Exploring Psychosocial Safety Climate within New Zealand Midwifery

Abstract

Psychosocial Safety Climate (PSC) is a concept that refers to employees’ perceptions of psychological safety within an organisation. While research on PSC has grown globally over the past decade, there remains a gap in the literature concerning its application within healthcare settings. Consequentially, an integrative review was conducted to determine where PSC had been measured for healthcare professionals internationally. The review revealed a clear need for further investigation into PSC in midwifery. Existing literature in healthcare underscores the critical role PSC plays in promoting employee wellbeing and enhancing patient care outcomes. Insight from the integrative literature review informed the development of the research question; ‘How is Psychosocial Safety Climate perceived by employed midwives working in New Zealand, and how does it influence their work engagement, job satisfaction, organisational commitment, and turnover intentions?’ Following the integrative literature review, PSC was examined for the midwifery healthcare profession, where significant recruitment and retention challenges were identified. A quantitative study was conducted to address the gap in knowledge. It examined the perceived Psychosocial Safety Climate among midwives working in hospitals and birthing facilities, and explored how PSC influences work engagement, job satisfaction, organisational commitment, and turnover intentions. The study utilised three years of data from the New Zealand Midwifery Work and Wellbeing (NZ-MidWoW) Study, with participants drawn from the New Zealand College of Midwives. It was hypothesised that PSC would be positively associated with work engagement, job satisfaction, and commitment, and negatively associated with turnover intentions. The findings supported these hypotheses, highlighting the significant role PSC plays in shaping midwives’ workplace experiences and retention. The Job Demands-Resources model was employed to examine Psychosocial Safety Climate as a job resource. The study’s findings supported the relevance of this theoretical framework, demonstrating that PSC functions as a protective factor that enhances employee wellbeing and organisational outcomes. Social Exchange Theory was used to explain the relationships within the findings. Social Exchange Theory helped explain how the level of PSC within an organisation can influence reciprocal behaviours—where positive PSC fosters constructive employee attitudes and behaviours, while low PSC may lead to disengagement or withdrawal. However, both the integrative literature review and the empirical findings of this study indicate that the JD-R model provides the most appropriate and comprehensive framework for understanding PSC in the context of midwifery. Based on these insights, key recommendations include the implementation of organisational policies that promote PSC, training for all employees on PSC principles, and ensuring leadership accountability in fostering a psychologically safe work environment.