{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:56:39Z","timestamp":1782539799086,"version":"3.54.5"},"reference-count":46,"publisher":"SAGE Publications","issue":"3-4","license":[{"start":{"date-parts":[[2015,8,1]],"date-time":"2015-08-01T00:00:00Z","timestamp":1438387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Policy, Politics, &amp; Nursing Practice"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:p>Healthcare resources are stretched perilously thin and the demand for primary healthcare services has never been greater. Despite this demand for service, relatively little is known about the practice environment of primary healthcare providers, particularly certified nurse-midwives (CNMs), where workforce surveys frequently include these specialists within the broader nurse practitioner category. A distinct professional discipline, nurse-midwives are one type of primary care provider recommended to enhance access to services. The objective of this study was to understand the nature of the nurse-midwifery practice environment in the state of Colorado. Online survey of Colorado CNMs ( N\u2009=\u2009328) found little ethnic\/racial diversity and an aging workforce, with most providing care in an urban, hospital\/medical center environment. Several key legislative issues were identified though respondents felt ill prepared to engage in legislative change. Overall, CNMs were optimistic about the future of midwifery and were largely satisfied with their practice.<\/jats:p>","DOI":"10.1177\/1527154415601477","type":"journal-article","created":{"date-parts":[[2015,9,8]],"date-time":"2015-09-08T21:24:03Z","timestamp":1441747443000},"page":"97-108","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Trends in Practice Patterns and Perspectives of Colorado Certified Nurse-Midwives"],"prefix":"10.1177","volume":"16","author":[{"given":"Marie","family":"Hastings-Tolsma","sequence":"first","affiliation":[{"name":"Baylor University, Louise Herrington School of Nursing, Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Tanner","sequence":"additional","affiliation":[{"name":"Frontier Nursing University, Hyden, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer G.","family":"Hensley","sequence":"additional","affiliation":[{"name":"School of Nursing, Vanderbilt University, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Anderson","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Colorado Denver, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Patterson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Colorado, Louisville, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen N.","family":"Dunemn","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Northern Colorado, Greeley, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan K.","family":"Purcell","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Colorado Denver, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,9,8]]},"reference":[{"key":"bibr1-1527154415601477","unstructured":"Advance Healthcare Network. (2014).\n                      2014 NP & PA Salary survey results\n                      . Retrieved from http:\/\/nurse-practitioners-and-physician-assistants.advanceweb.com\/Web-Extras\/Online-Extras\/2014-NPs-PAs-Salary-Survey-Results.aspx."},{"key":"bibr2-1527154415601477","unstructured":"American Association of Colleges of Nursing. (2014).\n                      2013\u20132014 Enrollment and graduations in baccalaureate and graduate programs in nursing\n                      . Retrieved from http:\/\/www.aacn.nche.edu\/research-data."},{"key":"bibr3-1527154415601477","volume-title":"Midwifery education trends report 2013","author":"American College of Nurse Midwives","year":"2013"},{"key":"bibr4-1527154415601477","unstructured":"American College of Nurse Midwives. (2014).\n                      Midwifery education programs\n                      . Retrieved from http:\/\/www.midwife.org\/Education-Programs-Directory."},{"key":"bibr5-1527154415601477","unstructured":"American Midwifery Certification Board. (2014a).\n                      Information for candidates of the national certification examination in nurse-midwifery and midwifery.\n                      Retrieved from http:\/\/www.amcbmidwife.org\/docs\/default-document-library\/candidate-handbook\u2014updated-november-20-2014.pdf?sfvrsn=0."},{"key":"bibr6-1527154415601477","unstructured":"American Midwifery Certification Board. (2014b).\n                      American midwifery certification 2014 annual report\n                      . Retrieved from http:\/\/www.amcbmidwife.org\/docs\/annual-reports\/2014-amcb-annual-report.pdf?sfvrsn=2."},{"key":"bibr7-1527154415601477","unstructured":"Centers for Medicare & Medicaid. (n.d.).\n                      Graduate nurse education demonstration\n                      . Retrieved from http:\/\/innovation.cms.gov\/initiatives\/gne\/."},{"key":"bibr8-1527154415601477","unstructured":"Colorado Department of Public Health and Environment Primary Care Office. (2014).\n                      Colorado health workforce development strategy\n                      . Retrieved from https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/PCO_CHSC_Health%20Workforce%20Development%20Strategy%202014.pdf."},{"key":"bibr9-1527154415601477","unstructured":"Conover, C. J. & Richards, R. (2015).\n                      Economic benefits of less restrictive regulation of advanced practice nurses.\n                      Duke University, center for health policy and inequalities research. Retrieved from http:\/\/chpir.org\/wp-content\/uploads\/2015\/02\/Report-Final-Version.pdf."},{"key":"bibr10-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1016\/S1526-9523(00)00091-X"},{"key":"bibr11-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1212938"},{"key":"bibr12-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2006.05.001"},{"key":"bibr13-1527154415601477","unstructured":"Federal Trade Commission. (2014).\n                      Policy perspectives: Competition and the regulation of advanced practice nurses\n                      . Retrieved from www.ftc.gov\/plicy\/reports\/policy-reports\/commission-and-staff-reports."},{"key":"bibr14-1527154415601477","unstructured":"Fellows, J. (2015, March 5).\n                      Following physician compensation trends? Read this first. Health leaders media\n                      . Retrieved from http:\/\/www.healthleadersmedia.com\/page-1\/PHY-314014\/Following-Physician-Compensation-Trends-Read-This-First."},{"key":"bibr15-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000006"},{"key":"bibr16-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12175"},{"key":"bibr17-1527154415601477","volume-title":"Online survey response rates and times: Background and guidance for industry","author":"Hamilton M. B.","year":"2003"},{"key":"bibr18-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"bibr19-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1177\/0193945908319989"},{"key":"bibr20-1527154415601477","unstructured":"Health Resources and Services Administration. National Center for Health Workforce Analysis. (2013).\n                      Projecting the supply and demand of primary care practitioners through 2020\n                      Retrieved from http:\/\/bhpr.hrsa.gov\/healthworkforce\/supplydemand\/usworkforce\/primarycare\/primarycarebrief.pdf."},{"key":"bibr21-1527154415601477","unstructured":"Health Resources and Services Administration. (2014).\n                      HRSA investments in the nursing workforce\n                      . Retrieved from http:\/\/www.hrsa.gov\/ourstories\/nursesweek\/investmentsinnursing.pdf."},{"key":"bibr22-1527154415601477","unstructured":"Health Resources and Services Administration. (2015).\n                      Medically Underserved Areas (MUAs) and Populations (MUPs).\n                      Retrieved from https:\/\/www.colorado.gov\/pacific\/sites\/default\/files\/PCO_HPSA-muamup-inset-may-2014.pdf."},{"key":"bibr23-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1306445"},{"key":"bibr24-1527154415601477","volume-title":"The future of nursing: Leading change, advancing health","author":"Institute of Medicine","year":"2010"},{"key":"bibr25-1527154415601477","unstructured":"Institute of Medicine. (2011).\n                      The future of nursing: Leading change, advancing health\n                      . Washington, DC: The National Academies Press. Retrieved from http:\/\/www.rwjf.org\/content\/dam\/farm\/reports\/reports\/2010\/rwjf67190."},{"key":"bibr26-1527154415601477","unstructured":"Institute of Medicine. (2015).\n                      Measuring the Impact of Interprofessional Education (IPE) on collaborative practice and patient outcomes.\n                      Retrieved from http:\/\/iom.nationalacademies.org\/Reports\/2015\/Impact-of-IPE.aspx."},{"key":"bibr27-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12191"},{"key":"bibr28-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1111\/puar.12082"},{"key":"bibr29-1527154415601477","doi-asserted-by":"crossref","unstructured":"Lyndon, A., Johnson, M. C., Bingham, D., Napolitano, P. G., Joseph, G., Maxfield, D. G. & O Keeffe, D. F. (2015). Transforming communication and safety culture in intrapartum care: A multi-organization blueprint.\n                      Obstetrics & Gynecology\n                      , 125(5), 1049\u20131055.","DOI":"10.1097\/AOG.0000000000000793"},{"key":"bibr30-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2012.06.004"},{"key":"bibr31-1527154415601477","unstructured":"National Institute for Health and Care Excellence. (2014, December). Intrapartum care: Care of healthy women and their babies during childbirth. Place of birth.\n                      Nice Guidelines CG190\n                      , 9. Retrieved from http:\/\/www.nice.org.uk\/guidance\/cg190\/chapter\/1-recommendations."},{"issue":"5","key":"bibr32-1527154415601477","first-page":"230","volume":"29","author":"Newhouse R. P.","year":"2011","journal-title":"Nursing Economics"},{"key":"bibr33-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12053"},{"key":"bibr34-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1097\/01.NPR.0000423380.32036.33"},{"key":"bibr35-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1097\/01.NPR.0000440642.09390.fa"},{"key":"bibr36-1527154415601477","volume-title":"The obstetrician\/gynecologist workforce in the United States: Facts, figures, and implications, 2011","author":"Rayburn W. F.","year":"2011"},{"key":"bibr37-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12086"},{"key":"bibr38-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12064"},{"key":"bibr39-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1177\/1527154411398137"},{"key":"bibr40-1527154415601477","unstructured":"State Demography Office. (2012).\n                      Colorado\u2019s aging trends\n                      . Department of local affairs. Retrieved from http:\/\/www.colorado.gov\/cs."},{"key":"bibr41-1527154415601477","unstructured":"The Lancet\u2019s Series. (2014, June). Midwifery.\n                      The Lancet.\n                      http:\/\/www.thelancet.com\/pb\/assets\/raw\/Lancet\/stories\/series\/midwifery\/midwifery_exec_summ.pdf."},{"key":"bibr42-1527154415601477","unstructured":"United Nations Population Fund, & World Health Organization. (2014).\n                      The state of the world\u2019s midwifery\n                      . UNFPA. Retrieved from http:\/\/www.unfpa.org\/sowmy."},{"key":"bibr43-1527154415601477","unstructured":"U.S. Department of Health and Human Services. (2010).\n                      Key features of the affordable care act\n                      . Retrieved from http:\/\/www.hhs.gov\/healthcare\/facts\/timeline\/."},{"key":"bibr44-1527154415601477","doi-asserted-by":"publisher","DOI":"10.1177\/0894318414534494"},{"key":"bibr45-1527154415601477","unstructured":"World Health Organization. (2010).\n                      Framework for action of interprofessional education & collaborative practice\n                      . 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