Drivers of job satisfaction in midwifery—A work design approach

BackgroundIdentifying common factors that influence job satisfaction for midwives working in diverse work settings is challenging. Applying a work design model developed in organisational behaviour to the midwifery context may help identify key antecedents of midwives job satisfaction.AimTo investigate three job characteristics – decision-making autonomy, empowerment, and professional recognition as antecedents of job satisfaction in New Zealand (NZ) midwives.MethodsLatent multiple regressions were performed on data from Lead Maternity Carer (LMC) midwives n = 327, employed midwives n = 255, and midwives working in ‘mixed-roles’ n = 123.FindingsWe found that professional recognition is positively linked to job satisfaction for midwives in all three work settings. At the same time, decision-making autonomy and empowerment were shown to influence job satisfaction for midwives working as LMCs only.DiscussionOur main finding suggests that the esteem generated from being acknowledged as an expert and valuable contributor by maternity health colleagues is satisfying across all work contexts. Professional recognition encompasses the social dimension of midwifery work and influences midwives job satisfaction. Decision-making autonomy and empowerment are task and relational job characteristics that may not be similarly experienced by all midwives to noticeably influence job satisfaction.ConclusionGiven that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.     

Factors associated with midwives’ job satisfaction and experience of work: a cross-sectional survey of midwives in a tertiary maternity hospital in Melbourne,Australia

BackgroundSignificant factors affecting the Australian maternity care context include an ageing, predominantly part-time midwifery workforce, increasingly medicalised maternity care, and women with more complex health/social needs. This results in challenges for the maternity care system. There is a lack of understanding of midwives’ experiences and job satisfaction in this context.AimTo explore factors affecting Australian midwives’ job satisfaction and experience of work.MethodsIn 2017 an online cross-sectional questionnaire was used to survey midwives employed in a tertiary hospital. Data collected included characteristics, work roles, hours, midwives’ views and experiences of their job. The Midwifery Process Questionnaire was used to measure midwives’ satisfaction in four domains: Professional Satisfaction, Professional Support, Client Interaction and Professional Development. Data were analysed as a whole, then univariate and multivariate logistic regression analyses conducted to explore any associations between each domain, participant characteristics and other relevant factors.FindingsThe overall survey response rate was 73% (302/411), with 96% (255/266) of permanently employed midwives responding. About half (53%) had a negative attitude about their Professional Support and Client Interaction (49%), and 21% felt negatively about Professional Development. The majority felt positively regarding Professional Satisfaction (85%). The main factors that impacted midwives’ satisfaction was inadequate acknowledgment from the organisation and needing more support to fulfil their current role.ConclusionFocus on leadership and mentorship around appropriate acknowledgement and support may impact positively on midwives’ satisfaction and experiences of work. A larger study could explore how widespread these findings are in the Australian maternity care setting.     

‘A perfect fit’ – Swedish midwives’ interest in continuity models of midwifery care

BackgroundMidwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives’ attitudes about working in continuity models must be investigated.Objectiveto investigate Swedish midwives’ interests in working in midwifery continuity models of care and factors influencing the midwifery workforce’s readiness for such models.MethodsA cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis.ResultsA total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents’ ages 24–35 years (OR 1.73) or 35–45 years (OR 1.46); years of work experience 0–3 years (OR 5.81) and 3–10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest.ConclusionA sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women’s interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.     

The impact of outpatient priming for induction of labour on midwives’ work demand,work autonomy and satisfaction

BackgroundInduction of labour often begins with the application of a priming agent to soften the cervix, generally requiring women to stay in hospital overnight (inpatient priming). An alternative is outpatient priming by a midwife, where women are allowed to go home following priming. This approach has the potential to impact, either positively or negatively, on the midwives involved.QuestionTo what extent did the introduction of outpatient priming influence midwives’ work demands, work autonomy, stress and job satisfaction.MethodsA before–after study (with two separate cross-sectional samples) was conducted alongside a randomized controlled trial of outpatient versus inpatient priming, conducted at two metropolitan teaching hospitals in Australia. Midwives completed a questionnaire before the introduction of outpatient priming and again approximately two years later.Findings208 midwives participated (response rates-time 1:81% (87/108); time 2:78% (121/156)). A mixed model analysis test of pre-post intervention differences found no changes in work demand, work autonomy and satisfaction. At time 2, over 80% of midwives reported that the introduction of the practice had reduced or made no difference to their work stress and workload, and 93% reported that outpatient priming had increased or had no impact on their job satisfaction. Furthermore, 97% of respondents were of the opinion that the option of outpatient priming should continue to be offered.ConclusionResults suggest that outpatient priming for induction of labour is viable from a midwifery practice perspective, although more research is needed.     

Midwives’ job satisfaction and intention to leave their current position in developing regions of Ethiopia

BackgroundThe aim of this research was to analyze midwives’ job satisfaction and intention to leave in developing regions of Ethiopia.MethodsA facility-based cross-sectional study was conducted amongst 107 midwives in four developing regions of Ethiopia. All midwives who were working in 26 health facilities participated in the study. A structured self-administered questionnaire, and in depth key informant interview guides, were used to collect data. Job satisfaction was measured by nine dimensions and intention to leave their current position was measured using three questions.ResultsMore than two-thirds (67%) of the midwives were female, with a mean age of 26.1 (sd ± 4.2) years old. Less than half (45%) of the midwives were satisfied with their job, less than half (42%) were satisfied with ‘work environment’ and less than half (45%) were satisfied with ‘relationship with management’ and ‘job requirements’. Relatively better satisfaction rates were reported regarding ‘professional status’, of which more than half (56%) of midwives were satisfied, followed by more than half (54%) of midwives being satisfied with ‘staff interaction’. Almost two-fifths (39%) of midwives intended to leave their current position.ConclusionJob dissatisfaction and intention to leave rates amongst midwives in developing regions in Ethiopia are a source of concern. The majority of midwives were most dissatisfied with their working environment and issues related to payment. Their intention to leave their current position was inversely influenced by job satisfaction. The introduction of both financial and nonfinancial mechanisms could improve midwives’ job satisfaction, and improve retention rates within the profession.     

The future of the Australian midwifery workforce – impacts of ageing and workforce exit on the number of registered midwives

ProblemEnsuring an adequate supply of the midwife workforce will be essential to meet the future demands for maternity care within Australia.BackgroundAim: To project the overall number of midwives registered with the Nursing and Midwifery Board of Australia and the timing of their retirement to 2043 based upon the ageing of the population.Methods: Using data on the number of registered midwives released by the Nursing and Midwifery Board of Australia we calculated the five-year cumulative attrition rate of each five-year age group. This attrition rate was then utilized to estimate the number of midwives registered in each five-year time period from 2018 to 2043. We then estimated the number of midwives that would be registered after also accounting for stated retirement intentions.FindingsBetween 2018 and 2023 the overall number of registered midwives will decline from 28,087 to 26,642. After this time there is expected to be growth in the total number, reaching 28,392 in 2028 and 55,747 in 2043. If midwives did relinquish their registration at a rate indicated in previous workforce satisfaction surveys, the overall number of registered midwives would decline to 19,422 in 2023, and remain below 2018 levels until 2038.DiscussionDue to the age distribution of the current registered midwifery workforce the imminent retirement of a large proportion of the workforce will see a decline in the number of registered midwives in the coming years. Additional retirement due to workforce dis-satisfaction may exacerbate this shortfall.     

The influence of wages on parents’ allocations of time to child care and market work in the United Kingdom

We use time-diary data on couples with children from the 2000 United Kingdom Time Use Survey to examine the impacts of own and partner’s wages on parents’ provision of child care and market work on weekdays and on weekends and holidays. We find that increases in partners’ wages increase women’s primary care on all days and decrease their market work on weekdays, while increases in women’s own wages increase their market work on weekdays. There is little evidence that men’s time use responds to changes in their own wages. However, an increase in men’s partners’ wages increases men’s passive child-care time on weekends and reduces their market-work time on weekends.

Midwives’ views of caseload midwifery – comparing the caseload and non-caseload midwives’ opinions. A cross-sectional survey of Australian midwives.

BackgroundMidwife-led continuity of care has substantial benefits for women and infants and positive outcomes for midwives, yet access to these models remains limited. Caseload midwifery is associated with professional satisfaction and lower burnout, but also impacts on work-life boundaries. Few studies have explored caseload midwifery from the perspective of midwives working in caseload models compared to those in standard care models, understanding this is critical to sustainability and upscaling.AimTo compare views of caseload midwifery – those working in caseload models and those in standard care models in hospitals with and without caseload.MethodsA national cross-sectional survey of midwives working in Australian public hospitals providing birthing services.FindingsResponses were received from 542/3850 (14%) midwives from 111 hospitals – 20% worked in caseload, 39% worked in hospitals with caseload but did not work in the model, and 41% worked in hospitals without caseload. Regardless of exposure, midwives expressed support for caseload models, and for increased access to all women regardless of risk. Fifty percent of midwives not working in caseload expressed willingness to work in the model in the future. Flexibility, autonomy and building relationships were positive influencing factors, with on-call work the most common reason midwives did not want to work in caseload.ConclusionsThere was widespread support for and willingness to work in caseload. The findings suggest that the workforce could support increasing access to caseload models at existing and new caseload sites. Exposure to the model provides insight into understanding how the model works, which can positively or negatively influence midwives’ views.     

Women’s reports of satisfaction and respect with continuity of care experiences by students: Findings from a routine,online survey

BackgroundPre-registration midwifery students in Australia undertake a minimum of ten continuity of care experiences with childbearing women. However, women are rarely asked to formally evaluate this care by students.AimTo evaluate data from a routine, web-based survey of women about having a midwifery student provide a continuity of care experience.MethodsAll women (n = 886) recruited by a midwifery student for a continuity of care experience during a 12 month period received an email inviting them to complete an online survey. The survey included personal details, experiences of care, and two scales on Respect and Satisfaction.ResultsA response rate of 57% (n = 501) was achieved. On average students attended six antenatal visits (mean = 5.83) and had six postnatal contacts with women. Most students attended labour and birth (92.6% n = 464). Most women rated overall satisfaction with care by their student as ‘better than they had hoped’. Positive correlations were found between number of antenatal visits and postnatal contact with students on both levels of satisfaction and respect felt by women. Women felt more satisfied when their midwifery student attended labour and birth.ConclusionsThe online survey was feasible and provided valid and reliable feedback from women about their student during a continuity of care experience. Women valued having an ongoing relationship with a student during pregnancy, labour and birth, and postpartum. Pre-registration midwifery education programs should continue to privilege relationship-based care and national standards should support the effective integration of continuity of care experiences.