One of California’s two packages for coaching nurse-midwives has stopped admitting college students whereas it revamps its curriculum to supply solely doctoral levels, a transfer that’s drawn howls of protest from alumni, well being coverage consultants, and college who accuse the University of California of placing earnings above public well being wants.
UC-San Francisco’s famend nursing faculty will graduate its remaining class of licensed nurse-midwives subsequent spring. Then the college will cancel its two-year grasp’s program in nurse-midwifery, together with different nursing disciplines, in favor of a three-year physician of nursing apply, or DNP, diploma. The change will pause UCSF’s practically 5 decades-long coaching of nurse-midwives till at the least 2025 and can greater than double the fee to college students.
State Assembly member Mia Bonta, who chairs the well being committee, mentioned she was “disheartened” to study that UCSF was eliminating its grasp’s nurse-midwifery program and feared the extra time and prices to get a doctorate would deter potential candidates. “Instead of adding hurdles, we need to be building and expanding a pipeline of culturally and racially concordant providers to support improved birth outcomes, especially for Black and Latina birthing people,” she mentioned in an e mail.
The swap to doctoral training is a part of a nationwide motion to require all advanced-practice registered nurses, together with nurse-midwives and nurse practitioners, to earn doctoral levels, Kristen Bole, a UCSF spokesperson, mentioned in response to written questions. The doctoral coaching will function extra courses in management and high quality enchancment.
But the motion, which dates to 2004, has not caught on the best way the American Association of Colleges of Nursing envisioned when it referred to as for doctorate-level training to be required for entry-level superior nursing apply by 2015. That deadline got here and went. Now, an acute want for maternal well being practitioners has some universities transferring within the different path.
This yr, Rutgers University reinstated the nurse-midwifery grasp’s coaching it had eradicated in 2016. The University of Alabama-Birmingham additionally restarted its grasp’s in nurse-midwifery program in 2022 after a 25-year hiatus. In addition, George Washington University in Washington, D.C., Loyola University in New Orleans, and the University of Nevada-Las Vagas added grasp’s coaching in nurse-midwifery.
UCSF estimates tuition and charges will value $152,000 for a three-year doctoral diploma in midwifery, in contrast with $65,000 for a two-year grasp’s. Studies show that 71% of nursing grasp’s college students and 74% of nursing doctoral college students depend on scholar loans, and nurses with doctorates earn negligibly or not more than nurses with grasp’s levels.
Kim Q. Dau, who ran UCSF’s nurse-midwifery program for a decade, resigned in June as a result of she was uncomfortable with the elimination of the grasp’s in favor of a doctoral requirement, she mentioned, which is at odds with the state’s workforce wants and pointless for scientific apply.
“They’ll be equally prepared clinically but at more expense to the student and with a greater time investment,” she mentioned.
Nurse-midwives are registered nurses with graduate levels in nurse-midwifery. Licensed in all 50 states, they work principally in hospitals and might carry out abortions and prescribe medicines, although they’re additionally educated in managing labor ache with showers, therapeutic massage, and different pure means. Certified midwives, in contrast, examine midwifery on the graduate degree exterior of nursing colleges and are licensed solely in some states. Certified skilled midwives attend births exterior of hospitals.
The California Nurse-Midwives Association additionally criticized UCSF’s program change, which comes amid a nationwide maternal mortality disaster, a severe scarcity of obstetric suppliers, and a rising reliance on midwives. According to the 2022 “White House Blueprint for Addressing the Maternal Health Crisis” report, the U.S. has the very best maternal mortality price of any developed nation and desires 1000’s extra midwives and different girls’s well being suppliers to bridge the swelling hole.
Ginger Breedlove, founder and CEO of Grow Midwives, a nationwide consulting agency, likened UCSF’s swap from grasp’s to doctoral coaching to “an earthquake.”
“Why are we delaying the entry of essential-care providers by making them go to an additional year of school, which adds nothing to their clinical preparedness or safety to serve the community?” requested Breedlove, a previous president of the American College of Nurse-Midwives. “Why they have chosen this during one of the worst workforce shortages combined with the worst maternal health crisis we have had in 50 years is beyond my imagination.”
A 2020 report revealed in Nursing Outlook failed to seek out that advanced-practice registered nurses with doctorates have been extra clinically proficient than these with grasp’s levels. “Unfortunately, to date, the data are sparse,” it concluded.
The American College of Nurse-Midwives additionally denounced the doctoral requirement, as have commerce associations for neonatal nurse practitioners and neonatal nurses, citing “the lack of scientific evidence that … doctoral-level education is beneficial to patients, practitioners, or society.”
There is not any proof that doctoral-level nurse-midwives will present higher care, Breedlove mentioned.
“This is profit over purpose,” she added.
Bole disputed Breedlove’s accusation of a revenue motive. Asked for causes for the change, she supplied broad statements: “The decision to upgrade our program was made to ensure that our graduates are prepared for the challenges they will face in the evolving health care landscape.”
Like Breedlove, Liz Donnelly, vice chair of the well being coverage committee for the California Nurse-Midwives Association, worries that UCSF’s swap to a doctoral diploma will exacerbate the dual crises of maternal mortality and a shrinking obstetrics workforce throughout California and the nation.
On common, 10 to 12 nurse-midwives graduated from the united states grasp’s program every year over the previous decade, Bole mentioned. California’s remaining grasp’s program in nurse-midwifery is at California State University in Fullerton, south of Los Angeles, and it graduated eight nurse-midwives final yr and 11 this yr.
More than half of rural counties within the U.S. lacked obstetric care in 2018, in line with a Government Accountability Office report.
In some elements of California, expectant moms should drive two hours for care, mentioned Bethany Sasaki, who runs Midtown Nurse Midwives, a Sacramento beginning middle. It has needed to cease accepting new purchasers as a result of it can not discover midwives.
Donnelly predicted the closure of UCSF’s midwifery program will considerably scale back the variety of nurse-midwives coming into the workforce and can inhibit folks with fewer assets from attending this system. “Specifically, I think it’s going to reduce folks of color, people from rural communities, people from poor communities,” she mentioned.
UCSF’s change may even probably undercut efforts to coach suppliers from various backgrounds.
Natasha, a 37-year-old Afro-Puerto Rican mom of two, has spent a decade making ready to coach as a nurse-midwife so she may assist girls like herself by being pregnant and childbirth. She requested to be recognized solely by her first identify out of concern of decreasing her possibilities of graduate faculty admission.
The UCSF program’s pause, plus the added time and expense to get a doctoral diploma, has muddied her profession path.
“The master’s was just the perfect program,” mentioned Natasha, who lives within the Bay Area and can’t journey to the opposite finish of the state to attend CSU-Fullerton. “I’m frustrated, and I feel deflated. I now have to find another career path.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation.
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