Certified Nurse Midwife

Job Summary:
Provides primary medical care and treatment to obstetrical and gynecological patients under supervision of Obstetrician.

Job Duties:
Routine duties shall include providing health care services to individuals eligible for services in accordance with the self-governance compact and funding agreement between the Cherokee Nation and United States executed under the authority of the Indian Self-Determination and Education Assistance Act. Provides routine obstetrical and gynecological care to women on an independent basis. Routine care would include obtaining a thorough history, performance of an appropriate examination, ordering laboratory tests, performing pap smears, sexually transmitted disease testing and any other accepted routine testing. Provides family planning education/services, prescribes birth control pills, inserts intrauterine contraceptive devices, fits diaphragms, etc. Provides independent care to women and babies that regularly involve high risk/problem cases on a co-management basis with the physician/obstetrician such as diabetes, pre-eclampsia, hypertension, anemia, infection, cardiac problems, arrested progress of labor, hemorrhaging, etc. Provides independent care within established guidelines of a medically directed health service. Collaborates in determining, and makes recommendations for broad program goals and objectives for maternal-child health care in Indian Health Service. Participates in designing and conducting research relevant to the health care needs of individuals, families and communities. Provides advice and serves as a health consultant to patients, other professionals, the community and others as requested. Maintains health records utilizing problem oriented format. Provides for comprehensive (total) care with the freedom to consult with and/or refer to other health care providers as necessary. Collaborates in planning and participates in teaching in educational programs for patients, families, para-professional, and professional health workers. Manages the medical and nursing care of patients in the antepartum period and during labor and delivery. Performs complete history and physical examination; determines dosage and timing of medications; orders and/or administers medication for relief of pain in labor; utilizes fetal monitoring equipment including application of scalp electrodes and interprets the meaning of the information recorded; determines the content, orders and/or administers intravenous solutions and medications and performs other specialized procedures. Conducts spontaneous vaginal delivery without the use of forceps; determines method and administers anesthesia such as paracervical, pudendal and local blocks; performs episiotomy and does repair of episiotomy and/or lacerations; records the delivery in permanent record book, and signs the completed birth certificate. Determines the need for ultrasound exams; fetal activity acceleration tests (FAAD); oxytocin challenge tests (OCT); interprets results of tests, and uses the results to plan and carry out a course of treatment. Manages the medical nursing care of patients during their postpartum period (clinic and inpatient), provides family planning education/services and gynecological services to women; prescribes birth control pills, inserts intrauterine contraceptive devices, fits diaphragms, does pelvic examinations and Pap smears. Collaborates in the care of newborn infants as needed. Initiates and provides emergency care measures in the event complications occur. Resuscitation of newborn infants includes intubation, administering oxygen, cardiopulmonary resuscitation (CPR), etc.  Manages the treatment of hemorrhage an shock, starts intravenous therapy, prescribes and administers medications, conducts manual removal of placenta, uterine exploration and bi-manual compression. Admits patients, obtains and records medical histories, performs physical examinations, determines plans of care and writes orders to carry out the plans. Orders and interprets laboratory studies. Orders, administers and monitors medications within prescribed guidelines. Under the guidelines, orders for medications are honored by nursing and pharmacy staff without counter-signature of a physician. Provides well child care as determined by Service Unit policy. Evaluates and determines the need for consultation and obtains physician consultations as needed. implements consultant management plan. Determines the need for referral to other agencies an health care providers and makes referrals. Determines the need to involve health care providers, obtains consultations, and works cooperatively with them. Teaches and informs patients and family members to promote informed consent and knowledgeable participation in their own care and ways to maintain and/or improve their health status. This includes nutritional counseling, potential complications of birth control pills, I.U.D.'s, etc. Teaches, directs and/or supervises other health professionals and students (nursing, nurse midwifery, medical, pharmacy practitioners, community health medics) in providing maternal-child health care.

 

SUPERVISORY RESPONSIBILITIES   

No supervisory responsibilities.

Qualifications:
EDUCATIONAL REQUIREMENT 

Graduate of an accredited School of Midwifery.

 

EXPERIENCE REQUIREMENT 

No additional experience required.

 

COMPUTER SKILLS

None required.

 

CERTIFICATES, LICENSES, REGISTRATIONS 

Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. 

 

OTHER SKILLS AND ABILITIES 

Knowledge of nurse midwifery and medical management practices. Knowledge of pharmacology in the areas of contraceptives, controlled drugs, sedatives, tranquilizers, anesthetics, intravenous solution, uterine stimulants, antibiotics, and other agents used to treat common medical problems. Knowledge of dietary patterns and beneficial plans to teach health maintenance for families outside of, and within, pregnancy and lactation. Knowledge and ability to anticipate and recognized deviations from normal in order to institute measures to safeguard the well-being of women and babies. Knowledge of current normal and abnormal anatomy and physiology of women during pregnancy, including labor and delivery mechanism, in order to identify and initiate appropriate management of care. Knowledge of emergency measures and the ability to institute treatment. Knowledge of interviewing and physical assessment techniques and the ability to obtain a complete history and physical. Knowledge of the significance of all information collected and the ability to interpret and apply the information in managing the care of patients. Knowledge and possession of manual skills sufficient to perform atraumatic delivery techniques, anesthesia, minor surgical and resuscitation techniques, and to utilize specialized equipment and contraceptive devices. Knowledge of teaching, learning principles, evaluation, and testing techniques for student and patient education. Broad based knowledge in order to develop a realistic, workable, comprehensive plan of care. Knowledge of human behavioral sciences, cultures and cultural practices, normal growth and development throughout the entire life cycle, the community and resources available, and knowledge of how to initiate things. Knowledge of research principles and techniques in order to design, conduct and implement research findings to improve health care.

 

OTHER QUALIFICATIONS

Employee must not and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG’s Cumulative Sanction Report, or the GSA’s List of Excluded Providers, or listed on the OIG’s List of Excluded Individuals/Entities (LEIE).

 

PHYSICAL DEMANDS 

While performing the duties of this Job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to sit; climb or balance; stoop, kneel, crouch, or crawl and taste or smell. The employee must occasionally lift and/or move more than 100 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

 

WORK ENVIRONMENT 

While performing the duties of this Job, the employee is regularly exposed to fumes or airborne particles and toxic or caustic chemicals.  The noise level in the work environment is usually moderate.

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