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Is it shift length or working practices that most affect midwives' wellbeing and ability to safely deliver care?

02 December 2018
Volume 26 · Issue 12


Midwives continue to experience high levels of work-related stress. Challenges in staffing and demands on services may contribute, but there are also indications that shift length or working practices may also be a factor, especially if midwives regularly work beyond their contracted hours or miss rest breaks. In the nursing literature, longer shifts have been associated with higher levels of fatigue, yet this has also been found in nurses working 8-hour shifts, due to the high number of consecutive shifts worked, suggesting that working practices also contribute to fatigue. Longer shifts have also been linked to poorer quality of care, yet this only appears significant when shifts exceed 12 hours. There are mixed views on job satisfaction, which may be due to personal preferences or the availability of flexible working. However, the findings of many studies are often limited by poor quality designs and cannot easily be applied to midwifery settings, where there continues to be a lack of research in this area. Further research is therefore required to understand the impact of shift length and working practices on the wellbeing of midwives and their ability to safely delivery care.

In 2016, the results from the NHS Staff Survey revealed that midwives reported the highest levels of work-related stress, more than any other NHS staff group (National NHS Staff Survey Co-ordination Centre, 2016). Two years on, ambulance technicians narrowly took the top spot, with 51% reporting this (National NHS Staff Survey Co-ordination Centre, 2018a), yet the reported levels of worked-related stress among midwives remained unchanged between the two surveys, at just under half. Interestingly, there are a number of parallels between the two staff groups: both the ambulance and maternity services face challenges in staff shortages, retention of staff, the rising complexity of care needs and often the unpredictable demand on services (Chief Nursing Officers, 2010; Royal College of Midwives (RCM), 2016; National Audit Office (NAO), 2017; NHS Digital, 2017; Office for National Statistics, 2018). Both services also provide 24-hour care, leading to a need for shift work, and while there may be a variety of shifts in operation, both use the longer 12-hour shifts (RCM, 2015; NAO, 2017).

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