60 | Chapter 3 Due to the lack or formal support for hospital-based NQMs in the Netherlands, team managers in hospital settings and the Dutch Royal Organization of Midwives may want to consider organizing settling-in and support programmes. For adaptation in the hospital setting, NQMs have to meet clear expectations about responsibilities and supervision in practice. Especially in hospital settings with a high workload and medium and high-risk care NQMs are vulnerable in their initiation period. The initial education of midwives in the Netherlands could prepare midwives more explicitly for the different working contexts: in the community and in a hospital settings. Although 10-20 percent of new graduates applies for a job as hospital-based midwife,30 it is important to raise awareness of the differences of working in primary and secondary/tertiary care and its implications for the settling-in period in practice. Our findings indicate that Dutch NQMs found themselves not fully prepared for working in a hospital setting . Based on this finding, future investigation should focus on the ways in which midwifery students are prepared for working in different contexts and what helps or hinders them in their adaptation in hospital settings. Based on our findings, further quantitative research is necessary about NQMs wellbeing as well as working conditions associated with wellbeing. These outcomes can help with building specific support programmes for NQMs in practice. CONCLUSION For Dutch NQMs, working in a hospital setting the context itself is demanding, due to a high workload and the complexity of the work. NQMs face also new managing tasks and have to learn additional medical skills required for working as a hospital-based midwife. Personal resources such as sociability help NQMs in becoming a member of a multidisciplinary team. Neuroticism and perfectionism hinder NQMs in practice. Clear expectations and a settling-in period and support from colleague midwives and obstetricians help NQMs to adapt to work in a hospital setting.
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