Intentions to leave and actual turnover of community midwives in the Netherlands. A mixed method study exploring the reasons why | 99 Every midwife in the Netherlands needs to renew her BIG-registration every five years.22 The most important requirement for on-going registration is a minimum number of hours spent working as a midwife. Next to the BIG-register, 80% of midwives are registered in the quality register from the Royal Dutch Organisation of Midwives. A registered midwife has to show in a minimum of 200 hours continuous education, training.25 Currently, there is a move towards closer collaboration between the different professional groups in ‘integrated care maternity care’. The finance system may change from separate payments for community and hospital-based maternity care to bundled payments for maternity care collaborations in which community midwifery care practices, maternity care organizations, ultrasound centres and hospitals participate. They will then be funded through the collaborative in which they work. This is a potential threat to the self-employed status of community midwives. Recruitment Recruitment of respondents took place between December 2018 and March 2019. The recruitment process consisted of two steps: in step one, a random sample of practising midwives (1,301 of the total population of 3,221 midwives in the Netherlands) registered in the database of the Netherlands Institute for Health Services Research (NIVEL) was used. This sample was supplemented with all Newly Qualified Midwives (< 3 years after graduation) that were available in the database. Midwives in the database had given permission to receive invitations to participate in research. A total of 60 letters were returned to sender, resulting in a NIVEL sample of N=1,241. Participant consent was obtained at the start of the questionnaire; participants could decide to stop filling in the questionnaire without explanation. Participant anonymity was assured as no name or other identifying data were collected. In step two, the Royal Dutch Organisation of Midwives – in which 84% of midwives are a member – sent an email with information about the survey to all members. A link and QR code leading to the survey was attached. The first question was about giving informed consent. Survey The questions used from the survey of the ‘Dutch national wellbeing of midwives study’ are presented in Figure 2. Furthermore, demographic characteristics and workplace characteristics were collected. The intention to leave was measured using three questions (1. Have you considered leaving the profession of midwifery in the past six months?
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