Certified Nurse Midwife

This position is located in the Obstetrics and Women’s Health Department of the Sage Memorial Hospital (SMH). The incumbent serves as an Independent Licensed Practitioner, Certified Registered Nurse Midwife, who specializes in gynecologic health, reproductive and sexual health, family planning, primary care, preconception counseling, and maternity care from the first prenatal visit through postpartum period. Assignments also include providing consultations to others in the same or other specialties.

Assignments may include various work shifts on nights, weekends, and holidays in addition to normal daytime work hours. This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

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• Provides independent diagnostic, preventive and therapeutic nursing and medical services for patients of varying complexity. Duties reflect the growing significance of evidence-based practice, evidence-based interventions, and population- based chronic care management. Initiates and implements strategies to evaluate outcomes of practice, practice patterns, and systems of care for women against National benchmarks.
• Assesses acute and non-acute clinical problems. Obtains and records a problem- oriented health history; orders and interprets related laboratory and diagnostic tests; performs a systematic physical examination and interprets abnormal and normal findings to form a diagnosis regarding physical, emotional, or social disabilities.
• Independently manages labor and childbirth in accordance with clinical privileges. Utilizes experimental theories and new developments in the solution of complex health care problems, not susceptible to treatment by accepted methods. Prescribes medications; initiates emergency care, as appropriate. Conducts interdisciplinary and interdisciplinary collaboration with physicians regarding patient management, to include evaluating and revising therapeutic plans and managing high-risk, unstable, or extremely complex patients, including the intrapartum setting. Makes a diagnosis by: utilizing critical thinking in the diagnostic process; synthesizing and analyzing the collected data; formulating differential diagnosis based on the history, physical examination, and diagnostic test results; establishes priorities to meet the health and medical needs of the individual, family or community.
• Provides comprehensive independent patient management services which may include the following if appropriate: 1) Writing admission, transfer, and discharge orders; 2) Documenting patient histories; 3) Ordering appropriate laboratory, radiologic and other tests and procedures necessary for patient assessment and diagnosis; 4) Ordering appropriate medication and treatments, the Nurse Midwife has full prescriptive authority. 5) Obtaining necessary clinical consultation when indicated. 6) Documenting through in-depth progress notes and dictation summaries; 7) Providing skillful monitoring of patients for possible adverse reactions to drugs or procedures that may require emergency treatment or revision of the prescribed regimen. 8) Performing emergency management procedures on unstable patients. 9) Exercising sound judgment and initiating emergency measures and interpreting observations to physicians; 10) Predicts and analyzes trends in patient conditions and develops a patient management plan in response to the data obtained; 11) Communicates and collaborates with the multidisciplinary team to ensure that patient management strategies are successful in meeting patient care and/or research needs. 12) Exercises responsibility and accountability for health promotion and patient education.
• Initiates and provides emergency care measures in the event complications occur to include resuscitation of the mother and newborn: intubation, administering oxygen, cardiopulmonary resuscitation (CPR), etc. Manages the treatment of hemorrhage and shock, starts intravenous therapy, prescribes and administers medications, and initiates lifesaving treatments. Maintains a process for systematic follow-up by; determining the effectiveness of the treatment plan with documentation of patient care outcomes, reassigns and modifies the plan with the patient and family as necessary to achieve health and medical goals. Together with the patient and family, establishes evidence based, mutually acceptable, cost-effective plan of care that maximizes health potential.
• Counsels patients and families in health education, for a diverse and complex patient population with consideration of the patient’s learning needs, learning readiness and impediments to the process. Serves as a patient advocate along with other health care professionals. Collaborates with the patient, family and significant others in developing plans that consider and respect the patient's cultural background, level of understanding, and available resources and support systems.
• Acts as a preceptor to graduate students, residents, nurse-midwives and/or nurse practitioners new to the organization. Performs clinical practice peer review and develops multidisciplinary quality improvement programs and projects. Collaborates with peers and other multidisciplinary team members to analyze and evaluate current systems of health care delivery and to identify and implement new practice patterns as appropriate.
• Demonstrates expertise in data management and computer skills. Reviews patient’s charts to collect relevant clinical data. Analyzes trends in patient responses.
• Recognizes patient issues that demand physician's immediate attention. Maintains and analyzes computerized data and independently develops charts, graphs, and statistical analyses from clinical data.
• Performs quality assurance and quality control activities as they relate to protocol adherence, protocol monitoring, data collection, data abstraction and data analysis.
• Provides clinical consultation during provision of patient care and utilizes epidemiologic data and incorporates evidence-based practice into new program development.
• Provides consultation to the healthcare team related to implementation and evaluation of specific protocols. Monitors and documents response to therapy and communicate findings to Chief Medical Officer with recommendations for appropriate intervention.
• Conducts patient care rounds and conferences. Presents patient cases and topics for patient care conferences for the express purpose of improving patient and research processes and outcomes.
• Provides specialty consultative services to colleagues in nursing, medicine and other disciplines.
• Completes administrative duties as assigned, including, but not limited to, completion of patient records, peer review, monthly reports, and attendance at required and assigned meetings. Participates in Quality Improvement programs and initiatives, ensuring compliance with Joint Commission and applicable standards.
• Performs other duties as assigned. Qualifications

• Must possess and maintain a current active, full and unrestricted Arizona Registered Nurse license or registration.
• Must have a Graduate Degree in Nurse-Midwifery from an Accreditation Commission for Midwifery Education, such as accredited Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or post-master’s certificate program.
• Active board certification from the American Midwifery Certification Board (AMCB) and an active, unrestricted Arizona Midwifery license to practice independently.
• Current DEA.
• Current BLS and NRP certification.
• Current valid Driver’s License.
• Must be able to successfully pass the Employee Health Program requirements and background investigation. Knowledge, Abilities, Skills, and

• Mastery of midwifery skills with advanced competency in assessment, diagnosing, and treating/managing patients with diverse healthcare needs and complex high-risk factors, such as nurse led initiatives addressing interpersonal, gender violence and sexual assault on a vulnerable populations complex historical trauma, domestic violence, and substance abuse.
• Expert knowledge to identify gaps in care, including access to care.
• Manage both low and high-risk patients in outpatient clinics, antepartum testing, OB triage, labor and delivery. Also provide preventative screenings and primary care to patients throughout the lifespan.
• Ability to generate new hypotheses; develop new theories; and apply experimental theories and new developments to the solution of complex high-risk health care problems, not susceptible to treatment by accepted methods; specifically, intensive management of patients with serious and acute illnesses.
• Skill and ability to independently manage labor and delivery while incorporating the midwifery model of care, to manage obstetrical complications and emergencies, consulting, collaborating or referring to physicians as appropriate.
• Mastery knowledge of, and ability to apply, evidence-based practice, evidence-based interventions and population-based chronic care management.
• Comprehensive clinical ability to collaborate with physicians regarding patient management, to include health assessment, continuity of care, and evaluation/revision of therapeutic plans.
• Sustained knowledge of current medical literature/journals and National benchmarks to determine, implement, and evaluate patient care practices, patterns, and systems.
• Skill and ability to obtain and document complete health histories and physical examinations; ability to independently communicate and interpret the data obtained.
• Knowledge of the epidemiological and biological aspects of the disease process and illness, including natural history and prognosis, to facilitate changes or modifications in healthcare policies and programs.
• Mastery knowledge and ability to design and effectively deliver patient and family education programs; to promote the effective participation in care by both the patient and family members.
• Ability to develop common policies, standards of practice, best practices and or other methods to improve the health of patients.
• Knowledge of current physiology and/or psychopathology, diagnostic evaluation procedures, therapeutic modalities including pharmacokinetics, nursing management, and rehabilitative processes in the areas of specialization.
• Knowledge of scientific principles and foundations of theory-based nursing practice and advanced nursing practice.
• Ability to manage and operate current medical technology used in direct patient care. Ability to communicate orally with patients to provide nursing care and information on procedures; counsel patients on physical and emotional health problems; and exchange, provide and obtain information using great tact and sensitivity.
• Ability to communicate effectively in writing to prepare abstracts, manuscripts, major presentations and other types of professional writing with minimal assistance. Physical Demands: The work requires some physical exertion such as periods of long standing, or recurring and considerable crouching. bending. standing, stooping, stretching, or walking such as in performing regular and recurring medical activities, inspections, or to observe healthcare operations in treatment facilities. Work also includes frequent lifting of moderately heavy items weighing less than 50 pounds such as equipment or assisting in self-care transfer activities. Patient care requirements may demand irregular or extended tours of duty. Work Environment: The work involves regular and reoccurring exposure to moderate risks, discomforts, and unpleasantness such as contagious diseases, infectious materials, carcinogenic materials, noxious fumes, radiation or potentially pathogenic bacteria. Special safety precautions such as protective clothing and equipment may be necessary

Graduate Degree