Midwives’ perceptions of the performance- and transition into practice of newly qualified midwives. A focus group study | 123 INTRODUCTION Dutch newly qualified midwives (NQMs) perceive their transition into practice as difficult.1,2 NQMs are registered midwives who have worked in midwifery practice for less than three years after graduation.1,2 Research has shown that NQMs’ levels of selfconfidence decrease during the first months in practice and that NQMs need support from experienced midwives.1,2 NQMs have to adapt to their new roles and responsibilities, which is experienced as difficult.3 In the Netherlands, the professional education of midwives in the Netherlands consists of a four-year direct entry Bachelor of Science programme which gives access to registration, allowing license to practice. 4 Midwifery students spend a minimum of 70 weeks of internships in their four years of educational training: 42 weeks in primary midwifery care, and 28 weeks in secondary/tertiary care settings.5 After graduation the majority of Dutch NQMs work in community practices, where they work independently and autonomously.6 Support from midwifery colleagues seems scarce in both hospitalbased and community-based settings due to the NQMs’ locum status and to the unavailability of experienced midwives to collaborate with.1,2 The NQMs’ decreased confidence levels may affect the performance of NQMs and therefore the quality of midwifery care, according to Offerhaus et al..7 Professional performance is defined as the knowledge, skill or care possessed and applied by a registered health practitioner in the provision of regulated health services.8 The lack of confidence might lead to NQMs who act cautiously, which ultimately leads to an increased number of unnecessary referrals to an obstetrician.7 These referrals create discontinuity of care, leading to more interventions and higher costs.9 Internationally, various countries organise formal support for NQMs to guarantee the quality of care for pregnant individuals.10,11 Although support of NQMs cannot not guarantee the quality of midwifery care, previous research on NQMs suggests that structured support from experienced midwives is an effective tool to increase NQMs’ levels of competence and confidence.12-14 Positive support by an experienced midwife as a mentor leads to reassurance and safety for NQMs, promotes better performance and competence and increases positive learning experiences.12,15 The main sources of formal support are experienced midwives who are employed within or outside the facility (mentors)14 and informal support from the midwifery team.16 Different countries recognise a period wherein NQMs can build competence and confidence as autonomously working and newly registered practitioners.3 This period is often defined as transition into practice: a foundational period at the start of a career.3
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