Perceived job demands and resources of newly qualified midwives working in primary care settings in The Netherlands

A global overview of midwives' working conditions: A rapid review of literature on positive practice environment

BACKGROUND

In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK.

OBJECTIVE

To describe midwives' perceptions and experiences of positive practice environments.

METHODS

A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12.

RESULTS

Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience.

CONCLUSIONS

Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions.

How to improve newly qualified midwives' transition-into-practice. A Delphi study

BACKGROUND

In the Netherlands, newly qualified midwives start work as registered midwives without any formal transition support. Research shows that newly qualified midwives do not feel sufficiently confident and competent in their work during the period following graduation. This could impact the quality of care provided by newly registered midwives. The aim of this study is to seek consensus with stakeholders concerning viable components of support for newly qualified midwives working in midwifery care in the Netherlands.

METHODS

A Delphi study was conducted among maternity care stakeholders in the Netherlands. During two rounds, sixteen statements derived from a theoretical framework of organizational socialization theory and previous studies were assessed (round 1, n = 56; round 2, n = 52). Stakeholders (N = 61) were invited and completed an online questionnaire that included spaces for opinions and remarks.

RESULTS

Stakeholders agreed about an introductory support period for newly qualified midwives, involving performance feedback and regional-level backup from fellow midwives during shifts. They further agreed on the responsibilities of established professionals that they should support newcomers in practice and provide mentoring or group coaching, although they face organizational barriers for supporting newcomers.

CONCLUSIONS

Stakeholders found consensus upon several components of support at the workplace. In addition, a stable work environment seemed less important in their opinion while previous research suggests otherwise. Practice organisations need to improve the employment conditions and support for newly qualified midwives to ensure the quality of midwifery care is guaranteed.

Midwives' occupational wellbeing and its determinants. A cross-sectional study among newly qualified and experienced Dutch midwives

OBJECTIVE

Internationally, about 40 percent of midwives report symptoms of burnout, with young and inexperienced midwives being most vulnerable. There is a lack of recent research on burnout among Dutch midwives. The aim of this study was to examine the occupational wellbeing and its determinants of newly qualified and inexperienced midwives in the Netherlands. The majority of practicing Dutch midwives are aged under 40, which could lead to premature turnover.

DESIGN

A cross-sectional study was conducted using an online questionnaire that consisted of validated scales measuring job demands, job and personal resources, burnout symptoms and work engagement. The Job Demands-Resources model was used as a theoretical model.

SETTING AND PARTICIPANTS

We recruited Dutch midwives who were actually working in midwifery practice. A total of N=896 midwives participated in this study, representing 28 percent of practicing Dutch midwives.

MEASUREMENTS AND FINDINGS

Data were analysed using regression analysis. Seven percent of Dutch midwives reported burnout symptoms and 19 percent scored high on exhaustion. Determinants of burnout were all measured job demands, except for experience level. Almost 40 percent of midwives showed high work engagement; newly qualified midwives had the highest odds of high work engagement. Master's or PhD-level qualifications and employment status were associated with high work engagement. All measured resources were associated with high work engagement.

KEY CONCLUSIONS

A relatively small percentage of Dutch midwives reported burnout symptoms, the work engagement of Dutch midwives was very high. However, a relatively large number reported symptoms of exhaustion, which is concerning because of the risk of increasing cynicism levels leading to burnout. In contrast to previous international research findings, being young and having less working experience was not related to burnout symptoms of Dutch newly qualified midwives.

IMPLICATIONS FOR PRACTICE

The recognition of job and personal resources for midwives' occupational wellbeing must be considered for a sustainable midwifery workforce. Midwifery Academies need to develop personal resources of their students that will help them in future practice.

Experiences of newly qualified midwives during their transition to practice: a systematic review of qualitative research

Objective

To summarize and evaluate the experiences and expectations of newly qualified midwives (NQMs) during their transition from school to clinical practice. One of the main objectives was to provide references for the development of midwifery professional teaching and provide a basis for hospital administrators and instructors of midwifery to develop guidelines and strategies.

Methods

A systemic review of qualitative research using meta-aggregation was conducted. We collected studies from 12 databases between inception and February 2023. All qualitative studies published in English and Chinese that reported on the experiences of NQMs during their transition to practice were included. Two independent reviewers assessed the study quality and the credibility of study findings by using the JBI Qualitative Assessment and Review Instrument. The process of searching followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.

Results

A total of 14 studies were included, and 84 findings were extracted. The results were grouped into 8 new categories and synthesized into 3 main themes: multi-dimensional challenges, physical and emotional responses, and demands and expectations. The included studies were identified to be of good quality and the results of the methodological quality appraisal were all B grade or higher.

Conclusion

The transition period is a critical career development for NQMs. However, they faced various stress during the period, which had a negative impact on their physical and mental health. Therefore, it's important to deeply understand their challenges and needs. And effective management strategies should be implemented, such as in-depth cooperation between hospitals and schools, improvement of the clinical transition support system, enhancement of continuing education, and standardization of the management system. This may be beneficial to improve the quality of clinical midwifery and maintain the stability and sustainable development of the midwifery team.

Midwives' perceptions of the performance- and transition into practice of newly qualified midwives, a focus group study

PROBLEM

Newly qualified midwives in the Netherlands perceive the adaptation to new responsibilities as difficult due to the autonomous nature of- and required accountability for the work they face in practice.

BACKGROUND

All Dutch newly qualified midwives are accountable for their work from the moment of registration while usually working solistically.

AIM

This paper explores the perceptions of experienced midwives regarding: (1) the performance- and transition into practice of newly qualified midwives, and (2) their supporting role in this transition.

METHODS

The design of this study is qualitative with focus groups. Experienced midwives' perceptions were explored by means of seven semi-structured focus groups (N = 46 participants) with two meetings for each focus group.

FINDINGS

Community-based and hospital-based midwives perceived newly qualified midwives as colleagues who did not oversee all their tasks and responsibilities. They perceived newly qualified midwives as less committed to the practice organisation. Support in community-based practices was informally organised with a lack of orientation. In the hospital-based setting, midwives offered an introduction period in a practical setting, which was formally organised with tasks and responsibilities. Experienced midwives recognised the need to support newly qualified midwives; however, in practice, they faced barriers.

DISCUSSION

The differences in experienced midwives' expectations of newly qualified midwives and reality seemed to depend on the newly qualified midwives' temporary working contracts and -context, rather than the generational differences that experienced midwives mentioned. Dutch midwives prioritised their work with pregnant individuals and the organisation of their practice above supporting newly qualified midwives.

Perceived job demands: a qualitative study of workplace stress in the Iranian healthcare workers (HCWs)

OBJECTIVES

Work-related stress is a common risk factor among healthcare workers (HCWs). In Iran, the healthcare system has undergone extensive changes to develop services. Organisational change has led to the creation of new working conditions for HCWs. The purpose of this study is to identify job demands that health workers perceive as stressors.

DESIGN

As a qualitative study, semistructured interviews, a focus group, and related data were analysed both inductively and deductively with reference to the job demand component based on the job demands-resources model and MAXQDA.

SETTING

This investigation was conducted in 18 primary healthcare centres in Qazvin, Iran.

PARTICIPANT

Twenty-one female HCWs with at least 6 months of work experience and an average age of 34.4 years.

RESULTS

The participants identified six key elements as the stressful job demands including organisation's supervisory function, role characteristics, workload, job insecurity, client service challenges and perceived job content.

CONCLUSIONS

After organisational changes and development, HCWs were faced with role changes and increased workload. In addition, organisational supervision in terms of quantity and quality and lack of job security intensified the pressures. These factors led to the high level of stress among employees who dealt with people and those who perceived their job content as unfavourable. Perhaps teaching stress control skills and organisational support interventions can be useful to reduce and control stress among HCWs.

Work Stressors and Intention to Leave the Current Workplace and Profession: The Mediating Role of Negative Affect at Work

The first aim of this study was to determine whether organisational constraints, interpersonal conflicts at work, workload and negative affect at work have a positive relationship with intention to leave a current job or profession. The second aim was to investigate whether negative affect at work mediates the relationship between work stressors and intention to leave a current job or profession. The study was a quantitative cross-sectional design in nature. Data were collected between March and April 2022. The sample consisted of 306 midwives working in the Polish public health service. The theoretical model was tested using structural equation modelling. The results confirmed positive direct relationships between workload and negative affect with intention to leave the current workplace and intention to leave the midwifery profession in general. The relationships between organisational constraints and interpersonal conflicts at work and intention to leave a job or profession were found to be completely mediated by negative affect at work. Our study revealed that workload is the strongest direct predictor of intention to leave the current job or profession. Organisational constraints and interpersonal conflicts at work lead to an intention to leave a job or profession by inducing negative affect at work. Interpersonal conflicts at work are the strongest predictor of negative affect at work.

The impact of workload and job satisfaction on occupational stress - A comparison among newly qualified and experienced midwives

BACKGROUND

Midwives are potentially exposed to high levels of occupational stress. The level of stress may be related to the job demands and job resources, as well as midwife seniority. To date, few studies on the determinants of occupational stress have examined Polish midwives.

OBJECTIVE

This study aims to investigate the roles of workload, job satisfaction, and seniority in shaping the stress levels of midwives in Poland.

METHODS

A cross-sectional approach and structural equation modeling (SEM) were used to compare two groups: newly qualified midwives (NQMs; n = 79) and experienced midwives (n = 99). All data were collected between January and November 2018.

RESULTS

Analysis revealed that in both NQMs (β = 0.34, p = 0.006) and experienced midwives (β = 0.40, p < 0.001) workload was a positive predictor of occupational stress. In contrast, job satisfaction was found to be a negative predictor of stress in both groups (NQMs: β = -0.44, p < 0.001; experienced midwives: β = -0.57, p < 0.001). The study groups did not differ significantly in terms of the levels of workload, job satisfaction, and occupational stress.

CONCLUSION

Workload and job satisfaction are predictors of occupational stress in midwives. The results of this study indicate the important role of job satisfaction and workload in the shaping of occupational stress levels. Resource-rich and low-stress work environments can enhance the quality of health care provided by midwives.

Assessment of the attitude towards childbirth in health sciences students - development and validation of the questionnaire Cave-St

The purpose of this study is to report on the validation process of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire can help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. A standardized procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha coefficient calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 560 students using principal components factor analysis with varimax rotation. Confirmatory factor analysis was undertaken. A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The results of the factor analysis finally revealed four latent dimensions. The questionnaire CAVE-st is a valid and reliable tool to assess health science students’ attitude towards women’s childbirth experiences. Further work to translate and adapt the instrument in other cultures and languages will be undertaken.

The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study

In the Netherlands, a percentage of newly qualified midwives start work in maternity care as a hospital-based midwife, although prepared particularly for working autonomously in the community.

AIM

This study aimed to explore newly qualified Dutch midwives' perceptions of their job demands and resources during their initiation to hospital-based practice.

DESIGN

We conducted a qualitative study with semi structured interviews using the Job Demands-Resources model as theoretical framework.

METHODS

Twenty-one newly qualified midwives working as hospital-based midwives in the Netherlands were interviewed individually between January and July 2018. Transcripts were analyzed using thematic content analysis.

FINDINGS

High workload, becoming a team member, learning additional medical procedures and job insecurity were perceived demands. Participants experienced the variety of the work, the teamwork, social support, working with women, and employment conditions as job resources. Openness for new experiences, sociability, calmness and accuracy were experienced as personal resources, and perfectionism, self-criticism, and fear of failure as personal demands.

CONCLUSION

Initiation to hospital-based practice requires from newly qualified midwives adaptation to new tasks: working with women in medium and high-risk care, managing tasks, as well as often receiving training in additional medical skills. Sociability helps newly qualified midwives in becoming a member of a multidisciplinary team; neuroticism and perfectionism hinders them in their work. Clear expectations and a settling-in period may help newly qualified midwives to adapt to practice. The initiation phase could be better supported by preparing student midwives for working in a hospital setting and helping manage expectations about the settling-in period.