208 | Summary Chapter 8 summarizes and discusses the main findings of this thesis, addresses the methodological considerations, and the implications for practice for educators, for policymakers, and for research. In this thesis, we found 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. This thesis also identified differences in perceptions about NQMs’ level of competence during their period of transition-into-practice and in attitudes towards work and home life. 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. 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. NQMs and experienced midwives in the Netherlands are highly engaged in their work in maternity care. NQMs are significantly more engaged than experienced midwives. Determinants of midwives’ positive wellbeing are various factors, such as working with colleagues and ‘with women’, together with trainable personal resources, such as resilience and optimism. One in three midwives intend to leave the profession. Determinants of intentions to leave, and reasons for leaving the profession are a combination of high workload, practice owner roles and responsibilities, and family responsibilities. Components of support for NQMs as agreed by stakeholders include proper induction in practice, expansion of tasks and responsibilities with performance feedback from practice owners or managers, 24/7 back-up during a shift, and mentoring and coaching on work experiences. Systemic, organizational, and cultural aspects of midwifery care hinder the implementation of formal support. Establishing a transition period for all NQMs in their first year of practice was recommended, supported by stable employment combined with practice support. NQMs cannot work at the competence level required for a locum midwife. Components of support on which there is consensus among stakeholders can be implemented at local and regional level, where practice owners and managers should take responsibility for implementation. Design-based research is recommended to further develop detailed support components based on existing literature. At local or regional level, participatory action research can be used to implement these components in a specific region. Regarding midwives’ wellbeing, periodic measures of their wellbeing in practice, their intentions to leave the profession and their intentions to remain in the profession are recommended for intervention and to build or enhance a sustainable midwifery workforce.
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