The initiation of Dutch newly qualified hospital-based midwives in practice, a qualitative study | 59 reported elsewhere previously.3,6,22,38 In addition, we identified demands, such as learning additional medical skills and working under direct supervision from an obstetrician as demanding for Dutch NQMs. An explanation for this outcome could be the focus of the Dutch educational programmes for most midwives working in primary care. This could lead to unclear expectations for new graduates about future employments (for both working in the community and in the hospital setting). Job insecurity in our study is also considered a job demand with an impact on NQMs confidence.4,26 Compared to other research, our findings on personal demands appear similar: neuroticism and perfectionism as poor personal resources.9,13 However, on studies on NQMs, specific personal demands were not yet reported: our study identified perfectionism, selfcriticism and fear of failure as specific demands among NQMs. Strengths and Limitations A strength of this study is that we used a theoretical framework. Working with the JD-R model, helped us identify job demands, job resources, personal resources, but also personal demands. Personal demands and resources were not explored in other studies on NQMs. Another strength in our study is that our participants reflected a representation of the Dutch hospital-based NQM population.30 In our sample, for instance, we had participants educated in the different academies in the Netherlands as well as participants educated abroad. In this study we explored and identified factors that influence well-being of hospitalbased NQMs. A limitation of our study is that we did not explicitly relate these specific demands and resources to well-being and performance of hospital-based NQMs. Another limitation is that we only interviewed hospital-based NQMs working in the Netherlands. These outcomes are possibly not applicable in other countries, due to the differences in the educational programmes and organization of maternity care. Implications for practice, education and research Our findings suggest that NQMs in their settling-in period need support and guidance from their managers, colleagues and team. Experienced colleague midwives and obstetricians are essential for the adaptation of NQMs to a hospital setting. Team members must be aware of their importance as job resource: positive support helps NQMs become an effective team member. Colleague midwives are important as role models and, together with obstetricians, important for their expertise: providing NQMs with expert feedback and guidance.
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