Direct-Entry Midwives moving into Health Visiting: a mixed method study.
Val Thurtle Annabel Jay Radica Hardyal City, University of London University of Hertfordshire University of Hertfordshire
Aimed to explore Why direct entry midwives move into health visiting? How they viewed their professional identity?
Context Health Visitor Implementation Plan (DH 2011) Concern with direct entry midwives moving into health visiting in one University
Why move from midwifery? Why move into health visiting? Difficulties combining career and family Keeping up to date Low staffing levels Could not provide appropriate standards of care and meaningful relationships with women Inflexible management Community based working Improved hours Increased professional autonomy Positive image of the profession
Methods Sample- all health visitor students who were direct entry midwives who qualified 2011-15 in one university. Online questionnaire Focus group Telephone and face-to-face interviews.
Year Total number of HV students Number qualified as direct-entry midwives % of total HV students 2011-12 56 5 9.4 % 2012-13 59 12 20.3% 2013-14 108 20 18.7% Health visitor students with a direct-entry midwifery background. Numbers from a single University in the South of England
Responses Number of direct entry midwives who qualified as health visitors Number of questionnaires returned 23 62% Number attending focus group 8 Number of interviews 5 37
Reasons: the working environment Number of responses Low morale in midwifery 18 Low staffing levels 15 Fear of litigation 14 Found midwifery too stressful 13 Disliked working antisocial hours 10 Too much responsibility/excessive workload 10 Professional burnout 5 Lack of support/poor management 3 Bullying 1
Reasons for stress and professional burnout Unable to provide a safe level of care due to excessive workload Number of responses Lack of support from senior staff 6 Long working days with no breaks 5 Shortage of staff in maternity units 4 Lack of sleep due to excessive workload 2 Lack of equipment / Daily incident forms/ Not cut out for work on labour ward / Didn t fit in / Hostile working environment 9
Reasons for becoming a health visitor Number of responses Wanted to do more work in the community 18 Preferred the hours in health visiting 17 Saw health visiting as less stressful 14 Wanted to work in health promotion 11 Wanted more autonomy 8 Influenced by advertising 5 Wanted a higher income / Enjoyed their taster day 1 with HV whilst a student midwife / Wanted to provide better continuity of care / Wanted to spend more time with families
Move into health visiting Push Pull Knowledge of health visiting Not a clue (D) Advertising
HV by default (B). HV first and foremost, to be honest I don t see myself as a MW now (E) Proud of both can t lose the MW thing (P3) Identity I see myself as a HV now having an awful lot of MW experience. P2 HV gave me an opportunity to be the person I feel I should be, real personal development (P6)
Working as :- Health visitors in the area where trained 18 Health visitor elsewhere 2 Family nurse practitioner 1 Health visitors undertaking occasional 3 bank midwifery work.
Their view of health visiting Positive and ongoing relationships with families Healthy population Building on and overlapping with midwifery but going further Support, respect, professional development, restorative and clinical supervision
Career aspirations five years hence Number of responses Specialist health visitor 17 Band 6 health visitor 9 Combined Health visitor/midwife role 7 Practice teacher 4 Specialist midwife 3 Health visitor team leader 2 Health visitor lecturer 2 Band 7 health visitor 2 Midwifery lecturer /FNP supervisor / Another public health role / No specific aspirations
Limitations Local One university Undertaken by educationalists, health visitors and midwives Short term follow up
City, University of London Northampton Square London EC1V 0HB United Kingdom T: +44 (0)20 7040 5060 E: department@city.ac.uk www.city.ac.uk/department