The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study | 47 INTRODUCTION Newly qualified midwives’ (NQMs) well-being after graduation is at stake, due to the demanding tasks and responsibilities NQMs face.1 These new responsibilities may influence NQMs’ professional confidence and competence, with possible negative consequences on the quality of the provided care,2,3 or exit from the profession within the first year of graduation.4 NQMs face different challenges when starting as a midwife in a hospital setting. Firstly, NQMs potentially lack confidence in their own clinical decision-making and they tend to struggle with the complexity of care.5 Secondly, NQMs still need time to learn to prioritize their work and they usually need training in additional clinical skills, for example performing fetal blood sampling and coordinating treatment in case of emergencies.6 Thirdly, NQMs need to become a trusted member of the multidisciplinary team in their work as hospital-based midwives.7 In different occupations, specific demands and specific resources lead to specific outcomes.8 The Job-Demands Resource model (JD-R) model (figure 1) is often used as a theoretical model, due to the focus on different job demands and resources depending on the specific profession and a focus on positive and negative well-being.8-10 Job demands (for instance work overload, heavy lifting or job insecurity) are aspects of the job requiring effort and are associated with mental or physical costs. Job resources (such as feedback, job control or social support) help the professional achieve job goals or reduce job demands.11 In addition to job demands and job resources, the JD-R model integrates personal resources.12 Personal resources are positive self-evaluations that are linked to resilience and refer to individuals’ sense of their ability to control and affect their environments successfully,13 and help employees in achieving goals.8 Personal resources partially mediate the association between job resources and work engagement.12 Figure 1. Adapted JD-R model of occupational wellbeing.8
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