Yates, Karen (2010) 'My passion is midwifery': midwives working across dual roles in the country. PhD thesis, James Cook University.

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Abstract

Over 130 maternity units closed across Australia between 1995 and 2008 (Bryant, 2009). In the majority of cases these closures were in rural areas and caused by workforce shortages, both medical and midwifery. The potential for midwives to leave rural and remote areas as a result of the closures has serious implications for birthing women and their families residing in these areas, as well as for the already depleted rural workforce. The reduction in maternity services in rural areas has led to a situation where midwives have been required to work in dual roles as nurse and midwife. Midwives in rural and remote areas face many challenges including the difficulty in maintaining midwifery skills, being required to work in nursing-oriented areas for which they may have little current clinical experience or interest, and the fear of working beyond their scope of practice which may result in dissatisfaction with the work environment, a known contributor to staff attrition (Jackson, Mannix, & Daly, 2001). Little is known about the challenges faced by midwives who work in dual roles in rural and remote locations in Australia.

The aim of this study was to describe midwives’ experiences of working in the dual role as nurse and midwife in rural areas of far north Queensland, Australia. The methodology was informed by Heidegger’s interpretive phenomenological philosophy and data analysis was guided by van Manen’s (1990) analytical approach. Data was generated by unstructured, conversational interviews with eight midwives. The interviews were recorded and transcribed verbatim, then analysed and interpreted using the van Manen (1990) hermeneutic phenomenological approach.

Three themes were identified that helped to explain what it is like to work in a dual role as nurse and midwife in rural far north Queensland. These were: Making choices between professional role and lifestyle: “Because I choose to live here”; Integration of maternity and general nursing: “All in together this fine weather” and, Shaped by location: “That’s part of working in a small place”. A number of sub-themes were also described under each of these themes. The findings revealed that the midwives saw their employment options limited by their rural location, however these limitations were largely accepted as being part of living in a rural area. A number expressed concern that they were deployed back and forth between midwifery and nursing areas, sometimes more than once during the same shift. There was philosophical conflict identified between the biomedical, illness based model of nursing and the partnership, wellness model of midwifery, and concern about the lack of support for midwifery services. While the midwives expressed a preference to work as midwives only, they did acknowledge that the variety offered by the dual role had some benefits in terms of maintaining nursing knowledge and skills. While the participants recognised that in rural areas it is important to be a multi-skilled generalist, they were concerned that midwifery skills could be eroded or even lost with the diminishing amounts of midwifery work available.

A number of recommendations arose out of this study. Further research is needed to examine the extent to which the requirement to work in a dual, or multi-faceted role is an impediment to the recruitment and retention of midwives to rural areas. Appropriate re-structuring of maternity services could provide better utilisation of the midwifery workforce in rural centres, and reduce the current problems associated with transferring birthing mothers from rural centres to larger facilities to birth their baby.

This study also highlighted the need to explore the dual role of the rural nurse and midwife from a nursing perspective. Rigorous evaluation of current rural midwifery-led models of care is important to create awareness of how these models may be able to be effectively implemented in rural settings in the future.

Item ID:	17226
Item Type:	Thesis (PhD)
Keywords:	dual roles; employment options; experiences; Far North Queensland; FNQ; limitations; maternity units; midwifery services; midwives; Northern Australia; NQ; Nth Qld; nurses; nursing; regional centres; remote communities; rural areas; rural workforce; skills shortages
Date Deposited:	31 May 2011 04:15
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111006 Midwifery @ 100%
SEO Codes:	92 HEALTH > 9202 Health and Support Services > 920210 Nursing @ 75% 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 25%
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