The Implications of Allowing Certified Nurse-Midwives to Practice Independently in North Carolina: One Solution for Combating the States' Health Care Worker Shortage
Creators: name: White, Brittany
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: National and state projections in the health care workforce show that the coming decades will reveal an inadequate supply of physicians to meet the health care demands of a growing and changing populace. Obstetrician-gynecologists are one specialty subset of physicians that currently does and will continue to fall short of service demand in North Carolina. One part of a multi-pronged solution to the projected physician shortage is to allow certified nurse-midwives (CNMs) to practice to the full extent of their education and training without state-mandated physician supervision for licensure. These providers are specialty trained and professionally certified to offer a wide variety of health care services to women and their families, from pregnancy and labor to primary care and gynecology. In North Carolina, CNMs are categorized as a class of advanced practice registered nurses (APRNs) who, pursuant to the Midwifery Practice Act of 1983, must provide care under the supervision of a licensed physician actively practicing obstetric medicine (Midwifery Practice Act, 1983). Lifting the physician supervision provision of the Midwifery Practice Act would enable CNMs to offer NC women greater access to high-quality maternity care, as well as alleviate projected shortages of primary care physicians anticipated in North Carolina by 2020 (North Carolina Institute of Medicine [NCIOM], 2007). For maternity care in particular, CNMs could help address the fact that, as of 2014, 31 NC counties had no obstetrician-gynecologist practicing in its borders, making access to high-quality women's health and labor care difficult to obtain in some areas (American Congress of Obstetricians and Gynecologists [ACOG], 2014). A 2015 study by Duke University found that allowing all APRNs, including CNMs, to practice without physician supervision would help NC residents to achieve better access to health care, maintain or improve the quality of the care they receive, and reduce some avoidable health care costs (Conover & Richards, 2015). To date, the North Carolina affiliate of the American College of Nurse-Midwives (NCACNM) has been working to pass new legislation that would modernize the statutory language concerning CNMs in North Carolina so that physician supervision would no longer be required. The largest hurdles NCACNM currently faces are a need to educate lawmakers and the public on how removing physician supervision would impact consumers and health care costs, as well as creating pathways for better CNM integration into the health care system. Legislative efforts would also be improved if there was sufficient research documenting shifts in maternal-child outcomes in states that had physician supervision requirements for CNMs removed. CNMs will also need to address health care issues that spur controversy in the state, including abortion care and home birth. Overall, allowing more trained and licensed health care providers to provide high-quality care to NC residents would represent a significant public health benefit to the residents of North Carolina.