Dr. Fawcett is right to underscore the need for research in nurse-midwifery; her emphasis on replication studies seems particularly sound. This companion editorial, therefore, is not meant to contest her point of view but to supplement it from a somewhat different perspective.
It is indisputable that nurse-midwifery needs to foster more qualitative and quantitative research among its practitioners. But it is an important step, one with a number of implications; and before nurse-midwives jump aboard the “research bandwagon” en masse, there are questions to be addressed and problems to be anticipated.
We need to recognize, first and foremost, that not everyone is equally equipped to do good research. Some individuals are excellent clinicians while lacking the skills so essential to becoming competent researchers. This is not to say, however, that the vast majority of CNMs could not be educated to assume increased research responsibilities. But it does raise some vital questions. What academic preparation should faculty, students, and clinicians have prior to doing and teaching research? Should all nurse-midwifery educational programs alike offer research and statistics courses? If so, what percent of the varied curricula should be research-oriented? What types of research should CNMs be undertaking? Should nurse-midwives engaged in research remain generalists or become subspecialized? Is there a danger that those clinicians or educators who are not inclined toward research might feel pressure to turn out publications? Might our profession succumb to the pitfall of ascribing greater recognition to the quantity of published studies rather than the quality of the research? These are certainly not insurmountable problems, but they at least warrant some thought and reflection.
The second thing to remember is that we have a limited number of nurse-midwives, who in turn have a limited number of hours which they can devote to their profession, not to mention the limitation of financial resources. There is no question that research involvement by nurse-midwives-at-large will have an impact on nurse-midwifery clinical practice. Like it or not, the quantity of patient contacts is often the measure of CNM employment feasibility. We must consider the cost/benefit of nurse-midwifery research as it applies to the profession, to the consumer, to government and to private industry. What about the time and economics involved in seeking research grants, in carrying out the research design and in publishing the study? Should employers of CNMs earmark a certain percent of salary and/or time for research activities? Is there a danger that the nurse-midwife's first level of accountability could shift from the consumer she serves to the sponsor of her research? Could the CNMs deep commitment to meeting the needs of the consumer become inadvertently diluted by her strict adherence to a research design? The CNM engaged in clinical research must be ever mindful of the need for informed consent.* There are implications–both obvious and not so obvious–as to who financially backs the research, e.g., employer, government, private industry, or nonprofit organizations. Could the source of funding influence the degree of freedom the researcher is permitted, both in conducting the research as well as in publishing it? Again, these are all issues that need not intimidate potential nurse-midwife researchers. It is strongly recommended, therefore, that the American College of Nurse-Midwives Research and Statistics Committee join forces with the Education, Clinical Practice and the Continuing Education Committees in order to develop specific guidelines for seeking research grants, for implementing research designs and for the subsequent publication of research papers.
Our profession will, hopefully, never be ruled by such imperatives as “publish or perish.” On the other hand, nurse-midwifery research should not be denigrated or subordinated. Far from it: we want the best research, done by those who are best equipped to do it. We need good researchers, insulated from the pressures of business and government, holding up the theoretical side of our profession, and good practitioners advancing the frontiers of practice. Those who can do both should, of course, be encouraged to do so. But we must not overlook the fact that different skills and problems attend each area, and that our supply of time and resources is not unlimited. A balance can and will be struck. We trust that our readers will reflect on the issues outlined in these two editorials in order to find the proper balance.