The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study | 57 Perfectionism was seen at times as unduly demanding; some NQMs just wanted to do their job extremely well, which, for instance, made it difficult for them to stop thinking about their work when their shift was over. They were overthinking the decisions they made and doubting their actions. They also criticized themselves about their work, when they compared their work with more experienced colleagues. ‘But also feelings of uncertainty, can I do it, am I doing it right? And sometimes sad feelings, I’ll never get the hang of it. For example, if I had to start an induced labor, and then it didn't work as I expected… And then my colleague told me: we can easily break the membranes. And then I was so embarrassed. And well then, I started to break the membranes and then I didn't succeed. And then I let her do it. Then just disappointment, gloom, insecurity…’ (P10) Participants also identified a fear of failure which hindered them to perform in practice. NQMs reported at times sensing the feelings of clients or colleagues, but they did not dare to ask for feedback. Consequently, they took feelings of anxiety with them at home, and did not check whether these feelings were right or wrong. ‘I am sometimes so much in doubt. Is it perfectionism, or is it some form of being afraid to fail. … I have noticed more than ever since my graduation that you carry responsibility for mother and child, that is a certain pressure that you feel. And then you think that can indeed be fatal… And perhaps it is a factor that I can be sensitive or afraid of doing things wrong.’ (P2) DISCUSSION Within this study, we explored the specific demands and resources Dutch NQMs face in hospital settings. Newly qualified hospital-based midwives face new tasks and challenges they did not expect beforehand. The hospital context itself is also demanding, with a high workload, necessary team membership and job insecurity. On the other hand, the hospital also provides social support from colleagues, and the variety of women and tasks. Personal resources such as openness to new experiences, sociability, calmness and accuracy help newly qualified midwives in their initiation period. However, perfectionism, self-criticism and fear of failure were perceived as personal demands. Similar job demands have been reported previously, with studies of NQMs reporting a high workload, working with women with complex needs and learning additional medical procedures.17 In our study we identified job resources in hospital setting that are similar to findings in other studies on NQMs: working in a supportive team, working with women and the variety and diversity of the work.21,23,33 However, this study added to the previous
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