192 | Chapter 8 Finally, NQMs are unaware of their roles and responsibilities in the practice organization, which in turn may be due to a lack of competence in organizational and administrative tasks (Chapters 2,3).6 Even though these competences could be further developed during their educational programme, without explicit socialization into a practice organization, NQMs will continue to have difficulties understanding what is expected from them as responsible practice team members. In summary, the findings of this thesis suggest differences in midwives’ attitudes and behaviour towards the socialization and support of NQMs in practice, towards the learning and development needs of NQMs in practice, towards the expected levels of organizational and managerial competence of NQMs, and towards responsibility for the organization of the practice (Chapters 2,3, 6,7). This thesis also identified differences in perceptions about NQMs’ level of competence during their period of transition-intopractice (Chapters 4, 6,7) and in attitudes to work and home life (Chapters 2,3,6). Established midwives valued working in practice, and valued employability and availability for the job, as suggested by the study of intentions to leave the profession (Chapter 5).47 Participants – midwives who had left their job as a midwife – considered themselves a burden to their colleagues when faced with physical or psychological limitations. Building a sustainable midwifery workforce requires recognizing and valuing differences in midwives’ competences, attitudes, and abilities, and valuing these differences in the organization of midwifery care. Recommendations for building sustainability in the workforce are provided in the Implications section. METHODOLOGICAL CONSIDERATIONS Strengths and limitations One of the strengths of this thesis, as compared to other international studies on midwives’ wellbeing, is that we accounted for the dimension of positive wellbeing. By including the motivational process in the study of midwives’ wellbeing, we obtained a more complete understanding of wellbeing. The existing knowledge on midwives’ occupational wellbeing was focused on burnout and its determinants. Furthermore, we have shown the importance of personal resources as determinants of wellbeing: they serve as a buffer when it comes to burnout symptoms, and they enhance work engagement.48,49 Another strength of this thesis is that NQMs’ transition-into-practice was studied comprehensively. Different perspectives on this topic were studied by involving various stakeholders (NQMs, established midwives, managers, practice owners), and by looking
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