Intentions to leave and actual turnover of community midwives in the Netherlands. A mixed method study exploring the reasons why | 115 Recommendations Further research is recommended on the intentions to leave for hospital-based midwives, and on the reasons to stay for all midwives in the Dutch midwifery context. With this information, a complete overview of the sustainability of midwifery in the Dutch healthcare system can be obtained, as well as any information on how to reduce job demands and optimise work resources. In addition, we recommend distinguishing between midwives’ intentions to remain in a hospital setting and in a community setting, due to the differences in work contexts. Considering the findings of this study, we would recommend midwifery academies to pay more attention in their educational programme to the management- and collaboration skills of midwives who are focused on working in their own business, as a locum and in an organisation. Potentially, when recruiting students, midwifery academies should also encourage students who like to work both as entrepreneurs and healthcare professionals. A recommendation for policymakers is that it is important to evaluate the optimal organisational structure, both in the community and in the hospital setting, to initiate a transition that will make the organisational structure a job resource rather than a demand. A collaboration of practice, education and research with an action research design could be useful in building a sustainable midwifery workforce in the Netherlands. At a national and an international level, we recommend addressing the issues of retaining a sustainable workforce while taking into consideration the values of practising midwives, increasing opportunities for social support in the workplace and improving the working conditions of midwives. We advise that priorities should be given to programmes for retaining older midwives in the profession, including, for example, more flexible on-call and night shifts. Furthermore, we recommend the arrangement of care pathways in which the continuity of the care is strengthened. Maintaining a sustainable midwifery workforce in the shift to integrated midwifery care requires a well-considered strategy. Due to the self-employment of community midwives, midwives have a great deal of control over the organization of their own practices in terms of workload and services. The shift to integrated midwifery care affects this autonomous position and therefore requires solutions that contribute to the wellbeing of the midwifery profession. The contribution of community midwives to these solutions is of great importance.
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