RECERTIFICATION IN NURSE-MIDWIFERY: A Critical Analysis of Use of a Written Examination


  • Judith T. Fullerton PhD, CNM,

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    • Judith T. Fullerton, PhD, CNM, is the test consultant to the American College of Nurse-Midwives' Division of Examiners. She received her BSN from Wayne State University, her MS and Certificate in Nurse-Midwifery from Columbia, and her PhD in Health Education (Health Administration tract) from Temple University. She is currently Associate Clinical Professor, University of California, San Diego, School of Medicine and UCSD Coordinator of the UCSF/UCSD Intercampus Graduate Studies Program, which offers a program of nurse-midwifery studies.

  • Joyce E. Thompson DrPH, CNM, FAAN

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    • Joyce E. Thompson, DrPH, CNM, FAAN, is the Chairperson of the Division of Examiners, American College of Nurse-Midwives. She received her BSN and MPH from the University of Michigan, Ann Arbor, her Certificate in Nurse-Midwifery from Maternity Center Association, and her DrPH in Population and Family Health from Columbia University. She is currently Associate Professor and Director of the Graduate Program in Nurse-Midwifery at the University of Pennsylvania School of Nursing, Philadelphia.

UCSD Coordinator, UCSF/UCSD Intercampus Graduate Studies, University of California, San Diego (T-009), La Jolla, CA 92093.


The Division of Examiners of the American College of Nurse-Midwives (ACNM) conducted a study to determine the feasibility of using an entry-level certification examination as a tool for reassessment of cognitive competency. A current valid and reliable form of the ACNM national certification examination was administered to a sample of midcareer nurse-midwives, stratified according to years since first examination and focus of employment. The effects of selected demographic variables on examination outcome performance were assessed. Interpretation of the data was limited by the effect of small sample size and by the volunteer nature of the sample itself. Data did seem to suggest that focus of employment had the most relevant effect on examination score. The failure rate was higher for the recertification subjects than for the control group of entry-level candidates. The recertification group represented a norm group significantly different from the norm group of first-time candidates. Conservative interpretation of these data suggests that further consideration should be given to reassessment of competency over time, and that the entry-level certification examination can be used as a tool for reexamination.