How is organisational fit addressed in Australian entry level midwifery job advertisements

Background: Midwifery job retention is an ongoing global issue. Prior research has recognised that considering an individual’s attributes in relation to their work environment may assist in improving job satisfaction among midwives, leading to improved long-term job retention in the midwifery profession. The aim of this study was to evaluate whether, and how organisational fit is addressed in current entry level midwifery job advertisements within Australia. Methods: Midwifery jobs were searched for within 12 search engines, using the search term ‘midwife’, including Seek.com, Indeed.com, government employment websites for all Australian states and territories, and private health organisation websites. Data were extracted from eligible job advertisements by three independent researchers. Extracted data encompassed elements addressing person-job fit and person-organisation fit. Content analysis involving chi-square and Fischer exact tests were completed on extracted data. Results: Key findings demonstrate private health care organisations (29.2%) are more likely than public health care organisations (8.8%) to ask potential candidates to have additional qualifications, however, public health care organisations (34.1% vs. 16.7%) are more likely to ask for dual registration as a midwife and nurse. This is further supported by private health care organisations being more likely to refer to the candidate as a midwife (72.9% vs. 48.4%) than as a nurse. Private health care organisations more often noted access to support for employees and were more likely to mention access to employee assistance programs (41.7% vs. 13.2%), orientations (16.7% vs. 0%) and included benefits (72.9% vs. 42.9%). Clinical skills and personality traits were more frequently addressed in public health organisation advertisements; these included a requirement of employees to be accountable (49.5% vs. 6.3%), innovative (28.6% vs. 0%), have teamwork (69.2% vs. 52.1%) and conflict resolution skills (36.3% vs. 8.3%), and have knowledge of legislation (44.0% vs. 25.0%) and contemporary midwifery issues (28.6% vs. 4.2%). Conclusion: This study highlights that organisations employing midwives may be unwittingly contributing to the problem of midwife attrition through inattention to factors that endear midwives to workplaces in job advertisements. Further work developing employee selection and recruitment processes that are informed by the concept of person-job-organisation fit, is necessary

“I love being a midwife; it's who I am” : A Glaserian Grounded Theory Study of why midwives stay in midwifery

Aims and objectives To understand why Western Australian (WA) midwives choose to remain in the profession. Background Midwifery shortages and the inability to retain midwives in the midwifery profession is a global problem. The need for effective midwifery staff retention strategies to be implemented is therefore urgent, as is the need for evidence to inform those strategies. Design Glaserian grounded theory (GT) methodology was used with constant comparative analysis. Methods Fourteen midwives currently working clinically area were interviewed about why they remain in the profession. The GT process of constant comparative analysis resulted in an overarching core category emerging. The study is reported in accordance with Tong and associates’ (2007) Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The core category derived from the data was labelled—“I love being a midwife; it's who I am.” The three major categories that underpin the core category are labelled as follows: “The people I work with make all the difference”; “I want to be ‘with woman’ so I can make a difference”; and “I feel a responsibility to pass on my skills, knowledge and wisdom to the next generation.” Conclusion It emerged from the data that midwives’ ability to be “with woman” and the difference they feel they make to them, the people they work with and the opportunity to “grow” the next generation together underpin a compelling new middle‐range theory of the phenomenon of interest. Relevance to clinical practice The theory that emerged and the insights it provides will be of interest to healthcare leaders, who may wish to use it to help develop midwifery workforce policy and practice, and by extension to optimise midwives’ job satisfaction, and facilitate the retention of midwives both locally and across Australia

Factors that enable midwives to stay in the profession : Why do midwives stay in midwifery?

Background: There is a global awareness regarding the challenges facing midwives to remain in the profession. Aim: The aim of this study was to understand why Western Australian (WA) midwives chose to remain in the profession. Methods: This study was undertaken using grounded theory (GT) methodology. Semi-structured interviews were conducted with 14 midwives working in the clinical area. Participants were interviewed about why and how they remain in the midwifery profession. Data were collected from December 2017 to November 2018 and were generated through open-ended semi-structured interviews, together with memos and field notes. The interviews were digitally recorded, transcribed verbatim and analysed and interpreted with the guidance of Glaser and Strauss’ (1967) coding stages. Ethical approval for this study was granted by the Human Research Ethics Committee at Edith Cowan University (record 18747) on 23 November 2017. Findings: The core category derived from the data was labelled: ‘I love being a midwife; it’s who I am’. The contextual factors that underpin the core category are labelled: ‘My rosters provide me with good work–life balance’; ‘You never know what’s going to happen [but] I can deal with the bad days because the good days outweigh them’; ‘I like my practice environment’; ‘It’s a juggling act but the women’s appreciation is worth it’ and ‘By looking after myself I’m a good midwife’. Bronfenbrenner’s (1997) theory was applied to the findings in the process of developing them into a middle-range theory of the phenomenon of interest. Conclusion: The findings of this study provide new insights into workplace and personal factors that contribute to enabling midwives to remain in their profession. Although this study represents midwives in only one geographical context it will be of value to professional and health care leaders

The impact of pandemics on healthcare providers\u27 workloads: A scoping review

Aims: To review and synthesize available evidence exploring the impact of pandemics on direct healthcare providers\u27 workloads in the acute care setting. Design: Scoping review. Data Sources: A review of English research articles published up to August 2022 that examined the impact of pandemics on healthcare providers’ workloads was undertaken. Studies were identified by searching four electronic databases: Medline (EBSCO), CINAHL (EBSCO), Web of Science and PsychInfo (EBSCO). Fifty-five studies met the inclusion criteria. Review Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review checklist. Results: Healthcare workers experience an increase in workload pressures during a pandemic. This included patients requiring more care, undertaking non-normal work activities, increase in work content including changes to documentation, increase in demand and skills required, an increase in overtime and hours of work per week and higher patient-to-nurse ratios. The review also highlighted changes to the work environment and worsened work environments, including staffing shortages. Conclusion: Focused efforts from health organizations to prioritize supportive conditions, policies focused on improved work environments, staffing adequacy and fair and reasonable workloads will enhance retention of the current workforce and future planning for pandemics. Impact: Understanding workload challenges faced by frontline health professionals during the pandemic can improve planning, including policies and procedures, and resource allocation for future pandemic or emergency situations. In addition, extended periods of high workloads can impact staff retention. As many countries return to life after COVID-19, it is important that healthcare organizations examine staff pressures and identify ways to support staff moving forward. This will be vital for the future sustainability of the workforce. Patient or Public Contribution: No patient or public contribution

Do midwifery international clinical placements influence students\u27 practice and employment decisions?

AIM: The aim of this study was to investigate whether an International two-week clinical maternity placement enhances, and is beneficial, to midwifery students\u27 future practice and employment decisions during the final year of an undergraduate degree. BACKGROUND: International placements are common in undergraduate pre-registration nursing midwifery university curricula, with the emphasis on preparing students to work with diverse women in multicultural environments whilst incorporating cultural competence. However, little is known as to whether an International placement influences future graduate\u27s work place choice. METHODS: Using a qualitative approach, focus groups were undertaken with 16 final year midwifery students from a University in Western Australia who had experienced a two-week International clinical midwifery placement in Tanzania (Africa) or Manilla (Philippines). Data was analysed using thematic analysis. FINDINGS: The results of the study revealed eight over-arching themes that revealed an increase in midwifery student\u27s confidence; an awareness of the need to consolidate knowledge and skills, reinforcement of their own career aspirations, midwifery beliefs and trust in women and physiological birth. CONCLUSION: This study confirms the benefits of overseas clinical placements, which provide opportunities beyond developing cultural sensitivity. Midwifery students are challenged to develop not only practical competence, but confidence to trust in themselves and the process of physiological birth. These experiences validate theoretical learning and provide opportunity to reflect on the possibilities of future employment and decision making as a midwife

What are the benefits and challenges of mentoring in midwifery? An integrative review

Aim: The aim of this review was to synthesize best available evidence on mentoring programmes for midwives who have worked within the clinical setting for more than 1 year. Background: Lack of job satisfaction, stress, burnout and limited managerial support contributes to midwifery workforce attrition and the ongoing global shortage of midwives. Mentoring may be one way to improve staff retention, leading to positive clinical and organizational outcomes. Design: A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute for conducting systematic reviews, was used to develop a search strategy, selection criteria, method for quality appraisal and the extraction and synthesis of data. Methods: Relevant articles were sought from the following databases: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, MIDIRS and Scopus. The search and screening process was guided by the Preferred Reporting Items for Systematic Reviews and Meta Analysis 2009 checklist. Narrative analysis was used to develop four main categories derived from the results from the included studies. Results: Eight studies were included in this review from which four themes were developed that are relevant to mentoring in midwifery; the impact on midwives\u27 direct environment, their immediate relationships with peers and management, and the overarching influence of the organization directly impact the accessibility and support midwives receive in mentoring programmes. Conclusion: To enhance staff retention in the workforce, midwives require support from the wider organization in which they work. Relevance to clinical practice: Understanding midwives\u27 perspectives of mentoring programmes will directly influence the development of midwifery-specific mentoring programmes, which may lead to improved staff retention in the midwifery workforce

Exploring the usability of the COM-B model and theoretical domains framework (TDF) to define the helpers of and hindrances to evidence-based practice in midwifery

Background Despite the advancement of scientific research in the field of maternity care, midwives face challenges translating latest evidence into evidence-based practice (EBP) and express reticence towards leading practice change in clinical areas. This study aimed to explore midwifery leaders’ views on what factors help or hinder midwives’ efforts to translate latest evidence into everyday practice and consider them in relation to both the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Methods This qualitative study formed part of a larger action research (AR) project that was designed to improve midwives’ EBP implementation capability. Data were obtained from eight Western Australian midwifery leaders who were employed in either managerial or executive positions within their organisation. Five midwives attended a focus group workshop and three opted for face-to-face interviews. Thematic analysis was used to code the transcribed data and group alike findings into sub-categories, which were collapsed to four major categories and one overarching core finding. These were mapped to a matrix combining the COM-B and TDF to establish the usability of these tools in midwifery contexts. Results Four major categories were developed from the data collected in this study. Three reported the hindrances midwives’ experienced when trying to initiate new EBPs: ‘For midwives, medical opposition and workplace culture are the biggest challenges’, ‘Fear can stop change: it’s personal for midwives’ and ‘Midwives are tired of fighting the battle for EBP; they need knowledge and the confidence to bring about practice change.’ The other major category highlighted factors midwives’ considered helpers of EBP: ‘Having stakeholder buy-in and strong midwifery leadership is a huge advantage.’ When mapped to the TDF and COM-B, these findings provided valuable insight into the helpers of and hindrances to evidence-based practice in midwifery. Conclusion Midwives are motivated to initiate evidence-based change yet have limited knowledge of implementation processes or the confidence to lead practice change. Factors such as inter-disciplinary buy-in, clear instruction for midwives and support from midwifery leaders were considered beneficial to implementing practice change in clinical areas. The TDF when used in combination with the COM-B was deemed useful to midwives wanting to lead practice change projects in clinical areas

Critical thinking development in undergraduate midwifery students: An Australian validation study using Rasch analysis

Background: Well-developed critical thinking skills are required to provide midwifery care that is safe, evidence-based, and woman-centred. A valid, reliable tool to measure is required the application of critical thinking in midwifery practice. The Carter Assessment of Critical Thinking in Midwifery (CACTiM) has previously been psychometrically assessed using classical methods at a single site. This study aims to further evaluate the properties of CACTiM tools using Rasch analysis in a diverse group of midwifery students and preceptors. Methods: The CACTiM tools were completed by undergraduate midwifery students studying at three Australian universities and their preceptors. Midwifery students’ critical thinking was evaluated separately through student self-assessment and preceptor assessment and then matched. Rasch analysis was used to evaluate the validity of the tools. Results: Rasch analysis confirmed both the preceptor and student CACTiM tools demonstrated good reliability and unidimensionality. The items can differentiate between students’ ability to apply critical thinking in midwifery practice. Person reliability and item reliability were above.92 for both scales indicating excellent reliability and internal consistency. Several improvements were identified to the tools, including enhanced wording to some items, and reduction to a 5-point Likert scale. Through analysis of lower-scoring items, midwifery programs can identify curricula enhancements. Conclusion: The CACTiM student and preceptor tools are valid and reliable measures of critical thinking in midwifery practice. The tools can assess students’ critical thinking abilities and identify areas for development for individuals and across student cohorts through curricula enhancements

I love being a midwife; it\u27s who I am : A Glaserian grounded theory study of why midwives stay in midwifery [thesis]

Midwifery shortages and the trend towards an inability to retain midwives in the profession is a global problem. The World Health Organisation (WHO) expressed concern about this issue in 2006, and despite efforts to implement remedial change, the retention of midwives continues to pose a large problem for healthcare internationally. The WHO (2006) asserted that midwives are the cornerstone to the reduction of maternal mortality and predicted that if the workforce retention issue was not addressed, then increases in maternal and neonatal mortality would ensue. In 2014, the United Nations Population Fund identified that, despite extensive worldwide efforts to address the midwifery shortage issue, the problem still existed and was worsening; an ageing workforce compounded by rising birth numbers means the issue is likely to persist. Consequently, the need for implementation of effective midwifery staff retention strategies is urgent, as is the need for evidence to inform these strategies. No research about why midwives stay has been undertaken in Australia since that conducted by Sullivan, Lock and Homer in 2011. There is more current research around reasons underlying midwifery workforce attrition; however, it cannot be assumed that simply addressing these issues will correct the problem. The aim of the study reported in this thesis was to understand why midwives across Western Australia (WA) choose to remain in the profession. The purpose of the research was to expose the factors leading to midwives staying in their jobs. Knowledge of why and how midwives stay in midwifery is imperative for recruitment into the profession and its sustainability and longevity. This WA study was undertaken using the Glaserian version of grounded theory methodology. Fourteen midwives currently working in clinical practice were interviewed about why they remain in the midwifery profession. Data were collected from December 2017 to November 2018 and were generated through open ended semi-structured interviews, together with memos and field notes. The interviews were digitally recorded, transcribed verbatim and analysed and interpreted with the guidance of Glaser and Strauss’s coding stages. The core category derived from the data was: “I love being a midwife; it\u27s who I am.” Two interrelated major categories emerged from the data that represent why midwives stay in midwifery; the factors that enable them to stay are comprised of eight sub-categories. The data revealed that, broadly, midwives’ ability to be “with woman,” the difference they feel they make to these women, the people they work with, and the opportunity to “grow” the next generation of midwives are crucial influences on whether they remain in the profession. The theory of “I love being a midwife; it\u27s who I am” provides new information about why midwives working in various models of maternity care across WA stay in the profession, and the factors that enable them to do so. A number of recommendations arose from this study for practice, policy, organisational processes, further research and pre-registration midwifery education

Approaches to clinical guideline development in healthcare: A scoping review and document analysis

Background: Over the past decade, an industry has emerged around Clinical Practice Guideline (CPG) development in healthcare, which has increased pressure on guideline-producing organisations to develop CPGs at an accelerated rate. These are intended to improve the quality of care provided to patients while containing healthcare costs and reducing variability in clinical practice. However, this has inadvertently led to discrepancies in CPG recommendations between health organisations, also challenging healthcare providers who rely on these for decision-making and to inform clinical care. From a global perspective, although some countries have initiated national protocols regarding developing, appraising and implementing high-quality CPGs, there remains no standardised approach to any aspect of CPG production. Methods: A scoping review of the literature and document analysis were conducted according to Joanna Brigg’s Institute methodology for scoping reviews. This comprised two qualitative methods: a comprehensive review of the literature (using CINAHL, Scopus and PubMeD) and a document analysis of all national and international guideline development processes (manual search of health-related websites, national/international organisational health policies and documents). Results: A set of clear principles and processes were identified as crucial to CPG development, informing the planning, implementation and dissemination of recommendations. Fundamentally, two common goals were reported: to improve the quality and consistency of clinical practice (patient care) and to reduce the duplication or ratification of low-grade CPGs. Conclusions: Consultation and communication between CPG working parties, including a wide range of representatives (including professional organisations, regional and local offices, and relevant national bodies) is essential. Further research is required to establish the feasibility of standardising the approach and disseminating the recommendations