Working towards being ready: a theory of how practising midwives maintain their ongoing competence to practise their profession
Every year in New Zealand midwives must declare that they have maintained their ongoing competence to practise their profession. There are a number of mandated activities undertaken which are aimed at maintaining public safety. Midwives work in a range of different roles in areas with varying access to resources that support development. There is no current documented research that explains what it is that midwives must do in order that they meet these mandatory requirements and self-identified areas of development.
Grounded theory was the methodology used in an attempt to understand the process that midwives engage, in order that they maintain their competence to practise. Twenty six midwives from around New Zealand, with varying degrees of experience, practice type, current role and qualifications were interviewed.
The finding of this study has led to the development of the theory “working towards being ready”. This is a continuous process in which midwives engage. The component parts are professional positioning, identifying needs, strategizing solutions and reflecting on practice. The process is contextual, diverse and is impacted on by practice setting. It is also dependent on salient conditions of resourcing, availability and opportunity for engagement in activities.
The consequence of this process is that midwives maintain their ability to continue to practise and also maintain their self-assessed competence. However midwives manage a plethora of obstacles some imposed by themselves, others by their practice environment in order to do this. What we see is that midwives start to place boundaries around the practice in which they will engage. Not only that but they develop expertise in certain areas and discard skills that have no relevance for their current clinical context. Ultimately across the profession of midwifery we have midwives working in different areas in different ways all working above the minimum requirement for safe practice and all under the umbrella of midwifery practice. Midwifery practice it seems is far more than just clinical practice and through the process of working towards being ready we see that there is depth to practise but at the consequence of breadth.
This study makes the recommendation that an evaluation occur of current mandated processes for midwives to ascertain if they are effective. Midwives it appears self-manage their practice in order to keep themselves and women that they care for safe and in order to be ready for the moment, whatever the moment may be.