RN apprentice with DEM?

533 Views 13 Replies 5 Participants Last post by Valerie, Apr 18, 2006

rnchrista

Discussion Starter · Apr 16, 2006

Hi. Wonder if anyone knows the answer or has some suggestions?

Non nurse midwifery is alegal in my state, so midwives don't have licensure.
If I were to consider an apprenticeship position with a DEM, could that impact my nursing license? Technically I'd be the only "licensed" person at a birth...so would I be accountable for the mw's actions, even though I'm the student? Could I loose my nursing license for practicing medicine without a license? And what does practicing medicine without a license constitute, anyway? would that include FHTs, labor support, VEs, catching?

This is the only thing that is holding me back....the legal concerns. Of course I recently read From Courtroom to Calling and that made it worse!
Otherwise everything has seemed to just drop in my lap. AAMI had a great discount on their Intro to Midwifery class, a local mw offered me an apprenticeship, and someone offered to be an on call sitter. I didn't even search any of this out! I had not planned on apprenticing quite yet but everything has just really come together and im wondering if someone is trying to tell me something LOL.

I did post this question on a nursing board and got a lot of negativity. Everyone told me to stay away from it. HOWEVER....Im wondering if their opinion comes more from their medical model of birth/homebirth fear rather then legal ramifications.

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Midwife Kris

· #2 · Apr 16, 2006

Probably the best thing to do is contact your state's nursing board and find out if there is anything excluded from your license. Here in CO, we can't be any kind of nurse AND a DEM at the same time (but can be CNM) because two different boards govern us.

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Valerie

· #3 · Apr 16, 2006

Quote:

Originally Posted by rnchrista
Hi. Wonder if anyone knows the answer or has some suggestions?

Non nurse midwifery is alegal in my state, so midwives don't have licensure.
If I were to consider an apprenticeship position with a DEM, could that impact my nursing license? Technically I'd be the only "licensed" person at a birth...so would I be accountable for the mw's actions, even though I'm the student? Could I loose my nursing license for practicing medicine without a license? And what does practicing medicine without a license constitute, anyway? would that include FHTs, labor support, VEs, catching?

Having been down that rather unfortunate road, I can assure you that YES -- you could lose your nursing license for practicing beyond its scope. Even though you are a student, what adminstrative agencies do is to look at your actions. That is to say, are you doing things that are reserved to the practice of medicine or advanced practice nursing?

Quote:

This is the only thing that is holding me back....the legal concerns. Of course I recently read From Courtroom to Calling and that made it worse!

Well, we hoped that it would make it better in some ways, by making midwives more informed about the potential consequences of their actions. Informed consent and all, you know...

Quote:

Otherwise everything has seemed to just drop in my lap. AAMI had a great discount on their Intro to Midwifery class, a local mw offered me an apprenticeship, and someone offered to be an on call sitter. I didn't even search any of this out! I had not planned on apprenticing quite yet but everything has just really come together and im wondering if someone is trying to tell me something LOL.

It sounds like a wonderful opportunity.

Quote:

I did post this question on a nursing board and got a lot of negativity. Everyone told me to stay away from it. HOWEVER....Im wondering if their opinion comes more from their medical model of birth/homebirth fear rather then legal ramifications.

It is hard to sort out their personal feelings from their general negativity about midwife-attended homebirth. But the truth of the matter is that your RN gives your state administrative agency a bit more of a "leash", and if they decide they don't like what you are doing, they are likely to use that leash to rein you in a bit (or more than a bit). What state are you in?

Valerie
Illinois

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rnchrista

Discussion Starter · #4 · Apr 17, 2006

Quote:

Originally Posted by Valerie

It is hard to sort out their personal feelings from their general negativity about midwife-attended homebirth. But the truth of the matter is that your RN gives your state administrative agency a bit more of a "leash", and if they decide they don't like what you are doing, they are likely to use that leash to rein you in a bit (or more than a bit). What state are you in?

Valerie
Illinois

Here is the main reason Im hesitant about contacting the state board of nursing...I dont want to be under their radar if I do decide to apprentice.
I just cant believe being a nurse is actually hindering my situation right now.

I'm in Michigan. Even though its alegal, it seems to be a pretty friendly mw state...at least I havent heard of any problems.

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rnchrista

Discussion Starter · #5 · Apr 17, 2006

Quote:

Originally Posted by Valerie
Having been down that rather unfortunate road, I can assure you that YES -- you could lose your nursing license for practicing beyond its scope. Even though you are a student, what adminstrative agencies do is to look at your actions. That is to say, are you doing things that are reserved to the practice of medicine or advanced practice nursing?

Valerie
Illinois

do you mind sharing what happened when you traveled that road?

Christa
www.birthnetwork.org

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rnchrista

Discussion Starter · #6 · Apr 17, 2006

Quote:

Originally Posted by metromidwife
Probably the best thing to do is contact your state's nursing board and find out if there is anything excluded from your license. Here in CO, we can't be any kind of nurse AND a DEM at the same time (but can be CNM) because two different boards govern us.

thanks for the info! I had thought about the CNM route....and I may go that route if its my only option but I'd rather not

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Valerie

· #7 · Apr 17, 2006

Quote:

Originally Posted by rnchrista
do you mind sharing what happened when you traveled that road?

Christa
www.birthnetwork.org

Not at all, though since you said you read From Calling to Courtroom, you can probably get the gist from the bio in the back of the book:

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Valerie Vickerman Runes, a former RN/CPM, has received two Cease and Desist orders from the State of Illinois, and has been involved in administrative, circuit, and federal court battles with the State since 1998. Her RN license has been suspended indefinitely by the Illinois Department of Professional Regulation for "practicing beyond its scope" as a homebirth midwife. The mother of four grown children, she is probably best known for her very open and public defiance of what she feels to be the unconstitutional application of Illinois' non-existent "law". Retired from active midwifery practice, her future plans include attending law school so she may be better armed to continue the battle.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

My license is still suspended, and I am currently in law school.

Valerie
Illinois

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rnchrista

Discussion Starter · #8 · Apr 17, 2006

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Well, I contacted the BON and talked to 2 different people. They were absolutley clueless. First, they insisted that you had to be a nurse to be a midwife. After I explained the different types of midwives, they told me there were no midwives that were not CNMs in MI and then they asked why anyone would not want to be a nurse before becoming a midwife.

They finally said it probably wouldn't be a good idea because I'd be practicing nursing independently and would be held to a higher standard.

I asked it I could provide doula services at home before going to a hospital. After I explained what a doula was, she said "why would anyone want to pay for that when just any person could do that" I explained the benefits of doulas and she told me that there were no nurses in MI that provide doula service. Of course I informed her that plenty do.

What a frusterating conversation. Its even more frusterated because I know what I want to do, I know what direction I feel Im being pulled in, but Im very leery of jepordizing my nursing license, my life, and my families, just so I can persue my dream. why does it have to be this hard? ugh.

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rnchrista

Discussion Starter · #9 · Apr 17, 2006

Quote:

Originally Posted by Valerie
Not at all, though since you said you read From Calling to Courtroom, you can probably get the gist from the bio in the back of the book:

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
Valerie Vickerman Runes, a former RN/CPM, has received two Cease and Desist orders from the State of Illinois, and has been involved in administrative, circuit, and federal court battles with the State since 1998. Her RN license has been suspended indefinitely by the Illinois Department of Professional Regulation for "practicing beyond its scope" as a homebirth midwife. The mother of four grown children, she is probably best known for her very open and public defiance of what she feels to be the unconstitutional application of Illinois' non-existent "law". Retired from active midwifery practice, her future plans include attending law school so she may be better armed to continue the battle.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

My license is still suspended, and I am currently in law school.

Valerie
Illinois

Ahhh, thats you! Jeesh, Im sorry you've had to deal with all that crap.
So, would you do it again? After going through all that, would you still have gone into midwifery?
And all the court battles...that has been more from you just attending births at home as a non nurse mw, right? Not specifically because you were a RN and a mw? In other words, would things have been any different if you weren't a nurse?

Thanks for your help Valerie!
Christa

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gemasita

· #10 · Apr 17, 2006

Hmmm....now, I don't think there is anything wrong with a RN serving as a doula. But then you just have to follow the scope of practice of the doula organization that you are certified by (unless you are not certified - then I guess you could write you contract to cover that). So as a doula in someone's home, you wouldn't be able to perform the medical tasks or an RN - you would have to only serve as a doula (which is emotional and physical support but not medical support).

I think there are many nurses who are doulas. You just have to make sure you are following your scope of practice for the particular "role" you are playing for that birth.

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rnchrista

Discussion Starter · #11 · Apr 17, 2006

Quote:

Originally Posted by gemasita
Hmmm....now, I don't think there is anything wrong with a RN serving as a doula. But then you just have to follow the scope of practice of the doula organization that you are certified by (unless you are not certified - then I guess you could write you contract to cover that). So as a doula in someone's home, you wouldn't be able to perform the medical tasks or an RN - you would have to only serve as a doula (which is emotional and physical support but not medical support).

I think there are many nurses who are doulas. You just have to make sure you are following your scope of practice for the particular "role" you are playing for that birth.

Nope, the BON informed me that if you're a nurse, you're functioning under the nurses scope of practice, even if you're just providing doula services, So, even if you're not providing the technical skills a RN can, you're still liable

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Defenestrator

· #12 · Apr 17, 2006

Quote:

Originally Posted by rnchrista
Nope, the BON informed me that if you're a nurse, you're functioning under the nurses scope of practice, even if you're just providing doula services, So, even if you're not providing the technical skills a RN can, you're still liable

See, I don't buy that. Doulas are not medical care providers. It is like saying that a nurse can't be an aerobics instructor without getting in trouble because she would be expected to monitor her student's cardiac function.

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rnchrista

Discussion Starter · #13 · Apr 18, 2006

Quote:

Originally Posted by Defenestrator
See, I don't buy that. Doulas are not medical care providers. It is like saying that a nurse can't be an aerobics instructor without getting in trouble because she would be expected to monitor her student's cardiac function.

LOL, why couldn't I have thought of something like that when I was on the phone to them?

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Valerie

· #14 · Apr 18, 2006

Quote:

Originally Posted by rnchrista
Ahhh, thats you! Jeesh, Im sorry you've had to deal with all that crap.
So, would you do it again? After going through all that, would you still have gone into midwifery?

In a heartbeat. When I got a nursing license, I knew there was a good chance I would lose it someday. It was a gamble I took with the State of Illinois to prove a point, and I lost. Sometimes I miss my nursing license -- any RN knows how much work it takes to get it -- but I will never regret the actions that led to its loss.

Quote:

And all the court battles...that has been more from you just attending births at home as a non nurse mw, right? Not specifically because you were a RN and a mw? In other words, would things have been any different if you weren't a nurse?

Being an RN and a midwife probably led to a lot more trouble than simply being a midwife. A seven-count complaint against my license (initiated by the state for "practicing beyond the scope" of my license) resulted in a three-week hearing, complete with three attorneys from the Department of Professional Regulation, a variety of nursing board folks, and testimony from the administration of the hospital where I had previously worked (in the course of its investigation, state investigators showed up at the hospital and I was subsequently fired). Marsden Wagner testified for us, though the state didn't take him seriously because he "didn't practice medicine in Illinois."

Being a nurse gave the state a methodology for discipline that they would not otherwise have had.

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Thanks for your help Valerie!
Christa

You are quite welcome.

Valerie
Illinois

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