Midwives who trained abroad may have the necessary skills – but there will be aspects of practice they’re not used to. Sarah Church and Krystyna Grey outline a course that aims to familiarise them with the UK midwifery system.
Following the expansion of the EU to include new member states, the rise in the number of migrant workers seeking employment in the UK has led to an increase in the birth rate (ONS, 2010) and a change in the diversity of the population.
In 2009, Northampton General Hospital NHS Trust secured funding to increase midwife numbers and appointed several midwives trained in Europe. It became apparent however, that there were differences in practice, culture and skills, specifically on issues of autonomy, the role of the midwife in the delivery of woman-centred care, and in some clinical skills such as the performance of vaginal examinations.
As a result, the supervisors of midwives wondered whether it would be appropriate to offer support to enable them to apply their knowledge and skills within the context of UK practice. It was acknowledged that a short-term investment would have long-term gains and an additional bonus of enriching the midwifery workforce.
Discussions took place between senior midwives from the trust and midwifery educationalists at the University of Northampton about developing an educational programme that would introduce registered midwives to the culture and organisation, as well as the provision and delivery of midwifery care in the UK.
Developing the programmeA part-time programme was developed to enable midwives to further their knowledge and understanding of midwifery practice in the UK, while gaining practical experience. Funding was secured from the strategic health authority.
The programme was offered in addition to the preceptorship programme provided by the trust, where a preceptor and a named supervisor of midwives were able to provide clinical support. Progress was monitored and professional support provided within the framework of the NMC (NMC, 2004).
The programme included 20 days of theory, delivered over three months, offering midwives 20 credits at level five, alongside clinical preceptorship and midwifery supervision.
The learning outcomes and programme content were broadly based on the standards of proficiency derived from the NMC (2007) standards for adaptation to UK midwifery, which reflect the philosophy and values that underpin the requirements of the NMC.
In 2010, two cohorts of midwives completed the programme. The first cohort of four midwives completed successfully in April; the second cohort of three completed in December. Of the seven midwives, four were originally from Bulgaria and three came from Poland.
Assessing the programmeThe programme was assessed by the completion of a portfolio of clinical-based evidence, which included a section on professional regulation and a midwifery care study. Midwives were asked to explore the professional, legal and ethical frameworks that support midwifery practice, and provide two pieces of evidence to illustrate their understanding of how each key document was applied within clinical practice. The documents included:
Midwives rules and standards (NMC, 2004);
Standards for medicine management (NMC, 2008a);
The code: standards of conduct, performance and ethics for nurses and midwives (NMC, 2008b);
Modern supervision in action: a practical guide for midwives (NMC, 2009a); and
Record-keeping (NMC, 2009b).
EvaluationFeedback from both cohorts was positive. All midwives enjoyed the programme, which afforded them the opportunity to discuss midwifery issues and facilitate learning in a safe, supportive environment. The use of specific case studies, group exercises, journal articles and PowerPoint presentations enabled them to discuss various experiences, including how midwifery practice in the UK differed to that in their respective countries.
Support All midwives rated the support they received as good or excellent. As they were writing assignments in English for the first time, each one was offered an individual tutorial to discuss her assignments and allocated a personal academic tutor for further support. Group tutorials were also arranged as requested. Their articulation of issues within the classroom environment was good, but they perceived the writing of a care study as difficult and more demanding of their English skills.
A midwifery care study offered midwives an opportunity to explore the concept of woman-centred care and the role of the midwife in more depth and discuss the evidence base for the care provided, supported by the use of relevant literature. Midwives were encouraged to make some comparison with the systems of care in their own countries.
Relevance to practiceAll midwives indicated that the programme was useful and had met their expectations. They reported that the programme had increased their understanding of the culture of midwifery practice.
Two midwives focused on the importance of the guiding rules and regulations, which underpin midwifery practice. One said: ‘The knowledge learned during this programme will help me better understand the rules and I will be more confident in my practice.’ Another said she was now more familiar with the structure of UK maternity services, and more aware of the law and regulations.
Midwives in the first cohort felt that they would have benefited from the programme when they were newly appointed rather than after a period of six months in practice. Before the second cohort enrolled, the course leader visited the midwives at work and gave them an overview of the programme. A short reading list was also provided. The second cohort considered this action to be positive.
The midwives also indicated that the programme had increased their understanding of the culture of midwifery practice and its boundaries in relation to the role of the midwife.
Conclusion Planning and delivering this programme has been an extremely enjoyable experience. Close links between practice and education have been strengthened and it is an example of how working in partnership can influence the provision of maternity care. While this programme will be evaluated regularly and developed in the face of changing demographics within the maternity services, it has been a great success so far. A further two cohorts from within the region will start the programme this year.
Further enquires regarding the programme should be sent to Dr Sarah Church at:
sarah.church@northampton.ac.uk
Dr Sarah Church and Krystyna Grey’s programme was shortlisted for the Johnson’s baby excellence in midwifery education award at the 2011 RCM awards.
Visit the award website
here.
References
NMC. (2004)
Midwives rules and standards. NMC: London.
NMC. (2007)
Standards for adaptation for midwifery programme. NMC: London.
NMC. (2008a)
The code: Standards of conduct, performance and ethics for nurses and midwives. NMC: London.
NMC. (2008b)
Standards for medicine management. NMC: London.
NMC. (2009a)
Record-keeping. NMC: London.
NMC. (2009b)
Modern supervision in action: a practical guide for midwives. NMC: London.
ONS. (2010)
Births in England and Wales by parents’ country of birth – 2009. Statistical Bulletin. Office for National Statistics: London.
