186 | Chapter 8 engaged in their work. NQMs showed higher rates of work engagement compared to experienced midwives. Therefore, the years of work experience appears to be a determinant of work engagement. Job resources associated with work engagement were: autonomy, career opportunities, clear responsibilities, collaboration with colleagues, communication, contact opportunities, feedback, financial rewards, job security, learning resources, variety, and work and rest times. Personal resources were more strongly associated with work engagement than job resources. All four measured personal resources, hope, resilience, optimism, and self-efficacy, were important determinants of work engagement. The quantitative findings of the study on intentions to leave the practice among Dutch Community-based midwives show that almost a third of the population planned to leave the profession within a year. A variety of factors were found to contribute to intentions to leave the job. Family commitments, in combination with heavy workloads and responsibilities as a practice owner, were perceived as a heavy burden in their job. Our findings also revealed that one third of the population of midwives was not satisfied with the organization of the practice. The qualitative part of this study demonstrates that the final decision to stop practicing midwifery turned out to be a process over time, during which midwives tried to improve their working conditions (job crafting). If they failed to do so, they became frustrated and felt a loss of commitment to their work, which also affected their performance in practice. The accumulation of job demands that they were no longer able or willing to meet, combined with poor social support from colleagues and responsibilities to their own families, ultimately led to the decision to quit. Support for NQMs The third research question concerned the support given to NQMs in their transitioninto-practice. What are the desired and the feasible components of support for the NQMs’ transitioninto-practice? Desired components of support, according to stakeholders’ opinions, are an introduction period, 24/7 support for NQMs, adequate feedback on performance, and aligning roles and responsibilities. Furthermore, stakeholders expressed that every NQM should be mentored or coached by trained mentors and coaches during their first year in practice. Financial and organizational issues emerged to bar the feasibility of these components, however. Introduction in practice and 24/7 back-up for NQMs in practice seemed important, but was sometimes not feasible due to the workload of experienced midwives. Regional arrangements between practices were important to provide the necessary
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