Issue Date: January 10, 2014
Volume 41 • Issue 1 • Pages 34—36
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 27 BOARD OF NURSING
10.27.05 Practice of Nurse Midwifery
Authority: Health Occupations Article, §8-205 (a)(1), (2), and (4), Annotated Code of Maryland
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to amend Regulations .01 and .02, repeal existing Regulations .03 and .08, recodify existing Regulations .04, .06, and .12 to be Regulations .03, .05, and .10 respectively, and amend and recodify existing Regulations .05, .07, .09—.11, and .13 to be Regulations .04, .06, .07—.09, and .11 respectively under COMAR 10.27.05 Practice of Nurse Midwifery. This action was considered by the Maryland Board of Nursing at a public meeting held on August 20, 2013, notice of which was given by publication on the Board’s website under Board News on July 1 and August 1, 2013.
Statement of Purpose
The purpose of this action is to:
(1) Add definitions for advanced practice nursing and certification for advanced practice;
(2) Require a certified nurse midwife (CNM) to establish practice guidelines established by the American College of Nurse Midwives or any other certifying body recognized by the Board;
(3) Add current requirements for advanced practice education;
(4) Specify that a medical record is required for each client and that the medical record should accompany the client in case there is a transfer of care;
(5) Require a CNM to maintain a plan for emergency consultation, transfer of care, and, if required, an admission plan for the client or newborn;
(6) Authorize a CNM to consult or collaborate with a physician or other health care provider as needed;
(7) Repeal the requirement that CNM’s have a Board approved collaborative plan for each patient and as a condition of practice;
(8) Repeal the requirement for a Review Committee on Midwifery;
(9) Specify that a CNM cannot practice on an expired national certification; and
(10) Make clarifying, technical, and conforming changes to ensure consistency with terms in other chapters in this subtitle.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 W. Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499; TTY:800-735-2258, or email to email@example.com, or fax to 410-767-6483. Comments will be accepted through February 10, 2014. A public hearing has not been scheduled.
A. (text unchanged)
B. Terms Defined.
[(1) “AMCB” means the American Midwifery Certification Board.
(2) “ACNM” means the American College of Nurse Midwives.]
(1) “ACNM” means the American College of Nurse Midwives.
(2) “Advanced practice registered nurse (APRN)” means a registered nurse who holds a current license as:
(a) A certified nurse midwife (CNM);
(b) A certified registered nurse anesthetist (CRNA);
(c) A certified nurse practitioner (CRNP);
(d) A clinical nurse specialist (CNS); or
(e) An advanced practice registered nurse/ psychiatric mental health (APRN/PMH).
(3) “AMCB” means the American Midwifery Certification Board.
[(3)] (4) (text unchanged)
(5)”Certification” means the status granted to a registered nurse who has:
(a) Met all the specified requirements of a national certifying body recognized by the Board: and
(b) Complied with the requirements of this chapter.
[(4)] (6) “Certified nurse midwife” means a registered nurse who [is:
(a) Certified by one of the following:
(i) By the AMCB; or]:
[(ii) By] (a) Is certified by the AMCB or any other certifying body [approved] recognized by the
(b) Has received an advanced nursing education at a master’s degree level or higher after completing the basic registered nursing program;
(c) Has completed an advanced nursing education program with a specialization in midwifery that is accredited by:
(i) The National League for Nursing Accreditation Commission (NLNAC);
(ii) The Commission on Nursing Education (CCNE); or
(iii) Any other certifying body recognized by the Board; and
[(b) Certified] (d) Is certified by the Board.
[(5)] (7) “Clinical practice guidelines” means written standards using guidelines [such as those established ]:
(a) Established by the ACNM in Standards for the Practice of Midwifery, as amended or supplemented, and available from ACNM, 8403 Colesville Road, Suite 1550, Silver Spring, MD 20910; or [any]
(b) Any other certifying body [approved] recognized by the Board [or any other guidelines approved by the Board that the nurse midwife has adopted and follows in practicing as a midwife].
[(6) “Collaborative plan” means the development and implementation of a plan:
(a) For consultation and collaboration with and referral to a physician and other health care providers to address complications:
(i) During a pregnancy; and
(ii) Beyond the educational preparation and scope of practice of the certified nurse midwife that require the consultation or attendance of a physician or other health care provider; and
(b) That includes an assurance that a client can be transferred, whenever required, to the care of a physician with admitting privileges to a facility with an OB/GYN unit located in the client’s geographic area.]
[(7)] (8)—[(13)] (14) (text unchanged)
[(14) “Review committee” means the Review Committee on Nurse Midwifery composed of an equal number of members appointed by the Board and the MBP.]
A. An applicant for certification as a nurse midwife shall hold a current:
[A. Hold a current license] (1) License to practice registered nursing in Maryland;
[B. Hold a current certification] (2) Certification as a nurse midwife from the AMCB or any other certifying body [approved] recognized by the Board;
[C.] (3) (text unchanged)
[D.] (4) Submit an affidavit that the applicant [is in compliance] agrees to comply at all times with the clinical practice guidelines [as defined] in accordance with Regulation .01B (7) of this chapter; and
[E.] (5) (text unchanged)
B. If the applicant’s nurse midwifery program was completed before July 1, 2014, and was not at a Master’s degree or higher level, but the applicant otherwise qualifies, the applicant for certification as a CNM shall provide the Board with:
(1) Verification of completion of a nurse midwifery program recognized by AMCB; and
(2) Current national certification by AMCB.
[.05] .04 Required Documentation.
A. A certified nurse midwife who provides home birth services and other services across the reproductive lifespan shall: [complete an individual care plan for each patient that includes plans for:
(1) Emergency consultation;
(2) Transfer of care; and
(3) When needed, admission to a hospital within the client’s geographic area]
(1) Maintain a medical record for each client; and
(2) In the case of a transfer of care to another provider or a facility, transfer the client’s medical records with the client.
B. A certified nurse midwife shall have available at all times for examination by the Board, written clinical practice guidelines that cover all aspects of care, practice, and quality assurance, including but not limited to:
(1) A plan for emergency consultation;
(2) A plan for transfer of care; and
(3) If needed, a plan for admission of the client or newborn to a hospital within the client’s geographic area.
[.07] .06 Scope of Practice.
A. A certified nurse midwife who meets the requirements of Regulation .02 of this chapter may perform the following functions:
(1) (text unchanged)
(2) [Management, in collaboration with a physician, of clients with medical complications] Consult or collaborate with a physician or other health care provider as needed; and
(3) Refer clients with complications beyond the scope of practice of the certified nurse midwife to a licensed physician [; and]
[(4) Consult with and refer to other health care professions in the delivery and evaluation of health care].
B. (text unchanged)
[C. A certified nurse midwife shall immediately advise the Board if the collaborative plan is ended by either party.]
[D.] C. A certified nurse midwife has the right and obligation to refuse to perform any delegated medical act, oral or written, if, in the certified nurse midwife’s judgment, it is unsafe or an invalidly prescribed medical act or beyond the competence of the certified nurse midwife, in which case the nurse midwife shall notify the delegating physician at once.
[.09] .07 Nurse Midwife Peer Review Advisory Committee.
The Board shall appoint at least four certified nurse midwives from names submitted for consideration to act as its Advisory Committee [, with such powers and duties as the Board may prescribe] in accordance with Health Occupations Article, §8-503, Annotated Code of Maryland.
[.10] .08 Renewal of Certification.
A. (text unchanged)
B. Before a nurse midwife’s certification expires, the midwife may renew [annually] biennially if the nurse midwife:
(1) Submits documentation of a current national certification in midwifery from a certifying body recognized by the Board;
[(1)] (2)—[(3)] (4) (text unchanged)
[.11] .09 Compliance.
A. The certified nurse midwife shall develop and comply with clinical practice guidelines as defined in Regulation [.03B ] .01B of this chapter.
B. The certified nurse midwife shall ensure that the Board has a record of the renewed certification if the certification expires before the registered nurse license renewal date.
C. Certification shall be deemed to have lapsed if the Board does not have a record of a current active certification.
D. Practicing on an expired national certification is prohibited and subject to discipline under Health Occupations Article, §8-316(a), Annotated Code of Maryland.
[.13] .11 Prescribing of Substances by a Certified Nurse Midwife.
A. Pursuant to Health Occupations Article, §8-601, Annotated Code of Maryland, a certified nurse midwife may:
(1)—(2) (text unchanged)
(3) Dispense substances prescribed in accordance with §A(1) and (2) of this regulation in the course of treating a [patient] client at a:
(a)—(e) (text unchanged)
B. The Board shall:
(1) Consult [annually] with the [MBP and the Pharmacy Board] Maryland Board of Pharmacy and Maryland Board of Physicians to review the formulary and make revisions as necessary; [and]
(2) Maintain a list of all certified nurse midwives who are authorized to prescribe[, and];
(3) Maintain a record of the approved formulary [which shall be made available to Maryland pharmacies through annual mailings and]; and
(4) Provide a copy of the approved formulary to Maryland pharmacies upon written request.
JOSHUA M. SHARFSTEIN, M.D.
Secretary of Health and Mental Hygiene