Vann M K
J Nurse Midwifery. 1998 Jan-Feb;43(1):41-5. doi: 10.1016/s0091-2182(97)00123-7.
Although full admission privileges are considered the hallmark of full practice autonomy, the majority of certified nurse-midwives (CNMs) are denied the right to autonomously admit and discharge patients or have access to privileges only through the authority of a physician. This practice jeopardizes the independence of certified nurse-midwives and identifies them as adjuncts to the attending medical staff. The situation can only become more complicated now that the American College of Nurse-Midwives certifies nonnurses (CMs). Midwifery has a unique and a once autonomous history that is separate in philosophy from medicine. Midwives require physician services for consultation, referral, and collaborative management, but not for authority to practice midwifery. State legislation is not consistent nationwide concerning the definition and governing of nurse-midwifery practice. The Joint Commission on the Accreditation of Health Care Organizations does not regulate admission privileges but provides standards for hospitals. These standards do provide an avenue for admission privileges. Recognizing the CNM/CM as competitive in the health care market is essential. Denial of privileges can be interpreted as a restraint of trade. Without professional autonomy, unfavorable economics may limit the professional practice of midwifery.
尽管享有完全的收治特权被视为充分实践自主权的标志，但大多数认证助产士（CNM）被剥夺了自主收治和出院患者的权利，或者只能通过医生的授权才能享有这些特权。这种做法损害了认证助产士的独立性，并将他们视为主治医务人员的附属品。鉴于美国助产士学院认证非护士（CM），这种情况只会变得更加复杂。助产术有着独特且曾经自主的历史，其理念与医学不同。助产士需要医生提供咨询、转诊和协作管理服务，但不需要医生授予从事助产术的权力。关于助产士实践的定义和管理，各州立法在全国范围内并不一致。医疗保健组织认证联合委员会并不规范收治特权，但为医院提供标准。这些标准确实为收治特权提供了一条途径。认识到认证助产士/认证助产士（CNM/CM）在医疗保健市场中的竞争力至关重要。拒绝给予特权可被解释为贸易限制。没有专业自主权，不利的经济因素可能会限制助产术的专业实践。
