ACNM Re-Entry to Midwifery Practice

The following guidelines provide suggestions for re-entry to clinical practice for Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs).

Target Audience:

1. CNMs/CMs with current AMCB certification who need to refresh in a specific skill(s) or area(s) of clinical practice
2. Practice managers
3. Employers for CNMs/CMs

Requirements:

CNMs/CMs must have current certification and meet continuing education unit (CEU) requirements through the American Midwifery Certification Board (AMCB). Midwives who have not maintained their AMCB certification must first comply with AMCB requirements for re-certification prior to initiating guidelines for re-entry. State licensing, institutional, and employer requirements for credentialing and privileging must be addressed in the plan for re-entry to midwifery practice.

A detailed plan should be outlined based on the individual needs of the CNM/CM working on re-entry. This plan would include the individual requirements established by the facility. The plan should include what items are to be evaluated, or monitored, and how competency will be assessed. Individual clinical experience should be acknowledged in the development of a plan for re-entry to practice. For example, a newly certified midwife who has not practiced since graduation 3 years ago will need a different level of mentored clinical experience prior to independent practice than an experienced midwife who took some time off for other obligations. For this reason, it is essential that the re-entry program is tailored to the individual needs of the person being mentored and evaluated for competency. There are two main components to a plan for re-entry to midwifery practice:

1. Didactic information for updating clinical knowledge
2. Clinical education and experience

Didactic Information

Midwives seeking re-entry should evaluate their own level of knowledge with current evidence-based practice. There are several ways this can be achieved:

1. Current AMCB certificate maintenance module and CEU completion
2. A program developed with the employer to facilitate updating practice knowledge
3. A formal education program offered through an accredited midwifery educational program that offers didactic knowledge and verifies competency assessment for re-entry into midwifery practice. Please note that formal re-entry to practice midwifery education programs are not standardized, evaluated, or accredited by the Accreditation Commission for Midwifery Education. 

Clinical Experience

Clinical experiences are a required component of a re-entry to practice program.

1. The re-entry midwife may choose to enroll in a formal education program offered through an accredited midwifery educational program that offers clinical simulation and precepted clinical experiences, as well as verifies competency assessment for re-entry into midwifery practice. Midwives who choose not to enroll in a formal re-entry program should establish a relationship with a Clinical Mentor. The re-entry midwife should follow these guidelines for this relationship.
   
   a. Prior to the determination of required clinical skills, or once the required clinical skills are determined, the re-entry midwife must secure a clinical mentor who is available to guide the midwife through clinical observation and re-entry verification of competency.
   
   b. The clinical mentor may be a currently practicing CNM or CM, a physician in obstetrics and gynecology, or in another related specialty. For example, if a women's health nurse practitioner is highly skilled in care during menopause, some portion of the mentored time could be with the WHNP to facilitate re-entry time with that skill set.
   
   c. The clinical mentor must maintain licensure and certification in good standing during the entire period of re-entry clinical mentorship. The re-entry midwife should request and retain documentation of the licensure and certification, as well as professional liability insurance coverage of the clinical mentor.
   
   d. The re-entry midwife may choose to enter in a written agreement with the clinical mentor related to the re-entry process.
   
   
2. Identification of required skills
   
   a. Required skills and objectives for the re-entry into practice mentorship should be determined and documented. These items should include the number of clinical experiences as required by state and institutional regulation. This process may occur in collaboration with the clinical mentor and/or employer.
   
   i. Skills included in basic midwifery practice are listed in the ACNM Core Competencies for Basic Midwifery Practice.
   
   ii. Advanced skills should be achieved through the ACNM Expansion of Midwifery Practice and Skills Beyond Basic Core Competencies document.
   
   
3. Professional Liability Insurance
   
   a. It is the responsibility of the CNM/CM who is working on a re-entry to clinical practice program to ensure coverage by Professional Liability insurance during the mentored clinical experience.
   
   
4. Documentation of Re-Entry to Practice Program Completion
   
   The re-entry midwife is strongly encouraged to create a document that identifies the process and timeline for the expected acquisition of required clinical skills. The document should address the following items in the following fashion:
   

1. Goals for didactic and clinical experiences during the practice re-entry program should be identified at the outset of the experience and documented as they are obtained/completed.
2. The plan for re-entry should include state, institutional or employer requirements, and include specifically-identified didactic and clinical components to be achieved.
3. The CNM/CM participating in the re-entry into practice program must document the credentials of the clinical mentor(s) they are working with during the period of re-entry.
4. The re-entry CNM/CM should maintain a log of the clinical experiences obtained during the re-entry process.
5. The clinical mentor and re-entry midwife should agree upon and document a method of evaluation and verification of clinical competency by clinical mentor upon completion of the re-entry process.

The following table can be used as a sample to organize the re-entry process for a midwife and the clinical mentor.

Sample Re-entry Checklist

Revised and developed by the Education Policy section of the Division of Education of the ACNM: Megan Arbour, Chair, Katharine Green, Sharon Holley, Jane Houston, Kelly Walker, and Judie Wika, with staff support from Elaine Germano, ACNM Senior Education Policy Advisor.

Approved by the ACNM BOD: May, 2016.