Core competency-based education, certification, and practice: the nurse-midwifery model.

It has been more than 70 years since the first nurse-midwives came to practice in the United States, and over 20 years since the American College of Nurse-Midwives (ACNM) established nationally recognized standards and core competencies for nurse-midwifery education, certification, and practice. Certified nurse-midwives are licensed in all 50 states and in the District of Columbia (DC) and have prescribing privileges in 45 states plus DC. More recent standard-setting activities include the establishment of a national mechanism for continuing competency assessment; adoption of the bachelor's degree as the minimum academic requirement for certification; development of national standards for education and certification of direct entry midwives; and placement of an 8-year time limit on certificates.