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

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.

'Bringing forth' skills and knowledge of newly qualified midwives in free-standing birth centres: A hermeneutic phenomenological study

AIM

To understand and interpret the lived experience of newly qualified midwives (NQMs) as they acquire skills to work in free-standing birth centres (FSBCs), as well as the lived experience of experienced midwives in FSBCs in Germany who work with NQMs.

BACKGROUND

In many high-, middle- and low-income countries, the scope of practice of midwives includes autonomous care of labouring women in all settings, including hospitals, home and FSBCs. There has been to date no research detailing the skills acquired when midwives who have trained in hospitals offer care in out-of-hospital settings.

METHODS

This study was underpinned by hermeneutic phenomenology. Fifteen NQMs in their orientation period in a FSBC were interviewed three times in their first year. In addition to this, focus groups were conducted in 13 FSBCs. Data were collected between 2021 and 2023.

FINDINGS

Using Heidegger's theory of technology as the philosophical underpinning, the results illustrate that the NQMs were facilitated to bring forth competencies to interpret women's unique variations of physiological labour, comprehending when they could enact intervention-free care, when the women necessitated a gentle intervention, and when acceleration of labour or transfer to hospital was necessary.

CONCLUSION

NQMs learned to effectively integrate medical knowledge with midwifery skills and knowledge, creating a bridge between the medical and midwifery approaches to care.

IMPLICATIONS

This paper showed the positive effects that an orientation and familiarization period with an experienced team of midwives have on the skill development of novice practitioners in FSBCs.

IMPACT

The findings of this study will have an impact on training and orientation for nurse-midwives and direct-entry midwives when they begin to practice in out-of-hospital settings after training and working in hospital labour wards.

PATIENT AND PUBLIC CONTRIBUTION

This research study has four cooperating partners: MotherHood, Network of Birth Centres, the Association for Quality at Out-of-Hospital Birth and the German Association of Midwifery Science. The cooperating partners met six times in a period of 2 ½ years to hear reports on the preliminary research findings and discuss these from the point of view of each organization. In addition, at each meeting, three midwives from various FSBCs were present to discuss the results and implications. The cooperating partners also helped disseminate study information that facilitated recruitment.

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.

Newly qualified midwives' experiences of caring for women in the maternity setting: An integrative review

INTRODUCTION

This integrative review aims to explore the experiences of newly qualified midwives (NQMs) when caring for women in the maternity setting.

METHODS

An integrative review (IR) method was chosen based on a systematic approach using Cooper's 1984 framework for transparency and rigorousness. A total of 2428 articles were located, duplicate records were removed, leaving 1428 records. All titles and abstracts were reviewed and 91 articles were then retrieved in full text. After applying inclusion and exclusion criteria, 22 studies were ultimately included in this IR. Appraisal tools were used for each study included in this review according to its research approach.

RESULTS

Literature demonstrated how NQMs' wellbeing is at stake after registration as they go through a tumultuous period full of psychological stress, fear and other surges of negative emotions. The importance for NQMs to form new and trusting relationships with colleagues and women patients is highly evident in the literature.

CONCLUSIONS

Transitioning from a student to a midwife brings about stress and tension especially when NQMs take full responsibility for the women under their care, knowing that their decisions might have a direct impact on the outcome for women, newborns, and families. Literature shows that NQMs are a precious entity to healthcare as they are the future of midwifery and hence more research is recommended.

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.

A causal model of job stress among Thai nurse-midwives

Objective

To test a causal model of job stress among nurse-midwives working in labor and delivery units in Thailand.

Methods

Random and convenience sampling was used to recruit 282 nurse-midwives with at least 6 months of work experience from 16 regional tertiary hospitals in Thailand. Data were collected from May to December 2020. Research instruments with good internal consistency reliability ranged from 0.83 to 0.91 including the Job Stress Scale and the Thai version of the Job Content Questionnaire (TJCQ). Descriptive statistics and a structural equation model were used for data analysis.

Results

Job demands were the strongest predictor of job stress. At the theoretical level, high job control plays a crucial role in directly reducing job stress. However, the present research provides contrary evidence to the theoretical predictions. When nurse-midwives perceive high job control, they perceive pressure to meet the expectations of their supervisors and colleagues. Therefore, high job control can contribute to job stress. Likewise, job support had an indirect effect on job stress among nurse-midwives through job control. The modified model fitted the empirical data (χ 2 = 57.76, df = 22, CMIN/df = 2.62, goodness of fit (GFI) =0.96, adjusted goodness of fit (AGFI) =0.91, comparative fit index (CFI) = 0.95, and root mean square error of approximation (RMSEA) = 0.07). The effects of job demands, job control, and job support on job stress among Thai nurse-midwives can explain 67% of the model's total variance for job stress.

Conclusions

Nurse-midwives who encounter high job demands and less control over their work control suffer from job stress. Job support does not directly affect nurse-midwives’ job stress but influences it through perceived job control. Strategies to decrease job stress among Thai nurse-midwives should focus on how to balance job demands, and enhance job control, and job support.

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.