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The Student Handbook for the Nurse-Midwifery Program at the University of Michigan. It includes information on the philosophy of the program, definition and scope of midwifery practice, academic advisor, absences, parking, information technology, written work, student code of conduct, didactic, grading, testing, modules, comprehensive exam, and clinical experience. The handbook aims to provide guidance and information to students enrolled in the program.
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You are a midwife; you are assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. You must take the leap, leap so that the mother is helped yet still free and in charge. When the baby is born, the mother will rightly say: we did it ourselves! The Tao Te Ching, 2500 Years Ago University of Michigan Nurse-Midwifery Student Handbook Updated August 2022
UM Nurse-Midwifery
UM Nurse-Midwifery Practice of Midwifery.^2 ACNM 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.^3 To maintain the designation of CNM or CM, midwives must be recertified ever 5 years through AMCB and must meet specific continuing education requirements. REFERENCES:
UM Nurse-Midwifery Fetoscopes In some clinical sites (particularly internationally) having a fetoscope (stethoscope designed for listening to the fetal heart beat) is beneficial. There are catalogs available, i.e., Moonflower Birth Supply, and they are available on amazon.com. Employment while in the Midwifery Program We recognize the need to support yourself and possibly your family, as well as accommodate the costs of your education or to maintain health benefits. If you are in the 3 year MSN or 4 year DNP program you have some flexibility for working during the first portion of your program. However, 2 year MSN, 3 year DNP and dual FNP/midwifery PNP/midwifery students need to plan to work very little if at all during their entire program. For all midwifery students, the final two clinical semesters have a very heavy clinical component and we strongly recommend you work as little as possible to get the best educational experiences possible and to be prepared to successfully complete the program requirements. There are factors, such as preceptor’s schedules and class days/times, that cannot be adjusted to accommodate student’s work schedules. The greater flexibility you have the more likely you are to accomplish the educational and clinical needs of the program. Students who work several days a week will have very limited options for clinical placements, as the site or preceptors may not be able to accommodate a particular day of the week. If your availability is very limited, it can also limit the options you have for a clinical placement. There is also drive time involved in the placements which require you to account for that in your schedule The UM Nurse-Midwifery program is fortunate to have a number of Preceptors that are exceptionally experienced and dedicated that are not in the Ann Arbor area so plan on commuting for at least one or more of your clinical experiences. For some of these sites this may require students to find accommodations near those sites. Finally, during the integration experience, it is expected that you are in clinical full time (mirroring the schedule of a full time CNM), thus holding a regular position outside of school is not possible. It is also noted that the rich clinical experiences that can be gained in some sites require you to be on call more than the actual clinical “hours” indicated for that clinical course. Outside work commitments can alter your ability to be placed in practices such a birth center setting or small midwifery practices. It is also expected that work commitments will not interfere with your ability to be in the classroom and the additional labs prior to the start of that clinical portion of your classes. This includes not working the night before class. Fatigue interferes with your ability to fully retain information and to participate in classroom discussions to assure you are clinically ready for the necessary experiences you will have in your clinical placements. We ask that you be in close communication with the program lead at the outset of the program and with the faculty for the clinical course you are enrolled in to assist in proactive planning to try to blend what we hope will not be two competing needs for employment and quality educational experiences.
UM Nurse-Midwifery Financial Aid The School of Nursing and University in general have multiple financial aid resources and services. During your admission process to the program, you will have gotten materials from the Financial Aid office. Your first step is to complete the FAFSA each year to then be considered for financial aid options. There is both need based support and scholarship and targeted recruitment support. There is also the Terri L. Murtland Scholarship offered each year to two midwifery students. The faculty will also provide you with links and emails about scholarship options and loan forgiveness opportunities as they become available. While the faculty works hard to stay on top of the many options that are available, we strongly encourage you to be in contact with the Financial Aid Office. https://nursing.umich.edu/admissions-aid/financial-aid Written Work The expectation is that students will be able to write at a graduate level. If writing is challenging for you, we strongly recommend you utilize the Sweetland Writing Center resources https://lsa.umich.edu/sweetland. The writing style for student papers, case studies and other assignments follows the guidelines of the latest edition of the Publication Manual of the American Psychological Association. These additional links include helpful information about using the APA style for course and / or research papers. http://www.apastyle.org/elecref.html. Student Code of Conduct Students are expected to abide by the code of academic conduct as written in the Graduate Student Handbook. This includes, but is not limited to, exams, written work, and use of computers, hospital information system and patient records, as well as nurse-patient relationships. DIDACTIC Classes/Seminars It is expected that students will attend all on-site lectures and seminars. It is extremely important that students arrive ON TIME for lectures and seminars in avoid disruptions to the class, faculty, and guest speakers who have come to support the program but may be on a very tight timeline. This means planning ahead for parking difficulties. Nurse-midwifery specialty courses follow the seminar format. Students are expected to come to class prepared having accomplished all the required reading. Although each objective may not be covered during the seminar, the student is responsible for all content covered in seminars and all objectives detailed in the syllabus/module. Students are expected to be prepared to participate in the discussion of all on-campus seminars and web discussions.
UM Nurse-Midwifery Students must pass all of the nurse midwifery exams with at least an 80%. If a student scores less than 80% they may, at the discretion of faculty, have the ability for a test re- take or have another alternative knowledge assessment to support the student’s continued progress in the course. Successful retake of the exam will only increase the score to 80% (regardless of how high the student scores on the retake) when it is factored into the final grade. The retake process confirms appropriate knowledge base and is not meant to allow students to improve their grade. One retake is allowed per exam and two retakes within a semester warrants a learning plan. This applies to each exam; midterm, final, and any interval examinations within the courses. Course Units Course syllabi and units of instruction are set up for mastery learning based on adult learning theory. The principles are as follows: Principles Governing Adult Learning Adults respond better in a non-threatening learning environment. Adults want to assess their progress against a relevant standard. Adults prefer to select their own learning experiences. Adults prefer a problem-oriented, patient-centered approach to learning, with an opportunity to apply their new-found knowledge to real situations. Students are strongly encouraged to contact the course faculty to clarify questions and concerns as they arise and in a timely manner. Comprehensive Exam In the last semester of the program, all students are required to take the nurse-midwifery comprehensive exam. The exam covers course content from the previous semesters in the midwifery clinical sequence of courses. This includes primary care, well person, family planning, antepartum, intrapartum, post-partum, newborn care, and professional issues. Pharmacology content specific to each of these areas is also included, as well as physical assessment evaluation of health conditions in each of these areas. It order to facilitate successful completion of board examinations students must pass the comprehensive exam with a grade of 80 % or higher. Successful completion of the exam is one of the criteria for completing the nurse-midwifery education program. If students score between 80% to 85% we strongly recommend students do the retake exam. Students may retake another version of the exam up to two times at an interval determined with the N faculty and Program Lead. Student Check-Out Before graduation, all students are required to “check-out” with the program lead. This may take varied forms, including a block of appointment times set aside in April, phone conferences after the exam period, and written program evaluations.
UM Nurse-Midwifery In order to be successfully “checked-out” students will:
UM Nurse-Midwifery For the final semester, clinical placements for Integration, N677, may be at out of state or international sites. If a site is desired that has not previously been offered, the clinical coordinator must be notified as soon as possible in order to negotiate a possible placement as contracts take time. Students going out-of-state for Integration sites may be required to obtain an RN license for that state. The faculty tries to have student Integration site plans confirmed before Thanksgiving, however this varies depending on locations desired and types of student placements being requested. Students are encouraged to begin the process of securing any additional licensure as soon as they know their integration site. Clinical Hours Midwifery education is competency based. The following clinical hours are the minimum required and in some cases students may need (or wish) to spend additional time in order to meet course objectives and ACNM competencies and guidelines for clinical experiences. The clinical hours follow: N546 ( Midwifery care during pregnancy and primary care ) Will be an average of 2 days per week. N676 (Intrapartum/Postpartum/Newborn) This may be in two blocks of time or on an “on call” of 24 to 48 hours call time per week and may include 8 hours of clinic (outpatient care – AP, or PP follow-up) time / week depending on the site. Days, nights, and/or weekends is nearly always a component of this time. N677 (Integration) = 36 - 40 hours/week Integration is a full time clinical commitment equivalent to 40 hours clinical time per week. Clinical will include weekends, on-call, and/or off shifts as schedules dictate. Clinical Performance Although we take into account the ACNM guidelines for number of clinical management experiences, we recognize that these are the minimum requirements and do not indicate skill mastery. Using a mastery approach, we do not count hours of clinical experience or assume that being part of particular care events accomplish mastery, but instead rely on the ongoing evaluations of the preceptors and course faculty during site visits to verify the competency of the students in the clinical environment. Students are encouraged to acquire experiences beyond the minimum requirements, but may need fewer if they already have some practice competencies, such as a post-master’s nurse practitioner or an individual who has been educated and practiced as a midwife in another country. Overall we use a competency based approach, so while the clinical hours and experiences are guidelines, we use evaluation of your skills as the primary determination for completion of a particular course and the program overall. Clinical Experiences This is the minimum recommended number to Be Completed by the End of the Nurse Midwifery Program Minimum Clinical Experiences (ACME 2019):
UM Nurse-Midwifery
UM Nurse-Midwifery The American Midwifery Certification Board (AMCB) Certification Exam The Nurse-Midwifery Program Lead must recommend each student, without reservation, to the American Midwifery Certification Board to write the examination. This recommendation is made based upon 1) satisfactory completion of the nurse-midwifery program of study, 2) passing the comprehensive examination, and 3) check-out. Students will not be eligible to sit for the certification exam until all three of the previous components are completed successfully. Students should access the AMCB booklet, Information for Candidates, and an application on the web at http://www.amcbmidwife.org. The exam is usually offered via computers in all states. The cost of the exam is currently $500.00 (this can change so please refer to the AMCB website at www.amcbmidwife.org). This fee must be paid in full at the time of application by cashier’s check, certified check, or money order. The national AMCB Office address is: American Midwifery Certification Board 849 International Drive, Suite 205 Linthicum, MD 21090410 - 694 - 9424 410 - 694 - 9425 (fax) ACNM State Affiliate The ACNM state affiliate group meets at varying locations three times a year. Information about upcoming meetings will be sent via email and on the Facebook group. If you are a member of the ACNM and have a Michigan address you will be on the Listserve to get emails from the Michigan Affiliate. You may also ask to join the Facebook Group: “Michigan Affiliate of the ACNM”. The leadership includes two students on its board. The state affiliate also has an annual winter “forward” where it awards Nurse-Midwifery Student Scholarships to attend the ACNM national meeting. These scholarships are chosen at random – the eligibility requirements are that you are a member and you must be present to win. Students are strongly urged to attend, as is it a great way to meet other students, CNMs around the state, and have some time to relax while also getting CEUs. ACNM Annual Meeting The faculty encourages students to attend the ACNM Annual Meeting, which is held each year in the spring. No nurse-midwifery classes are held during the week of the Annual Meeting. The total cost depends on whether you share a room, how far away from Michigan the meeting is, and how long you decide to stay. Most students share accommodations, which is part of the fun of attending the Annual Meeting. You can apply to act as a page or assist with the meeting to receive a reduced registration fee or the ability to attend a workshop for free. A student representative is selected from each Midwifery Education program. They participate in developing a report with the students from the other midwifery programs that one of the student representatives reads to the entire Annual Meeting attendees. The student representative brings concerns/issues from the students in each program to student meetings at the Annual Meeting
UM Nurse-Midwifery for inclusion in the report. This report is taken very seriously and carries weight with both the Board of Directors, and membership. An additional student leadership opportunity is as the School student member of the ACNM Government Affairs Committee. This student participates in disseminating information about legislative activity and advocacy work to promote midwifery practice and the health care of women and their families. The student who is in this role the prior year will ask for volunteers for this position as they graduate or you can ask your advisor for more information.
Appendix A - ACNM Philosophy We, the midwives of the American College of Nurse-Midwives, affirm the power and strength of women and the importance of their health in the well-being of families, communities and nations. We believe in the basic human rights of all persons, recognizing that women often incur an undue burden of risk when these rights are violated. We believe every person has a right to:
Appendix B—ACNM Core Competencies ACNM Core Competencies for Basic Midwifery Practice The Core Competencies for Basic Midwifery Practice include the fundamental knowledge, skills, and abilities expected of new midwives certified by the American Midwifery Certification Board (AMCB). They serve as guidelines for educators, students, health care professionals, consumers, employers, and policymakers. The Core Competencies constitute the basic requisites for graduates of all midwifery education programs pre-accredited or accredited by the Accreditation Commission for Midwifery Education (ACME). They are inclusive of the hallmarks of midwifery practice. Midwifery practice is based on the Core Competencies for Basic Midwifery Practice , the Standards for the Practice of Midwifery, the Philosophy of the American College of Nurse- Midwives, and the Code of Ethics developed and disseminated by the American College of Nurse-Midwives (ACNM). Midwives certified by the AMCB assume responsibility and accountability for their practice as primary health care providers for the individuals they serve as defined in the Definition of Midwifery and Scope of Practice of Certified Nurse- Midwives and Certified Midwives. ACNM defines the midwife’s role in primary health care based on the Institute of Medicine’s report, Primary Care: America’s Health Care in a New Era (1) the Philosophy of the American College of Nurse-Midwives (2) and the ACNM position statement, “ Midwives are Primary Care Providers and Leaders of Maternity Care Homes. ” (3) Primary health care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing the majority of health care needs, developing a sustained partnership with clients, and practicing within a context of family and community. As primary health care providers, midwives certified by AMCB assume responsibility for the provision of and referral to appropriate health care services, including prescribing, administering, and dispensing of pharmacologic agents. The concepts, skills, and midwifery management processes identified in the Core Competencies form the foundation upon which practice guidelines and educational curricula are built. Midwives provide health care that incorporates appropriate consultation, collaborative management, and/or referral, as indicated by the health status of the individual. ACNM endorses that health care is most effective when it occurs in a system that facilitates
