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Future directions: A time for establishing goals and priorities
FUTURE DIRECTIONS:
A Time for Establishing
According to the ACNM’s 1977 study of nurse-midwifery in the United States, there are less than one thousand nurse-midwives currently practicing in this country. Although this number represents approximately 3% of a combined work force of nurse-midwives and physicians who are providing reproductive health care to American women and their families, nurse-midwives deliver only approximately 1% of the babies born in the United States. Even though our numbers are doubling every eight to ten years, it seems evident that we will continue to be a minority group of health-care providers for some time. Under such circumstances, what directions can we take that will maximize our impact on the American health-care system and best allow for our expansion both in numbers and in practice? With which forces must we align ourselves and which forces must we utilize to further the interests of our profession and of the health care of our clients? It is recognized that there is a growing consumer interest in seeking health care and providers that allow for participation in decision making,
philosophy of patient care. How many consumers, however, are aware that such services are available through nurse-midwives or have access to nurse-midwifery care? AIthough the media recently has given some attention to the nurse-midwife, often we find that the scope of our practice is not recognized by the public. Clearly there is a need for further education of consumers as to the modem image and practice of the nurse-midwife. We must also both individually and collectively align ourselves firmly with issues and other organizations which support this move towards consumer-oriented health care, a climate in which nurse-midwifery can only flourish. Invariably any discussion of forces affecting the future directions and availability of nurse-midwifery services touches on the area of legislation and the importance of influencing the legislative process to provide and protect policies which will allow for full participation by nursemidwives in the mainstream of the American health-care system. We must insure our inclusion in any proposals for a national health service or insurance plan and maintain channels through which our input can shape the quality of reproductive care provided through such plans. It
open communication, and avoidance of unnecessary invasive procedures-all basic aspects of our
Journal
of Nurse-Midwifery
l
Vol. 24, No. 3, May/June
1979
Goals and Priorities
is imperative that we be aware of and implement ways in which the scope of midwifery practice can be expanded and supported through the legislative process. If such tasks are to be accomplished by a relatively small group of health-care providers, such as ourselves, and a comparatively young organization, such as the American College of Nurse-Midwives, what forces can we best utilize to insure our goals? What strategies must we develop to cope with the intricacies of the media and the legislative power structures? Who can best represent us in these arenas? Obviously each individual CNM and member of the College has an obligation to be an ambassador to the public for nurse-midwifey. Opportunities to spread the word about our profession come frequently on a personal one-to-one level with people we meet and often on a larger scale with groups and organizations of interested listeners. Certified nurse-midwives who become involved in community activities and with political issues that relate to health care make a powerful statement about who nurse-midwives are and about their role as consumer advocates. As the ACNM officially
1
makes more public statements in support of important health-related issues, our consumers or potential consumers will have an even clearer image of modern nurse-midwives. The various committees of the ACNM, especially the Legislative Committee and the Publicity and Public Relations Committee, are effective groups for helping to shape a campaign for making nurse-midwifery a visible issue in the world of health-care politics and nursemidwives a viable and available alternative in the reproductive healthcare system. The Legislative Committee functions primarily to maintain a system of information pertinent to the legal status of nurse-midwifery practice in this country, to develop guidelines for evaluating and changing existing laws, to keep members apprised of national legislation relating to nurse-midwifey and maternal- child health, and to represent the College with other organizations or groups specifically concerned with legislation. Currently members of the ACNM Board and the ACNM Washington Task Force are also spending time meeting with legislators to interpret and support the interests of the College. The Committee tries to keep in touch with all the various legislative issues that affect the status of our profession, certainly a difficult task for even a dedicated group of volunteers. The Publicity and Public Relations Committee is charged to interpret to professionals and consumers services provided by the College, components of maternal and child health care, and the role of the certified nurse-midwife in the provision of quality health care. Such communication is provided primarily through exhibits, the speakers bureau, news releases, publications, and educational materials. Again, a demanding charge for a group of nurse-midwives most of whom also have full-time professional and personal commitments.
2
Obviously individual College members and our committees are the ones who will always be primarily responsible for clarifying our image as certified nurse-midwives and for promoting and protecting our professional interests. However, how long can we continue to expect such an important campaign to progress and to flourish without full-time, paid leadership? In the past few years there have been many individuals within the College who have spoken out in support of both a full-time president and the employment of a professional lobbyist to represent the ACNM in Washington. Both issues have been discussed and debated in local and national meetings of the College and in Board meetings. Ad hoc committees have been appointed to investigate the feasibility of such positions. Various questions have been raised among ACNM members with relation to the employment of a lobbyist. What specifically would such an individual do and would this indeed be a full-time position? What would be the preparation for such a job and would it be possible to find a CNM who could qualify? Can the College support such a person? If there should be a full-time ACNM president could this individual also act as our lobbyist? Peter Willson’s article, “Lobbying: Influencing the Decision-Makers” in the Fall, 1978 issue of the Journal of Nurse-Midwifery should answer many questions related to the functions and qualifications of a lobbyist. Although lobbying takes place on all levels throughout the political structure, the importance of having a skilled and actively involved individual representing our interests in Washington can be readily appreciated, especially at such a crucial time in history when issues that will shape the future of the American health-care system are being debated and decisions are being made that will profoundly affect the practice of nurse-midwifery in the United States. It seems vey
likely that among our diverse group within the College there is a certified nurse-midwife who could and would fill such a position either on a fulltime or part-time salaried basis. The need for a full-time ACNM president can hardly be debated any longer. If we want to continue to grow as a profession, there are many internal issues and goals which need vigorous, full-time leadership to delineate and implement them through comprehensive programs. There is an urgent need to further increase our numbers through the establishment of additional educational programs, to further develop new models for practice, and to constantly improve and expand our current models. Certainly no officer of the ACNM, either part or full-time, can accomplish such goals alone. Fulltime leadership, however, can be an effective force in moving our profession in the appropriate direction. A full-time president also can be a visible representative of nurse-midwifey in the public eye. Can we as members of ACNM afford either a full-time president or a lobbyist? Can we afford both or can we combine the two in one individual? Given our minority status in the health-care system and the urgent needs for expanding our profession both in numbers and in practice, it seems that we must make the financial commitment required to support active, full-time leadership. Ideally it seems that this would mean taking the leap and employing both a full-time president and a lobbyist who can work together to lead us through the maze of internal and external forces which will shape the future of our profession. We come from a history of reliance on dedicated, volunteer effort-a history which has produced a group of professionals who display commitment to their consumers and dedication to their ideals, but who frequently find themselves overcommitted and financially insecure. At a time when individual nurse-
Journal of Nurse-Midwifery
l
Vol. 24. No. 3. May/June
1979
midwives are struggling with modes of practice which require business, economic, managerial, and legal acumen, we must recognize a need
for professional leaders who are not overwhelmed by multiple demands on their time and energy, but who can channel their efforts into the
work of the College on a full-time salaried basis. Gail Sinquefield, C.N.M., M.S. Associate Editor
25thANNUAL MEETING AMERICAN COLLEGE OFNURSE-MIDWIVES SILVERANNIVERSARY CELEBRATION Radisson Hotel, Downtown Minneapolis, Minnesota May 10-15, 1980 The ACNM Program Committee invites CNMs and other health professionals to submit 250-300 word abstracts to be considered for presentation at the 25th ACNM Annual Meeting. Abstracts for the keynote address, educational sessions, workshops, panels, etc. are welcome. Deadline for submission August 1, 1979. Please send abstract to: Program Committee ACNM Headquarters 1012 14th Street, N.W., Suite 801 Washington, D.C. 20005
We regret to announce
the death of
Mary I. Crawford, C.N.M., Ed.D., April 1, 1979. A tribute to Dr. Crawford will appear in a subsequent
Journal of Nurse-Midwifery
l
Vol. 24, No. 3, May/June
1979
issue of JNM.
3
A Time for Establishing
According to the ACNM’s 1977 study of nurse-midwifery in the United States, there are less than one thousand nurse-midwives currently practicing in this country. Although this number represents approximately 3% of a combined work force of nurse-midwives and physicians who are providing reproductive health care to American women and their families, nurse-midwives deliver only approximately 1% of the babies born in the United States. Even though our numbers are doubling every eight to ten years, it seems evident that we will continue to be a minority group of health-care providers for some time. Under such circumstances, what directions can we take that will maximize our impact on the American health-care system and best allow for our expansion both in numbers and in practice? With which forces must we align ourselves and which forces must we utilize to further the interests of our profession and of the health care of our clients? It is recognized that there is a growing consumer interest in seeking health care and providers that allow for participation in decision making,
philosophy of patient care. How many consumers, however, are aware that such services are available through nurse-midwives or have access to nurse-midwifery care? AIthough the media recently has given some attention to the nurse-midwife, often we find that the scope of our practice is not recognized by the public. Clearly there is a need for further education of consumers as to the modem image and practice of the nurse-midwife. We must also both individually and collectively align ourselves firmly with issues and other organizations which support this move towards consumer-oriented health care, a climate in which nurse-midwifery can only flourish. Invariably any discussion of forces affecting the future directions and availability of nurse-midwifery services touches on the area of legislation and the importance of influencing the legislative process to provide and protect policies which will allow for full participation by nursemidwives in the mainstream of the American health-care system. We must insure our inclusion in any proposals for a national health service or insurance plan and maintain channels through which our input can shape the quality of reproductive care provided through such plans. It
open communication, and avoidance of unnecessary invasive procedures-all basic aspects of our
Journal
of Nurse-Midwifery
l
Vol. 24, No. 3, May/June
1979
Goals and Priorities
is imperative that we be aware of and implement ways in which the scope of midwifery practice can be expanded and supported through the legislative process. If such tasks are to be accomplished by a relatively small group of health-care providers, such as ourselves, and a comparatively young organization, such as the American College of Nurse-Midwives, what forces can we best utilize to insure our goals? What strategies must we develop to cope with the intricacies of the media and the legislative power structures? Who can best represent us in these arenas? Obviously each individual CNM and member of the College has an obligation to be an ambassador to the public for nurse-midwifey. Opportunities to spread the word about our profession come frequently on a personal one-to-one level with people we meet and often on a larger scale with groups and organizations of interested listeners. Certified nurse-midwives who become involved in community activities and with political issues that relate to health care make a powerful statement about who nurse-midwives are and about their role as consumer advocates. As the ACNM officially
1
makes more public statements in support of important health-related issues, our consumers or potential consumers will have an even clearer image of modern nurse-midwives. The various committees of the ACNM, especially the Legislative Committee and the Publicity and Public Relations Committee, are effective groups for helping to shape a campaign for making nurse-midwifery a visible issue in the world of health-care politics and nursemidwives a viable and available alternative in the reproductive healthcare system. The Legislative Committee functions primarily to maintain a system of information pertinent to the legal status of nurse-midwifery practice in this country, to develop guidelines for evaluating and changing existing laws, to keep members apprised of national legislation relating to nurse-midwifey and maternal- child health, and to represent the College with other organizations or groups specifically concerned with legislation. Currently members of the ACNM Board and the ACNM Washington Task Force are also spending time meeting with legislators to interpret and support the interests of the College. The Committee tries to keep in touch with all the various legislative issues that affect the status of our profession, certainly a difficult task for even a dedicated group of volunteers. The Publicity and Public Relations Committee is charged to interpret to professionals and consumers services provided by the College, components of maternal and child health care, and the role of the certified nurse-midwife in the provision of quality health care. Such communication is provided primarily through exhibits, the speakers bureau, news releases, publications, and educational materials. Again, a demanding charge for a group of nurse-midwives most of whom also have full-time professional and personal commitments.
2
Obviously individual College members and our committees are the ones who will always be primarily responsible for clarifying our image as certified nurse-midwives and for promoting and protecting our professional interests. However, how long can we continue to expect such an important campaign to progress and to flourish without full-time, paid leadership? In the past few years there have been many individuals within the College who have spoken out in support of both a full-time president and the employment of a professional lobbyist to represent the ACNM in Washington. Both issues have been discussed and debated in local and national meetings of the College and in Board meetings. Ad hoc committees have been appointed to investigate the feasibility of such positions. Various questions have been raised among ACNM members with relation to the employment of a lobbyist. What specifically would such an individual do and would this indeed be a full-time position? What would be the preparation for such a job and would it be possible to find a CNM who could qualify? Can the College support such a person? If there should be a full-time ACNM president could this individual also act as our lobbyist? Peter Willson’s article, “Lobbying: Influencing the Decision-Makers” in the Fall, 1978 issue of the Journal of Nurse-Midwifery should answer many questions related to the functions and qualifications of a lobbyist. Although lobbying takes place on all levels throughout the political structure, the importance of having a skilled and actively involved individual representing our interests in Washington can be readily appreciated, especially at such a crucial time in history when issues that will shape the future of the American health-care system are being debated and decisions are being made that will profoundly affect the practice of nurse-midwifery in the United States. It seems vey
likely that among our diverse group within the College there is a certified nurse-midwife who could and would fill such a position either on a fulltime or part-time salaried basis. The need for a full-time ACNM president can hardly be debated any longer. If we want to continue to grow as a profession, there are many internal issues and goals which need vigorous, full-time leadership to delineate and implement them through comprehensive programs. There is an urgent need to further increase our numbers through the establishment of additional educational programs, to further develop new models for practice, and to constantly improve and expand our current models. Certainly no officer of the ACNM, either part or full-time, can accomplish such goals alone. Fulltime leadership, however, can be an effective force in moving our profession in the appropriate direction. A full-time president also can be a visible representative of nurse-midwifey in the public eye. Can we as members of ACNM afford either a full-time president or a lobbyist? Can we afford both or can we combine the two in one individual? Given our minority status in the health-care system and the urgent needs for expanding our profession both in numbers and in practice, it seems that we must make the financial commitment required to support active, full-time leadership. Ideally it seems that this would mean taking the leap and employing both a full-time president and a lobbyist who can work together to lead us through the maze of internal and external forces which will shape the future of our profession. We come from a history of reliance on dedicated, volunteer effort-a history which has produced a group of professionals who display commitment to their consumers and dedication to their ideals, but who frequently find themselves overcommitted and financially insecure. At a time when individual nurse-
Journal of Nurse-Midwifery
l
Vol. 24. No. 3. May/June
1979
midwives are struggling with modes of practice which require business, economic, managerial, and legal acumen, we must recognize a need
for professional leaders who are not overwhelmed by multiple demands on their time and energy, but who can channel their efforts into the
work of the College on a full-time salaried basis. Gail Sinquefield, C.N.M., M.S. Associate Editor
25thANNUAL MEETING AMERICAN COLLEGE OFNURSE-MIDWIVES SILVERANNIVERSARY CELEBRATION Radisson Hotel, Downtown Minneapolis, Minnesota May 10-15, 1980 The ACNM Program Committee invites CNMs and other health professionals to submit 250-300 word abstracts to be considered for presentation at the 25th ACNM Annual Meeting. Abstracts for the keynote address, educational sessions, workshops, panels, etc. are welcome. Deadline for submission August 1, 1979. Please send abstract to: Program Committee ACNM Headquarters 1012 14th Street, N.W., Suite 801 Washington, D.C. 20005
We regret to announce
the death of
Mary I. Crawford, C.N.M., Ed.D., April 1, 1979. A tribute to Dr. Crawford will appear in a subsequent
Journal of Nurse-Midwifery
l
Vol. 24, No. 3, May/June
1979
issue of JNM.
3