Recruiting the right people matters

By Gill Walton, RCM General Secretary on 10 November 2022 Maternity Services Midwifery Workforce NHS England Safety Maternity Safety

Staffing levels in maternity services are at an all-time low, and the number of midwives leaving the profession continues to increase. Understandably, Directors and Heads of Midwifery are looking for new and creative ways to fill their vacancies. They also want to grow their staff so that midwives and maternity support workers (MSWs) are not working in services which are continuously experiencing a staffing crisis.

One of the initiatives to increase staffing levels, supported by NHS England, is to bring nurses into maternity services to work in areas such as theatres, recovery and high dependency units (HDUs). However, the need to improve staffing levels in maternity has led to a role creep, with nurses now being frequently employed on the postnatal ward to carry out routine postnatal care of mothers and babies.

In our latest position statement, we express concern about a nurse’s sphere of practice when working in particular areas of maternity services such as postnatal care. The NMC standards of proficiency for nurses do not cover midwifery care and nurses do not have the knowledge or skills to provide competent postnatal or neonatal care.

In an already over-stretched and under-resourced maternity service, this poses a significant safety risk for mothers and babies. Maternity units employing nurses in this way are laying themselves open to serious issues of accountability and are at risk of contravening the legally protected title and role of the midwife.

The RCM believes that nurses in maternity settings, with the exception of those in theatres and recovery, and in specialist nurse roles working within the multi professional team, are working outside the limits of their competence and scope of practice. They have not had the theory or practice in their nursing education to be able to provide proficient midwifery or neonatal care. The RCM believes that the only appropriate training for nurses working in maternity is to undertake a midwifery programme (short course) and become a legally qualified and NMC registered midwife.

The role of the MSW has been specifically developed to support the role of the midwife. In England, there is now a nationally recognised competency framework for MSWs, which is also being discussed in the other UK countries. This enables MSWs to progress their career, for instance, entering a Midwifery Degree Apprenticeship programme to become an NMC registered midwife. The RCM believes the MSW role is the appropriate role to support the midwife and to provide supervised maternity care for mothers and babies.