Wisconsin is the state in which I will be discussing practice barriers for the nurse midwife, nurse
anesthetist, nurse practitioner, and clinical nurse specialist.
Midwife
In accordance with the written agreement outlined in s. N. 4.06 (2), a nurse-midwife is not
permitted to manage difficulties on their own (Licensure of Nurse-Midwives, 2022). N. 4.06 (2)
states a nurse-midwife must have a formal contract with a doctor who has completed
postgraduate obstetrics training before working together (Licensure of Nurse-Midwives, 2022).
Caesarean sections and forceps deliveries are not permitted to be done by nurse-midwives.
Only during emergency deliveries is a nurse-midwife permitted to utilize vacuum extractors
(Licensure of Nurse-Midwives, 2022). A nurse-midwife is not allowed to take on any duties out
of line with her education, training, and experience. A nurse-midwife may continue to oversee a
birth after notifying a doctor as required by Section 441.15(4) of the Statutes if emergency
measures are necessary and the doctor has not yet arrived (Licensure of Nurse-Midwives,
2022). 441.15 (4) states that the collaborating physician should be consulted by a nurse-midwife
who finds evidence that any part of treatment entails any complications that endanger the
health or life of a mother or newborn (Licensure of Nurse-Midwives, 2022).
Nationally, numerous issues have arisen in states lacking a proper regulatory framework. The
handling of complaints, with improper oversight and punishment, is particularly troublesome
(Jefferson et al., 2021). The availability of accurate workforce data, which is necessary for all
regulators and stakeholders to make good policy decisions, is another issue. One significant
strategy to stop the worsening maternity care issue in the United States is by expanding the
midwifery profession (Jefferson et al., 2021). The WHO International Year of the Nurse and the
Midwife and a worldwide pandemic brought attention to the importance of nurses and
midwives and deepened understanding of these "sister" professions, providing a crucial
opportunity to change the laws and regulations that currently impede the development of the
field and access to care (Jefferson et al., 2021).
Nurse Anesthetist
Because of how well-regarded nurse anesthetists' skills are, Wisconsin state law exempts CRNAs
from physician supervision. Wisconsin is also one of 19 states that choose not to impose the
federal Medicare physician supervision requirement for CRNAs (2005) (Wisconsin Association of
Nurse Anesthetists, 2021)
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