General discussion | 187 support. Facilitating coaching, mentoring or group counselling for NQMs seemed to be feasible according to stakeholders, either within or outside the workplace. They felt that being able to give NQMs the choice between mentoring or coaching, based on NQMs’ special needs, is important. However, a stable working environment for NQMs in practice, which emerged as very important in international research, appeared to have a lower priority in stakeholders’ opinions. DISCUSSION OF THE MAIN FINDINGS In this section, we reflect on the main findings of this thesis. We first reflect on the transition-into-practice of NQMs, then on the occupational wellbeing of midwives, and finally on the transition support for NQMs. Transition-into-practice As written in the introduction of this thesis, transition into practice entails ‘a foundational period, whereby a newly registered practitioner can build competence and confidence as an autonomously working professional’.1 We reflect on NQMs’ perceptions of their transition-into-practice, and their need for support during this transition. We also reflect on stakeholders’ views of the working conditions for NQMs and the autonomy of NQMs in practice. According to our findings, NQMs and established midwives recognize a transition period in which NQMs need to learn to work across the full range of midwifery practice (Chapter 2,3 6). This includes performing administrative and organizational tasks, taking full responsibility for the care of pregnant women, and becoming a trusted team member in local and regional maternity care collaborations. Dutch NQMs noticed that they felt less competent and less confident in their decision-making, which is consistent with experiences reported in previous research (Chapter 2,3).2-5 These findings are also similar to research findings about young doctors’ readiness to work in independent practices.6 Both NQMs and young doctors felt less competent in management, administration, and leadership tasks.6,7 This may be explained by the level of competence at the time of graduation.8 NQMs are qualified to provide care to pregnant women as competent professionals, but they perform as beginning competent professionals in organizational and managerial tasks.9 They have to develop themselves from beginning competent professionals, whose behaviour is based on context-free rules, to fully competent professionals, whose behaviour is based on situational rules in the specific context.8 Building expertise requires deliberate practice with performance in practice guided by mentors or coaches.10 However, the current quality of learning and development of NQMs depends on the quality of NQMs’ self-directed and self-regulated learning skills,
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