How to improve newly qualified midwives’ wellbeing in practice. A Delphi study | 167 The latter process takes place in the workplace, after graduation, and is the responsibility of that workplace. Limitations and strengths One limitation of this study might be the limited generalisability of our findings to midwifery contexts in other countries, due to the distinctive way in which midwifery is organised in the Netherlands. However, support in community-based midwifery features prominently in our findings, so these may well be applicable to community-based NQMs working in other countries One strength of this study was the response rate in both Delphi rounds. This supports our view that the study is a true reflection of the opinions held by the midwifery workforce in the Netherlands. Another strength of this study was the online version of a Delphi study, which demanded very little of the stakeholders’ time and effort. Recommendations The sustainable implementation of components of support for NQMs in midwifery practice in the Netherlands requires collaboration at both national and regional level. NQMs have to work according employment contracts in their first year in practice, instead of working self-employed as a locum. Changes in the employment conditions will improve NQMs’ self-confidence and competence in professional practice. Therefore, the implementation of support must be considered at both regional and national level.28 Together with its members, the RDM could take the lead in policymaking with regard to support for NQMs, with a view to enhancing the quality of midwifery care and developing a sustainable workforce. At the level of organisational implementation,28 the various regional maternity care cooperative groups should take responsibility for providing around-the-clock backup for NQMs. Furthermore, NQMs must be willing to approach back-up in the region for help with implementing around-the-clock backup. Moreover, practice owners and hospitalbased managers should create stable employment conditions for NQMs within the region. A subsidised implementation plan should be drawn up (with the RDM taking the lead) to help the various regions implement stable employment conditions for NQMs, together with support for all NQMs. CONCLUSION
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