14 | Chapter 1 Problem statement NQMs’ wellbeing and performance in practice in the Netherlands is unknown, due to a lack of existing research about this topic.24 International research on NQMs is hard to generalize for the Dutch work environment, because these studies mainly focus on hospital-based midwifery.24 Assumptions are made in previous research that NQMs in the Netherlands tend to avoid risks and that the care they provide might be substandard.37 International research indicates that midwives who prefer to be ‘on the safe side’ might initiate more premature interventions (‘too much too soon’).38 Moreover, overuse of interventions leads to unnecessary risks for pregnant women and higher healthcare costs.38 Healthcare workers’ wellbeing is important because their wellbeing is an important indicator of the quality of care provision and the healthcare system in general.39 Burnout, psychological distress, and poor social resources are associated with suboptimal patient care, unprofessional conduct, and leaving the profession.39 The importance of work engagement and its contribution to performance in practice and professionals’ wellbeing is shown for various occupational groups but data about midwives is lacking.20 Previous research on NQMs suggest that they lack self-confidence and doubt their own competence, which has implications for their wellbeing and performance in practice.24,40 NQMs meet different challenges in their chosen work environment.25 For instance, NQMs have to become a trustworthy member of the monodisciplinary and multidisciplinary team and have to work as a member of the profession.27 Furthermore, NQMs experience a theory-practice gap, and have to work according to job expectations. When these expectations do not meet their own values, NQMs experience anxiety, stress, and attrition from the job.27,41-43 Research on NQPs who work in independent practices indicates that this environment creates barriers to asking for help from colleagues, which affects their performance in practice.44 Furthermore, the importance of a supportive team and positive support from fellow midwives in the transition-into-practice is highlighted in previous research. 24,26,29 Knowledge gaps Research on midwives’ occupational wellbeing in the Netherlands is outdated. Data on burnout levels date back to 1996.45 Internationally, research on occupational wellbeing of midwives primarily focuses on negative wellbeing: burnout symptoms.5 There is a lack of knowledge on the positive wellbeing of midwives and its determinants in the hospital and in the community settings.18 How the specific work environment of NQMs in the
RkJQdWJsaXNoZXIy MTk4NDMw