132 | Chapter 6 Participants emphasised that available backup from colleagues was important for NQMs’ confidence in practice and therefore the quality of care that they provide. However, some participants expressed concerns about NQMs’ need for backup. They suggested that midwives’ autonomy requires autonomous decision-making in practice. They may ask for help, but they must make their own decisions. Participants mentioned the importance of individual work conversations with colleagues during a shift as accommodating NQMs. Experienced midwives must be aware that NQMs in practice require an investment in time and attention during a shift. But when you have a younger NQM as a locum in your practice, then you also know in advance that the shift handover will just take a little longer in the morning. In that case, you briefly go through some things together. (FG 3.2) Furthermore, participants mentioned that working group meetings (weekly or monthly meetings to discuss different cases) were facilitating NQMs in their work. Due to their locum employment status, NQMs were sometimes not permitted to join these meetings. If NQMs are not permitted to participate in these meetings, they lack the opportunity to discuss the practical situations with their colleagues. …for your locums, you are their commissioner at some point, mainly in primary care. So actually, you cannot oblige them to participate in working group meetings. (FG 3.1) Hospital-based practice Participants in hospital-based settings described formal orientation periods for NQMs as common practice. The duration of the orientation differed per hospital. The first period in hospital-based midwifery also showed a sequence for additional midwifery skills training and a build-up in responsibilities. Both employers and NQMs seemed to be aware of these requirements. However, in practice the orientation period was often reduced due to understaffing. Participants expressed their concerns about the lack of orientation for NQMs and the risks of leaving the job early. They expressed the important role of management towards facilitating NQMs’ transition on the labour ward. We now have someone [NQM]. I think a really good midwife, whom we have tried to initiate into practice and that has gone completely wrong, so now she's actually facing the consequences and probably has to leave. (FG 3.2) The way in which NQMs were supported in practice differed between hospitals. Participants described workplaces that provided NQMs with a mentor or a buddy, while
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