Presentation and Discussion of the Results
4.3 Presentation of the Findings
4.3.1 Major Theme 1: Experiences of Being a Newly Graduated Midwife in Labour Ward
4.3.1.1 Theme 1.1: Physical Strain Outlined
Empirical findings revealed that newly graduated midwives experienced a lot of physical exhaustion as the labour ward was very busy, and they also raised an issue of serious shortage of staff. This was consistent with what was reported by Fenwick
CHAPTER 4 | 4.3.1.1.1 Sub-Theme 1.1.1: Labour Ward Viewed As a Traumatic Environment
the labour ward which resulted in physical exhaustion as the workload was too much for them.
4.3.1.1.1 Sub-Theme 1.1.1: Labour Ward Viewed As a Traumatic Environment
Empirical findings revealed that participants described labour ward as a very traumatic and stressful environment. Results further revealed that the business of the labour ward affected the level of care graduates provided to patients, especially because the support they got from the experienced midwives was not effective. In their study about‘newly graduated midwives’ experiences,’ Kensington et al. (2016) argued that the environment where newly qualified midwives first work is crucial to a smooth transition, yet the majority of newly qualified midwives experienced lack of support.
NGM 3 from LR hospital said:
The labour ward is abnormally busy, in such a way that sometimes you even feel like taking your shoes off and walk around with your bare feet. Oh! Working in labour ward is so tiring.
NGM 1 from SRR hospital confirmed when she reported:
There are days that are so busy in such a way that we may end up delivering more than ten women; and that means provision of care to twenty patients or more in case of multiple births. The women expect special attention regardless of shortage of staff. We just don’t have time to give that level of care, even though we’d like to. That is so demanding.
In a study conducted by Hobbs (2012), participants hated that they had to ‘spread themselves so thin’ and regularly described their working day as ‘chasing their own tails’. According to Lennox and Foureur’s (2012) findings, working in extremely busy labour wards left newly qualified midwives suffering from fear, anxiety and diminished
CHAPTER 4 | 4.3.1.1.1 Sub-Theme 1.1.1: Labour Ward Viewed As a Traumatic Environment
confidence, which left them struggling to cope. The authors further reported that, at times, feelings such as these were accompanied by acute physical reactions which included palpitations, abdominal pains and diarrhoea.
NGM 5 from LR hospital reported:
Despite the fact that labour ward is busy, there is a very serious shortage of staff. Sometimes the experienced midwives fail to give us the support we need, not because they don’t want but due to shortage of staff.
This was supported by NGM 4 from MR hospital who stated that:
There is shortage of experienced midwives and it is very serious.
This shortage also contributes to lack of support by experienced midwives. How will they assist us when there is such a shortage?
Skirton, Stephen, Doris, Cooper, Avis and Fraser (2012) revealed that staff shortages were a major contributing factor to lack of support given to newly qualified midwives once in a post, rather than unwillingness from established members of staff. This should be a concern for ward managers who decide what constitutes adequate staffing levels, as this will directly affect the policy of a mandatory preceptorship programme. Fenwick et al. (2012) identified that due to pressures of a busy ward environment, newly qualified midwives said they were treated as part of the workforce and their learning needs were not a priority. These negative experiences exacerbated their feelings of stress and affected their perceptions of qualification. NGM 4 from MP hospital stated:
I am concerned about my level of knowledge and skills, but I also find the workplace challenging in terms of workload and staff shortage.
CHAPTER 4 | 4.3.1.1.2 Sub-Theme 1.1.2: High Level of Responsibility and Accountability Accompanying the Status of a Registered Midwife
In their study on ‘graduates’ experiences regarding transition, Bolden, Cuevas, Raia, Meredith and Prince (2011) revealed that participants reported a situation that was challenging to them in terms of lack of experience, heavy workload and staff shortages. Frustration was connected with feelings about being unable to give optimal midwifery care and the work focusing on high-risk situations, rather than normal midwifery. The reality of busy clinical areas where support was perceived as limited also left participants feeling frustrated and dissatisfied with the care they provided.
Feeling ‘pressured,’ ‘out of control’ and ‘panicked’ were common concepts, referred to by participants (Banks, Roxburgh, Kane, Lauder, Jones, Kydd and Atkinson, 2011).
NGM 1 from TR hospital said:
The off duties we use here are very tiresome. Seven days in seven days out, they are too long you become exhausted, but there is no choice.
In a study conducted by Bolden et al. (2011), participants reported that long shifts and long stretches of working consecutive days led to extreme tiredness leaving them in a situation whereby they did not want to continue working.
4.3.1.1.2 Sub-Theme 1.1.2: High Level of Responsibility and Accountability Accompanying the Status of a Registered Midwife
The findings of the study revealed that newly graduated midwives found it very hard to adjust themselves to the responsibilities of a professional midwife as they felt incapable of dealing with the challenges of a professional midwife’s role. In an Irish study of newly qualified midwives, Van der Putten (2008) found that newly qualified midwives often struggled to adapt to their new role. These midwives explained that the increased responsibility and awareness of accountability, often led to feelings of fear and insecurity. Based on a study conducted by Hillman and Foster (2011), the increase
CHAPTER 4 | 4.3.1.1.2 Sub-Theme 1.1.2: High Level of Responsibility and Accountability Accompanying the Status of a Registered Midwife
in newly qualified midwives’ responsibility and accountability is a major stressor in the transition process.
NGM 4 from LR hospital stated:
One thing that makes me scared is the high level of responsibility and accountability accompanying this new role, whereby I am expected to make decisions regarding care of patients as well as management of the ward. I feel like I can run away.
This is congruent with what was reported by Hillman and Foster (2011) as well as Fenwick et al. (2012) who asserted that transition from a student to a professional practitioner puts some burden on graduates as they are scared and anxious about their ability to cope with the demands of a new role. According to Delaney (2013), midwifery graduates experienced problems in adjusting themselves with the role of a professional midwife; as they were not certain whether they would be able to carry out the functions of a professional midwife.
NGM 1 from MP hospital confirmed when she stated:
I like being a professional nurse, but it’s very stressful, everything just has to be perfect. What makes the situation worse is that you’re also expected to be accountable for the actions of the subordinates.
Oh! It’s such a challenge. I really need strong supervision and support before I can manage that on my own.
NGM 5 from SRR hospital made a confirmation when she said:
Maybe it would be better if we were given one responsibility at a time.
Like for instance, if we were only responsible for patients’ care, but it is not like that. They expect us to do everything including teaching and supervision of students, Oh! That’s too much. How can I be
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.