38 | Chapter 2 Strengths and limitations A strong aspect of this study is the use of the JD-R model. By using this theoretical model, it is possible to compare our outcomes with studies among other professions. Using group interviews instead of individual interviews is another strength of this study. During the group interviews, participants were able to reflect on the differences and similarities between their experiences with others in similar circumstances. Another strength was the background of participants in that they reflected the diversity within the NQM population. For instance, in our study, 71% of the participants worked as a locum and 26% as an employed midwife, which is similar to the entire population of Dutch NQMs.8 By using different interviewers as facilitators we prevented bias from researchers during the interviews. Moreover, it was clear that we reached data saturation, as the last two group interviews did not yield any new insights. A limitation of this study was that we did not include deviant cases: NQMs who had left primary midwifery care. Kenens et al.8 show that 10% of NQMs do not work as a midwife after graduation. If we had found NQMs who had stopped working in primary midwifery care, we could have explored which factors they perceived as reasons for resigning from the job. Another limitation of our study was the focus on primary care midwives. Although 72% of NQMs work in primary midwifery care, the outcomes may not be generalizable to the whole population of Dutch NQMs. Most of the remaining 28 percent of the NQMs work as employees in a hospital setting (mean of 21% in the past 20 years) in which dynamics are different from working in primary care.8 Implications for practice, research and education The findings of our study suggest that Dutch NQMs in primary care face similar challenges to other NQMs and newly qualified professionals. In addition, they face challenges that are unique to the circumstances of the Dutch maternity system. Yet, there is no formal support for them, such as available in other developed countries. Our findings suggest that colleagues and peers are important job resources. Colleagues in primary midwifery care may have to be increasingly aware of their importance as a job resource (and, in the case of employer, as a job demand) and their influence on the wellbeing of NQMs. NQMs may need to consider organizing their own informal (peer)support system before graduation, in order to provide themselves with the necessary resources. The professional organization of midwives in the Netherlands may need to reconsider the lack of formal support for NQMs. Enhancing the position of locum midwives, especially for NQMs, requires better employment prospects for NQMs. Most NQMs do not have a choice about the type of
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