How to improve newly qualified midwives’ wellbeing in practice. A Delphi study | 151 INTRODUCTION There are increasing concerns about the occupational wellbeing of newly qualified midwives (NQMs) in the Netherlands. Dutch NQMs start work right after graduation, as registered midwives in the community (82%), or in hospitals (15%).1 Three out of four NQMs in the community work as a locum midwife.1 Locum midwives work selfemployed and are hired by primary care midwifery practices to cover for holiday, maternity or sick leave. NQMs need encouragement in their decision making and 24/7 backup to help them work confidently and competently in practice 2,3 However, none of these work contexts seem to meet the NQMs’ support needs.4 Previous studies5,6 found that NQMs’ do not feel sufficiently confident and competent in their professional practice in the period following graduation.7 This could have an impact on the quality of care they provide. 5,6 This period at the start of a midwife’s career is acknowledged to be a transitional phase 8 During this time, NQMs build their competence and confidence as autonomously working, newly registered practitioners. With regard to NQPs (newly qualified practitioners), workplace issues are known to be correlated with a decreased quality of care and higher patient mortality.9 Furthermore, in the Netherlands, Offerhaus et al. suggested that insecurity and a lack of confidence on the part of NQMs could cause them to choose safer options. This leads to operating on the safe side, and, in turn, might explain the rising referral rates to secondary care seen in low-risk women during labour.10 In the Netherlands, NQMs feel that their transition to professional practice is very tough, whether in the community or in hospitals.2,3 NQMs lack work experience in professional practice and need to develop routines. Dutch NQMs start work straight away as registered midwives, which means that they are fully responsible and accountable for the care they provide to their clients.11 In addition, many find it difficult to transition from working with backup from a supervising midwife to working autonomously. Furthermore, aside from caring for their clients, NQMs must perform the numerous organisational and administrative tasks involved in everyday practice, all of which are new to them. 3 In the hospital setting, NQMs must learn to work partly autonomously and partly under the supervision of an obstetrician. In addition, they must also learn to care for several clients at the same time, in different delivery rooms. This requires a good overview of the situation and the ability to delegate tasks to obstetric nurses.2 Previous studies revealed that Dutch NQMs felt there was a lack of support during their transition into professional practice.2,3 In the community, there are no orientation programmes for NQMs, nor are there introductions to specific workplaces.3 In
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