Abstract

AimTo investigate Norwegian midwives’ perceptions of their working environment.DesignA nationwide postal survey in 2014 collected information from 489 midwives, including the Practice Environment Scale and seven open‐ended questions concerning the workplace.MethodsPsychometric‐, descriptive‐ and comparative analysis was used for the quantitative data and content analysis for the qualitative data.ResultsPsychometric analyses yielded five subscales: Quality of management; Resource adequacy; Midwife‐doctor relations; Opportunities for development; and Midwifery foundation for care. Content analyses identified four main themes: Lack of resources; Insufficient support; Staying in midwifery; and Lack of influence. Subthemes only found in the qualitative analysis were as follows: Fear of adverse events and The strain of shift work. Most midwives rated the PES subscales Midwife‐doctor relations and Quality of management favourable. In contrast, the theme Lack of influence showed that midwives felt powerless in a constantly changing work environment and ruled by the medical model of care.

Highlights

  • Midwives have always had challenging working conditions, working shifts or on‐calls and weekends, as well as experiencing peaks in the workload that no duty roster can prepare for (Mollart, Skinner, Newing, & Foureur, 2013; Pezaro, Clyne, Turner, Fulton, & Gerada, 2016; Yoshida & Sandall, 2013)

  • Compared with midwives working in management, research and development or with special duties, midwives without leader‐ ship and special duties rated Quality of management and Resource adequacy significantly more often unfavourable, adjusted Odds Ratio 3.00 and aOR 2.29, respectively

  • Our study showed that midwives in Norway found it a challenge to be a midwife in the 21st century. Both quantitative and qualitative data showed that midwives struggled with lack of resources, per‐ ceived they worked in a medical model of care, experienced in‐ sufficient support from their midwifery leaders and wanted more opportunities for professional development

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Summary

Introduction

Midwives have always had challenging working conditions, working shifts or on‐calls and weekends, as well as experiencing peaks in the workload that no duty roster can prepare for (Mollart, Skinner, Newing, & Foureur, 2013; Pezaro, Clyne, Turner, Fulton, & Gerada, 2016; Yoshida & Sandall, 2013). Midwives leave the workforce because of un‐ suitable hours, increasing workload, insufficient clinical support and Nursing Open. LUKASSE and HENRIKSEN inadequate education and professional development opportunities (Hildingsson & Fenwick, 2015; Kirkham, 2007). Opportunities to influence practice and decision‐making, feeling supported by col‐ leagues and managers, adequate resources and close relationships with clients have been identified as factors that encourage midwives to stay (Sullivan, Lock, & Homer, 2011). Much of the work midwives do, especially in hospital, is increasingly directed (guided/dictated) by national and local procedures, leaving individual midwives with di‐ minishing professional autonomy. While doctors are not usually present at straightforward uncom‐ plicated births, the medical profession instructs midwives how to conduct them. While higher up in the hierarchy most leadership positions are held by medical doctors

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