Career Pathways and Employment Experiences of Certified Nurse-Midwives Compared With Other Advanced Practice Registered Nurses in the United States

Abstract

Introduction

Despite recent growth in the certified nurse-midwife (CNM) workforce and data showing better perinatal outcomes associated with their care, midwives continue to be underused in the United States. To facilitate targeted policies for integrating and sustaining this workforce, information is needed regarding the career pathways and employment experiences of CNMs.

Methods

In this longitudinal study, we used the 2018 and 2022 National Sample Survey of Registered Nurses to examine how CNM demographics, career pathways, and job experiences changed over time and in comparison with other advanced practice registered nurses (APRNs). We used multivariable logistic regression to examine the odds of education, financing, and employment characteristics among CNMs compared with other APRNs, then used regression output to calculate predicted probabilities of each characteristic among CNMs compared with other APRNs.

Results

The size and racial diversity of the CNM workforce changed over time. CNMs had a 5.4% higher probability of working as a community health worker and a 9.5% higher probability of taking out a loan to finance their education than other APRNs. CNMs’ predicted mean annual salaries were up to $25,000 lower than other APRNs, and CNMs had up to a 6.3% higher probability of $60,000 or more in remaining debt compared with the other APRN groups. Finally, compared with other APRNs, CNMs were up to 15.0% less likely to report practicing to the full extent of their license and their education and training, respectively.

Discussion

Although there was change in the size and diversity of the workforce, CNMs’ financial and employment situations may contribute to persistent challenges in entering and maintaining practice. Future research should explore additional factors related to CNM turnover and retention. Workforce policies should target barriers to practice and support more competitive salaries for CNMs.