The Research and Statistics Committee of the American College of Nurse-Midwives is to be congratulated for completing the monumental project, “Nurse-Midwifery in the United States: 1982.” This fifth report is the most comprehensive of a series presenting the who, what, where, when, and how of nurse-midwives in the United States. As part of the current study, the committee distributed a survey questionnaire to 2218 nurse-midwives in the United States and abroad. Completed questionnaires were returned by 1684 participants, and the findings from this study were distributed recently to the ACNM membership. All nurse-midwives should read the survey carefully to familiarize themselves with the most up-to-date information about nurse-midwives and nurse-midwifery in the United States.
This editorial will focus on specific data from the study for the purpose of calling attention to the employment status of nurse-midwives, trends in the practice of nurse-midwifery, and selected items of general interest.
According to the study findings, 88.1% of the participants who completed the questionnaire indicated that they were employed and two-thirds were practicing nurse-midwifery. Overall, 98.9% of the respondents stated that they had practiced clinical nurse-midwifery at some time after they completed their basic program.
It would have been helpful if the report had addressed the following questions in more detail. Did a relationship exist between academic preparation of nurse-midwives and their employment status? Were nurse midwives who graduated from masters degree programs more likely to be employed than those whose basic preparation took place in a certificate program? If so, in what capacity? Were younger nurse midwives more likely to be employed than older nurse midwives? If so, in what capacity? Was the chronologic age when respondents completed their nurse-midwifery studies a factor in their employment? What about employment trends among nurse-midwifery graduates of various decades?
One would expect that a higher percentage of nurse-midwives who held masters and doctoral degrees would be employed than those who did not. When the data were looked at more closely, it became apparent that almost identical numbers of nurse-midwives who held diploma/associate degree, baccalaureate, and masters degrees were employed in some capacity (88.2, 88.5, and 88.6%, respectively). The number who were employed in nurse-midwifery clinical practice did not vary markedly (66.2, 68.4, and 64.8%) within this same group. In contrast, nurse-midwives who held doctoral degrees (excluding MD) had the highest rate of employment (92.6%) and at the same time the lowest incidence of employment of all groups in nurse-midwifery clinical practice (34%). In what positions were these academically well-prepared nurse-midwives functioning? Were their contributions to nurse-midwifery indirect, ie, educational administration, research, consultation? What are the implications for gathering data in future surveys?
Whether basic preparation took place in a certificate program or at the masters level, the number of participants who indicated that they were employed at the time of the study did not vary significantly. Respondents whose basic nurse-midwifery preparation took place at the masters level were employed more frequently than those whose basic preparation took place in certificate programs (69.6 versus 64.0%). What implications are there for recruitment? Are the data sufficient to favor one program over the other?
Among survey participants who completed their nurse-midwifery program from 1950 to 1959, a large number were still employed (77.9%) at the time of the survey, although 26 to 35 years had lapsed since graduation. In this particular group, 26.7% were employed in nurse-midwifery clinical practice. Of those respondents who completed their nurse-midwifery program from 1960 to 1969, 89% were employed, and 40.7% of those working were employed in nurse-midwifery clinical practice. During the decade of the seventies, a very large number of nurse-midwives were prepared. Of the 847 who completed the survey questionnaire, 90.2% were employed, and 73.2% of those employed were practicing nurse-midwifery. No data were available to determine whether employment of any of the groups was part-time or full-time.
A consistently high rate of employment was evident in all age groups. In the 25- to 29-year-old group, the number who responded that they were employed was almost identical to that in the 45- to 49-year-old group (88.2 versus 88.6%). As might be expected, there was a sharp drop in employment for the 65 year and older age group. Nevertheless, 61.6% of this group were still in the workforce, and 36.6% of those working were practicing nurse-midwifery. What then, are the implications for addressing the availability of retirement benefits to nurse-midwives in future surveys? What long-term benefits do practitioners who remain in the workforce accrue? Could this be a factor in the type of employment chosen?
The number of nurse-midwives practicing nurse-midwifery was not distributed evenly through the age groups. A gradual decline was reported from a high (81.4%) in the 25- to 29-year-old group to a low of 33% in the 50- to 64-year-old group. Nevertheless, there has been a gradual rise in the number of nurse-midwifery practitioners each decade from the 1950s through the 1970s (26.7, 40.7, and 73.2%, respectively) Among respondents who graduated from their nurse-midwifery program from 1980 to 1982 (the last group for whom data were available), 80.1% of those employed were practicing nurse-midwifery. Interestingly, 16 male nurse-midwives completed the survey questionnaire and all are employed in nurse-midwifery clinical practice. Does this have implications for recruitment? What factors encourage nurse-midwives to practice, nurse-midwifery over their lifetime? What support systems are available to counter the “burnout” that some respondents named as a problem? What factors make other kinds of employment attractive? What positive outcomes can result when nurse-midwives choose other types of employment?
It is fascinating to note the tenacity with which some nurse-midwives believe that all CNMs should be practicing nurse-midwifery. Would this be to our advantage? Would our profession have thrived over the past three decades without nurse-midwives in key positions to exert their influence and secure funding for nurse-midwifery clinical services and educational programs? Would the number of nurse-midwives have grown over the past 30 years without the nurse-midwives who were administrators and educators developing programs to teach nurse-midwives? Would nurse-midwives have made the sweeping legislative changes without the help of nurse-midwives who were lawyers and lawyers who were friends of nurse-midwifery? Would nurse-midwifery be in the enviable position as consumer advocates without the assistance of researchers who designed studies which objectively evaluated the safety of nurse-midwifery care? Would the number of CNMs have grown without the recruitment efforts of nurse-midwives who were involved at all levels of nursing education? Some of the nurse-midwives who have made great contributions to our profession did not establish themselves as clinical practitioners. Rather, they emerged as individuals whose vision enabled them to see nurse-midwifery's place encompassing consumer interests, the health care system, and health economics. These are the individuals whose talent and genius enabled them to ignite nurse-midwives and nurse-midwifery and make them thrive rather than survive.
The brief section of the survey entitled, “Trends in United States Nurse-Midwifery” presents comparisons from the surveys conducted in 1963, 1969, 1971, 1976 to 1977, and 1982. The growth in nurse-midwifery, which has taken place from the 1976 to 1977 survey to the current one, has been phenomenal.
Each of the members of the Research and Statistics Committee deserve recognition with special kudos to Constance Adams, Project Director. The product of their efforts is outstanding.