36 | Chapter 2 Dutch NQMs’ working conditions are different, compared to NQMs from other (highincome) countries. Working in a community practice requires the NQMs to adapt to collaboration structures and organizational tasks which are specific to that practice. This relates to collaboration with different professionals in the community as well as with health care professionals in the hospital. Organizational tasks and procedures, such as making invoices and ordering supplies can also vary by practice. These working conditions are a consequence of the specific organization of maternity care in the Netherlands,5 which requires a high level of autonomy of NQMs both in providing care and on the organizational/ administrative elements of the job. Similar to other studies on newly qualified health care practitioners, NQMs indicated that they are lacking competence with regard to organizational aspects of the job.23,24 In our previous study25 among final year student midwives in the Netherlands, we found that they were aware of the importance of organizational competencies. However, after graduation, in practice, it turns out to be a demanding task. NQMs feel competent in providing client care, but regarding organizational tasks they indicated that they perform at a lower level (advanced beginner (Dreyfus’ five stage model),26 which implies limited situational perception and lack of routines. Awareness about these differences in competency levels may help both NQMs and colleagues/employers in readjusting expectations. Two specific pressures that Dutch locum midwives face are the pressure to gain enough work and having to work in a variety of contexts. The nature of these job demands has not been described in previous studies. NQMs in previous studies were employed and did not work in different work settings at the same time.1,17 Different work settings are highly demanding for Dutch NQMs. This is particularly felt when NQMs have to apply local and regional agreements in clinical reasoning and decision-making, and simultaneously have to communicate with their clients and other maternity care providers. This requires the processing of a high amount of information, which can lead to incomplete and ineffective information processing possibly leading to a negative effect on the provided quality of the care.27 Comparing job demands on NQMs with other occupations and professions in the Netherlands,20 the job demands on NQMs show different outcomes due to the organizational setting of employed professionals. Employed professionals experience rapidity of changes in the workplace and working pressure as highly demanding. These outcomes differ from our studies on NQMs; the majority of NQMs in primary care are working as self-employed locums and do not work within an organizational context. In
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