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The Costs and Benefits of Nurse-Midwifery Education: Model and Application


  • Kathleen Fagerlund CRNA, PhD,

    Corresponding author
    1. Kathleen Fagerlund, CRNA, PhD, is a Clinical Associate Professor at the University of Minnesota School of Nursing, Minneapolis, MN, where she serves as the Program Director of the Nurse Anesthesia Area of Study. Dr. Fagerlund is a Professional Liaison member of the American Midwifery Certification Board.
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  • Elaine Germano CNM, DrPH

    1. Elaine Germano, CNM, DrPH, FACNM, is the Education Projects Manager for the American College of Nurse-Midwives in Silver Spring, MD. She has experience in midwifery education and public health administration and practices at Planned Parenthood of the Mid-Hudson Valley.
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University of Minnesota School of Nursing, 5–140 Weaver Densford Hall, 308 Harvard St. SE, Minneapolis, MN 55455. E-mail:


To promote nurse-midwifery education, it is important for educators to know the value students bring to clinical training sites and academic institutions, the value nurse-midwifery graduates bring to taxpayers who help support nurse-midwifery education, and the value an education in nurse-midwifery brings to the graduate. The first purpose of this study was to develop a model to include all costs and benefits of nurse-midwifery education to: 1) students; 2) clinical sites where nurse-midwifery students obtain clinical experience; 3) academic institutions that house nurse-midwifery education programs; and 4) others (most often taxpayers) who may contribute to nurse-midwifery education. The second purpose of the study was to develop a prototype nurse-midwifery education program to illustrate the use of the model. Considering the four entities together, the costs, benefits, and net benefits to society were estimated. Data were collected to estimate all costs and benefits to the four entities as they function within this prototypical program. For the prototype, all entities realize a net benefit from the investment in nurse-midwifery education. For society, the benefit-cost ratio is 1.57. Nurse-midwifery students show the highest benefit-cost ratio (2.05) of the four entities, followed by the clinical sites, others (primarily taxpayers), and academic institutions.