High-tech skills in low-tech hands. Issues of advanced practice and collaborative management

Nurse-midwifery practice has been defined by the American College of Nurse-Midwives (ACNM) as "the independent management of essentially normal newborns and women ... occurring within a health care system which provides for medical consultation, collaborative management or referral. ..." As the health care delivery system in the United States becomes increasingly complex and reliant on new forms of technology, it has become necessary to clarify roles and responsibilities for the nurse-midwife. In addition, mechanisms for acquiring new skills and for collaborating with physician colleagues must be well understood. A question frequently asked is where the boundaries of nurse-midwifery practice end and those of medical practice begin. Although practice scenarios vary for individual nurse-midwives and nurse-midwifery services, recent statements approved by the ACNM Board of Directors discuss these issues in an attempt to clarify the potentially confusing areas of collaboration and skill acquisition. This article explores the areas of expanded nurse-midwifery practice and collaborative management. Although individual clinical skills are not necessarily endorsed, a step-by-step approach that nurse-midwives can use for incorporation of new skills is presented. The concepts discussed will be a valuable tool to nurse-midwives in their practice.