Addressing the workplace needs of Western Australian midwives: a Delphi studyYvonne L. Hauck A B D , Sara J. Bayes A B and Jeanette M. Robertson C
A Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Bagot Road, Subiaco, WA 6008, Australia.
B School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. Email: firstname.lastname@example.org
C Princess Margaret Hospital, Roberts Road, Subiaco, WA 6008, Australia. Email: email@example.com
D Corresponding author. Email: firstname.lastname@example.org
Submitted: 31 March 2011 Accepted: 25 August 2011 Published: 4 May 2012
Objective. To determine the workplace needs of Western Australian midwives working in public metropolitan secondary hospitals.
Method. Using a three-round Delphi approach, Round 1 incorporated focus groups and a questionnaire. Fifteen focus groups were conducted with midwives also having the option of contributing through an open-ended questionnaire. During Round 2, 38 items reflecting seven themes were prioritised with a final ranking performed in Round 3. In total, 114 midwives participated in Round 1, 72 in Round 2 and 89 in Round 3.
Results. During Round 1, workplace needs identified as being met included: working across all areas of midwifery; ability to work in areas of interest; opportunity to work with low to moderate risk women; supportive colleagues; accessible parking; hospital close to home and friendly work atmosphere. Round 2 items revealed the five top unmet needs as: adequate midwifery staff coverage; access to maintained equipment; competitive pay scales; patient safety issues and opportunities to implement midwifery models. The top ranked needs from Round 3 included: recognising the unpredictable nature of midwifery services; provision of competent medical coverage, and adequate midwifery staff coverage.
Conclusions. Demand for maternity services is unpredictable; however, in order to maintain a sustainable maternity workforce, WA midwives’ prioritised needs would suggest health management focus upon expanding the availability of midwifery models of care, fostering flexible working conditions and ensuring collaboration between maternity health professionals occurs within clinically safe staffing levels.
What is known about the topic? Dissatisfaction with working conditions, staff shortages, and feeling undervalued or unsupported contribute to healthcare workforce attrition. However, positive practice environments and health service management and leadership can influence employee satisfaction and retention.
What does this paper add? These insights into Western Australian midwives’ met and unmet needs within the context of public metropolitan secondary units provide a more practical basis for the revision of work conditions than has been reported previously.
What are the implications for practitioners? Our findings reinforce the urgent need to address the midwifery workforce priorities highlighted in the Australian National Maternity Services Plan. Specifically, this study strongly underscores the requirement to expand the availability of midwifery models of care, foster flexible working conditions and ensure collaboration between maternity health professionals occurs within clinically safe staffing levels.
References Chen L, Evans T, Anand S, Boufford J, Brown H, Chowdhury M, Cueto M, Dare L, et al Human resources for health: overcoming the crisis. Lancet 2004; 364 1984–90.
| Human resources for health: overcoming the crisis.CrossRef |
 Australian Health Workforce Advisory Committee. The midwifery workforce in Australia AHWAC Report 2002.2. Sydney; 2002.
 Australian Institute of Health and Welfare. Nursing and midwifery labour workforce 2007. Canberra: AIHW; 2009.
 Preston B. The Australian nurse and midwifery workforce: Issues, developments and the future. Collegian 2009; 16 25–34.
| The Australian nurse and midwifery workforce: Issues, developments and the future.CrossRef |
 Newman K, Maylor U, Chansarkar B. “The nurse satisfaction, service quality and nurse retention chain”: implications for management of recruitment and retention. J Manag Med 2002; 16 271–91.
| “The nurse satisfaction, service quality and nurse retention chain”: implications for management of recruitment and retention.CrossRef |
 Walker K. Fast-track for fast times: catching and keeping generation Y in the nursing workforce. Contemp Nurse 2007; 24 147–58.
| Fast-track for fast times: catching and keeping generation Y in the nursing workforce.CrossRef |
 Ball L, Curtis P, Kirkham M. Why do midwives leave? London: Royal College of Midwives; 2003.
 Curtis P, Ball L, Kirkham M. Why do midwives leave? Talking to managers. London: Royal College of Midwives; 2003.
 Curtis P, Ball L, Kirkham M. Flexible working patterns: balancing service needs or fuelling discontent? British Journal of Midwifery 2006; 14 260–4.
 Curtis P, Ball L, Kirkham M. Working together? Indices of division within the midwifery workforce. British Journal of Midwifery 2006; 14 138–41.
 Curtis P, Ball L, Kirkham M. Management and morale: challenges in contemporary maternity care. British Journal of Midwifery 2006; 14 100–3.
 Casey M, Saunders J, O’Hara T. Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings. J Nurs Manag 2010; 18 24–34.
| Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings.CrossRef |
 Cheung J. The decision process of leaving nursing. Aust Health Rev 2004; 28 340–8.
| The decision process of leaving nursing.CrossRef |
 Oncel S, Ozer ZC, Efe E. Work-related stress, burnout and job satisfaction in Turkish midwives. Soc Behav Pers 2007; 35 317–28.
| Work-related stress, burnout and job satisfaction in Turkish midwives.CrossRef |
 Doherty ME. Voices of midwives: a tapestry of challenges and blessings. Matern Child Nutr 2010; 35 96–101.
| Voices of midwives: a tapestry of challenges and blessings.CrossRef |
 Baumann A. Positive practice environments: quality workplaces = quality patient care. Geneva: International Council of Nursing; 2007.
 Smith HL, Hood JN, Waldman JD, Smith V. Creating a favorable practice environment for nurses. J Nurs Adm 2005; 35 525–32.
| Creating a favorable practice environment for nurses.CrossRef |
 Unden LD, Monarch K. The ANCC magnet recognition program: converting research findings into action. In: McClure ML, Hinshaw AS, editors. Magnet hospitals revisited: attraction and retention of professional nurses. Washington DC: American Nurses Publishing; 2002.
 Tomey AM. Nursing leadership and management effects work environments. J Nurs Manag 2009; 17 15–25.
| Nursing leadership and management effects work environments.CrossRef |
 Shirey MR. Authentic leaders creating healthy work environments for nursing practice. Am J Crit Care 2006; 15 256–69.
 Maternity Coalition, Australian Society of Independent Midwives, Community Midwifery WA Inc National maternity action plan. Birth Matters 2002; 6.3 6–18.
 WA Branch of The Maternity Coalition. A positive solution to maternity service problems in WA: ‘implementing the National Maternity Action Plan (NMAP) in WA’. 2004. Available at http://www.maternitycoalition.org.au/wa/MC%20WA%20%20A%20Postive%20Solution.pdf [verified 20 March 2012].
 Brodie P, Barclay L. Contemporary issues in Australian midwifery regulation. Aust Health Rev 2001; 24 103–17.
| Contemporary issues in Australian midwifery regulation.CrossRef | 1:STN:280:DC%2BD387htFSrsw%3D%3D&md5=46d48e7ed61528bff22bde7e96b70bedCAS |
 Australian Nursing and Midwifery Council. National competency standards for the midwife. 2006. Available at http://www.anmc.org.au/userfiles/file/Midwifery%20Competency%20Standards%20August%202008%20%28new%20format%29.pdf[verified 20 March 2012].
 Bryant R. Maternity services review: improving maternity services. Canberra: Australian Commonwealth Government; 2009. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/64A5ED5A5432C985CA25756000172578/$File/Improving%20Maternity%20Services%20in%20Australia%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf [verified 20 March 2012].
 White J. Australian nursing and midwifery: now more than ever, opportunities for access, influence and innovation. Collegian 2009; 16 99–100.
| Australian nursing and midwifery: now more than ever, opportunities for access, influence and innovation.CrossRef |
 Tracy S, Barclay L, Brodie P. Contemporary issues in the workforce and education of Australian midwives. Aust Health Rev 2000; 23 78–88.
| 1:STN:280:DC%2BD3M3gs1ygtA%3D%3D&md5=0e56fb76bae1fb5f10d2f5aabb8745fcCAS |
 Nursing and Midwifery Board of Australia. 2010. Available at http://www.nursingmidwiferyboard.gov.au/About-the-Board.aspx [verified 20 March 2012].
 Fenwick J, Butt J, Downie J, Monterosso L, Wood J. Priorities for midwifery research in Perth, Western Australia: a delphi study. Int J Nurs Pract 2006; 12 78–93.
| Priorities for midwifery research in Perth, Western Australia: a delphi study.CrossRef |
 Preston B. The Australian nurse and midwifery workforce: issues, developments and the future. Collegian 2009; 16 25–34.
| The Australian nurse and midwifery workforce: issues, developments and the future.CrossRef |
 Leap N, Barclay L, Sheehan A. Results of the Australian Midwifery Action Project Education Survey. Paper 3: workforce issues. Aust J Midwifery 2003; 16 12–7.
| Results of the Australian Midwifery Action Project Education Survey. Paper 3: workforce issues.CrossRef |
 Maltby J, Williams G, McGarry J, Day L. Research methods for nursing and healthcare. Sydney: Pearson Education Ltd; 2010.
 Polit D, Beck C. Essentials of nursing research: appraising the evidence for nursing practice 7th ed. Sydney: Lippincott Williams & Wilkins; 2010.
 Kennedy H. Enhancing Delphi research: methods and results. J Adv Nurs 2004; 45 504–11.
| Enhancing Delphi research: methods and results.CrossRef |
 Twigg D, Pugh J. A survey of midwives working in Western Australia; April 2010. Joondalup, WA.: School of Nursing and Midwifery, Edith Cowan University; 2011.
 Watson L, Potter A, Donohue L. Midwives in Victoria, Australia: a survey of current issues and job satisfaction. Midwifery 1999; 15 216–31.
| Midwives in Victoria, Australia: a survey of current issues and job satisfaction.CrossRef | 1:STN:280:DC%2BD3M7ns12ltQ%3D%3D&md5=c381a61521ab4df2768d89a4679e8147CAS |
 Homer C, Passant L, Brodie P, Kildea S, Leap N, Pincombe J, Thorogood C. The role of the midwife in Australia: views of women and midwives. Midwifery 2009; 25 673–81.
| The role of the midwife in Australia: views of women and midwives.CrossRef |
 Curtis E. Job satisfaction: a survey of nurses in the Republic of Ireland. Int Nurs Rev 2007; 54 92–9.
| Job satisfaction: a survey of nurses in the Republic of Ireland.CrossRef | 1:STN:280:DC%2BD2s7gvVOmsQ%3D%3D&md5=c4d9755d1f5d815c2687721115b2de97CAS |
 Ulrich B, Buerhaus PI, Donelan K, Norman L, Dittus R. How RNs view the work environment: results of a national survey of registered nurses. J Nurs Adm 2005; 35 389–96.
 McCarthy G, Lehane E. Intention to ‘leave’ or ‘stay’ in nursing. J Nurs Manag 2007; 15 248–55.
| Intention to ‘leave’ or ‘stay’ in nursing.CrossRef |
 Coomber B, Barriball KL. Impact of job satisfaction components on intent to leave and turnover for hospital nurses: a review of the research literature. Int J Nurs Stud 2007; 44 297–314.
| Impact of job satisfaction components on intent to leave and turnover for hospital nurses: a review of the research literature.CrossRef |