Journal of Nursing Education

Major Article 

The Experience of Nurse–Midwives in Teaching Roles

Mary Ellen Doherty, PhD, RN, CNM

Abstract

Background:

The nursing faculty shortage has generated the interest of some nurse–midwives to teach in baccalaureate nursing programs. These seasoned practitioners bring a wealth of knowledge and clinical expertise to classrooms and clinical settings. The purpose of this study was to explore and describe the experiences of nurse–midwives who teach in baccalaureate nursing programs.

Method:

This study used a qualitative phenomenological research design based in the naturalistic paradigm. Colaizzi's procedure for analyzing phenomenological data was used to examine verbatim transcriptions from 16 interviews. Data saturation was achieved.

Results:

Six themes emerged from the data: Emphasis on Normal; Knowing My Stuff: Confidence and Competence; Students Wanting to Become Nurse–Midwives in the Future; Students Desiring Nurse–Midwifery Care; Teaching and Imparting the Nurse–Midwifery Philosophy; and Professional Challenges: The Faculty Role.

Conclusion:

Nurse–midwives teaching in baccalaureate nursing programs are in strategic positions to influence nursing students. While helping the faculty shortage, they impart professional values and skills. They may inspire students to embrace the nurse–midwifery model of care. [J Nurs Educ. 2017;56(2):77–84.]

Abstract

Background:

The nursing faculty shortage has generated the interest of some nurse–midwives to teach in baccalaureate nursing programs. These seasoned practitioners bring a wealth of knowledge and clinical expertise to classrooms and clinical settings. The purpose of this study was to explore and describe the experiences of nurse–midwives who teach in baccalaureate nursing programs.

Method:

This study used a qualitative phenomenological research design based in the naturalistic paradigm. Colaizzi's procedure for analyzing phenomenological data was used to examine verbatim transcriptions from 16 interviews. Data saturation was achieved.

Results:

Six themes emerged from the data: Emphasis on Normal; Knowing My Stuff: Confidence and Competence; Students Wanting to Become Nurse–Midwives in the Future; Students Desiring Nurse–Midwifery Care; Teaching and Imparting the Nurse–Midwifery Philosophy; and Professional Challenges: The Faculty Role.

Conclusion:

Nurse–midwives teaching in baccalaureate nursing programs are in strategic positions to influence nursing students. While helping the faculty shortage, they impart professional values and skills. They may inspire students to embrace the nurse–midwifery model of care. [J Nurs Educ. 2017;56(2):77–84.]

The current nursing faculty shortage has sparked the interest of some nurse–midwives to consider a teaching role in an academic setting. Teaching can be a rewarding enterprise for nurse–midwives who are eager to share their knowledge and clinical expertise with those entering the nursing profession or those returning to school for a baccalaureate degree. Teaching provides an opportunity to influence students and shape their professional development for the future (Penn, Wilson, & Rosseter, 2008). Nurse–midwives as educators can model professional values and skills that will affect the quality of care provided by future nurses.

Although the primary mission of nurse–midwives as faculty members is to teach, embedded in their teaching is the midwifery model of care. They are responsible for educating the workforce in normal birth physiology, evidence-based nursing care to enhance normal birth, and personal choices throughout the childbearing season and lifespan. Some students may be inspired to eventually become nurse–midwives, and others may come to embrace the midwifery model of care for themselves and encourage others to do so as well. Recruitment could be considered a secondary mission of the teaching role.

Although no previous studies explore the experience of nurse–midwives teaching in baccalaureate nursing programs, many studies focus on the nurse educator role. The majority of these studies discuss the transition from expert nurse clinician to nurse educator. That body of literature was helpful in understanding the experiences of the nurse–midwife educators in the current study. For example, Schoening (2013) conducted a grounded theory study to generate a theoretical model that describes the social process that occurs during role transition from nurse to nurse educator. The nurse educator transition (NET) model identifies four phases in the role transition process: the anticipatory/expectation phase, the disorientation phase, the information-seeking phase, and the identity formation phase. Recommendations to aid in the transition included that formal pedagogical education content be integrated into graduate nursing programs and that orientation and mentoring programs be created for novice nurse faculty.

Most clinical nurses become nurse educators because of their desire to teach and share their wealth of knowledge and clinical expertise with nursing students. New nurse educators may come to nursing education with some teaching experience, whereas others are novice educators in the truest sense. Weidman (2013) studied clinical nurse experts who became novice nurse educators without any background in education theories. Data analysis from this study yielded three themes:

  • Clinical Nurse Experts Have Expert Knowledge to Share and a Desire to Educate the Next Generation.
  • The Transition Process Elicits Feelings of Stress Related to Not Having Educational Theory.
  • Consistent Mentoring Contributes to an Easier Transition to the Role.

The study's findings urged nursing program administrators to assist new nurse educators in the areas of educational theory, test construction, curriculum development, and evaluation.

Gazza (2009) conducted a hermeneutic phenomenological study to understand the experience of being a full-time faculty member in a baccalaureate nursing program. The participants were seasoned nurses. Five themes emerged from the data:

  • Making a Difference in the Student, Profession, and World.
  • Being a Gatekeeper to the Profession.
  • Trying Ways to Balance Multiple Roles.
  • Support Is Vital; Can't Do It Alone.
  • Workplace Relationship: The Good, the Bad, and the Ugly.

These findings have implications for the recruitment and retention of nursing faculty with regard to the creation of orientation and mentoring programs, time management and stress reduction workshops, and other collaborative endeavors to promote well-being among nurse educator colleagues.

Gardner (2014) conducted a qualitative study to understand the lived experience of nurse educators and to identify the characteristics, traits, and practices that influenced their development and competence in the role. Eight overarching themes emerged from the data:

  • Becoming a Nurse Educator.
  • Finding Support.
  • Developing a Teaching Style.
  • Gaining Confidence and Competence.
  • Teaching and Learning as a Partnership.
  • Being Part of a Bigger Picture.
  • The Best and the Worst Experiences.
  • Looking Toward the Future.

Penn, Wilson, and Rosseter (2008) reported the findings of the American Association of Colleges of Nursing survey of member school deans and directors. Survey results identified five skills to be the most essential for new faculty: teaching skills; knowledge, experience, and preparation for the faculty role; curriculum and course development skills; evaluation and testing skills; and personal attributes (p. 10). With the examination and evaluation of these skills, it is of paramount importance to keep the desired outcome of the teaching endeavor in mind, which is student learning. Often, novice educators spend countless hours focusing on their own teaching when the emphasis should be on student learning.

Replete in the literature on the faculty role are summaries of the benefits, challenges, and responsibilities that go along with the role. Some of the benefits mentioned include personal satisfaction gained by helping nursing students in mastering concepts and skills; collaboration with colleagues; autonomy; access to library services and technology resources; flexible work hours; reasonable vacation, holiday, and summer schedules; opportunities to supplement income through consulting, faculty practice, and professional presentations; support to conduct research and publish research in peer-reviewed journals; and opportunities to write and grants (Culleiton & Shellenbarger, 2007).

Conversely, possible challenges that are most likely to affect inexperienced educators include having a lower salary in academia than in clinical practice and having a heavy workload outside the classroom to prepare for classroom and clinical experiences. Time consuming but necessary tasks include reading and grading examinations and papers, planning assignments, and completing student evaluations. Nurse educators also need to keep clinical skills current and pursue scholarly work for their program of research. Finally, student interaction is of paramount importance, and this also means handling students who are struggling or failing (Culleiton & Shellenbarger, 2007).

A broad array of faculty responsibilities mentioned in the literature include classroom and clinical experiences; advising and mentoring students; grading student assignments; serving on committees within the nursing program and also in the college or university; attending faculty meetings; engaging in scholarly work, such as research, publishing in peer-reviewed journals, and giving professional presentations; writing grants and seeking extramural funding; participating in professional organizations related to one's clinical specialty or in nursing education; maintaining certifications and clinical competencies; engaging in peer review; serving as an advisor to student groups; and doing volunteer work in the community (Lewallan, 2002; Zambroski & Freeman, 2004).

Sorrell and Cangelosi (2016) suggested several strategies for a successful transition to the nurse educator role. These are identifying the reasons for deciding to make a transition; identifying strengths brought to the new role, as well as those areas in need of improvement or guidance; sharing ideas and concerns with others in nursing education; finding a mentor; and keeping a journal to describe experiences to monitor progress and competence in the new role (p. 17).

Although the aforementioned literature provides some background and insight concerning the path expert clinicians take to become nurse educators, no empirical studies explore and describe the experiences of nurse–midwives who teach in baccalaureate nursing programs. Therefore, the purpose of this phenomenological study was to explore and describe their experiences.

Method

The study employed a phenomenological research design based in the naturalistic paradigm (Lincoln & Guba, 1985). Naturalistic inquiry is closely aligned with nurse–midwifery, having a humanistic and holistic philosophy. Phenomenology is the study of human experience from the perspective of those who have had the particular experience (Husserl, 1970). It seeks to understand the contexts and meanings the experience holds for an individual.

Purposive sampling was used to identify nurse–midwives who are teaching or who had previously taught in baccalaureate nursing programs. Participation criteria included certification by the American Midwifery Certification Board, clinical practice as a certified nurse–midwife for a minimum of 5 years, and teaching experience in a baccalaureate nursing program for a minimum of 2 years. Nurse–midwives participating in the American College of Nurse–Midwives (ACNM) caucus, “Midwives Teaching Nurses,” were contacted via the electronic mailing list. Additional snowball sampling allowed nurse–midwives who met the participation criteria to refer others for possible future participation.

The study proposal was approved by the institutional review board where the researcher was employed. Participation in the study was voluntary and could be withdrawn at any time. A study packet was mailed to potential participants that included a letter explaining the study, a consent form, and a demographic form. Participants returned the consent form and the demographic form to the researcher in a self-addressed stamped envelope. Procedures for data collection, analysis, storage, and use of the data were explained in the informational letter. After informed consent was obtained, interviews were scheduled. Data collection continued over a 6-month period. Face-to-face interviews were conducted in naturalistic settings chosen by each participant, such as cafes and restaurants. Eight interviews were face to face, and eight interviews were telephone interviews. The telephone interviews were necessary because of geographic distance. All interviews were audiorecorded and transcribed verbatim by the researcher. Every precaution possible was taken to protect the confidentiality and privacy of the participants. All data were coded and accessible only to the researcher.

Data analysis followed the procedure outlined by Colaizzi (1978). Audiotapes were listened to several times by the researcher to gain familiarity with the tone, content, and flavor of the data. The researcher reviewed each verbatim transcript, coded the data, and extracted significant statements to develop themes. An audit trail was used to highlight the decisions and interpretations made by the researcher during the analytical process. Field notes were taken by the researcher using the notation system of Schatzman and Strauss (1973) for observational, theoretical, and methodological notes. Findings were integrated into an exhaustive description of the lived experience of nurse–midwives who teach in baccalaureate nursing programs. To further strengthen the analysis, the researcher enlisted the consultation services of another experienced qualitative researcher to examine the coded transcripts, extracted significant statements, and designation of themes. Consensus was achieved.

Rigor in qualitative research is established and maintained by attending to the trustworthiness of the study. Five criteria for evaluating the trustworthiness of naturalistic inquiry were developed by Lincoln and Guba (1985): credibility, dependability, confirmability, transferability, and authenticity. Credibility and confirmability of findings were enhanced by keeping field notes during the data collection and analysis stages of the study and by audiotaping the interviews and transcribing them verbatim. Dependability and transferability were strengthened by keeping an audit trail, which served as a means of holding up to scrutiny the methodological and theoretical decisions made throughout the research process. Authenticity of findings was reinforced by member checking and sharing the transcripts with the participants. Finally, sharing the intricacies of the findings with another seasoned qualitative researcher gave further testimony to the trustworthiness of the study.

Results

Four data-generating questions guided the interview process:

  • Describe your experience as a nurse–midwife teaching in a baccalaureate nursing program.
  • How have you incorporated the midwifery philosophy in your teaching?
  • What has been the response of students to being taught by a midwife?
  • Is there anything else you would like to tell me about your experience?

Data saturation was achieved with a sample of 16 nurse–midwives, meaning that no new themes emerged from the data. All 16 nurse–midwives participating in this study were women. One educator was African American and 15 educators were White. The age range of the sample was from 37 to 65 years. Participants were from all geographic regions of the United States, and their clinical midwifery experience ranged from 7 to 37 years. Their years of teaching in a baccalaureate nursing program ranged from 3 to 17 years. Two nurse–midwives in the study had been family nurse practitioners. One nurse–midwife had been a maternal–newborn clinical nurse specialist prior to becoming a nurse–midwife. Educational levels included five nurse–midwives with doctoral degrees and 11 with master's degrees, four of whom were enrolled in doctoral programs.

Six themes emerged from the data: Emphasis on “Normal”; Knowing My Stuff: Confidence and Competence; Students Wanting to Become Nurse–Midwives in the Future; Students Desiring Nurse–Midwifery Care; Teaching and Imparting the Nurse–Midwifery Philosophy; and Professional Challenges: The Faculty Role.

Emphasis on “Normal”

The nurse–midwives stressed the importance of learning what is normal in the realm of women's health care throughout the lifespan. This theme was mentioned by every study participant. One nurse–midwife reported:

I start the course off by telling the students that they are going to be generalist nurses, so I set the stage that “normal” is what they need to know normal pregnancy, normal birth, normal newborn care, normal women's health care. They need to know the normal before they can appreciate deviations from normal.

A professor who teaches both nursing students and nurse–midwifery students stated:

I see nurse-midwifery's place within the nursing curriculum because I think we lend that normal perspective…. Midwives are the guardians of the normal.

The sentiments of these nurse–midwives reflected their mission to educate nurses about normal birth and the caretaking activities that enhance its possibility. Their beliefs and actions are undergirded by the midwifery model of care. The emphasis on normal may be a distinguishing characteristic of nurse–midwife educators because every nurse–midwife in the study stressed the importance of looking at pregnancy and birth from this perspective.

Knowing My Stuff: Confidence and Competence

Nurse–midwives employed in teaching roles are usually seasoned practitioners with years of experience, clinical expertise, and advanced educational preparation. The study participants met that description and their sense of confidence and competence was clearly evident in their responses. One educator stated, “The students like being taught by an instructor who is passionate about women's health and newborn care.”

Another nurse-midwife added:

I think the students really respect what I do as a midwife. I've been a midwife for over 20 years and I've helped over 2,000 babies into the world. I do my best to help students understand content and I make it real for them. They understand that I know my stuff and that I'm not a pushover. I'm credible to them.

These three exemplars capture the nurse–midwife educators' perceptions of their teaching roles. They recognize the need for the students to be taught by strong role models who teach by example. The educators in this study emphasized that confidence and competence are needed to demonstrate high-quality health care; to foster advocacy for women, infants, and families; and to promote change within the health care system. They felt that they communicated this to their students in both the classroom and in the clinical setting.

Students Wanting to Become Nurse–Midwives in the Future

The nurse–midwives in this study told stories about past students who have become nurse–midwives. Some talked about seeing former students at the ACNM annual meeting, others took on the role of mentor, and one nurse–midwife credited herself with increasing the nurse–midwifery population by four. This professor stated:

Nursing students are very receptive to midwifery…. Last year at the Pinning Ceremony, many students said that they wanted to become nurse midwives and that's a very nice thing for me to hear. They were taught by nurse midwives, and they've had clinical experiences with nurse midwives. They describe clinical with nurse midwives as having more calmness in care-providing situations, more teaching, and more client involvement in the birthing process.

Another nurse-midwife reported:

I have lots of students come to me who want to be midwives in the future. Students really respond to that same kindness that we show our patients. I apply some of the same principles to teaching students that I do in caring for patients. As students learn, they blossom…. I'm able to realistically discuss what a career in midwifery entails with students.

When nursing students have the opportunity to be taught by nurse–midwives, especially in clinical settings, they may see the role through a clear and enlightened lens. The nurse–midwives in the current study saw themselves as effective role models for students. As educators, they framed student learning experiences and told how they tried to inspire and motivate students to seek additional educational preparation to realize their career aspirations.

Students Desiring Nurse–Midwifery Care

The study participants shared numerous vignettes of nursing students expressing the desire for nurse–midwifery care for themselves and their family members as a result of learning about the midwifery model of care. One educator told how some of her male nursing students expressed the wish for their wives or girlfriends to seek health care from nurse–midwives. Another educator commented:

I've had students come up to me at the end of a semester and thank me for the self-knowledge they have gained for their own health care practices. Some say that even though they want to be an [intensive care unit] nurse or an [emergency department] nurse, they want midwifery care for themselves for pregnancy, birth, and primary care.

Another nurse–midwife stated, “Students love being taught by nurse–midwives and some say that before being taught by a midwife, they didn't know this type of care was available.”

Thus, it appears that students become knowledgeable about the midwifery model of care from their maternal–newborn nursing course and clinical experiences. As a result, many come to embrace this model of care for themselves and their families.

Teaching and Imparting the Nurse–Midwifery Philosophy

All 16 nurse–midwives in the study mentioned how they imparted the nurse–midwifery philosophy of care in their teaching. One shared:

You know the slogan “changing the world one baby at a time”…well, teaching is “changing the world one student at a time”…and we don't have enough midwives in our country right now. I realize the incredible power that nursing has at the bedside to make birth go well…to influence the outcome. Let's teach the people in the trenches about what the evidence is to support the midwifery philosophy…. I see teaching nursing students as an amazing opportunity to make the world a better place for mothers and babies. I feel like I am reaching more people by teaching.

Another participant added, “The midwifery philosophy is a way of life for me. I don't have to consciously think about it. It's part of me.”

A third participant reflected on her teaching career, “I feel like I was meant to do this—to teach. Midwifery and teaching seem inextricably linked in my mind. I feel like I am on a mission to get the message of the midwifery model of care across to my students.”

Nurse–midwives do not teach just to recruit future nurse–midwives or to convince students to seek nurse–midwifery care. They teach because they love maternal–newborn and women's health nursing and want to convey the joy and satisfaction they feel from providing excellent care to women throughout the lifespan. They want to teach students evidence-based care and respect for women, infants, and families. Yet, their teaching may contribute to the recruitment of future nurse–midwives and may facilitate others embracing the midwifery model of care as well.

Professional Challenges: The Faculty Role

The nurse–midwives in the study mentioned a variety of professional challenges associated with the faculty role. Many related that they did not have full comprehension of the demands inherent in a full-time teaching position until they were immersed in it and felt overwhelmed. Some were trying to juggle their own clinical hours with a full-time teaching workload which proved to be extremely difficult. Others did not realize the time commitment involved with planning class content; making clinical assignments; advising students; and fulfilling service responsibilities to the university, nursing department, and the community. With academic positions came the expectation to produce scholarly work in the form of research studies, professional journal articles, and presentations at nursing conferences. One nurse–midwife lamented:

I love almost everything about my academic role, it's just that there are not enough hours in the day to accomplish everything I am supposed to do. My priority is classroom teaching and clinical teaching in the hospital…but when am I going to find time for everything else?

Some of the nurse–midwives in the study expressed concern about what they perceived as a dichotomy between nursing and midwifery. One educator summarized the sentiments of many, stating:

Midwifery and nursing need to come back together as friends. Midwives have so much to offer nursing education. We need to turn strong nurses into strong midwives.

Another voiced her frustration about comments made to her since she transitioned from clinical practice to a teaching role. She reported:

Every now and then I run into someone who says, “You used to be a midwife?” Well, I feel very strongly that midwives make the world a better place for families. I don't need to have my hands at the perineum. I'm making the world a better place with my teaching. I think it's great for midwives to be involved in nursing education.

The same nurse-midwife added:

I will always be a midwife even though I am not currently birthing babies. Midwives can make wonderful contributions in a variety of settings and they do different types of work: clinical, teaching, consulting, and research. It's not just thinking outside the box, it's creating a new box.

This final theme touched on myriad issues within the academic educator role. Simply stated, these nurse–midwives are trying to succeed in the faculty role while maintaining professional identity as nurse–midwives. This touches on the responsibilities they have in the faculty role to fulfill teaching, scholarship, research, and service components of the role while maintaining certification and clinical competence. It is apparent these educators deserve respect and support from colleagues and not unfounded criticism because they have chosen to take on a teaching role. The nurse–midwife educators in this study became involved in nursing education after years in clinical practice. None of them expressed regret with their decision to teach nursing in a baccalaureate program. There was a definite sense of giving back to guide future generations of nurses.

Discussion

It is important to understand the lived experience of nurse–midwives who choose to teach in baccalaureate nursing programs. These positions are viable options for seasoned nurse–midwives who bring a plethora of knowledge and skills to the academic setting. For many, the academic role offers opportunities to grow and expand their skill set in a variety of ways and at a point in their careers where they are able to entertain a host of new possibilities. Those without doctoral degrees at the beginning of their teaching career often choose to pursue a terminal degree and become involved in a program of research. This was true of the nurse–midwife educators in this study. Many suggested that academia opened a new world to them and they discovered “delight and meaning” in teaching nursing students. The educators in this study were pleased with their decisions to become nurse–midwives and were proud of their chosen profession. They had a strong desire to care for women and newborns and were in awe of the miracle of birth. They were advocates for women and families and enjoyed teaching nursing students. These findings were congruent with those of other studies (Carolan, 2011; Carolan & Kruger, 2011; Fraser & Hughes, 2009; Green & Baird, 2009; McCall, Wray, & McKenna, 2009; Seibold, 2005).

Study participants described various reasons for making the transition from clinical midwifery to nursing education. Some of the newer educators in the sample had some educational preparation for teaching, whereas others did not. All of the educators in this study planned to stay in academia because they enjoyed it, felt like they were making a difference, and were interested in a program of research that would further promote nurse–midwifery.

Interview data revealed a strong emphasis on normal, which was striking but not surprising given the way nurse–midwives are educated in graduate programs throughout the United States. The voices of the study participants echoed their belief in normal physiologic birth. This is a sentiment heard loud and clear in the global midwifery community in an effort to diminish the high cesarean birth rate. Operative births are at an all-time high in the United States and these nurse–midwife educators expressed their concern. They described how this situation informed their teaching of nursing students and how it may have influenced student decisions for their future careers and for their own health care during the childbearing season.

The nurse–midwife educators who participated in this study commented on their feelings of confidence and competence. They viewed these two qualities as essential to their teaching and practice roles. Both the nursing and midwifery literature support this contention (Belinsky & Tataronis, 2007; Perry, 2009; Price, 2004). The importance of confidence in the nurse–midwife's abilities coupled with trust was emphasized repeatedly (Doherty, 2010; Kennedy, 1995; Walker, Hall, & Thomas, 1995). In addition, competence was considered a trait of presence and was defined as professional judgment, critical thinking, taking appropriate actions, communication, active listening, and having expertise (Belinsky & Tataronis, 2007).

An indirect result of having nurse–midwives in the educational workforce may be the recruitment of future nurse–midwives. As role models and educators, they have numerous opportunities to plant the seeds of midwifery care wherever they go. Role models also influence the selection of nursing as a career choice, and an overwhelming number of nursing students indicate that they want to make a difference in people's lives and that they increase their personal satisfaction by helping people (Shatell, Moody, Hawkins, & Creasia, 2001).

In examining the theme Students Want to Become Nurse–Midwives in the Future, it is clear that these particular students need to be encouraged and guided in the direction of further knowledge development. Activities such as shadowing, watching videos, attending a nurse–midwifery chapter meeting, or auditing a nurse–midwifery class in a graduate program may be helpful to interested students. It is always advantageous if nursing programs can procure clinical placements with nurse–midwives in clinics, hospitals, birthing centers, and private practices so students will have opportunities to learn about the midwifery model of care.

It is interesting to note that many of the comments made by the nurse–midwife educators in this study referred to feedback they had received from their students. They candidly recalled some meaningful comments made to them about being taught maternal–child nursing by a nurse–midwife. They often reflected on student feedback about their emphasis on the normal in their teaching. These educators were pleased that students had told them of their desire to become nurse–midwives in the future or about their plans for nurse–midwifery care for themselves during the childbearing season.

Most research on the transition process from clinical nursing to nursing education focuses on the first few years as a new nurse educator. Studies typically explore the work transition (Anderson, 2009; Penn et al., 2008; Sorrell & Cangelosi, 2016), the influence of cultural differences (Schriner, 2007), and the fostering of a smooth transition (Cangelosi, Crocker, & Sorrell, 2009).

Although much of the nurse–midwifery literature looks through the lens of women's experiences with care, it appears that many descriptions can also be applied to the experiences of nurse–midwife educators with their students. Although no previous studies exist on the topic of nurse–midwives teaching nursing students, related literature has shed some light on this topic. For example, several authors (Ayers, 1986; Belenky, Clinchy, Golkberger, & Tarule, 1986; Weimer, 2008) have commented on the linkage between midwife and teacher. Belenky et al. (1986) coined the term midwife-teacher in their work on women's ways of knowing. Midwife-teachers were described as being there “to assist students in giving birth to their own ideas, in making their own tacit knowledge explicit and elaborating on it” (p. 217). Comparably, Weimer (2008) wrote, “the midwife is still my favorite metaphor for teaching because it captures the complexity, power, and richness of a dynamic relationship: teachers, students, and learning” (p. 5). Just as the midwife cares for and guides the laboring woman, the teacher supports the struggling student. Each respective dyad forms an alliance. Ayers (1986) compared the occasion of birth and beginning parenting to the experience of personal renewal for teachers when they see intellectual curiosity and potential in their students. Although midwives and teachers are not synonymous, they may be linked because of their shared attributes, such as positive presence, experience, understanding, and patience (Ayers, 1986; Belenky et al., 1986; Weimer, 2008).

In the current study, nurse–midwife educators freely described their experiences in the teaching role, and in doing so, they often related what they deemed to be the student perspective or what students had told them about being taught by a nurse–midwife. Their narratives reflected what was important to them and how they made sense of their teaching experiences. The nurse–midwives in the current study wanted their voices to be heard, but they also incorporated feedback from students in the descriptions of their teaching experiences. This suggests that these educators cared deeply about the message they were getting across to the students.

When students develop a love of maternal–newborn nursing, feel a calling to nurse–midwifery, or have an epiphany moment, it may be the result of being taught by a nurse–midwife (Ulrich, 2009). This should come as no surprise because they were taught to give comforting labor support; to use myriad pain relief methods, such as mental imagery, relaxation techniques, and breathing exercises; and to engage in reflection about the miracle of birth and the positive presence of being “with woman.” When students reach this point, their nurse–midwife educators need to be present to inform and advise them. The same holds true for the nursing students who choose another clinical specialty area for their practice but who are interested in the midwifery model of care for themselves. This finding is extremely important because these future nurses can be strong advocates for the midwifery model of care.

The findings of the current study are synchronous with those of Hughes and Fraser (2011), who suggested that the best role models for nurse–midwifery students are practitioners who possess a woman-centered philosophy of care. In their study, successful learning experiences depended mostly on the relationship between student and preceptor. Similarly, the current study highlights the importance of nurse–midwife educators in facilitating student learning. Readiness to learn is optimized when the student feels supported, respected, and cared for as a person and when the educator is interested in assisting them in meeting their needs (Warne et al., 2010). In the current study, student learning was enhanced by motivated faculty who were willing to share their expertise in both the classroom and the clinical setting.

The participants in the current study seemed to be past the initial hurdles of the nurse educator role and were focused on student learning to a great extent. Yet, the final theme narratives mentioned challenges associated with time management in the faculty role with the components of teaching, scholarship, research, and service. There was also mention of friction between nursing and midwifery, which probably hints at one contingent within the ACNM wishing to separate from nursing, whereas the majority of members are aligned with keeping the name of the organization the same. In addition, some of the nurse–midwife educators expressed frustration with comments suggesting they were no longer midwives because they were not engaged in full-scope practice because they were fulfilling an academic role. The aforementioned issues compounded their challenges in the nurse educator role.

The themes in this study reflect the voices of the nurse–midwife educators as they described their experiences in the academic role. There were some similarities with the findings of this study and other studies, especially with regard to the professional challenges educators face as they try to meet role expectations (Jackson, Peters, Andrew, Salamonson, & Holcomb, 2011; McDermid, Peters, Daly, & Jackson, 2013).

The findings of this phenomenological study cannot be generalized to all nurse–midwives who teach in baccalaureate programs. Yet, the study had a sample size of 16 participants, and these participants represented all geographic regions of the United States.

A possible limitation of the study could have been that the interviews were audiorecorded, which can make some people uncomfortable or distracted. The data met the trustworthiness criteria, data saturation was achieved, and member checking was used. The coding of the data, use of Colaizzi's (1978) framework, and the development of themes were agreed on by two experienced qualitative researchers. These activities strengthened the study.

Conclusion

This study described the lived experience of nurse–midwives teaching in baccalaureate nursing programs. These nurse–midwives are in strategic positions as role models to foster a love of maternal–newborn and women's health nursing, influence career decisions, and interest nurses in the midwifery model of care throughout the lifespan. These educators have the power, expertise, and leadership to carve out a significant place in nursing education.

The nurse–midwives in this study shared meaningful stories about their work, how they viewed themselves, and of their interactions with nursing students. This reflects both positively on the qualities of the nurse–midwives themselves and on the experience they bring to nursing education.

The following recommendations for nurse–midwives engaged in teaching roles warrants further consideration:

  • Nurse–midwives teaching in baccalaureate nursing programs should elicit support from others with experience in the teaching role, such as the members of the “Midwives Teaching Nurses” caucus within the ACNM.
  • Nurse–midwives who are new to the teaching role should seek mentorship from seasoned nursing faculty.
  • Nurse–midwives teaching nursing students should recognize and appreciate the value of their role in the recruitment of future nurse–midwives and in the promotion of the midwifery model of care for the lifespan.
  • Maternal–newborn and women's health nursing courses should include clinical experiences with nurse–midwives if at all possible.
  • The positive contribution made by nurse–midwives teaching in nursing programs should be articulated more fully within the aspects of higher education and within the ACNM. This can be accomplished by highlighting the contributions made by nurse–midwife educators at colleges and universities to showcase their clinical expertise. Similarly, the ACNM should give greater recognition to the teaching role of nurse–midwives in baccalaureate nursing programs as a viable option for those who want to teach after years of clinical practice.

More research is needed about the experience of nurse–midwives teaching nursing students. The current study should be replicated using a larger and more ethnically diverse sample. Another study could compare the experience of the nurse–midwife educators with that of the nursing students they teach. It would be interesting to see how these experiences match up. The student perspective deserves exploration and would be a worthwhile partner to the current study. Listening to the voices of nursing students may identify what they found to be helpful, inspirational, energizing, and supportive, as well as the opposite. Finally, future research is also needed to identify the most effective pedagogic approaches to meet the needs of current nursing students, which will benefit nurse–midwifery as well.

Thus, it is likely that the proportion of nurse–midwives teaching in baccalaureate nursing programs will continue to grow. Although this is advantageous for the profession as a whole and exposes students to dynamic role models, it is also likely to help the nursing faculty shortage.

References

  • Anderson, J.K. (2009). The work-role transition of expert clinicians to novice nurses educators. Journal of Nursing Education, 48, 203–208. doi:10.3928/01484834-20090401-02 [CrossRef]
  • Ayers, W. (1986). About teachers and teaching: Thinking about teachers and curriculum. Harvard Educational Review, 56, 49–52. doi:10.17763/haer.56.1.h8576w146u254840 [CrossRef]
  • Belenky, M., Clinchy, B., Golkberger, N. & Tarule, J. (1986). Women's ways of knowing: The development of self, voice and mind. New York, NY: Basic Books.
  • Belinsky, S.B. & Tataronis, G.R. (2007). Past experiences of the clinical instructor and current attitudes toward evaluation of students. Journal of Allied Health, 36, 11–17.
  • Cangelosi, P.R., Crocker, S. & Sorrell, J.M. (2009). From expert to novice: Clinicians learning new roles as clinical nurse educators. Nursing Education Perspectives, 30, 367–371.
  • Carolan, M. (2011). The good midwife: Commencing students' views. Midwifery, 27, 503–508. doi:10.1016/j.midw.2010.03.012 [CrossRef]
  • Carolan, M. & Kruger, M. (2011). Undertaking midwifery studies: Commencing students' views. Midwifery, 27, 642–647. doi:10.1016/j.midw.2009.10.002 [CrossRef]
  • Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In Valle, R. & King, M. (Eds.), Existential-phenomenolgical alternatives for psychology (pp. 48–71). New York, NY: Oxford University Press.
  • Culleiton, A. & Shellenbarger, T. (2007). Transition of a bedside clinician to a nurse educator. Medsurg Nursing, 16, 253–257.
  • Doherty, M.E. (2010). Voices of nurse-midwives: A tapestry of challenges and blessings. MCN: The American Journal of Maternal Child-Nursing, 35, 96–101.
  • Fraser, D.M. & Hughes, A.J. (2009). Perceptions of motherhood: The effect of experience and knowledge on midwifery students. Midwifery, 25, 307–316. doi:10.1016/j.midw.2007.07.007 [CrossRef]
  • Gardner, S.S. (2014). From learning to teach to teaching effectiveness: Nurse educators describe their experiences. Nursing Education Perspectives, 35, 327–329. doi:10.5480/12-821.1 [CrossRef]
  • Gazza, E.A. (2009). The experience of being a full-time nursing faculty member in a baccalaureate nursing program. Journal of Professional Nursing, 25, 218–226. doi:10.1016/j.profnurs.2009.01.006 [CrossRef]
  • Green, S. & Baird, K. (2009). An exploratory comparative study investigating attrition and retention of student midwives. Midwifery, 25, 79–87. doi:10.1016/j.midw.2007.09.002 [CrossRef]
  • Hughes, A.J. & Fraser, D.M. (2011). ‘SINK or SWIM’: The experience of newly qualified midwives in England. Midwifery, 27, 382–386. doi:10.1016/j.midw.2011.03.012 [CrossRef]
  • Husserl, E. (1970). The crisis of European science and transcendental phenomenology. Evanston, IL: Northwestern University Press.
  • Jackson, D., Peters, K., Andrew, S., Salamonson, Y. & Holcomb, J. (2011). ‘If you haven’t got a PhD, you're not going to get a job: The PhD as a hurdle to continuing academic employment. Nursing Education Today, 30, 340–344. doi:10.1016/j.nedt.2010.07.002 [CrossRef]
  • Kennedy, H.P. (1995). The essence of nurse-midwifery care: The woman's story. Journal of Nurse-Midwifery, 40, 410–417. doi:10.1016/0091-2182(95)00046-M [CrossRef]
  • Lewallan, L.P. (2002). Using your clinical expertise in nursing education. Clinical Nurse Specialist, 16, 242–246. doi:10.1097/00002800-200209000-00006 [CrossRef]
  • Lincoln, Y. & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
  • McCall, I., Wray, N. & McKenna, L. (2009). Influence of clinical placement on undergraduate midwifery students' career intentions. Midwifery, 25, 403–410. doi:10.1016/j.midw.2007.07.008 [CrossRef]
  • McDermid, F., Peters, K., Daly, J. & Jackson, D. (2013). ‘I thought I was just going to teach’: Stories of new nurse academics on transitioning from sessional teaching to continuing academic positions. Contemporary Nurse, 45, 46–55. doi:10.5172/conu.2013.45.1.46 [CrossRef]
  • Penn, B.K., Wilson, L.D. & Rosseter, R. (2008). Transitioning from nursing practice to a teaching role. The Online Journal of Issues in Nursing, 13 (3), 1–12.
  • Perry, B. (2009). Role modeling: Excellence in clinical practice. Nursing Education in Practice, 9, 36–44. doi:10.1016/j.nepr.2008.05.001 [CrossRef]
  • Price, B (2004). Mentoring: The key to clinical learning. Nursing Standard, 18, 52. doi:10.7748/ns2004.09.18.52.1.c6647 [CrossRef]
  • Schatzman, L. & Strauss, A. (1973). Field research: Strategies for a new sociology. Englewood Cliffs, NJ: Prentice Hall.
  • Schoening, A.M. (2013). From bedside to classroom: The nurse educator transition model. Nursing Education Perspectives, 34, 167–172. doi:10.5480/1536-5026-34.3.167 [CrossRef]
  • Schriner, C.L. (2007). The influence of culture on clinical nurse transitioning into the faculty role. Nursing Education Perspectives, 28, 145–149.
  • Seibold, C. (2005). The experiences of a first cohort of Bachelor of Midwifery students, Victoria, Australia. Australian Midwifery Journal, 18, 9–16. doi:10.1016/S1448-8272(05)80024-0 [CrossRef]
  • Shatell, M., Moody, N., Hawkins, R. & Creasia, J. (2001). Nursing students career choices: A pilot study. Tennessee Nurse, 64(3), 14–15,18.
  • Sorrell, J.M. & Cangelosi, P.R. (2016). Expert clinician to novice nurse educator: Learning from first-hand narratives. New York, NY: Springer.
  • Ulrich, S. (2009). Applicants to a nurse-midwifery education program disclose factors that influence their career choice. Journal of Midwifery and Women's Health, 54, 127–132 doi:10.1016/j.jmwh.2008.09.002 [CrossRef]
  • Walker, J., Hall, S. & Thomas, M. (1995). The experience of labor: A perspective from those receiving care in a midwife-led unit. Midwifery, 11, 120–129. doi:10.1016/0266-6138(95)90026-8 [CrossRef]
  • Warne, T., Johansson, U., Papastavrou, E., Tichlaar, E., Tomietto, M. & den Bossche, K.V. (2010). An exploration of clinical learning experiences of nursing students in nine European countries. Nursing Education Today, 30, 809–815. doi:10.1016/j.nedt.2010.03.003 [CrossRef]
  • Weidman, N.A. (2013). The lived experience of the transition of the clinical nurse expert to the novice nurse educator. Teaching and Learning in Nursing, 8, 102–109. doi:10.1016/j.teln.2013.04.006 [CrossRef]
  • Weimer, M. (2008). The teacher midwife. The Teaching Professor, 5–6.
  • Zambroski, C.H. & Freeman, L.H. (2004). Faculty role transition from a community college to a research-intensive university. Journal of Nursing Education, 43, 104–106.
Authors

Dr. Doherty is Professor, Department of Nursing, Western Connecticut State University, Danbury, Connecticut.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Mary Ellen Doherty, PhD, RN, CNM, 638-53 Danbury Road, Ridgefield, CT 06877; e-mail: dohertym@wcsu.edu.

Received: March 06, 2016
Accepted: September 27, 2016

10.3928/01484834-20170123-04

Sign up to receive

Journal E-contents