022 it will be possible to access the virtual community via a smartphone, by downloading the Nursing and Midwifery Global Community of Practice App Nurses Beyond the Bedside_WHO_CSW66 Side Eventavailable for Android and IOS system via the APP store.

A 2017 Report on the history of nursing and midwifery in the World Health Organization 1948–2017, demonstrates how WHO, since its inception, has given this workforce a voice, and highlights the critical role nurses and midwives play in improving health outcomes across the world.

• Boniol M, Kunjumen T, Nair TS, et al.The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage?BMJ Global Health 2022;7:e009316.
• The Global Strategic Directions for Strengthening Nursing and Midwifery
• Nursing and Midwifery in the History of the World Health Organization, 1948–2017
• Nurse Educator Core Competencies
• Midwifery Educator core competencies
• The State of the World’s Nursing 2020 Report
• The State of the World’s Midwifery 2021 Report

WHO resolutions on nursing and midwifery

• WHA64.6 - Health workforce strengthening
• WHA64.7 - Strengthening nursing and midwifery
• WHA59.27 - Strengthening nursing and midwifery

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Beyond the academic essay: Discipline-specific writing in nursing and midwifery

2008, Journal of English for Academic Purposes

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Role Of The Midwife Health And Social Care Essay

Info: 2396 words (10 pages) Nursing Essay Published: 11th Feb 2020

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13 Midwife as Researcher

Eileen K. Hutton, BSc, MSc, PhD

The generation of knowledge is a defining characteristic of professions. As in other health care fields, midwifery research helps to describe the profession and provides evidence for its activities. (1) This chapter provides a historical context for midwives as researchers, describes the research process, and provides a rationale for midwives to undertake research. A description of the role for midwives as they generate profession-specific knowledge is provided.

13.1 History of Midwives in Research

Midwives have a long history of generating new information and of communicating this information to enhance the quality of care provided by their colleagues. As clinicians, midwives are natural researchers; they ask questions about the care that they provide, critique clinical observations, and shape practice based on these findings. Today we describe this activity as reflective practice , and going far into midwifery history we have examples of midwives who undertook this same activity and contributed to the knowledge base of the profession.

13.1.1 Catharina Schrader (1693-1746)

A Flemish midwife who cared for over 4,000 women and newborns and carefully documented her the care she provided (Figure 13-1). Her records show that over her many years of practice she prepared summaries of best management so others might benefit from her observations.

Did You Know?

Catharina Schrader’s notes were published in a memoir titled ‘Memoryboeck van de Vrouwens. Het notitieboek van een Friese vroedvrouw 1693-1745’. Her notes were meant to serve as a financial record, patient registry and a guide to future midwifes. The notes were translated into English in a book titled ‘Mother and child were saved. The memoirs (1693-1740) of the Frisian midwife Catharina Schrader.’

13.1.2 Angélique Marguerite Le Boursier du Coudray (1712-1794)

In 1759, after practicing midwifery for ten years in Paris, King Louis XV named Mme du Coudray (Figure 13-2) as, the King’s Midwife. She was well paid to travel the country and provide what we would now call continuing education to both urban and rural midwives. She authored a textbook for use by midwives, and invented and developed teaching manikins (Figure 13-3), which revolutionized midwifery education. It is reported that by 1780 two-thirds of all French midwives had studied with Mme du Coudray. The teaching tools and approaches that she developed speak to both her role as an educator, and demonstrate her early role in  knowledge translation .

Many of Mme Du Coudray’s obstetrical teaching manikins can still be seen in the Musée Flaubert et d’histoire de la médecine in Rouen, France.

The life-like teaching models were made of leather and in very many ways are similar to the torsos in use now that are made of plastic. The models were easily transported and could demonstrate the basic manoeuvres of normal birth, as well as manoeuvres involved when complications associated with variations in position are encountered such as occipital posterior, or breech presentations. Approved by the French Academy of Surgeons in 1758, her models are confirmed to be the first approved teaching model for simulated learning in obstetrics.

External Link

To learn more about Mme du Coudray, visit:

http://www.cjmrp.com/articles/volume-9-2010/educating-midwives-with-the-world-s-first-simulator-madame-du-coudray-s-eighteenth-century-mannequin

13.1.3 Ethel Margaret Burnside (1877-1953)

Midwife Burnside was the first woman to be appointed as chief health visitor in the county of Hertfordshire, on the northern border of London, UK. Concerns had been raised about the general health of children in the  country, and Burnside established a standardized record to be used for childbirth, newborn and early child hood care. These records included birth weight, method of feeding and records of each child’s ongoing weight, illnesses and general development for the first year of life. Her team of midwives and nurses used these standardized forms at all of their clinical visits and the data was subsequently transcribed into ledgers at the county office. This system was in place from 1922 until 1948 and provided a wealth of information that was later used to link birth outcomes and early childhood experiences to adult outcomes and provide the basis for David Barker’s Hypothesis, which is now referred to as the Developmental Origins of Health and Disease or the DOHaD theory.

To read more about the DOHaD Theory, visit:

https://dohadsoc.org/wp-content/uploads/2015/11/DOHaD-Society-Manifesto-Nov-17-2015.pdf

13.2 Midwives & Research

Midwives, like all health professionals, have come to appreciate the role of research in informing best practice. Much of the information used by midwives to guide clinical practice can be garnered from research findings of other professions, such as nursing, and medicine – particularly obstetrics and neonatology. So, one might question whether specific midwifery research is needed and further, whether it should be midwives who conduct the research.There are, of course, many reasons that midwives should be involved in primary research, three of the fundamental reasons include:

• Midwives ask questions that are of unique importance and relevance to improving care to women and infants during pregnancy and childbirth
• Other health providers may not ask the questions to which midwives need answers
• Midwives have a professional responsibility to generate knowledge relevant to their specialty

Two additional reasons for midwives to be involved in generating knowledge relate to the nature of midwifery. The first reason relates to the magnitude of effect that can result from an absence of knowing. Internationally, pregnancy and childbirth are considered normal, physiologic functions and most women giving birth are considered to be at low risk of associated complications and are thus under the care of midwives; therefore, if midwives get something in their care wrong, it has the potential to affect large numbers in the birthing population. For example, for many years clamping of the newborn umbilical cord immediately following birth was encouraged as part of a postpartum hemorrhage prevention strategy. Early in the 21st century adequate research emerged to suggest that this action was detrimental to newborns, affecting them for as long as six months following birth. Midwives played an important role in generating this research: Judith Mercer, a midwifery scientist in Boston led the earliest research on delayed cord clamping involving very preterm infants. The results of her work has changed practice for these very vulnerable infants. Eileen K. Hutton, a Canadian midwifery researcher published the first systematic review of delayed cord clamping in the full term infant. (2) Diane Farrar, a British midwifery researcher, studied the transfusion effect of delaying cord clamping by weighing infants immediately following birth. (3) These works contribute to the changed and changing guidelines. The strategy of clamping the umbilical cord within seconds of birth had been used for years without any testing and has impacted generations of infants.

Reflective Practice Question

Why do you believe we need midwifery research? Why do you think it is important that  midwives conduct research?

Judith Mercer discusses how observation from practice can lead to research in the following interview:

https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=99

The second reason for midwives to undertake research has more to do with the evolution of obstetrical practices over the last century, many of which have become ‘usual care’ without research evidence of their benefit, and perhaps more concerning, no evidence on their potential harm. For example, electronic fetal heart monitoring (EFM) was first developed in the 1970s and introduced to routine care with the hope that it would identify fetuses who were experiencing difficulty during labour. At the time, there was no research to demonstrate its effectiveness in screening for at risk fetuses among low risk labouring women. It is still used in many settings today, yet no studies since have been able to show if or how EFM improves outcomes for these neonates. (4) However, EFM is associated with higher rates of intervention, including increased rates of cesarean birth. (4) Even in the absence of evidence of benefits, and strong evidence that, routinely used, EFM is harmful, it is very difficult to change practice.

Women and infants have been exposed to many practices in maternity care that have had both short and long term detrimental effects. As late as the 1970s, because birth was treated as a surgical event, all women routinely received an enema in labour  to cleanse the birthing site. Women were placed in stirrups and were covered in sterile drapes to maintain a sterile area around the birth canal. Women also routinely received an episiotomy in order to ease the birth of the infant across the perineum. This was meant to prevent uncontrolled damage to the perineum as it was thought that a surgical incision would heal better than a ragged tear . Preparing the surgical site for the episiotomy meant that the perineal area had to be shaved in early labour, and further cleansing of the birthing site involved swabbing the perineum and vaginal cavity with cleansing agents such as povidone-iodine (trade names: betadine®, or proviodine™ and others). All of these activities likely changed the normal flora that the infants were exposed to during the birthing process. We are just now beginning to understand how this flora might be important to the life-long health of the infant. (5)

Midwifery-specific research helps shape the profession and makes it responsive to the current needs of society. Although some might argue that midwifery has been slower than many other professions to undertake research, in the last number of years considerable headway has been made. Some very influential research papers have been shaping contemporary midwifery. For example, the Cochrane review  (6) reporting that continuity of midwifery care models improved outcomes for women and babies provided a powerful basis to support the reintroduction of a model of care that in many jurisdictions had all but disappeared. Research papers on homebirth from the UK, the Netherlands and Canada have provided solid evidence that has altered national guidelines to state that care providers should, ‘explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth.’ (7) These are important research papers because they have helped to ensure that women and families who want to choose a birth at home have this option available to them. In addition to enhancing care and broadening care options for women, midwifery lead research influences the way the profession is perceived. The role of positive research outcomes helps maintain the credibility of the profession of midwifery in a way that should not be underestimated.

The Lancet Series on Midwifery published in 2014 enhanced the understanding and credibility of midwifery as a profession. The series reported on a major research initiative undertaken by world leaders in midwifery research to develop a research framework. Their project also outlines priority research areas for midwifery globally and describes how investing in midwives will enhance quality of care in the areas of reproductive, maternal, newborn and child health.

The Lancet Series on Midwifery can be found here:  http://www.thelancet.com/series/midwifery

13.3 The Research Process

The research process has been widely described in the literature and may vary somewhat depending on the field of study. In general, it refers to a systematic approach to collecting information, sometimes called data, which is then analyzed to answer a question of interest. The research process is briefly described below.

In health sciences, questions are very often a narrow, clinical questions such as, ‘When is the best time to place the umbilical cord clamp on a healthy term infant following birth?’ Other questions of interest to clinicians may be broader types of research questions such as, ‘How does interprofessional education during training affect working relationships among midwives and obstetricians?’ or ‘What do pregnant women understand about weight gain in pregnancy?’ In the research process the development of the initial question is a very important step in the process, and it is then refined following a careful review of the literature so that the question can be framed in terms of what is already known about the subject.

Once the question is formed and refined the most appropriate research method to answer the question must be determined. For example, a researcher might choose a randomized controlled trial to test a particular approach or an intervention in comparison to what is in current practice. Sometimes random assignment of an intervention is not possible, feasible or even ethical. In such cases, a cohort study design is an alternative approach that might be considered. In the case of determining opinions or beliefs about a topic qualitative methods may be appropriate. Once the method is settled upon, the study design is written up into a study protocol that will inform all the details of how the study will be carried out.

The next step is to collect data to answer the study question. This might involve recruiting and interviewing participants or administering questionnaires, for example. Another potential data source is data collected as part of population databases, like the Better Outcomes Registry & Network (BORN) database to which Ontario midwives contribute. To ensure accuracy of the data the dataset is cleaned and prepared by undertaking logic checks such as date of birth follows date of entry to care. The cleaned dataset can then be used for analysis and the results interpreted.

The final step in the research process is knowledge translation whereby new information is disseminated, usually in the form of a scientific manuscript, ideally published in a peer reviewed , or refereed journal. Information is also often shared at scientific conferences to research peers, and at conferences for practitioners when there is direct clinical application of the findings.

Visit the BORN website here:  https://www.bornontario.ca/

13.4 Funding Research & Researchers

Obtaining grant funding is typically a highly completive process and in many respects shapes and limits the research that is undertaken. Thus, grantsmanship is an important skill to master for any midwife entering the research arena as a primary researcher. Much time is spent on applying for grants, many of which are not successful in the grant competition process. For midwives with academic positions, or other positions focusing on research, maintaining an up-to-date academic curriculum vitae (CV) is essential. The CV is the credential used to move through the promotions process, but most importantly it is the document that provides reviewers of research grant proposals with information needed to evaluate research capacity – the ability to undertake the research being proposed to ensure the project under consideration for funding in is likely to be done, and done well. Research grant reviewers consider the researcher’s:

• Educational background
• Awards of distinction received during academic training or research career
• Number and type of grants previously received
• Number of peer reviewed publications including those resulting from grants
• Number of first authored papers
• Publications by the quality of journal where the work is published
• Number of times the publications has been cited
• Presentations – peer reviewed, keynote invitational, oral, poster
• Presentation awards received
• Number of graduate students that have been supervised, awards those students obtained

13.5 Contributing to Research

Research has become increasingly sophisticated and typically requires specific expertise and outside funding to undertake. Nonetheless, there are a variety of ways in which all midwives can contribute to scientific research endeavours.

13.5.1 Practitioners

Midwives practitioners are experts in the provision of maternal child care and have a major role to play as part of the research team. Research questions often arise from day-to-day practice, and although a midwife may not lead a research project, communicating an important question and working collaboratively on the development of a project to answer it can make a significant contribution to increasing knowledge in the field. During the development phase of a research protocol midwives can provide insight to ensure that the study design is suited to answer the research question being asked. They are best able to determine if the proposed methods for things, such as recruitment and implementation of the study protocol, are feasible in the practice setting. Midwives are also the primary route through which clients are recruited from the practice setting.

Many research questions can be answered using population databases . Midwifery databases have been used to answer very specific questions such as to determine the outcomes of planned home birth. The quality of the research in these cases depends entirely on the quality of data input at the midwifery practice level; thus midwives have a critical role in deriving these data. At the time of entry of data into population data sets, it may be difficult to justify the value of time spent on the activity, however, studies that have resulted from using these data have been essential in informing, maintaining, and enhancing choice for women regarding matters such as place of birth. (8,9)

An example of a data base study can be found here: http://pediatrics.aappublications.org/content/pediatrics/early/2014/09/17/peds.2014-1146.full.pdf

Mme du Coudray, who was introduced earlier in this chapter demonstrated that she understood the value of what we now call KT when she travelled widely with her teaching models to upgrade practitioners level of clinical knowledge. The role of KT is being increasingly recognized as an critical component of successful research. It has become a standard that research proposals include endorsements or partnerships with knowledge users . It is also increasingly common to have interprofessional research teams. Midwives can participate in research projects led by midwife researchers or by researchers from other professions or disciplines, contributing a midwifery perspective to every aspect of the research. Once new knowledge is gained, it will be of little or no use if practitioners do not use it. By working with their professional associations to develop clinical practice guidelines, or in their own practices to prepare practice protocols, midwives can contribute to knowledge translation. Midwives should also participate in presenting new information to colleagues and learners, for example at hospital rounds .

13.5.2 Research Team Members

When midwives generate a research question, they may play a key role as either a principal investigator , co-investigator , or a co-applicant on research project. Sometimes midwives have particular expertise that they bring to the research question being asked, and may be invited to participate on a project on that basis. Alternatively, midwives with additional research training may wish to work in the capacity of salaried research assistants or coordinators. Research projects often require research assistants or research coordinators to help to manage the undertaking, and these positions can be funded by research grants. In some settings, such as Australia and the UK, staff midwifery research positions are available in hospitals or other organizations involved with health care. The role of the midwife researcher in these positions varies, but may include assisting with external research projects, initiating and running the daily operations of research projects, and knowledge translation for midwives and other interprofessional members of the obstetrical care teams.

13.5.3 Clinician Scientist

Clinician scientist is the term frequently used to describe those who both lead research endeavours and provide health care. The term ‘scientist’ is inclusive and refers not only those who are doing basic science, but to those doing epidemiological work, or using qualitative approaches; it includes social scientists, bio-scientists, and many others.

The division of time spent by clinician scientists in research and in clinical practice will depend on the funding arrangement that supports their salary. Typically, a clinician scientist focuses on health research or basic research as it applies to a medical field. However, such a scientist could have training in other specialties, such as sociology or anthropology, and make contributions to knowledge of care provision. Clinician scientists typically understand research questions relevant to clinical practice, and can play a role in transferring findings from research bench-to-bedside, closing this breach with effective knowledge translation. Their contribution to the profession is key in ensuring generation of the knowledge needed for best clinical practice. Opportunities for midwifery clinical scientists are more common in the UK and Australia than in Canada at this time where such opportunities are rare. Professions such as medicine have well identified pathways to become a clinician scientist– in Canada, for example, there are two routes:

• The Royal College of Physicians and Surgeons approved doctor of medicine (MD)/ doctor of philosophy (PhD) degree program where the undergraduate MD and PhD programs are combined
• The Clinician Investigator Program where PhD studies are undertaken concurrent with the postgraduate medical education (residency). (10)

Usually a clinician scientist is prepared for research at the doctoral level in their area of specialty. A qualified midwife might have additional training in health economics , or in clinical epidemiology , or in bioethics , for example. Their research might specialize in studying clinical interventions (e.g. use of sterile water injections for pain management using methods such as randomized controlled trials) or using population databases to answer questions about health care utilization (e.g. comparing home and hospital birth outcomes). They may also use qualitative methods to explore a particular health topic (e.g. the needs of obese pregnant women or the experience of uninsured immigrant women seeking maternity care).

In the academic setting and within the research milieu, the expectation is that a researcher will build a ‘body of research’. This means that the research undertaken by a particular researcher will, over time, contribute to a growing understanding of a particular topic. That is, each small study builds to try to understand a particular phenomenon or problem of interest. In specialties like midwifery, this expectation that researchers build a ‘program of research’, such that researchers develop expertise in particular areas and build on the work in their area of study over their careers. This body of research is considered when research contributions are being evaluated for funding purposes or for tenure and promotion within the academic setting, so it is important that researchers understand the expectations of the system in order to increase the likelihood of career success.

13.6 Building Research Capacity

13.6.1 challenges.

Despite the examples of early midwife researchers given at the beginning of this chapter, in most settings, midwifery research has not developed alongside clinical practice. Evidence derived from research has become the expected underpinning for contemporary clinical practice, thus imposing on the profession a sense of urgency to generate knowledge. Research takes time to arrive at answers and the incongruence of a need for knowledge and the time required for knowledge generation can cause frustration.

Research is expensive to undertake and can be seen as using scarce resources without immediate benefit. (10) Lack of infrastructure support for midwifery researchers – including access to financial support during advanced research training; balancing research with other career demands; and absence of research infrastructure for funding, publications and presentation of findings is also common. Perhaps as a result of these factors, development of research capacity is a challenge faced by the midwifery profession in many jurisdictions. (11) As a result, Canada currently has midwives who may do some research as part of academic work with teaching and practice but few who commit significant time to the research process as career research scientists. The profession needs to develop strategies to enhance the opportunities for growth of research generally, and particularly to address the shortage of midwifery clinician scientists.

13.6.2 Strategies

The role of a good mentor in the success of a researcher cannot be underestimated. The requirement for good mentoring begins in the early stages of acquiring additional research skills. Making careful choices around the educational program that is selected for advanced degrees, with particular attention to the choice and role of supervisors during this process will pay off. Characteristics of a good mentor include one who will (12):

• Provide support in securing resources needed
• Provide opportunities to enhance learning, develop skills and gain experience
• Provide advice without expectations
• Protect the mentee in transiting academic pathways – either as learner or as new researcher

Relative to other professions, midwifery has proportionately fewer research scientists, and those entering the realm of research may find that they need to look outside of the midwifery profession for mentors. Although this might be viewed as a limitation, it can also be a potential strength. A mentor who is an expert researcher outside of midwifery may in fact be able to provide excellent, and unbiased mentoring.

13.7 Conclusion

Professions like midwifery often prioritize clinical practice as their core business to the extent that the needs of researchers are ignored. However, it is incumbent upon the profession to create midwifery specific knowledge, resulting in a professional obligation to support researchers undertaking this needed work. In order to continue to provide the best possible care to clients and their infants, the profession needs researchers who will think critically and creatively and undertake high quality research, in order to make meaningful changes to practice through the generation of new knowledge. Midwifery scientists have an essential contribution to make to the sustainability of the profession and it is contingent upon individual midwives, professional associations, regulatory agencies and funding bodies to support this important activity.

• Higgins I, Parker V, Keatinge D, Giles M, Winskill R, Guest E, et al. Doing clinical research: The challenges and benefits. Contemp Nurse. 2010;35(2):171–81.
• Hutton EK, Hassan ES. Late vs Early Clamping of the Umbilical Cord in Full-term Neonates. JAMA [Internet]. 2007 Mar 21 [cited 2017 Aug 1];297(11):1241. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17374818
• Farrar D, Airey R, Law GR, Tuffnell D, Cattle B, Duley L. Measuring placental transfusion for term births: Weighing babies with cord intact. BJOG An Int J Obstet Gynaecol. 2011;118(1):70–5.
• Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Alfirevic Z, editor. Cochrane Database Syst Rev [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2017 Feb 3 [cited 2017 Aug 1]; Available from: http://doi.wiley.com/10.1002/14651858.CD006066.pub3
• Romano AM, Lothian JA. Promoting, Protecting, and Supporting Normal Birth: A Look at the Evidence. J Obstet Gynecol Neonatal Nurs [Internet]. 2008 Jan [cited 2017 Aug 1];37(1):94–105. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18226163
• Sandall J, Soltani H, Gates S, Shennan A, Devan D. Midwife-led continuity models versus other models of care for childbearing women. 2013.
• National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies [Internet]. NICE; 2014 [cited 2017 Jul 31]. Available from: https://www.nice.org.uk/guidance/cg190
• Darling EK, Ramsay T, Sprague AE, Walker MC, Guttmann A. Universal Bilirubin Screening and Health Care Utilization. Pediatrics [Internet]. 2014 Oct 1 [cited 2017 Aug 1];134(4):e1017–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25246625
• Hutton EK, Cappelletti A, Reitsma AH, Simioni J, Horne J, McGregor C, et al. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ [Internet]. Canadian Medical Association; 2016 Mar 15 [cited 2017 Aug 1];188(5):E80-90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26696622
• Lockyer J, Beck P, Hollenberg M, Hemmelgarn B, Thake J, Taber S, et al. 11. The Clinician Scientist in Canada: Supporting Innovations in Patient Care through Clinical Research [Internet]. Royal College of Physicians and Surgeons of Canada; 2014. p. 16. Available from: http://www.royalcollege.ca/portal/page/portal/rc/common/documents/advocacy/clinician_scientist_in_canada_e.pdf
• McCance T V., Fitzsimons D, Keeney S, Hasson F, McKenna HP. Capacity building in nursing and midwifery research and development: an old priority with a new perspective. J Adv Nurs [Internet]. 2007 Jul [cited 2017 Aug 1];59(1):57–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17559611
• Sackett DL. On the determinants of academic success as a clinician-scientist. Clin Invest Med [Internet]. 2001 Apr [cited 2017 Aug 1];24(2):94–100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11368152

Long descriptions

Figure 13-3.

A photograph taken in a museum of a cloth dummy. It appears to be a beige, coarse material, and stitching can be seen throughout. The dummy is a basic model of the female form from about the bellybutton to the mid-thigh. the thighs are spread open, and held up by stirrups, displaying the sewn vulva. Out of the vaginal opening (a split in the material), a sewn newborn is being birthed, with its head and arms already out. [ Return to Figure 13-3 ]

Midwife as Researcher Copyright © 2017 by Eileen K. Hutton, BSc, MSc, PhD is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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• DOI: 10.1016/j.nedt.2024.106352
• Corpus ID: 271869852

Should I stay or should I go? Nursing and midwifery academics intention to stay in or leave academia: A scoping review

• Marion Tower , Rachel Muir , +6 authors Elizabeth Elder
• Published in Nurse Education Today 1 August 2024

64 References

Factors influencing nursing faculty members' intent to stay: a structural equation modeling approach., nursing research: on the brink of a slippery slope., the relationship among faculty-to-faculty incivility and job satisfaction or intent to leave in nursing programs in the united states., time to solve persistent, pernicious and widespread nursing workforce shortages., pressures in the ivory tower: an empirical study of burnout scores among nursing faculty, reflections on transitioning from senior nurses to novice nurse academics, what do we know about midwives' transition from clinical practice to higher education teaching roles a scoping review., addressing the associate level nurse faculty shortage: do job and mentoring satisfaction predict retention, playing the set game: how teachers view the impact of student evaluation on the experience of teaching and learning, coping with covid-19. work life experiences of nursing, midwifery and paramedic academics: an international interview study, related papers.

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Nursing & Midwifery Council Code Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Defining the nmc code, the value of the code, concluding remarks, reference list.

Nursing requires a high level of professionalism and exceptional attention to patients’ needs. The development of nursing has led to the creation of specific rules and standards that regulate the modern healthcare system. Workers in the field of nursing have a significant impact on public health, whether they work in caring, educating or managing positions. For purposes of setting professional standards for nurses and protecting public interests, The Nursing & Midwifery Council (NMC) code was created.

The professions regulated by the code have various skills, knowledge and responsibility; however, they all practice ethics outlined in the NMC code and are accountable for their work based on the key provisions of the code (Snelling 2016). Only nurses, midwives and nursing associates who follow the code and meet its requirements are allowed to work in the UK. This paper will critically analyse the Nursing & Midwifery Council code of professional conduct and how it acts to promote professional values and guide professional nursing practice and care for patients.

Before exploring the NMC code and its impact on the quality of care provided to patients, it is imperative first to define it. The Nursing & Midwifery Council is regulatory for midwifery and nursing professionals in the United Kingdom (NMC 2019). It keeps a register of all the nurses, midwives and nursing associates and sets standards for their education, training, performance and conduct. NMC also deals with cases when these standards are neglected or not met. The Nursing & Midwifery Council developed the code to present a framework of professional standards that nurses, midwives and nursing associates must follow in order to be registered to practice in the UK (NMC 2018). The code emphasizes four main themes: prioritise people, practice effectively, preserve safety and promote professionalism and trust.

The provision of “prioritising people” explains that nurses and midwives need to retain people’s dignity and treat them as individuals, be attentive to people’s preferences and concerns, respond to their physical, psychological and social needs, respect their rights to privacy and confidentiality, and always act in the best interest of people (Callwood 2015). The second provision, “practice effectively,” requires practitioners to act in accordance with the best available evidence, work cooperatively, communicate clearly, maintain accurate records relevant to one’s practice, share their experience, knowledge and skills where appropriate and improve one’s professional practice according to the received feedback.

The third part of the conduct, “preserve safety”, states that the nurse or midwife must recognize and work within the limits of their competence, practice the “duty of candour” (NMC 2018). It also obligates a nurse or a midwife to immediately raise concern whenever the public or patients’ safety is at risk and take specific actions to deal with matters when it is appropriate. The fourth part is based on promoting professionalism and trust by maintaining the reputation of one’s profession and position, presenting personal commitment to the code, and remaining a figure of leadership and integrity (NMC 2018).

The code allows for the professional growth of healthcare practitioners based on the patients’ needs and feedbacks. The fifth component, “promote professionalism and trust”, is developed to ensure that nurses uphold a high standard of reputation and professionalism at all times. The professionals are expected to exhibit a personal commitment to the standards of behaviour and practice that have been outlined by the code. This means that each nurse should act as a role model for integrity when providing care to patients regardless of their cultural background, race, gender, ethnicity, education, or socioeconomic status (Royal College of Nursing 2017).

Thus, the general tone of the NMC code is ensuring that professionals are operating in the sphere of nursing and midwifery show as much respect and compassion to the needs of patients to foster a positive environment in which the care requirements are met.

The NMC code is essential for promoting professional values and guide professional nursing practice as applied to the UK health care context (Royal College of Nursing 2019). As mentioned by Fitzpatrick (2018), the code underlines the importance of communication as a professional value that encourages upholding and protecting patient care. As nurses spend a lot of time with their patients, they are expected to develop trusting relationships with them and facilitated rapport (The Queen’s Nursing Institute 2017). Such relationships are imperative because they offer practitioners an opportunity to evaluate the health of their clients in terms of both emotional and physical well-being.

Throughout the NMC code of conduct, it is stated that nurses are expected to communicate effectively not only to benefit patients but also to work in teams (Peate 2016). Because of this, every standard, prioritising people, practice effectively, preserve safety, the duty of candour and promote professionalism and trust, imply a certain degree of communication. The professional values of nurses are reinforced and supported with the help of communication, which helps to facilitate honesty, transparency, and the fostering of environments that encourage high-quality care.

As related to professional values, the NMC code influences the facilitation of positive attitudes within the process of care. Newly-qualified nurses that only begin their work should reflect on their own values and standards and their influence on practice (NHS 2019). Thus, it is expected that nurses who have a genuine desire to help people will be more likely to possess such integral qualities as respect, honesty, and responsibility.

In conclusion, it should be mentioned that the NMC code makes a connection between the personal values of nursing practitioners and their professional duties as identified in the code. Professionals should be compassionate and respectful of patients for whom they care in order to improve their health as well as life in general. The best way to provide care for patients is to facilitate care, commitment, compassion, competence, and communication. The combination of these principles encourages professionals to be dedicated to their work and use evidence-based care in conjunction with principles of respect and positive attitudes to the process.

Callwood, A 2015, Developing and evaluating the multiple mini interview in student midwife selection. Web.

Fitzpatrick, L 2018, ‘The importance of communication and professional values relating to nursing practice,’ Links to Health and Social Care , vol. 3, no. 1, pp. 27-40.

NHS 2019, General practice nursing induction template . Web.

NMC 2015, The code . Web.

NMC 2019, Midwifery regulation . Web.

Peate, I 2016, Medical-surgical nursing at a glance , John Wiley & Sons, Chichester, UK.

Royal College of Nursing 2017, RCN guidance for mentors of nursing and midwifery students . Web.

Royal College of Nursing 2019, Principles of nursing practice . Web.

Snelling, P 2016, ‘The metaethics of nursing codes of ethics and conduct’, Nursing Philosophy , vol. 17, no. 4, pp. 229-249.

The Queen’s Nursing Institute 2017, Transition to distinct nursing service . Web.

• Clinical Nurse Educator Role in Swan Hill Hospital
• Professional Presentations for Nurses
• The Qualities Needed to Effectively Manage a Midwifery Group Practice
• The Perception of a Midwife and Its Impact
• Midwives’ Beliefs in Professional Practice
• Nursing Fieldwork Experience: Infection Control
• Nurses’ Communication Quality Improvement
• Nursing Seminars as a Scholarly Activity
• Advocacy as an Ethical Issue in Nursing
• Registered Nurse Building Professional Capacity
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Midwife vs Nurse Midwife: What Are the Differences?

• Midwife vs CNM Difference
• Types of Midwives
• Certified Nurse Midwife
• Certified Midwife
• Certified Professional Midwife
• Direct-Entry Midwife
• Lay Midwife
• Key Takeaways

Many people often wonder about the differences between a midwife and a  certified nurse midwife . Both professions play crucial roles in providing healthcare and support during pregnancy, childbirth, and postpartum care. However, there are clear distinctions between the roles.

This article compares midwife vs nurse midwife duties and explores the different types of midwives, the certifications needed, salaries, and education and training requirements.

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What’s the Difference Between a Midwife vs a Nurse Midwife?

When looking at a certified nurse midwife (CNM) vs a midwife, the main differences lie in their education, scope of practice, and typical work settings. In short, a nurse midwife is an advanced practice registered nurse with a certification in midwifery, while other types of midwives are not registered nurses and have obtained some other form of midwifery training. Let’s look at the differences in more detail. 

>> Related:  Doula vs Midwife: What's the Difference?

What is a Midwife?

A midwife is a healthcare professional specializing in providing care to women during pregnancy, childbirth, and postpartum. Midwives receive specialized education and training in midwifery. This training focuses on the natural process of birth and promoting the mother's and baby's well-being.

Midwives obtain their education through dedicated midwifery programs. The American College of Nurse-Midwives notes that you can become a certified midwife (CM) without first being a registered nurse (RN). To pursue that path, you must obtain a health-related bachelor's degree followed by a graduate midwifery program degree.

However, other midwifery pathways, such as a certified professional midwife (CPM), direct-entry midwife, or lay midwife, require much less education. We'll get into those a little later in the article. 

What is a Nurse Midwife? 

On the other hand, a certified nurse midwife is an  advanced practice registered nurse (APRN) who has obtained certification in midwifery. Nurse midwives begin their journey as registered nurses and then pursue further education and training in midwifery. Check out our CNM meaning guide to learn more about what it means to be a nurse midwife.

What do nurse midwives do ? Certified nurse midwives have a broader scope of practice as they possess both nursing and midwifery expertise. In addition to providing pregnancy, childbirth, and postpartum care, nurse midwives offer women primary healthcare services throughout their lifespans.

All midwife and nurse midwife graduate programs must have accreditation from the Accreditation Commission for Midwifery Education (ACME). Midwives and nurse midwives must also pass an exam administered by the American Midwifery Certification Board (AMCB) exam to obtain certification.

>> Show Me Online Nurse Midwife Programs

What Are the Different Types of Midwives? 

There are broadly five types of midwives: certified nurse midwives (CNMs), certified midwives (CMs), certified professional midwives (CPMs), direct-entry midwives, and lay midwives. 

However, the types of midwives and their roles may vary depending on individual state regulations. Check with your state to learn the scope of practice and level of authority where you plan to work.

1. Certified Nurse Midwife (CNM)

A CNM is an APRN certified through the AMCB in midwifery. CNMs are qualified to provide a full range of healthcare services to women, including but not limited to the following:

• Prenatal care
• Labor and delivery support
• Postpartum care
• Gynecological services
• Reproductive health visits

2. Certified Midwife (CM) 

A CM is a non-nurse midwife who completed a midwifery program and attained AMCB certification.  CMs provide comprehensive care to women throughout childbirth, including prenatal, intrapartum, and postpartum care.

3. Certified Professional Midwife (CPM)  

CPMs are non-nurse midwives who have obtained their education through various pathways. They earn midwife certifications through apprenticeships or educational programs that have received accreditation from the Midwifery Education Accreditation Council (MEAC).

Certified professional midwives primarily focus on out-of-hospital births. They care for women during pregnancy, childbirth, and the postpartum period in settings such as birthing centers or home births.

Most CPM graduates typically receive a certificate or an associate's degree. CPMs may legally practice in 35 states and the District of Columbia as of 2020.

4. Direct-Entry Midwife 

Direct-entry midwives are all midwives who enter the profession without first becoming registered nurses. Types of direct-entry midwives include certified midwives, certified professional midwives, and lay midwives.

Direct-entry midwives typically don’t require a bachelor’s, master's, or doctoral degree. They undergo midwifery training through various educational pathways, such as apprenticeships or direct-entry midwifery programs. Direct-entry midwives typically care for women outside hospitals, often in home birth settings.

5. Lay Midwife 

Lay midwives are typically self-taught or informally trained individuals who practice midwifery without formal education or certification. They often provide care in home birth settings, primarily for uncomplicated pregnancies and births. 

We want to emphasize that the term "lay midwife" may have different legal and regulatory implications depending on where you live. Some states require specific certifications or licensure to practice midwifery.

Now that you know the different types of midwives, let's get into the specifics of their different roles.

What Is a Certified Nurse Midwife?

A certified nurse midwife (CNM) is an APRN specializing in providing healthcare services to women throughout childbirth. They provide comprehensive care, including prenatal, intrapartum, postpartum, and gynecological services.

Education & Training Requirements 

Certified nurse midwife education begins with a Bachelor of Science in Nursing (BSN) degree and RN licensure. After working as an RN for at least one year, you may attend a CNM program. CNM programs specialize in midwifery and grant either Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degrees.

CNM graduate-level education focuses on advanced knowledge in midwifery, reproductive healthcare, and women's health. CNMs also undergo clinical training, which includes hands-on experience in providing care during pregnancy, labor and delivery, and postpartum periods.

A CNM must take the American Midwifery Certification Board (AMCB)  Nurse-Midwifery/Midwifery Examination to earn CNM certification.

The salary of all types of midwives can vary depending on geographic location, years of experience, and practice setting.

According to the US Bureau of Labor Statistics (BLS),  the median nurse midwife salary is $129,650. The bottom 10% of earners make about $95,530 annually, and the top 90% earn $211,820 or more.

Duties & Scope of Practice

CNMs have the widest scope of practice of any type of midwife and have and can perform various duties, including:

• Labor & delivery
• Health education
• Family planning
• Providing evidenced-based care throughout the reproductive lifespan

CNMs often collaborate with other healthcare professionals, such as obstetricians, pediatricians, and lactation consultants, to provide comprehensive and coordinated care. They can practice in various settings, including hospitals, birthing centers, and clinics. Some even practice at-home births, depending on local regulations and individual preferences.

What is a Certified Midwife (CM)?

A CM is a non-nurse midwife who has completed a midwifery education program with a graduate degree. CMs receive specialized training in midwifery and are qualified to provide comprehensive care to women throughout childbirth. The services CMs provide include prenatal, intrapartum, and postpartum care.

Education & Training Requirements

Since CMs have a direct entry into midwifery, their programs do not include a nursing curriculum. Instead, their educational focus is solely on midwifery practice. Additionally, there are very few CM programs available in the US ( here is one example of a CM graduate program).

Becoming a CM requires first obtaining a bachelor's degree, preferably in a health-related field. CM graduate programs include academic coursework, clinical training, and supervised practical experience. The education and training encompass all aspects of midwifery care, including pregnancy, childbirth, postpartum care, and gynecological services.

Like nurse midwives, CMs must take the AMCB  Nurse-Midwifery/Midwifery Examination to earn CM certification.

The BLS does not differentiate between the salaries of CMs and CNMs. However, they report that the median annual salary for midwives with specialized graduate-degree education is $131,570, with salaries typically ranging between $87,320 to $177,530.

Duties & Scope of Practice 

CMs collaborate with other healthcare professionals, including obstetricians and nurses, to ensure comprehensive and coordinated patient care. They provide essential services such as:

• Conducting physical exams
• Ordering and interpreting laboratory tests
• Providing prenatal and postpartum care
• Assisting with labor and delivery
• Offering contraceptive counseling

The role of a CM may vary depending on the legal and regulatory framework in the state where they practice. It's important to note that CMs are recognized and authorized to practice in some states but not universally recognized throughout the country.

What Is a Certified Professional Midwife (CPM)?

A CPM is a healthcare provider specializing in providing midwifery care to women during pregnancy, childbirth, and postpartum. CPMs primarily focus on out-of-hospital birth settings, such as homes and birth centers.

CPMs gain entry into the field through MEAC-accredited educational programs . Certification in this field does not require an academic degree but does require a demonstrated level of competency. 

Applying to a CPM program requires that the candidate holds a high school diploma or equivalent degree. Most CPM graduates typically receive a certificate or an associate's degree.

ZipRecruiter reports that CPMs earn a medium annual salary of $116,674 per year or $56 per hour. However, the highest-earning CPMs make yearly salaries of $141,000 or more.

According to the American College of Nurse-Midwives , CPM duties may include:

• Providing hands-on support and assistance during pregnancy, labor, birth, and the immediate postpartum period
• Helping provide maternal and well-baby care for approximately 6-8 weeks following childbirth
• Conducting comprehensive assessments and providing appropriate treatment
• Performing  some physical examinations and administering some medications (within state law limits)
• Ordering and interpreting laboratory and diagnostic tests

What Is a Direct-Entry Midwife?

The term "direct-entry midwife" describes a midwife who enters the profession through a pathway other than nursing. Unlike certified nurse-midwives, direct-entry midwives pursue midwifery education and certification without first becoming RNs.

Types of direct-entry midwives may include:

• Certified midwives
• Certified professional midwives
• Lay midwives

The education requirements for direct-entry midwives can vary depending on the type of direct-entry midwifery credential:

• Certified midwife: Health-related bachelor's degree, a master’s degree in midwifery, and pass the AMCB Midwifery Exam to earn certification
• Certified professional midwives: A MEAC-accredited CPM certificate or diploma program
• Lay midwives: no formal education (not legally recognized throughout most of the US)

The salaries for each type of direct-entry midwife can vary depending on factors, which include:

• Type of program and education
• Practice setting

In general, certified midwives earn significantly more than a CPM or lay midwife. This salary difference is because CM certification requires more specialized graduate-degree education. 

The scope of practice also varies depending on the type of midwife and the level of education. In general, the higher the level of required education required, the broader the scope of practice the direct-entry midwife will have.

What Is a Lay Midwife?

A lay midwife provides midwifery care without formal certification or licensure. Lay midwives typically acquire skills and knowledge through informal training, apprenticeships, or personal experiences. They may assist women during childbirth, provide prenatal and postnatal care, and offer general support and guidance throughout the childbirth process.

While CNMs can legally practice in all 50 states, and CMs and CPMs are recognized as legal practitioners in some US states, lay midwives are not widely recognized as practitioners. In some states, lay midwifery is illegal or unregulated. However, other states may have specific regulations or guidelines in place. 

There are no formal education or training requirements for lay midwifery. A lay midwife typically learns through apprenticeships, classes, or midwifery workshops.

However, some lay midwives who wish to build a career in midwifery go on to become CPMs through a certification or associate's degree program.

According to Comparably , the median annual salary of a lay midwife is $54,201.

Lay midwife duties may include:

• Provide massages or baths
• Help the mother with breathing exercises
• Help during the delivery of babies outside hospital settings

Midwife vs Nurse Midwife: Key Takeaways 

Nurse midwife vs midwife differences lie primarily in their educational backgrounds, the scope of practice, and work settings. 

Midwives obtain their education through dedicated midwifery programs, which don’t require a nursing background. Many midwives work in out-of-hospital settings, including birthing centers and home births. They provide care to women who prefer a more natural and personalized approach to childbirth. 

On the other hand, nurse midwives begin as registered nurses and then pursue education and training through a graduate-level APRN midwifery program. Nurse midwives may practice in various settings, including hospitals, birthing centers, and clinics.

Nurse midwives also have a broader scope of practice as they possess both nursing and midwifery expertise. In addition to providing comprehensive care during pregnancy, childbirth, and postpartum, nurse midwives can offer women primary healthcare services throughout their lifespans. However, the scope of practice and regulations for midwives vs nurse midwives will vary depending on individual state regulations.

Sarah Jividen , RN, BSN, is a trained neuro/trauma and emergency room nurse turned freelance healthcare writer/editor. As a journalism major, she combined her love for writing with her passion for high-level patient care. Sarah is the creator of Health Writing Solutions , LLC, specializing in writing about healthcare topics, including health journalism, education, and evidence-based health and wellness trends. She lives in Northern California with her husband and two children. 

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Exemptions and Special Approvals

On this page..., special approval process.

An exemption application is available upon request. Licensees must apply for an extension or exemption before the renewal.

A licensee is exempt from continuing education requirements for the following conditions:

• A licensee claiming this exemption must show evidence of active duty upon request.
• An active licensee residing in another state that requires mandatory continuing education.
• A licensee claiming this exemption must show evidence of employment outside the United States upon request.
• A health care provider must sign the application confirming the disability or illness.

A licensee claiming an exemption must show a copy of the written approval upon request.

To request a medical exemption application, email us at [email protected] .

Special approvals provide the licensee an opportunity to use non-standard continuing education. This includes programs offered by a non-approved provider and address appropriate subject matter .

See Iowa Administrative Code 655 Chapter 5.2(5)  for a full list of approved providers. If your provider is NOT on the list, then you must submit a special approval application.

Submit special approvals during the renewal period to fulfill the requirements. Licensees must complete the educational offering before submitting a special approval application. Include the following with your application:

• Documentation of the date, time, location, and program title
• Purpose and objectives
• Intended audience
• Credentials of instructors
• Evidence of contact hours

Licensees must keep the above documentation and approval letter for license renewal. If denied, an appeal can be made to the board within 30 days of the denial.