206 | Summary experienced midwives in the Netherlands. A cross-sectional study was conducted using an online questionnaire that consisted of validated scales measuring job demands, job and personal resources, burnout symptoms and work engagement. A total of N=896 midwives participated in this study, representing 28 percent of practising Dutch midwives. Data were analysed using regression analysis. Seven percent of Dutch midwives reported burnout symptoms and 19 percent scored high on exhaustion. Determinants of burnout were all measured job demands, except for experience level. Almost 40 percent of midwives showed high work engagement; newly qualified midwives had the highest odds of high work engagement. Master’s or PhD-level qualifications and employment status were associated with high work engagement. All measured resources were associated with high work engagement. A relatively small percentage of Dutch midwives reported burnout symptoms, the work engagement of Dutch midwives was very high. However, a relatively large number reported symptoms of exhaustion, which is concerning because of the risk of increasing cynicism levels leading to burnout. In contrast to previous international research findings, being young and having less working experience was not related to burnout symptoms of Dutch NQMs. Chapter 5 concerns a mixed-methods study, whereby midwives’ intentions to leave and reasons to leave the job was explored. In the Netherlands, the turnover of midwives of relatively young age is high. This is concerning since a lack of experience in the workplace can negatively affect the quality of maternity care. This study aims to identify the rate and the reasons for intending to leave, and to explore the reasons for leaving midwifery jobs in the Netherlands. We used a mixed-methods design including a quantitative survey (N=726) followed by qualitative interviews (N=17) with community midwives. Almost one third of the respondents considered leaving the profession. The decision to actually leave the job was the result of a process in which midwives first tried to adapt to their working conditions, followed by feelings of frustration and finally feelings of decreased engagement with the work. Compared to international figures, we found a lower rate of midwives who considered leaving the profession. This could be explained by the differences in the organisation of midwifery care and the relatively high job autonomy of Dutch midwives. Innovations in the organisational structure that focus on continuity of care for pregnant individuals, job satisfaction for midwives and building a sustainable workforce may result in an increase in the retention of midwives. These innovations would ensure that women and their babies receive the best care possible. Chapter 6 describes a qualitative study on established midwives’ perceptions on supporting NQMs in practice. NQMs in the Netherlands perceive the adaptation to new responsibilities as difficult due to the autonomous nature of- and required accountability
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