194 | Chapter 8 IMPLICATIONS For midwifery organizations This thesis has cast light on the current level of occupational wellbeing of NQMs and experienced midwives, and what is needed and important to improve the wellbeing of midwives. According to organizational change theory, knowledge and understanding of the wellbeing of NQMs are a first step towards changes in the transition of NQMs into practice.50 Our findings in this thesis suggest systemic changes to help NQMs integrate into the midwifery workforce. Regarding the transition of NQMs into practice, we have established stakeholder agreement (Chapter 7) on a shared vision, on commitment to socialization into practice, and on the required components of support for NQMs in practice. The next step is developing a shared vision on how to organize and manage the necessary changes in practice.50 Maternity care organizations, i.e. midwifery practices, hospitals, and regional corporations or collaboratives, need to take responsibility for implementation. They can do so by identifying leaders who can become responsible for arranging these components of support for NQMs at the local or regional level.50 For the wellbeing of NQMs and the quality of their performance in practice, it is recommended that everyone concerned should be involved in implementing the following components of support: formal induction into practice, 24/7 support from colleagues, performance feedback from practice owners or managers, and mentoring from fellow midwives. Furthermore, it is recommended to change the temporary employment conditions for NQMs in their first year in practice to a stable environment to guarantee a safe start in practice and quality of performance for all NQMs. Under these conditions, NQMs will be able to work in practice with available colleagues, which in turn will allow them to learn more deliberately from practice experiences and develop into fully competent midwives. For the community, the rationale for this recommendation is that the self-employed status of NQMs, which requires them to work as locum midwives, has hindered their induction and socialization in practice (Chapters 2, 6, 7). Therefore, a reassessment of the labour requirements for locum midwives is recommended. In hospitals, we found a similar situation for NQMs who work on a zerohours contract. This makes them a temporary team member, and less committed to the organization. At a local level, we believe managers and practice owners need to take the lead in working with established midwives and other colleagues to implement support for NQMs. In the community, it is recommended that permanent employment contracts be provided to
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