84 | Chapter 4 score group of the UBOS-C is based on 10 percent primary care professionals, while 81 percent of our sample were primary care midwives.32 Working in the community with continuity of care protects against burnout symptoms.4 The cut-off point for burnout symptoms might therefore be too strict for our sample. The occurrence of exhaustion among Dutch midwives is a reason for concern, despite the low levels of burnout symptoms: about one in five Dutch midwives suffered from exhaustion. The burnout percentages are relatively low due to the low percentages of cynicism within this group. High scores on exhaustion combined with high scores on work engagement indicate that this group remains energetic because of their motivation for their work and the buffers against burnout symptoms.5 However, there is a risk that cynicism will increase if scores on job resources decline. This could cause this group to become less committed to their work and less involved with their clients, resulting in lost working days due to sick leave, with a risk of them leaving the profession.5 The vulnerability of NQMs to burnout symptoms, based on previous research by Suleiman et al., could not be confirmed in our population.4 A possible explanation might be the difference in the working context of Dutch midwives, whereby most NQMs work in a community setting,31 which provides them with more job resources than hospitalbased midwives. This study is the first to measure work engagement using a large sample of midwives who are working in different contexts. Other international studies on midwives’ wellbeing do not report work engagement,4 or studied a small sample of hospital midwives,41 making a comparison within the occupational group of midwives impossible. However, similar results regarding work engagement were found among Dutch doctors in postgraduate training (residents) (43% highly engaged doctors vs 38% highly engaged midwives)42 This could be explained by the meaningful and resourceful work that healthcare provides.12 Our study shows the relevance of reporting work engagement in studies on midwives’ wellbeing. Although burnout and work engagement are intertwined constructs, previous research on the determinants of midwives’ occupational wellbeing has only identified associations between job demands and burnout symptoms, and not between job resources and work engagement.4,17 Adding work engagement and job resources to research on midwives may provide a more comprehensive view on their wellbeing. The determinants of high work engagement – higher educational levels and selfemployment – are consistent with previous research.12 In this study, however, a young age and little working experience were determinants of high work engagement, in contrast with the outcomes of Hakanen et al.12 A possible explanation for these
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