The route to standardisation
Ruth Sanders and Deborah Caine consider the effects of standardising the role of the MSW, and reveal the work they have undertaken to develop MSWs in their area.
Following the government announcement in March to increase midwifery numbers and develop new midwifery training pathways, it is important to consider the standardisation plans for the role of the MSW. The proposed development of new nationally standardised roles, as well as a voluntary register for MSWs, could change their working practices as well as clarifying the remit of these highly valued but seldom heard from maternity practitioners.
Working closely with midwives to provide quality care to women, babies and the wider family unit throughout women’s childbearing experience, MSWs are an essential component of many women’s maternity journeys (Hutchinson, 2014; Linay and Rogers, 2011). Yet the voice of the MSW often remains unexpressed or unheard within a multifaceted and hierarchical field of professional expertise.
Providing training courses over the last three years to MSWs has given us at the University of East Anglia (UEA) a unique insight into the developing and varied role of the MSW, who forms an integral part of this multidisciplinary maternity team. Midwives are responsible for supporting and supervising MSWs and using their professional judgement to delegate tasks appropriately, ensuring the right skill mix and safe staffing (NMC, 2018; NICE, 2015). It is arguable that, with the workload and other pressures midwives routinely face, there is limited opportunity to consider MSWs’ individual value and strengths. If, as is suggested by the WHELM study (Hunter et al, 2017), midwives feel they are ‘fire-fighting’, how likely will they be able to delegate in ways that are considered and directed at providing a high standard of care?
The learning opportunities provided by the UEA short course offers MSWs a chance to discuss previously unexpressed nuances of their job and in doing so, the need for the proposed standardisation and role clarity. What has also emerged is that MSWs desire a comprehensive and collaborative connection with other members of the maternity team in order to feel valued and included.
It is widely acknowledged that there is great variation in the responsibilities and tasks completed by MSWs (Griffin et al, 2012; Hussain and Marshall, 2011; Sandall et al, 2011) and that the relationship between midwife and MSW is crucial to the experience of women in our care. However, because the delegation of MSW tasks is undertaken using the clinical judgement of the midwife on an individual, case-by-case basis (NMC, 2018; RCM, 2016a), what constitutes routine MSW practices can be left open to interpretation, particularly without the guidance of national standards and job descriptions.
Feedback from providing MSW training since 2016 has reflected a desire within the workforce for practice to be clearer, highlighting that even in a small demographic area the expectations and delivery of the MSW role vary widely.
Actions cited by MSWs that could improve their working experiences:
- More opportunities for active feedback/discussion
- Verbal appreciation
- More training before starting the job or moving areas
- Improved training opportunities
- Implementation of a ‘buddy’ system
- MSW meetings to support each other.
Collaborating closely with practice development midwifery clinicians, a short course was devised to offer further training and consolidation of core skills to MSWs. The two-day training course covers essential skills, including fluid balance and catheter care, maternal observations, post-operative care, wound care and neonatal resuscitation assistance.
What participants reported as being crucial for their clinical practice, however, was the chance to voice experiences and share learning with peers, as well as reflect on what made them feel valued or not, and suggesting actions that could improve their relationships within the maternity team (see MSW responses, right). Discussions developed in response to exercises exploring a variety of job descriptions, perceptions of accountability and workplace responsibilities, human factors and teamworking. MSWs expressed a deep sense of commitment to and accountability for their work, reporting concern at the lack of standards to base their work upon.
What became apparent was that through sharing experiences in this forum, MSWs who had reported that they lacked the courage to voice concerns felt empowered to change, stating that an important outcome from the course was that they felt confident to speak up and that their voice was an important one.
Training with practitioners from other trusts enabled positive conversations about the actions needed to improve the experiences of working as an MSW. Standardising training in line with Health Education England plans to ‘professionalise’ MSWs through the development of national education standards and the introduction of a voluntary register for employers could assuage the uncertainty and subsequent challenges faced by current MSWs.
Better births foresees fewer barriers to holistic working practices and better professional interactions (Cumberlege, 2016). To fully support these recommendations requires not only better role definition for MSWs, national education standards, standardised training and career progression opportunities,
but also a willingness for professional co-workers to openly consider the working practice of other practitioners.
Midwives are often asked to walk in the shoes of the women they care for (RCM, 2016b); this not only extends to those in our care but also across our working relationships. If we are to realise the potential of the national maternity review and centralise the families we care for, perhaps we are also required to walk in the shoes of our colleagues.
At this opportune moment in the development of an MSW competency framework, perhaps it also falls to the midwives working alongside them to champion their voices, ensuring that each MSW colleague feels valued and supported (see MSW responses, right). This could lead to a deeper understanding of the complexities of the MSW role, adding compassion and an ability to understand the human factors at play in our working relationships in order to improve the quality of the care we deliver.
MSWs felt valued by:
- Being involved in meetings, debriefs and updates, and good communication
- Getting a ‘thank you’ at the end of the shift
- Being given the chance to progress and undertake training
- Being listened to when raising concerns
- Being involved in continuity – seeing families from start to finish was rewarding
- A mum being so grateful and knowing their name – that means a lot
- Fully supporting and helping the clients
- Being appreciated
- Having their welfare taken into account
- Being listened to
- Working with women who have complex needs and gaining trust
- Being trusted by professionals
- Women showing appreciation for breastfeeding support.
MSWs felt unvalued by:
- Not having either critical or positive feedback from staff or senior team members
- Not being fully trained or not using skills
- Not having clear directions
- Not being given opportunities to learn and progress
- Being expected to do something rather than being asked
- Not being listened to
- Not being supported
- Things being expected when others are not willing to do it themselves
- Being ignored
- Being spoken to rudely or abruptly.
Ruth Sanders and Deborah Caine are midwifery lecturers at UEA. They would like to thank the MSWs who agreed to their reflections being included in this piece
Cumberlege J. (2016) Better births. Improving outcomes of maternity services in England. A five year forward view for maternity care.See: england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf (accessed 16 October 2018).
Higher Education England. (2018) Maternity support workers. Frequently asked questions. See: hee.nhs.uk/sites/default/files/documents/FAQ%20-%20Maternity%20Support%20Workers%20.pdf (accessed 22 October 2018).
Hunter B, Henley J, Fenwick J, Sidebotham M, Pallant J. (2017) Work, health and emotional lives of midwives in the United Kingdom: The UK WHELM study. See: https://www.rcm.org.uk/sites/default/files/UK%20WHELM%20REPORT%20final%20180418-May.pdf (accessed 22 Ocotber).
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Hutchinson J. (2014) The evolution of the maternity support worker. British Journal of Midwifery 22(11): 814-8.
Sandall J, Homer C, Sadler E, Rudisill C, Bourgeault I, Bewley S, Nelson P, Cowie L, Cooper C, Curry N. (2011) Staffing in maternity units. Getting the right people in the right place at the right time. King’s Fund: London.
Linay D, Rogers H. (2011) Task force. Midwives 14(3): 38-9.
NICE. (2015) Safe midwifery staffing for maternity settings. NICE: London.
NMC. (2018) The Code. Professional standards for practice of behaviour for nurses, midwives and nursing associates. See: nmc.org.uk/standards/code/ (accessed 22 October 2018).
RCM. (2016a) Quality maternal and newborn care: Implications for the UK of The Lancet Series on Midwifery. See: rcm.org.uk/sites/default/files/Implications%20for%20the%20UK%20of%20The%20Lancet%20Series%20on%20Midwifery%20A4%2036pp%202016_3.pdf (accessed 22 October 2018).
RCM. (2016b) The roles and responsibilities of MSWs. See: rcm.org.uk/sites/default/files/The%20Role%20and%20Responsibilities%20of%20Maternity%20Support%20Workers%20A5%2020pp_12%20Spreads_0.pdf (accessed 22 October 2018).
RCM. (2014) Position statement: Maternity support workers. See: rcm.org.uk/sites/default/files/Maternity%20Support%20Workers%20B_2.pdf (accessed 22 October 2018).