AWHONN Position Statement
An official position statement of the Association of Women's Health, Obstetric and Neonatal Nurses.
This position statement was previously three separate statements: Doctorate of Nursing Practice, Education for Entry into Professional Nursing Practice, and Inclusion of Maternal/Newborn Content in Schools of Nursing. The three statements were combined, revised, and approved by the AWHONN Board of Directors, November, 2013.
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The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) supports the requirement of a baccalaureate degree in nursing as the minimum educational preparation for entry into professional nursing practice. All academic nursing programs should incorporate didactic content in maternal, newborn, and child health along with guided clinical experience. AWHONN also encourages nurses to pursue higher levels of education and training beyond a baccalaureate degree as a means of career development and growth. All nurses should practice to the full extent of their education and training.
Baccalaureate Degree as Entry into Practice
Unlike other health professions, nursing is unique in that there are several basic educational pathways to entry-level professional practice (American Association of Colleges of Nursing [AACN], 2012). While identifying the optimal educational pathway for entry into practice has long been debated, research suggests that there is link between patient outcomes and nursing education. For example, patients experience lower rates of mortality and failure-to-rescue (deaths following a major complication) in hospitals with higher proportions of registered nurses educated at the baccalaureate level (Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Friese, Lake, Aiken, Silber, & Sochalski, 2008; McHugh et al., 2013). In an effort to reduce adverse outcomes for patients, the Institute of Medicine (IOM) and many policy experts recommend moving to a nursing workforce in which a higher proportion of registered nurses are required to have at least a baccalaureate-level education (IOM, 2010).
Professional nursing practice encompasses a wide variety of populations, settings, and skills. Baccalaureate nursing programs include all of the course work taught in associate degree and diploma programs as well as additional and more comprehensive content related to leadership, nursing research, evidence-based practice, population health, disease prevention, interprofessional communication and collaboration, and the humanities (IOM, 2010). This information is essential for nurses to effectively navigate an increasingly complex healthcare environment.
The social, cultural, developmental, and economic context of patients’ lives can make providing individualized, high-quality nursing care challenging. In addition, science and technology in the health care setting are rapidly evolving, and new developments in areas such as health information technology, stem cell research, and genomics require nurses to acquire new knowledge and skills at a similar pace. Baccalaureate nursing programs instill the analytical and critical thinking skills required to appropriately respond to these changes.
In order to achieve the goal of amassing more registered nurses educated at the baccalaureate level, AWHONN encourages academic institutions to establish systems that allow seamless academic progression for nurses who choose to pursue higher levels of education (IOM, 2010).
Maternal and Newborn Content
Maternal and newborn nursing education is necessary for entry-level competency. Childbirth is the primary reason for hospitalization in the United States (Russo, Wier, & Steiner, 2009). The majority of women in the United States become pregnant at some point in their lives, and providing high quality, safe care for these women and their families before, during, and after pregnancy is crucial to the overall health of the nation.
Further, women of childbearing age, pregnant women, breastfeeding mothers, and newborns routinely require care in venues outside of maternal/newborn specific areas. Such settings may include emergency rooms, medical-surgical units, psychiatric care environments, operating rooms, ambulatory care units, and community or public health–based venues. Registered nurses who do not work in the perinatal setting but who provide care for women elsewhere should be aware of the implications that diseases, physical and psychosocial trauma, medications, and other medical-surgical management can have on women of childbearing age and on the health of a fetus or newborn. Because women and newborns receive care in various settings, all nurses need at least basic didactic and clinical preparation in maternal and newborn nursing to appropriately care for them.
Graduate Nursing Education
AWHONN recognizes that masters and doctoral programs in nursing bring unique value to nursing practice and the science that informs that practice. Graduate nursing education often provides more opportunities for nurses to conduct research, work in nursing administration or health systems leadership, work in academia or informatics, and provide higher levels of direct patient care.
Four roles are available for registered nurses who choose to become advanced practice registered nurses (APRNs): nurse practitioner, certified nurse-midwife, clinical nurse specialist, and certified registered nurse anesthetist. In order for an individual to practice in an APRN role, she/he must complete an accredited graduate program, pass a certification examination (when required by state law), and obtain a license or registration in one of the four APRN roles.
The four types of APRNs may also pursue a clinically-focused doctoral degree in nursing practice (DNP). AWHONN supports the range of doctoral nursing programs (PhD, DNP, DNSc) but does not believe that a DNP should be required for entry into practice for APRNs. Substantial empirical evidence demonstrating that DNP prepared nurses provide higher quality, more cost effective care than their master's prepared counterparts should exist before such a change is made.
Scope of Practice
Regardless of their levels of education, baccalaureate, master's or doctoral preparation, nurses should practice to the full extent of their education and training. Laws and regulations guiding a nurses’ scope of practice are defined at the state level. As a result, what a nurse may do in a clinical setting is not entirely dependent on education or training but instead on geographic location and the political climate of the state. Because of the variations in state regulations related to scope of practice, states are encouraged to evaluate and expand their scope of practice laws to permit all nurses to practice to the full extent of their education and training.
Further, the federal government can play a key role in helping to eliminate certain scope of practice barriers through reimbursement policies that include all APRNs. Additionally Centers for Medicare and Medicaid Services (CMS) can provide opportunities for the implementation of demonstration projects utilizing evidence-based APRN services that support quality and cost effective outcomes. This evidence may expand the support for maximizing the scope of practice of the ARPN and improve reimbursement policies for APRNs in the public and private sectors.