ABOUT THE ACNM CORE COMPETENCIES FOR BASIC MIDWIFERY PRACTICE

The American College of Nurse-Midwives' (ACNM) Core Competencies for Basic Midwifery Practice are the basis for entry into practice for certified nurse-midwives (CNMs) and certified midwives (CMs) who graduate from an ACNM accredited education program. Core competencies for nurse-midwifery practice in the United States were first developed in 1978. They were revised in 1985 and 1992. The most recent core competencies were approved in May 1997.

DETERMINATION OF CORE COMPETENCIES

The core competencies are defined by the ACNM, the professional association for CNMs and CMs. The core competencies go through a rigorous review approximately every five years and are revised to reflect the current practice expectations for individuals entering the profession. This review process is coordinated by members of the association on the Education Section of the ACNM Division of Education. The process takes a full year and involves an opportunity for input from every member of the profession. The final core competencies are then ratified by the ACNM Board of Directors (BOD).

CORE COMPETENCIES AND ACCREDITATION

The Core Competencies for Basic Midwifery Practice identify the content that must be offered in education programs seeking preaccreditation and accreditation from the ACNM Division of Accreditation (DOA). The Core Competencies for Basic Midwifery Practice do not identify the requirements for clinical experience. The clinical requirements are part of the Criteria for Preaccreditation of Education Programs in Nurse-Midwifery and Midwifery with Guidelines for Elaboration and Documentation and the Criteria for Accreditation of Education Programs in Nurse-Midwifery and Midwifery with Guidelines for Elaboration and Documentation (available through the research catalog.

Preaccreditation and accreditation by the ACNM DOA is a voluntary process between the education program and the DOA. If a program seeks accreditation, it must be granted preaccreditation status before students are admitted. After preaccreditation status is granted, a program goes through an initial accreditation review within six months after graduating its first class. The initial accreditation status can be granted for a maximum of five years. Accreditation status granted after the initial accreditation can be granted for a maximum of eight years. Accreditation review is an ongoing requirement by the ACNM DOA and includes a self evaluation report written by the education program, a site visit by a team of DOA qualified site visitors, and a review and decision by the DOA Board of Review. An annual monitoring report tracks the programs between full reviews.

During the six months after the revised core competencies receive approval by the ACNM BOD, education programs scheduled for review by the DOA are given the choice of demonstrating that either the new core competencies or the core competencies immediately previous to the new ones are fully incorporated into the curriculum. Six months after the new core competencies receive approval, all education programs seeking preaccreditation or accreditation by the DOA must demonstrate that the new core competencies are fully incorporated into the curriculum.

CORE COMPETENCIES AND NATIONAL CERTIFICATION

To ensure that graduates of ACNM DOA accredited education programs meet the minimum requirements for entry into practice, they must pass a national certification examination. This exam was developed and administered by the ACNM until 1992 when a contract was established with a separate organization, the ACNM Certification Council, Inc. (ACC), to provide a national certification exam for graduates of ACNM accredited education programs. After the ACNM approves new core competencies, the ACC conducts a task analysis that includes development of draft research forms, a pilot study to test the validity of the forms, followed by data collection and analysis. The results of the analysis become a blueprint used by the ACC
Exam Committee in development of test questions. The ACC plans on conducting the next task analysis in 1999-2000, and projects that questions on the new core competencies will appear on the exam in Fall 2000.

PRACTICE THAT GOES BEYOND CORE COMPETENCIES

The Core Competencies for Basic Midwifery Practice describe the entry point into the profession, but do not necessarily reflect the scope of practice by individual CNMs or CMs. The ACNM has established Guidelines for Incorporation of New Procedures into Nurse-Midwifery Practice for midwives to use in expanding their scope of practice beyond the core competencies. The ACNM also encourages midwives to participate in the Continuing Competency Assessment (CCA) Program or other formal continuing education programs to remain current in knowledge and practice skills.

CERTIFICATION MAINTENANCE

CNMs who received certification before January 1996 have no time limitation on their initial certification. CNMs and CMs who were certified after January 1996 are certified for a maximum of eight years and must demonstrate certification maintenance as determined by the ACC in order to renew their certification for another eight year period. For more information on the Certification Maintenance Program requirements, please contact the ACC at 301/459-1321.

The Core Competencies for Basic Midwifery Practice
May 1997

The core competencies for basic midwifery practice represent the delineation of the fundamental knowledge, skills, and behaviors expected of a new practitioner; as such, they serve as guidelines for educators, students, health care professionals, consumers, employers, and policy-makers and constitute the basic requisites for graduates of all nurse-midwifery and midwifery education programs accredited by the American College of Nurse-Midwives (ACNM)*.

Midwifery practice is based on the Core Competencies for Basic Midwifery Practice, The Standards for the Practice of Nurse-Midwifery and the Code of Ethics promulgated by the American College of Nurse-Midwives. Midwives who have been certified by the ACNM or the ACNM Certification Council, Inc. (ACC) assume responsibility and accountability for their practice as primary care providers.

Midwifery education is based on a theoretical foundation in the health sciences as well as clinical preparation which focuses on the knowledge, judgment, and skills deemed necessary to provide primary care and independent management of women and newborns within a health care system that provides for medical consultation, collaborative management, or referral as appropriate. Recognizing that creativity, innovation, and individuality, are essential to the vitality of the profession, each education program may develop its own unique identity and may choose to extend beyond the core competencies into other areas of health care. In addition, each graduate is responsible for complying with the laws of the jurisdiction where the practice of midwifery is conducted.

The ACNM defines the midwife's role in primary care based on the Institute of Medicine's definition (1994), the ACNM's Philosophy (1989), and the ACNM Board of Directors' Position Statement on Primary Care by Nurse-Midwives (1992). Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing the large majority of personal health care needs, developing a sustained partnership with patients, and practicing within the context of family and community. Certified nurse-midwives (CNMs) and certified midwives (CMs) are often the initial contact for providing health care to women and they provide such care on a continuous and comprehensive basis. As a primary provider, the CNM or CM assumes responsibility for provision of and referral for appropriate services within a defined scope of practice.

The concepts and skills identified below and the midwifery management process outlined in the sections that follow apply to all components of midwifery care and comprise the foundation upon which practice guidelines and curriculum content must be built. This document is reviewed and revised at least every five years to reflect changing trends and new developments in midwifery practice and must be adhered to in its entirety.