Taking on responsibility

Taking on responsibility was identified as a key area of development and was also linked closely with becoming confident and two other aspects of competence - coping and judgement. As discussed in Chapter Six under Transition, new midwives at registration are required to move from a relatively passive student role to the active practitioner role, which requires them to take on responsibility for the role of the midwife and to be accountable for what they do, for any omissions on their part, and decisions that they make.

The analysis suggests that at registration the new midwives in this study were aware of what it meant to be responsible and accountable as a midwife. In addition they had been given varying degrees of experience of taking on responsibility, towards the end of programmes. Interviewees suggested that with experience over the year, most new midwives became more comfortable with being responsible. It is also suggested that developing as a responsible practitioner occurs across several dimensions including:

 expansion of the breath of responsibility from providing care for one woman at a time or a small caseload to managing a larger group of women/caseload- requiring the midwife to be able to prioritise

 expansion of the scope of practice beyond providing midwifery care only for women with normal pregnancy or low risk cases to assisting with or providing care for women who are ill or have pregnancy complications and taking on non-midwifery responsibilities related to managing a ward

 taking on responsibility and becoming more independent/autonomous, including making decisions and developing a better understanding of responsibility and the midwifery role

 coming to terms with being accountable.

7.3.3 Coping

Also very closely linked with taking on responsibility was learning to cope with the realities of practising as a midwife. Several new midwives talked about the enormity of responsibility that they took on at the point of registration, how stressful they found the experience, and some suggested that they had been ‘thrown in the deep end’.

The first six months I used to come to work and I used to feel sick in the bottom of my stomach, because I didn't know what was gonna be there, but then I took a step back after six months and realised that no matter what was there, I coped. So why was I getting so panicky? And once I'd decided that I stopped feeling sick before I went to work and I actually started enjoying it (new midwife).

Examples were given of midwives having to cope with the types of situations in which they found themselves, in addition to functioning as a midwife. For example about a fifth of midwives found themselves having to contend with working on a very busy ward, while at the same time trying to deliver a good standard of care and having to develop as practitioners. One new midwife described having to ‘juggle’ all that had to be done and to ensure that everyone in a caseload got the care that they required.

Midwives also suggested that they had to learn to cope with the non-routine and the unfamiliar. It is suggested that as students, participants were largely protected from the more unpleasant aspects of the role, such as dealing with loss and bereavement, and after qualifying midwives had to cope with dealing with these more difficult aspects -often for the first time. Dealing with the unexpected also posed new midwives with a challenge. As new midwives, participants also had to cope with taking on wider responsibilities, many of which were not directly related to providing care or that they would not have been expected to deal with as students. A small number of new midwives also had to deal with staff shortages.

Several participants also talked about developing coping mechanisms and ways of dealing with situations, including building support networks.

I tend to switch off, I go and find a quiet place, I look at my piece of paper and think now right, what do I need to do first and then start again, … (new midwife).

They also talked about developing the ability to pre-empt situations, thus reducing the impact that surprise held for them. One new midwife talked about being empowered to stand up and say that she could not cope and that she had too much to deal with. However, one new midwife suggested that at the end of her first year in practice she was still not coping. She suggested that the key issue for her was that she was unable to reconcile the reality of practice with her aspirations for practice.

… I feel that I'm not available for the woman to ask me questions or give the information if I'm already caring for a couple of other women who also need the same sort of information to make choices … like some women say, ‘please stay with me’ and you've got to explain that you are caring for say one or two other women and you will be with them as

much as you can, and then you think oh, it's not matching up to their expectations (new midwife).