As a lecturer I see lots of students start and complete courses of study, and it is nearing that time of year when another cohort of students are preparing to complete their midwifery programme and take up posts as newly qualified midwives. It is one of the most rewarding parts of my role to see students develop in confidence, knowledge and skills over the 3 years to become competent ‘at the point of registration’. This, of course, requires not only a great deal of effort on their part but also the support of mentors and lecturers.
Students all reach the point of qualification via different paths, having varying experiences and often feeling more confident in some areas of practice than others. Due to the amount of time most students spend in hospital placements, they tend to feel more comfortable with high-risk care. This is something most programmes are seeking to address ensuring placements support confidence in low-risk care such as birth centres and with team midwives. Promoting normality in every situation is encouraged and the role of the supervisor of midwives is being developed to support students in their practice in relation to this. This rounded experience is required to ensure that the midwife who is ‘fit for purpose at the point of registration’ continues to develop within this role.
Most of the students I speak to worry, to varying degrees, about their new role and what is expected of them. They demand a great deal of themselves; to be able to work almost autonomously in every situation and often view asking for help as a weakness. In fact this questioning and awareness of their limitations can be helpful to reassure other members of the team that the midwife will ask if they are unsure and question their own practice. Senior student midwives should be proactive in practice to address any weaknesses and work closely with mentors to set achievable aims for each placement. Working with indirect supervision as a student is a way to promote confidence and allow them to prepare for competent, autonomous practice.
Competence is a complex issue and relies on the ability of the individual to be accountable for their own practice. However, it also requires the employer to continue to offer training and support appropriate to the contractual role. Competence is defined by the Nursing and Midwifery Council (NMC, 2014) as having the skills, knowledge and judgement to practise safely. A lack of competence is said to be an issue if, over a prolonged period of time, the midwife continues to make errors or continues to show poor practice. This includes not only clinical skills but matters such as working as a member of the team or having poor communication skills (NMC, 2014). The term ‘prolonged period’ is not defined so individual employers will need to make a decision in relation to this. It could relate to the midwives attitude to learning, taking opportunities and developing their skills. If the individual fails to make progress despite support then this might constitute repetition of mistakes and thus the ‘prolonged period’.
Newly qualified midwives require development and a preceptorship period. Employees should also have an induction to their area of work, training and supervision as required, preceptorship, ongoing access to professional development and clinical supervision (NMC, 2011). These are things that can be all too often be lost when staff and resources are limited. So while this is the employer’s responsibility, the midwife must raise concerns if they do not have a proper induction or continued support in practice. This might again be discussed with their named supervisor of midwives or manager. Interestingly, the NMC (2011: 7) go on to state that if a midwife ‘accepts responsibility for practice which is deemed to be beyond their capability…both employer and employee are accountable’. This is something to be taken into consideration when assessing competence. What is certain is that newly qualified midwives need to draw on their assertiveness skills to ensure they continue to receive appropriate training and support and do not undertake anything, unsupervised, that they are not competent to do. External factors, such as stress and fatigue can affect the ability to say no and this is where preceptorship, clinical supervision or regular meetings with a line manager can help address problems before errors are made.
So to all the students about to qualify, enjoy your new career as wonderful as it is but know your own limitations and do not be afraid to ask for help and support.