AT THE ONSET OF APPRENTICESHIP

Step 1 : Submit the Preceptor Request Form

Student must submit the “Preceptor Request Form” indicating they intend to begin an apprenticeship. This should be done PRIOR to beginning to work with a preceptor. Additionally, students should not begin work with a preceptor until all steps in this workflow are completed, which can take approximately 2 weeks to complete.

Upon receipt of this form, NMI will do the following:

• Administrative Office will review the Preceptor and Clinical Site status.

• If either Preceptor or Clinical Site are missing documentation, NMI will contact the prospective preceptor to request that Step 2 be completed.

• If both the Preceptor and Clinical Site are active and in good standing, NMI will send Preceptor and student a Work Agreement for signature (see Step 3).

Step 2: If Preceptor and Clinical Site are NOT Registered at NMI:

NEW Forms were released March 2023. All Preceptors and Clinical Sites must complete these new forms (if preceptor was approved prior to March 2023 they will need to submit new documentation if this is not already submitted).

• Preceptor submits New Preceptor Registration Form

• Clinical Site submits Clinical Site Form - may be completed by Administrative Staff at the Clinical Site

Step 3: Complete the Work Agreement

After Step 1 and Step 2 are completed, NMI will send a Work Agreement Template to both the student and preceptor.

Together, student and preceptor will complete their Work Agreement. This document outlines expectations that both the Preceptor and the Student have during their working relationship.

NOTE: Again, student should not begin care experiences prior to this work agreement being finalized.

Objectives

Apply Study Group module learning to community-based midwifery practice.

Demonstrate skills progression with qualitative midwifery competence meanwhile advancing through beginning, intermediate and advanced midwifery practica.

Acquire entry level competence in the scope of practice outlined by the Midwives Alliance of North America (MANA) core competencies, the North American Registry of Midwives (NARM) certification guidelines, the California Midwifery licensing requirements as well as other state licensure requirements, and the International Confederation of Midwives (ICM) International Definition of the Midwife.

Activities

Apprenticeships are based in home birth or birth center practices. Students are responsible for securing their apprenticeships and should examine options in-depth, as well-suited opportunities can be unique to each student.

Students should be familiar with the Clinical Instruction section of the Student Handbook. There you will find information on:

• How to find a preceptor and succeed in apprenticeship.

• Preceptor qualifications: criteria & requirements.

• Expectations for clinical documentation.

• Student clinical skills advancement.

• Apprenticeship experience.

• Clinical requirements for graduation.

Learning Materials

The NMI Media Library provides access to an institutional Full Text subscription to MEDLINE, a list of DVDs and print media available to borrow from the NMI Office, and NMI's digital subscriptions available to students and faculty.

Students are also expected to access material listed on the NMI Book List (shared upon enrollment) and Study Group modules throughout their apprenticeships.

Learning Resources

The ‘Other Resources’ page of the Student Portal includes links to bi-weekly Hive Mind sessions in which NMI instructors provide real time online instruction and Study Group module support. Midwifery Skills Labs are included in the rotation of topics scheduled for bi-weekly Hive Mind sessions, and are intended to support students’ acquisition of learning skills through the experiential learning format of clinical apprenticeship.

Observe

Students are active observers at a birth, or supporting in a doula-type role. Students are not performing clinical skills.

• some students complete these observe experiences prior to enrolling with NMI, during their previous birth support or doula work

• these births need to be signed/acknowledged by a witness, but this witness does not need to be a registered preceptor, it can be anyone present at the birth with the student

Assistant Midwife Under Supervision

Students are actively engaged in the clinical experience (prenatal visit, family planning visit, birth, postpartum visit, other types of client interactions), and assisting the midwife in all essential tasks and skills. Students are learning to perform clinical skills.

• students may act as a birth assistant or back-up midwife at births when a midwife feels they are competent. This may include proficiency in emergency skills if assistance is needed, charting, vital signs, fetal heart rate, etc.

• catching a baby is usually a skill learned during the assist phase, starting with four-handed catches, and progressing until proficiency and independence in the Primary Under Supervision Phase

• generally, students are able to learn and eventually complete basic clinical skills, but not yet able to manage/run a whole appointment or birth independently

Primary Midwife Under Supervision

Students are competent and proficient at managing client interactions and performing clinical skills independently. The precepting midwife supports and supervises from the sidelines.

• students should function as if they are the midwife, and demonstrate independent skills. Clients should perceive them as their equal or primary midwife.

• students demonstrate proficiency not just in clinical skills, but in planning ahead, documenting and charting, restocking supplies, etc.

• preceptors still support students and clients when new situations present, more information or wisdom is needed, or emergencies need intervention.

The first time that you log in the NMI Clinical Tracking App, please check that your name and contact information are correct in the profile section. Please enter the name and phone number of an emergency contact, as well.

Documenting clinical experiences is an important part of clinical education at National Midwifery Institute. It’s important to document and track each clinical experience you have while working as a midwifery student, and important for your preceptor and NMI to follow along in order to support your progress.

All tracking is ONLINE through a clinical experiences tracking app. ALL STUDENTS are required to track their clinical experiences through the Clinical Tracking App, and all preceptors will approve experiences through the app as well.

Using the Clinical Tracking App

The app can be accessed at www.nmiclinicaltracking.com. The following provides detailed instructions on logging in for the first time and how to use the app:

Student Documentation of Care - Student Instructions

Paper Forms

Fillable PDF forms are available for preceptors to sign clinical experiences. Note that these will still need to be uploaded to your student profile in the app for Clinical Director Approval.

Use of paper forms must be approved by the Clinical Director. Paper forms are only approved for rare exceptions.

If you upload a paper form to the CTA, you must submit one page per experience. If you combine pages and upload as one single PDF they will be denied. Please note that use of PDF forms will delay processing times.

CLICK TO ACCESS CLINICAL FORMS

NMI students and their preceptors working together are expected to turn in paperwork within certain timeframes:

QUARTERLY - Experience Documentation

Any and all clinical experiences attended require preceptor signature and submission to NMI at the end of the quarter they were completed. This includes initial prenatal, prenatal, postpartum, and newborn exams, as well as births attended.

PERIODICALLY - Skills Log Forms

Prior to graduation, students and preceptors must complete five skills logs that assess clinical readiness for entry-level practice. NMI encourages periodic completion skills logs to track clinical progression. Meeting NMI requirements for skills logs requires a rating of “3” on log items, by student and preceptor assessment.

NMI Students are expected to begin apprenticeship within certain timeframes after enrolling with the program:

• Within 36 months of initial enrollment: student must secure an apprenticeship

• Within 42 months of initial enrollment: student must begin filing documentation of non-primary experience (observes, assists)

• Within 60 months of initial enrollment: student must begin filing documentation of Supervised Primary Care

NMI’s clinical experience requirements meet NARM certification standards, California licensing requirements, and licensing requirements of many states. In order to meet Clinical Requirements for Graduation the student must demonstrate the following:

OBSERVE PHASE:

Functioning in any role (observer, doula, family member, friend, beginning apprentice):

• 10 Observe Births

ASSIST PHASE:

Functioning in the role of student-assistant midwife under supervision:

• 20 Assist Births

• 22 Assist Prenatal exams

• 3 Assist Initial Prenatal exams

• 20 Assist Newborn exams

• 10 Assist Postpartum exams

PRIMARY PHASE:

Functioning in the role of student-primary midwife under supervision:

• 25 Births attended

• 55 Prenatal exams

• 20 Initial Prenatal exams

• 20 Newborn exams

• 40 Postpartum exams within 24 hours and 6 weeks of birth

Continuity of Care Clients

Of the 25 required Student-Primary under Supervision births, 10 must be with clients for whom the apprentice provided Partial Continuity of Care.

• Partial Continuity of Care: 1 prenatal exam and birth as Primary Midwife Under Supervision.

Of the 25 required Primary Midwife Under Supervision births, an additional 5 must be with clients for whom the apprentice provided Full Continuity of Care.

• Full Continuity of Care: at least 5 prenatal visits spanning at least 2 trimesters, birth, newborn exam, and at least 2 postpartum exams between 24hrs and 6wks, all in primary midwife under supervision role. Each encounter must be documented separately in the Clinical Tracking App to link to these Full Continuity of Care experiences.

Hospital transports cannot count towards Continuity of Care.

Please note:

No more than 4 births during the Assistant Midwife Under Supervision phase can be a transport. Per NARM, a transport includes a transport that occurs during labor, birth, third stage and or fourth stage.

No more than 3 births during the Primary Midwife Under Supervision phase can be a transport. Please refer to the above for the definition of transports.

CLINICAL SKILLS:

Demonstrate competence in each skill on the NARM Skills List, with a rating of at least 3, as recorded by both student preceptor on the Preceptor Evaluation/ Student Self-Assessment of Midwifery Skills for the following categories:

-Prenatal Skills Log

-Labor/Birth/Immediate PP Skills Log

-Postpartum Skills Log

-Newborn Skills Log

-Additional Skills Log

SECOND VERIFICATION OF SKILLS:

Provide evidence of Second Verification of Skills in the following NARM required categories:

-Basic Physical Exam

-Routine Prenatal Exam of Pregnant Person at Least 28 Weeks Gestation

-Newborn Exam

-Postpartum Exam at 24-72 hours

-Drawing up and Administration of IM Medication

-Set Up and Administration of Oxygen

-Sterile Technique

CPR/BLS & NRP

Provide evidence of current CPR (adult and infant) or BLS for Healthcare Providers and Neonatal Resuscitation (NRP) certification.

For more information, please read our NMI Graduation Policy & Procedure.

Please refer to the Student Handbook for information regarding Evaluations. The forms required are provided below:

Biannual Student Assessment : for preceptors to fill out twice per year as a discussion point and check in on student’s continued fit for the preceptor’s practice.

Biannual Student Assessment of Preceptor : for students to fill out to evaluate their preceptor and their working relationship with their preceptor. This may be shared with preceptor or simply submitted directly to NMI, at the student’s discretion.

Preceptors may invoice National Midwifery Institute for exams and births attended with students if the student performed as student assistant or as student primary midwife under supervision of the preceptor. All experience must be under the direct observation of the preceptor who signs as witness. 

For students who enrolled prior to June 2019 and who have a Preceptor Honorarium on reserve, please use the Preceptor Invoice for Births to submit a request for payment.

Payment will only be approved if Preceptor has completed a W-9, and experience documentation is on file and approved in the Clinical Tracking App.