DEFINITION

A certified nurse midwife is an individual

educated and licensed in the disciplines
of registered nursing and nurse midwifery
who possesses evidences of certification.
Certified nurse midwives are registered
nurses with advanced training in
midwifery that allows them to care for
expectant mothers and to provide a
range of clinical services for women.
SCOPE OF PRACTICE
Independent, comprehensive management of
womens health care in a variety of settings
focusing particularly on pregnancy, childbirth,
postpartum period, care of the infant and the
family planning and gynecological needs of
women throughout the life cycle
repared both academically and clinically to
provide a broad range of health care services
for women and newborns.

midwives functions include
diagnostic studies (history taking, physical
assessment,
ordering appropriate laboratory tests and
procedures),
therapeutic management (outlining care,
providing prescriptions, co -ordinating
consultations and referrals) and
health promotion and risk reduction activities.
assess and manage common illnesses in
adults.
legally allowed to write prescriptions

PRACTICE SETTINGS
Private outpatient practices
Health maintenance organizations
Hospitals
Health department
Free standing birth centres
REGULATION OF THE PROFESSION
Certified nurse midwives are regulated at two
different levels
1. Licensure: It is a process that takes place at the
state level.. The current trend is to require
Masters Degree preparation and National
certification.
2. Certification: It is established through a national
organisation and requirement for minimal
professional standards are made consistent.
National certification is required. Graduates of
nurse midwifery programme are eligible
LEGAL AUTHORITY FOR PRACTICE
i. Only registered nurses who have been certified as
certified nurse midwife may use the title Certified
Nurse Midwife.
ii. A certification programme involves up to 12 months
training while the Masters programme usually takes 2
years
iii. They are authorized to perform and repair
episiotomies and to repair first and second degree
lacerations of the perineum
iv. They can dispense, furnish or provide prescription for
antibiotic drugs to sexual partners of partners of a
patient with a diagnosed STD.
v. They can practice in collaboration with the physicians
DEFINITION
Three levels of clinical nurse specialist are
defined as below:
Clinical Nurse Specialist is a registered
nurse who holds a Masters Degree or a
Doctoral degree in nursing with expertise
in a clinical nursing specialty.
Clinical Nurse Specialist is a graduate
nurse with a specific clinical expertise who
engages in direct care, education,
research, leadership and consultation
Clinical Nurse Specialist is a registered
nurse who by virtue of her education and
expertise is providing comprehensive and
quality care to the patients.

CORE CONCEPTS OF THE ROLE OF CLINICAL
NURSE OR MIDWIFE SPECIALIST
Clinical focus:
The clinical practice role may be divided into two
categories: direct and indirect care.
Direct care comprises the assessment, planning,
delivery and evaluation of acre to patients and their
families.
Indirect care relates to activities that influences others in
their provision of direct care.
Patient care: The Clinical Nurse / Midwife Specialist
role involves communication, negotiation and
representation of the client/patient values and
decisions in collaboration with other professionals
and community resource providers.
Consultant: Inter and Intra disciplinary consultations
both internal and external are recognized as part of
the contribution of the clinical nurse specialist to the
promotion of improved patient management.

Education and training:
The Clinical Nurse / Midwife Specialist unit for
education and training consists of structured
educational opportunities to facilitate staff
development and patient education.
Each Clinical Nurse / Midwife Specialist is
responsible for his/her continuing education through
formal and informal educational opportunities thus
ensuring continued clinical credibility amongst
nursing, medical and paramedical colleagues.
Audit and research: Audit of current nursing practice
and evaluation of improvements in the quality of patient
care are essential. The Clinical Nurse / Midwife
Specialist must keep up to date with current relevant
research utilization. The Clinical Nurse / Midwife
Specialist must contribute to nursing research which is
relevant to his/her particular area of practice.
, etc.


Nomenclature: The nomenclature can be
given under two major headings:
System/disease and Portfolio. A few
examples are given as below:
System / disease: Cardio-pulmonary
nursing specialist, Oncology nursing
specialist, Orthopedic nursing specialist,
psychiatric nursing specialist, etc.
Portfolio: Intensive care nurse specialist,
Medical and surgical nursing specialist,
Neonatal nursing specialist, Maternity
nursing specialist
ROLE OF NURSE SPECIALIST
1. Provide specialist clinical care
2. Promote learning for patients and staff
3. Promote quality care
4. Contribute towards research
5. Ensure collaborative practice with
others
6. Assess and monitor patient progress
7. Administer therapeutic intervention
OBSTACLES FOR SPECIALISATION IN
NURSING
1. Lack of support from administration
2. Long working hours
3. Improper designation and carrier ladder
4. Role conflict and gender problems
5. Lack of assertiveness and accountability
6. Turnover of staff
7. Knowledge barrier and poor enthusiasm
8. Home situation
QUALITIES OF A CLINICAL NURSE
SPECIALIST
1. Possess scientific body of knowledge
2. Communication capabilities, verbal and in
written
3. Mature judgment and problem solving skills
4. Physical and psychological stamina
5. Analytical thinking abilities
6. Practical awareness
CRITERIA FOR CLINICAL NURSE /
MIDWIFE SPECIALIST / MIDWIFE
1. The person must be a registered nurse
2. The person must be registered in the division in which
the application is being made in exceptional
circumstances which must be individually appraised
the criterion may not apply
3. The person must have extensive experience and
clinical expertise, i.e. a minimum of 5 years post
registration experience following registration either in
midwifery or in the division of nursing in which the
application is being made including a minimum of two
years experience in the specialist area
4. The person must be competent i.e. the person
must have the ability to practice safely and
effectively fulfilling his/her professional
responsibility within his/her scope of practice
5. The person must demonstrate evidence of
continuing professional development
6. The person must be educated to higher diploma
level or above. If the appointed candidate is not
educated to higher diploma level, he/she must
undertake a contractual agreement to obtain a
relevant higher diploma. Credit must be given for
prior education, learning and experience.