Exploring the experiences of Indigenous women who participated in a 'follow-through' journey within a Bachelor of Midwifery program

[Extract] Summary: • The women interviewed in our study reported the many benefits of having an Indigenous midwifery student provide them with Continuity of Care • Increasing the number of Aboriginal & Torres Strait Islander midwives is essential to improving health outcomes for Aboriginal & Torres Strait Islander familie

Midwives in the United Kingdom: levels of burnout, depression, anxiety and stress and associated predictors

Objective The overall study aim was to explore the relationship between the emotional wellbeing of UK midwives and their work environment. Specific research questions were to: assess levels of burnout, depression, anxiety and stress experienced by UK midwives; compare levels of burnout, depression, anxiety and stress identified in this sample of UK midwives, with levels reported in Australia, New Zealand and Sweden; identify demographic and work-related factors associated with elevated levels of burnout, depression, anxiety and stress. Design Cross sectional research design using an online survey. The WHELM survey tool was developed within the Australian maternity context and includes a number of validated measures: The Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21), as well as items from the Royal College of Midwives (RCM) ‘Why Midwives Leave’ study (Ball et al., 2002). Setting United Kingdom. Participants An on-line survey was distributed via the RCM to all full midwife members in 2017 (n = 31,898). Data analysis The demographic and work-related characteristics of the sample were analysed using descriptive analyses. Levels of depression, anxiety, stress and burnout, measured by the CBI and DASS scores, were analysed using non-parametric statistical tests. Comparisons were made between groups based on demographic and work characteristics. Mann-Whitney U tests were used for two group comparisons, and Kruskal Wallis tests were used for groups with 2+ groups. Given the large number of analyses undertaken, statistically significant comparisons were identified with a conservative alpha level (p < .01). Findings A total of 1997 midwives responded to the survey, representing 16% of the RCM membership. The key results indicate that the UK's midwifery workforce is experiencing significant levels of emotional distress. 83% (n = 1464) of participants scored moderate and above for personal burnout and 67% (n = 1167) recorded moderate and above for work-related burnout. Client-related burnout was low at 15.5% (n = 268). Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%), anxiety (38%) and depression (33%). Personal and work-related burnout scores, and stress, anxiety and depression scores were well above results from other countries in which the WHELM study has been conducted to date. Midwives were more likely to record high levels of burnout, depression, anxiety and stress if they were aged 40 and below; reported having a disability; had less than 10 years’ experience; worked in a clinical midwifery setting, particularly if they worked in rotation in hospital and in integrated hospital/community settings. Key conclusions and implications for practice Many UK midwives are experiencing high levels of stress, burnout, anxiety and depression, which should be of serious concern to the profession and its leaders. NHS employed clinical midwives are at much greater risk of emotional distress than others surveyed, which has serious implications for the delivery of high quality, safe maternity care. It is also of serious concern that younger, more recently qualified midwives recorded some of the highest burnout, stress, anxiety and depression scores, as did midwives who self-reported a disability. There is considerable scope for change across the service. Proactive support needs to be offered to younger, recently qualified midwives and midwives with a disability to help sustain their emotional wellbeing. The profession needs to lobby for systems level changes in how UK maternity care is resourced and provided. Making this happen will require support and commitment from a range of relevant stakeholders, at regional and national levels

"Overwhelmed and out of my depth" : responses from early career midwives in the United Kingdom to the Work, Health and Emotional Lives of Midwives study

Background Efforts to resolve the longstanding and growing staffing crisis in midwifery in the United Kingdom have been hampered by very poor retention rates, with early career midwives the most likely to report burnout and intention to leave the profession. Aims To establish the key, self-described factors of satisfaction and dissatisfaction at work for early career midwives in the United Kingdom, and suggest appropriate and effective retention strategies. Methods Thematic analysis was undertaken on a subset of free text responses from midwives who had been qualified for five years or less, collected as part of the United Kingdom arm of the Work, Health and Emotional Lives of Midwives project. Findings Midwives described feeling immense pressure caused by an unremittingly heavy workload and poor staffing. Where relationships with colleagues were strong, they were described as a protective factor against stress; conversely, negative working relationships compounded pressures. Despite the challenges, many of the midwives reported taking great pleasure in their work, describing it as a source of pride and self-esteem. Midwives valued being treated as individuals and having some control over their shift pattern and area of work. Discussion These results, which reveal the strain on early career midwives, are consistent with the findings of other large studies on midwives’ wellbeing. All available levers should be used to retain and motivate existing staff, and recruit new staff; in the meantime, considerable creativity and effort should be exercised to improve working conditions. Conclusion This analysis provides a ‘roadmap’ for improving staff wellbeing and potentially retention

Examining the transformation of midwifery education in Australia to inform future directions: an integrative review

BackgroundIntegral to quality midwifery practice is the education of midwives. Like other countries, Australia faces ongoing challenges in delivering midwifery education programs. Reasons include escalating program costs, challenges in securing meaningful clinical experiences, subsumption of midwifery with nursing, and associated loss of identity in some institutions.AimTo critically examine the literature exploring the historical and current drivers, supports and impediments for entry-to-practice midwifery programs to identify strategies to strengthen midwifery education in Australia.MethodsA structured integrative literature review using Whittemore and Knafl’s five-stage framework was undertaken; 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation of results.FindingsThe literature search identified 50 articles for inclusion. The thematic analysis identified four key themes: i. a commitment to educational reform, ii. building a midwifery workforce, iii. quality maternity care through midwifery education, and iv. progressing excellence in midwifery education.DiscussionExtensive literature describes the evolution of midwifery education in Australia over the last 30 years. Through collaboration and amidst opposition, quality midwifery education has been established in Australia. Identification of midwifery as a distinct profession and transformative leadership have been integral to this evolution and must be grown and sustained to prevent a decline in standards or quality.ConclusionThere is a need to address priorities in midwifery education and for the evaluation of midwifery programs and pedagogy. The provision and maintenance of quality education and practice require shared responsibility between education providers and health care services

United Kingdom educated migrant midwives' experience of working in Queensland

Abstract The nursing and midwifery workforce is becoming increasingly mobile and the globalisation of the midwifery workforce has been fuelled by the marketing strategies used by employers within Queensland to recruit midwives from overseas to fill vacancies within both the public and private sector. The United Kingdom has been specifically targeted, and the numbers of nurses and midwives moving to Queensland has more than doubled in five years and continues to rise. Little is known about the reasons why midwives are leaving the United Kingdom and what their experience is of working within midwifery in Queensland. This research was conducted within a phenomenological framework. A total of 18 midwives who had moved to Queensland within an eight year period were interviewed, who also completed a reflective journal about their motivations for moving, and subsequent experience of midwifery within Queensland. Data analysis was undertaken using an adaptation of the Van Kaam method of analysis of phenomenological data, as described by Moustakas. A Textural –Structural description of the meanings and essences of the experience incorporating the invariant constituents and themes was constructed for each participant. From the Textural –Structural Descriptions from all of the participants a composite description was constructed of the meanings and essences of the group experience. The reasons for leaving the United Kingdom were predominantly associated with an expectation of achieving an improved lifestyle for themselves and their families; and there was also a sense of seeking adventure. Participants also expressed dissatisfaction with life in the United Kingdom, which was particularly associated with work related issues such as bullying and harassment, increased workloads and burn out. Midwives reported choosing Queensland because of weather and lifestyle factors, but were also influenced by having friends, family or former colleagues already settled in the State. The main essences of the reported experience of working within the midwifery profession in Queensland included feelings of fear, frustration, shock and sadness. Despite the initial difficulties experienced in settling in to the midwifery profession, most midwives found a way to resume their midwifery career in Queensland by moving between jobs until they found one that enabled them to practise midwifery in a way they were comfortable with. Recommendations are made based on the findings to guide employers in their recruitment practices and assist with orientation of midwives recruited from the United Kingdom with a view to improved retention. In order to avoid the feelings of frustration and sadness described by the midwives in this study, employers should seek to match the skills of the midwives recruited to the positions available within the unit, and ensure systems are in place to facilitate recognition of prior learning and early credentialing to allow midwives to practise to their full scope and ability. In addition, in order to enable UK trained midwives to practise at their highest potential, supportive management structures should include access for migrant midwives to support in adjusting to midwifery practice differences between the UK and Queensland

Finding a way : The experiences of UK educated midwives finding their place in the midwifery workforce in Australia

Background: the number of midwives and nurses migrating from the United Kingdom (UK) and seeking registration in Australia is growing annually. Studies examining nurse migration have yet to identify features of the experience that apply specifically to the midwifery workforce. This information is vital to inform future international recruitment practice and to promote midwifery retention. This paper reports on a study examining the experiences of a group of midwives from the United Kingdom settling into the workforce within one state in Australia. Design: this descriptive phenomenological study examined the lived experience of UK migrant midwives practising in Queensland using open ended interviews and reflective journaling. Data analysis was conducted following the guidance of Moustakas, adapted from the van Kaam method of analysis of phenomenological data. Setting: all data gathered from midwives living and working in Queensland. Participants: midwives (n=18) working in Queensland who had left the UK after 1 January 2000. Findings: a central theme emerging from participants' experiences is described as 'finding a way'. Their experience was encompassed in a model of acculturation used by the midwives to find their way through the health-care systems in Queensland to be the kind of midwife that suited them and their life style. The three ways of being were influential association, capitulation and detachment. The most common feature of the experience was that of influential association. Key conclusions: midwives need to be well informed to provide realistic expectations prior to migration. Recruitment and management personnel should seek to match midwifery capacity with roles where their skills will be maximised

The virtual international day of the midwife:Social networking for continuing professional development

In order to maintain competence to practice, midwives must become lifelong learners and engage in education and CPD activities. The Virtual International Day of the Midwife event (VIDM) is a free online annual synchronous conference that uses social networking tools to bring midwives together to network, share research and practice information. This paper presents the evaluation based on the 2010 and 2011 events. Participants appreciated the opportunity to be able to network with colleagues in an international context, believed the event provided access to quality material and presenters, and valued the accessibility and availability of the event and resources. Participants suggested that the event could be improved by making the program more accessible, with sessions spread over several days, as opposed to 24 hours; providing information about appropriate netiquette and extensive advertising. Further research is required to investigate how social networking and initiatives such as the VIDM impact on practice in the long term.No Full Tex

International Networking: connecting midwives through social media

Purpose: This article reports on the 'Virtual International Day of the Midwife E-vent', an innovative initiative that uses social media to provide opportunities for learning and networking internationally. Background: This e-vent was conceived of and initiated in 2009 by a small group of midwives with an interest in social media. The e-vent uses web conferencing software and schedules a presentation every hour for a 24-h period so as to reach midwives or other interested parties in all time zones of the globe. Methods: The authors draw on their experiences to describe the e-vent including the e-vent aims and organizing processes, and to report on participation trends over the 3-year period. Findings: The e-vent has seen significant growth over a 3-year period with participation increasing from an average of five participants per session to 50. The organizing committee has expanded to include an international team and they have extended the reach of the project by establishing a Facebook page. Conclusions: While the use of social media has its limitations, projects such as the International Day of the Midwife E-vent have real potential to increase access to educational materials and provide opportunities for international networking. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses

The future of the Australian midwifery workforce—impacts of ageing and workforce exit on the number of registered midwives

Problem: Ensuring an adequate supply of the midwife workforce will be essential to meet the future demands for maternity care within Australia. Background: Aim: To project the overall number of midwives registered with the Nursing and Midwifery Board of Australia and the timing of their retirement to 2043 based upon the ageing of the population. Methods: Using data on the number of registered midwives released by the Nursing and Midwifery Board of Australia we calculated the five-year cumulative attrition rate of each five-year age group. This attrition rate was then utilized to estimate the number of midwives registered in each five-year time period from 2018 to 2043. We then estimated the number of midwives that would be registered after also accounting for stated retirement intentions. Findings: Between 2018 and 2023 the overall number of registered midwives will decline from 28,087 to 26,642. After this time there is expected to be growth in the total number, reaching 28,392 in 2028 and 55,747 in 2043. If midwives did relinquish their registration at a rate indicated in previous workforce satisfaction surveys, the overall number of registered midwives would decline to 19,422 in 2023, and remain below 2018 levels until 2038. Discussion: Due to the age distribution of the current registered midwifery workforce the imminent retirement of a large proportion of the workforce will see a decline in the number of registered midwives in the coming years. Additional retirement due to workforce dis-satisfaction may exacerbate this shortfall