I made the decision to become a nurse midwife early on. I wanted to do something that I could do anywhere in the world. I can say that I was right about midwifery being a versatile profession. If you want to be an actor, you probably have to move to Los Angeles. But if you want to be a midwife, you can live almost anywhere.
About Jennifer Horch Cromar, MSN, CNM: Jennifer Horch Cromar is a Certified Nurse Midwife at Marin Community Clinics (MCC) who has over 15 years of experience in providing medical care to women and infants. As a CNM at MCC, Ms. Cromar provides gynecological care, such as pap smears, STI testing and treatment, birth control and infertility consultations, and other preventative care and education services to women of all ages. Prior to her work at MCC, Ms. Cromar was a CNM at a private practice in Berkeley, CA, where she collaborated with the physician to provide gynecological and obstetrical care and consultations to women and their families. Before working in private practice, she worked as a CNM for Family Planning Associates Medical Group and Planned Parenthood Mar Monte. She has also worked in many different medical settings both in a full-time and a per-diem capacity as an RN in Labor and Delivery. Ms. Cromar earned her Bachelor of Science in Nursing from California State University, Chico in 1997, and her Master of Science in Nursing from Yale University in 2002.
[OnlineFNPPrograms.com] Could we please have an overview of your academic and professional path in nurse midwifery?
[Jennifer Horch Cromar, MSN, CNM] I received my Bachelor of Science in Nursing degree at California State University, Chico in 1997. My first nursing job was in Labor and Delivery (L&D) at Community Hospital of the Monterey Peninsula. I went straight into L&D because I knew that I wanted to eventually become a midwife. As a new grad, it wasn’t easy getting an L&D position, so I had to be flexible about where I would live. During my time in Monterey, I also worked as a SART (sexual assault response team) nurse for the county.
In 2000, I was accepted to the Nurse-Midwifery program at Yale, so I headed off to New Haven. I received my MSN from Yale in 2002. I returned to my native California and did some work as a registry nurse while I looked for a position as a CNM. Registry nurses work for companies that send them to different hospitals on a per diem basis. They do not work for one hospital, but may go to five different hospitals on five different days of the week. As a registry nurse, I was sent to hospitals all over the Bay Area including UCSF, Alta Bates, Highland General, and many more. I think working as a registry nurse is a fantastic skill-building job. You have to be able to be adaptable and walk straight in to patient care with no orientation.
Pretty soon, I got a job as a clinician at Planned Parenthood. I found that I loved working for a non-profit. I also loved working with teens and the underserved. After about a year, I took the position of Lead Clinician at Planned Parenthood. I learned a lot about quality control and management.
After three years at Planned Parenthood, I decided to move to Los Angeles. I mostly worked as a travel nurse in Labor and Delivery. I took short assignments (usually three months) at several different hospitals, and got to experience labor and delivery in a huge variety of places.
A few years later, I returned to Northern California. I worked at Kaiser for a while as a per diem/on call nurse. I loved the flexibility and the compensation but hated getting phone calls at 4am asking me to come in to work. I subsequently decided to work in private practice with Dr. Streitfeld. I enjoyed working in private practice with mostly healthy patients, but missed working in the far more challenging public sector.
I decided to take a job at Marin Community Clinic, where I have been working for the past six years. Working for a community clinic has a lot of challenges but is very rewarding.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Certified Nurse Midwife and Nurse Practitioner for Marin Community Clinics? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Jennifer Horch Cromar, MSN, CNM] I love my role as a Nurse Practitioner/Nurse Midwife at Marin Community Clinic. In my particular role, I do mostly gynecology. I have a schedule and do not take any call, since I do not do deliveries. Also no weekends or holidays. It is basically regular doctor’s office hours.
In a typical day, I see about 18-20 patients. I would say that 95% of my patients are women, but I do see an occasional man for STDs, erectile dysfunction, or other sexual health issues. For women, common types of visits are pap smears, birth control consults, postpartum visits, STI diagnosis and treatment, IUD and Nexplanon insertions, pregnancy testing and counseling, infertility, breast concerns, menopause. My patients are scheduled in 15 minute blocks. I would say about 50% are monolingual Spanish speakers. I do not speak Spanish so I have to have a translator for these visits. It really extends the visit time and also makes it harder to connect with the patient.
Most of my patients are uninsured or using a government funded type of insurance. Because of this, a good deal of my job is trying to help my patients acquire the services that they need. For example, if someone needs an ultrasound or an MRI, I can’t just refer them. I have to figure out how they will be able to access the care if they are unable to pay. This is very different from working in private practice.
In my clinic, we have all different kinds of practitioners working under one roof. We have primary care providers, mental health providers, chiropractors, acupuncturists, pediatricians, etc. I love working in an environment like this because you can learn so much from other clinicians. I have had other jobs where I have been alone or mostly alone a lot of the time. Autonomy is nice, but I think you can learn so much more when you work around more people.
[OnlineFNPPrograms.com] Could you please elaborate on the maternity and nurse midwifery services that Marin Community Clinics provides, as well as the structure of your team at MCC? What part do Certified Nurse Midwives play on a larger multidisciplinary team at MCC, and how do you and your colleagues collaborate to optimize patient care?
[Jennifer Horch Cromar, MSN, CNM] At Marin Community Clinic, we work in collaboration with a group of midwives and doctors that are employed by a private practice (Prima Medical). We all work under the same roof but are employed by different people. Prima is responsible for our patients from confirmation of pregnancy to delivery. When a patient is found to be pregnant by MCC, care is transferred to Prima. After delivery, the patients and their babies care is transferred back to Marin Community Clinic. Even though I am a CNM, I work for Marin Community Clinic, not Prima. Which is why I do not do any prenatal care or deliveries. Sometimes I think that I would like to do deliveries again, but it turns out I really don’t like staying up all night and working weekends and holidays.
So, as a CNM/NP at MCC I work with the patients in need of GYN/sexual health care. As I mentioned before, there are many different types of providers at MCC, and most of our patients see several different types of providers within the clinic. Patients are often referred to me by primary care providers or others. I often refer patients to other providers within the clinic for primary care concerns or to other specialists.
We are very lucky at MCC because we work in teams made up of one provider and one medical assistant. This is not the case in most practices. It is so great to have a dedicated medical assistant working with me. They are so knowledgeable and do so much. I would never be able to handle the patient load I have without these amazing people.
[OnlineFNPPrograms.com] Could you please describe your past experiences as a Certified Nurse Midwife for a private OB/GYN practice? How was your role different from your current position, in terms of daily responsibilities and work environment?
[Jennifer Horch Cromar, MSN, CNM] These are two very different roles! In private practice, I worked in an office with just myself and the doctor. We were the only providers. All of our patients were insured. The demographic was upper-middle class and generally highly educated. I did almost all of the well woman visits. Pregnant patients would rotate between seeing me for prenatal visits and seeing the doctor. Most of the patients were early to prenatal care. They were almost always well educated about their bodies and pregnancies. They were well nourished and generally had stable living situations and employment. The doctor I worked for would want to see a patient if there was anything wrong at all. Often I would just pop my head in to his office and he would come and see the patient right away. If the doctor had a day off or was doing a delivery, I would be the only provider in the office. Very quiet with just me and the receptionist.
In my current job at MCC, things are very different than in private practice. Many of my patients will wait until something is really wrong before they seek out health care. So I see a lot more. Also, doctor visits are very hard to schedule. They are so booked up it can be a month or more before a patient can see a doctor (OB/GYN). NPs and CNMs in this situation manage a lot more complicated patients. The clinic is very busy, with many providers seeing patients on a daily basis.
Private practice was definitely less stressful in many ways. However, I like the challenge of more complicated patients.
[OnlineFNPPrograms.com] Why did you decide to become a certified nurse midwife, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Jennifer Horch Cromar, MSN, CNM] I made the decision to become a nurse midwife early on. Before I had even stepped foot in a hospital as a volunteer. I was maybe 19 years old. I wanted to do something that I could do anywhere in the world. I figured babies are born everywhere, so I can be a midwife anywhere in the world. I think I envisioned myself delivering babies in small villages in South America or Africa. While that had not come to pass, I can say that I was right about midwifery being a versatile profession. If you want to be an actor, you probably have to move to Los Angeles. But if you want to be a midwife, you can live almost anywhere.
So after I decided I wanted to be a midwife, I got to work doing my nursing prerequisites at community college. That took a few years. During that time, I worked as a volunteer in a hospital, just to make sure I wouldn’t pass out at the sight of blood or anything. I think volunteering in a hospital would be wise for anyone thinking of entering this field. For me, the experience was wonderful and solidified my desire to go to nursing school.
Then came nursing school. While I was a nursing student, I worked as a medical assistant in the hospital. I think that was very helpful. I worked with great nurses who helped me get through nursing school.
After nursing school, I got my first job as a nurse in labor and delivery. I had already known for many years that I planned to move on and get my Master’s degree eventually. But I wanted a few years of experience as an RN first. I learned SO much during those next few years and I was so excited to learn more and advance my career.
When I went on to my master’s program, I had a definite advantage. In my program, almost all of my fellow students were Master’s Entry Program in Nursing (MEPN) students. So when I arrived, they had just completed their first year of their program and were brand new nurses. I had completed 2.5 years of nursing school and had been working as an L&D nurse for 2 years. Some of my classmates had never even seen a baby being born. I had a lot of time and experience that reassured me that I was on the road I wanted to be on. That program produced a lot of amazing midwives. I don’t think that being an RN first makes you a better midwife, but it certainly makes those years of school easier.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in women’s health nursing and obstetrics? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Jennifer Horch Cromar, MSN, CNM] The most rewarding part is being able to help people. In OB, you are a part of one of the most important days of the patient’s life. That is an honor. Some days are so filled with so much joy, you can’t believe you get to have such an awesome job.
Other days are horrible. People always want to think about L&D being the “happy” place to work. But sometimes things go wrong. Those days can be among the worst of your life. More than most careers, this one has high peaks and deep valleys. People will talk to you about how they had a stressful day at work and you will think, “You have no idea.” I think it is important to consider this when you are thinking of becoming a midwife. Are you okay with having a job that will be emotionally very difficult?
Aside from the emotional component, I think one of the other great challenges of being a midwife (who is doing deliveries) is the schedule. When I was single and in my 20s, working nights, weekends and holidays was no big deal. I knew what I was getting myself into when I pursued my degree and I thought the schedule would be no problem. I just wanted to catch babies and I thought that nothing would change my mind. As I have gotten older (and I’m in my mid 40s, so really not old at all) I have changed my mind. Working nights is miserable for me. Some people do great with it. I do not. I don’t want to miss Christmas or Thanksgiving. Weekends are precious as it is the only time our whole family gets to be together. So my priorities have changed. Which is why I now do all GYN. When making the decision to pursue a career as a midwife, I would encourage you to be really honest about how important this aspect is to you.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming certified nurse midwives, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Jennifer Horch Cromar, MSN, CNM] Do everything you possibly can! Grab any experience or class or volunteer activity that you can get your hands on. Talk to all kinds of different nurses and midwives and doctors about their careers and ask for their advice. Soak up as much knowledge and experience as you can. But try not to burn yourself out. That’s one of the biggest mistakes us nurses make. Take time for yourself. Don’t forget about the other interests in your life. Don’t neglect your family or your friendships. At least, not for long periods of time. Because you WILL neglect yourself, your family and your friends for periods of time as you go through this process. You will have to if you want to make it through. But ultimately, you want to be a whole person on the other end. So take care of yourself. It will make you a much better midwife.
Thank you Ms. Cromar for participating in our APRN career guide interview series!