174 | Chapter 7 APPENDIX II Starting midwives in Dutch professional practice Labour market context More than three quarters of graduated obstetricians are working in primary care when they start practising, 72% of them as observers.1 In practice, it appears that starting midwives mainly work as observers (ZZP-er), usually at several practices. Well-being of NQMs Starting midwives are more inspired than experienced midwives in the Netherlands, according to our own research. Emotional exhaustion and burnout symptoms score at similar levels (9% with burnout symptoms, 20% suffer from emotional exhaustion). (Kool et al, submitted). If learning opportunities, career prospects and available feedback are available, these are determinants of engagement, in addition to variation in work and autonomy. Contrary to international research findings, young and less experienced midwives in the Netherlands are not more susceptible to burnout symptoms.2 This difference can possibly be explained by the work context. Starting midwives in the Netherlands are much more likely to work in primary care in contrast to abroad. Job demands The expectations of starting midwives in primary care and the reality in practice differ.3 In practice, starters appear to work in different practices, often also in different regions. Being a self-employed midwife is not a choice for all starting midwives. At work, they have to get used to irregular shifts, making sure there are enough working hours and the amount of availability. They also lack routine in the work and regularly have doubts about the policy pursued.1,3 The induction programme is lacking or consists of a verbal handover and written practical information. Direct colleagues are an important resource, although not available or present in the practice. Starting midwives use support from peers, who appear to be approachable and accessible. Starting midwives desire 24/7 backup from peers to test themselves when it comes to decisions they have made and build selfconfidence as midwives. In addition, they desire regular collaboration with midwives. Midwives recognise the desire of starting colleagues but see their role as clients as a barrier and expect facilitation by other parties for this. Starting midwives in the clinical setting still need further training in new tasks as midwives: managing additional midwifery skills several delivery rooms simultaneously and gaining a place in the team.4 Temporary or 0-hour contracts make them feel like temporary or contingent team members. It seems common in the clinical setting for an entry-level midwife to be inducted before being allowed to function independently. In practice, the duration and content of the induction programme appears to depend on availability of clinical midwives. Starting midwives are eager to work with other midwives on a regular basis to achieve ongoing socialisation as a midwife. They also expect to be guided and supported by the gynaecologist and manager of the department in picking up their new tasks and responsibilities and to be able to fall back on them when necessary.
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