190 | Chapter 8 lower work engagement in NQPs. An explanation for these findings may be the work environment of NQMs in the Netherlands. NQMs mainly work in community practices,2 where their work with pregnant women is often aligned with their own midwifery values and ideology.32 Previous findings on Dutch student midwives show the importance of ‘enhancing physiology’ in pregnancy and childbirth in becoming a good midwife.33 Job resources such as autonomy at work and working ‘with pregnant women’ seem to contribute positively to Dutch NQMs’ wellbeing at work. Both NQMs and experienced midwives in the Netherlands are highly engaged in their work (Chapter 4). Our findings on midwives are encouraging, as it is known that working with people in social and health care contributes to positive wellbeing.30 Internationally, our findings provide a basis for measuring midwives’ work engagement, as an international comparison of midwives’ work engagement is not yet available.34 By including work engagement and its determinants, international research on midwives becomes more comprehensive. Transition support Similar to international conclusions, our findings show that NQMs need support in practice after graduation (Chapters 2,3,6,7).5,35,36 Research suggests that support for NQMs is effective for their wellbeing, but also beneficial for the quality of care they provide.37-40 In our studies, NQMs’ need for support from fellow midwives was recognized by all stakeholders (Chapter 6,7). However, in current practice, support from fellow midwives for NQMs is not formally arranged and available, and is mainly dependent on the goodwill of fellow midwives. Midwives expect NQMs to be able to work as an independent (locum) midwife, which requires a level of competence they do not yet have when they enter practice (Chapter 6). These findings reveal discrepancies between established midwives’ attitudes and behaviour towards supporting NQMs. Midwives believe that NQMs learn and develop through serendipitous practice experiences rather than through deliberate practice experiences with their colleagues.10 The discrepancy between midwives' beliefs and behaviour may be found in the reasoned action perspective.41 This perspective suggests that attitudes and behaviour are usually activated by automatic processes. Moreover, attitudes can vary depending on the context in which they are expressed or based on inadequate information or beliefs. From this perspective, established midwives believed that NQMs primarily learn from random practice experiences. They also believed that NQMs need to develop competences in practice. In their attitude they recognized NQMs’ need for development. In their behaviour, however, they felt themselves conditionally able to support NQMs.
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