The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study | 53 nature of the maternity ward. Participants mentioned not feeling very well prepared for the hectic nature and high workload on the maternity ward. Becoming a team member Membership of a multidisciplinary team required competences in collaboration, cooperation, and leadership. For NQMs, especially in comparison to their internships, it took effort and adaptation to become a full member of the team. Furthermore, they also had to decide when direct supervision of the obstetrician was required. ‘… it also depended on the colleagues you are working with. Is it someone who helps you and who guides you a little or is that someone who thinks: ‘Well, another youngster, and let her prove herself’?’ P4 Participants had on one hand to learn how to delegate tasks to the obstetric nurses and on the other hand had to work under strict supervision of an obstetrician. Working under supervision of an obstetrician required collaboration and learning to function semiautonomously. NQMs mentioned having to show their competence in order to build trust and reliability. ‘There are a lot of dynamics in the hospital …. And it took me some time to realize which disciplines are involved and which agreements are made per hospital, and about protocols. And even if you have a protocol, the usual way of doing things can be different, and it takes a while before you know this. It differs per hospital, but also per obstetrician it is different again, and per nurse and per primary care midwife. That is so diverse, it really took me a while before I really knew how it works and I still run into issues now and then.’ (P3). Additional midwifery skills and procedures Hospital-based NQMs faced different midwifery skills and procedures, which they were not specific trained for during their education. For instance, they had to learn how to insert Foley-catheters and fetal-scalp electrodes. These procedures required additional skills, which they had to learn in practice. Other midwifery procedures were trained before graduation, but NQMs were less experienced in practice, such as assessing fetal monitoring or suturing complex episiotomies. NQMs lacked routine in these complex procedures, so these procedures required effort. ‘Especially with the CTG [cardiotocogram], you are immediately thrown in at the deep end. You have to work in practice with the CTG and it remains difficult and partially subjective. What one person thinks can be different from another and you must have a lot of experience with it if you want to be able to take advantage of it. And then you sometimes
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