Theme 1.2: Evidence of Psychological Burden

CHAPTER 4 | 4.3.1.2 Theme 1.2: Evidence of Psychological Burden

expected to take care of students when I am still struggling like this?

In their study, Lennox and Foureur (2012) revealed that newly qualified midwives found it very difficult to take the responsibility of supervising the students, especially during their first months of employment as graduates because they also needed supervision from the experienced colleagues. Kumaran et al. (2014) echoed a similar view when they reported that newly graduated midwives experienced frustration when they were expected to carry out responsibilities for patients’ care and students’

learning. Chick and Meleis’ (1986) transition theory cited in Kumaran et al. (2014) is also relevant in relation to midwifery graduates experiencing incongruence between former sets of expectations experienced during training; and those that prevail in the new situation as a midwifery graduate faced with a high level of responsibility and accountability as the cornerstone of midwifery practice.

CHAPTER 4 | 4.3.1.2.1 Sub-Theme 1.2.1: Professional Nurses Status: An Admirable Status, Though Stressful

that of the student was sheltered, whereas the world of the newly qualified was exposed.

NGM 1 from LR hospital stated:

The fact that I am a professional nurse is good and makes me happy, but the fact that every junior member of staff looks up at me for solution is stressful and makes me wish somehow I were still in students’ boots.

NGM 4 from LR hospital stated said:

One thing that makes me scared is the reality that I have to stand as a professional nurse and make decisions regarding care of patients and management of the ward. At the same time the students want me to assist them and patients are also expecting quality care from me.

NGM 1 from MP hospital confirmed when she stated:

I like being a professional nurse because it is good, but this causes a lot of stress. Why do I say that? Because everything you do must be perfect. How can I be perfect whe I have only passed now, and I don’t have any experience?

Lennox and Foureur (2012), found that the expectation to take responsibility for overseeing junior students while consolidating their own training was difficult, especially when it occurred within the first month of employment. Asking very newly qualified midwives to take on this responsibility led to increased anxiety and frustration, which undermined their time for their own preceptorship and support.

Kensington et al. (2016) reflected a similar view when they reported that there is nothing frustrating for a newly graduated midwife than being responsible for patients’

CHAPTER 4 | 4.3.1.2.1 Sub-Theme 1.2.1: Professional Nurses Status: An Admirable Status, Though Stressful

care as well as students’ learning at the same time.

NGM 4 from MR hospital stated:

When I wake up every morning and start to think that I am no longer a student and have to be a professional nurse who is responsible, I feel stressed. It is not that I don’t want to be a professional nurse. I want to be a professional nurse but, that post needs somebody who is very prepared. Now, I don’t feel prepared and ready, that is why I am stressed, especially because the experienced midwives do not want to help. Maybe if they were helpful I would be less stressed.

NGM 2 from SRR hospital stated:

Besides conduction of delivery, another procedure that causes a lot of anxiety for me is to order the drugs and to keep the drug cupboard key. I am afraid of this procedure.

Solowiej, Upton and Upton (2010), also reported drug administration by newly qualified professionals as a major cause of anxiety during the period of transition.

Before qualifyin g, students had carried this procedure out only under rigorous supervision, but were expected to practise unsupervised following qualification (Solowiej et al., 2010). Lennox and Foureur (2012) concurred when they noted inconsistencies in preparation for management, suggesting that while the theoretical context was adequate, the practical aspects, such as drug administration, prioritising, decision making and clinical skills were variable. Lennox and Foureur (2012) argued that this area of practice is not adequately addressed during the educational preparation of nurses and midwives.

NGM 4 from MP hospital said:

The big challenge that is facing us as newly qualied midwives is that

CHAPTER 4 | 4.3.1.2.1 Sub-Theme 1.2.1: Professional Nurses Status: An Admirable Status, Though Stressful

things have changed. The patients and community members are now aware of their rights; if you do something wrong they will report you. They expect us to be perfect in everything we do.

In a study conducted by Bolden et al. (2011), participants reported on their awareness of the depth of trust placed in them by the women they care for and the increased levels of expectations of women and their families today as being stressful.

NGM 4 from TR hospital stated:

Losing a status of being a student is good because it is part of growth. Learn to put everything you were taught in practice. Learn to be responsible and accountable, deliver patients. What is frustrating is that you learn to do all these things, at the same time you also learn to think creatively so that you make reasonable decisions because nobody is supervising you. At this stage I have no one to depend on, unlike previously where I used to depend on my lecturers. I feel stressed and anxious.

NGM 4 from MR hospital said:

It’s awful, it’s a lot harder than I expected. I didn’t know that becoming a registered midwife would be this difficult. May be it is because when we were students we were working under the prtotection of both our lecturers and the ward sisters, but now you are the one who is in charge and should also protect the students.

Fenwick et al. (2012) suggested that despite an obvious lack of support, newly qualified nurses learnt to cope with the change in status from supernumerary student to independent practitioner as an aspect of their new role. The unfortunate part of it is that you master that alone with nobody giving you any support, as the world of the newly qualified is not sheltered but exposed.

NGM 2 from SRR hospital stated:

CHAPTER 4 | 4.3.1.2.1 Sub-Theme 1.2.1: Professional Nurses Status: An Admirable Status, Though Stressful

Experienced midwives also cause some confussion because when it comes to work like delivering of the patients, they say do it yourself, you are a midwife. When it comes to decision making it is different, if I make a certain decision regarding off duties or those of the subordinates, they say no you are still a comserve, you can’t make decisions. They only acknowledge my status as a midwife and a professional when it suits them.

This is congruent with the findings of Solowiej et al. (2010) which concluded that decision-making was seen to be controlled by the delivery suite coordinators and/or the obstetric team. Kensington et al. (2016) concurred when they reported that participants did not feel valued or trusted in decision-making and they perceived they were required to carry out preordained instructions for the clients who were in labour.

NGM 5 from TR hospital reported:

Being a professional nurse is so demanding; sometimes you just have to compromise your peace and try to impress the experienced midwives. This we are forced to do in order to buy favours from experienced midwives; especially because they don’t accept us.

In a study conducted by Bolden et al. (2011), participants reported their perceived need to impress their delivery suite senior colleagues, even when they had been unkind to them, in order to feel that they ‘belonged’ and were accepted. When they realized they were not able to impress them, they became stressed. Delaney (2013) concurred with Bolden et al. (2011) when reporting that the participants’ working worlds often seemed to revolve around others’ moods or their perceptions of their characters. If the delivery suite coordinator was nice, participants felt positive in their work and had an increased level of morale. They began to know who to ask if they were unsure about what to do and who to avoid.

CHAPTER 4 | 4.3.1.3. Theme 1.3: Uncertainties Causing Burden on Emotional Being

4.3.1.3. Theme 1.3: Uncertainties Causing Burden on Emotional Being