General discussion | 185 multidisciplinary team and the variation in the work with pregnant women in the hospital were perceived by NQMs as helpful in this transition. There was usually an introduction period, during which tasks and responsibilities were expanded. The multidisciplinary teams in hospital settings also felt responsible for the quality of NQMs’ work in practice. After settling in, support for NQMs remained informal. Peer support was less important for hospital-based NQMs, because most peers did work in the community. In both work environments – the community and the hospital – job insecurity obstructed NQMs in their work in a team. They felt like temporary team members. Although fellow midwives were valued as important role models and as equal sparring partners, the possibilities for working alongside fellow midwives in practice were scarce. Established midwives perceived NQMs as having problems adapting to their new role and responsibilities in practice and working autonomously. They experienced NQMs as focused on their own tasks and shifts, and as protective of their time off. They therefore perceived NQMs as less committed to the practice and to organizational tasks compared to their own start in their jobs. On the other hand, established midwives were aware of NQMs’ need to continuously learn and develop as professionals. Regarding support for NQMs, different opinions were given. Some practice holders said that putting effort into training of NQMs ultimately leads to better colleagues, and can thus guarantee the quality of care provided in their practice. Others did not see this opportunity to support NQMs, because they felt they were commissioners and not employers of locum-working NQMs. Midwives’ wellbeing and its determinants The second research question in this thesis was about the occupational wellbeing of midwives: What are the levels of wellbeing of NQMs and experienced midwives in the Netherlands, and which determinants are associated with wellbeing and intentions to leave the practice? The population of practicing midwives in this study consisted of 896 midwives, a quarter of the total population of midwives in the Netherlands. In this sample, based on measurement through self-assessment scales, seven percent of the midwives were found to have burnout symptoms. One in five midwives suffered from emotional exhaustion at work. All measured job demands (changing tasks, complexity, emotional load, mental load, organization of work, physical strain, problems with tasks, variety, work pace and work quantity) were found to be burnout symptoms. The number of years of work experience was not a determinant of burnout. Regarding midwives’ positive wellbeing, midwives scored high on work engagement: 40% of the respondents were highly
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