Factors influencing the retention of midwives in the public sector maternity services in Johannesburg
Date
2019
Authors
Richardson, Won-li
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Abstract
Midwives face workplace challenges potentially leading to high staff turnover and poor retention within maternity care services. High turnover and low retention are associated with staff shortages, which inadvertently affect patient outcomes for mothers and their newborn babies. This study explored the work-life challenges and motivating factors that influence the retention of midwives in maternity services and measured midwives’ quality of work-life.
A concurrent mixed method design with a mixed method notation of QUAL+quan was used. The study consisted of two phases that occurred concurrently. In phase one, midwives were selected using non-probability self-selection sampling. In phase two, convenience sampling was used. Both samples consisted of midwives working in maternity services in the public sector of Johannesburg, specifically at Midwives Obstetric Units (MOUs) where midwives work independently. Creswell’s six steps were followed to analyse qualitative data from in-depth interviews. Questionnaires based on Brooks’ Quality of Nursing Worklife Survey (BQNW) were analysed to yield descriptive statistics. Findings from a scoping review were integrated into the overall analysis of findings with the use of the Conceptual Framework for Predicting Nurse Retention (CFPNR) by Sawatzky and Enns (2012).
Four themes identified in the qualitative data were: motivation to stay; staff shortages; the inner context; and the outer organisational context. The context refers to the institutional or organisational setting. Main findings indicated that midwives are intrinsically motivated to stay in the profession. However, they are predominantly challenged by issues related to perceived staff shortages, an apparent lack of support and resources, and community conflict. All data and scoping review findings consisted of the influencing and intermediary factors of the CFPNR, which in turn impact employees’ intention to leave, thus influencing retention of midwives.
Staff shortages increase midwives’ current high workload, hinder opportunities for training and are associated with employee burnout. Midwives lack various forms of support, which include assistance from management, doctors and support staff, in addition to debriefing and counselling. Other challenges include inadequate
equipment and resources, as well as community and patient conflict. As a result, an apprehension of litigation is instilled.
Recommendations from the study include that management is to recognise and acknowledge midwives for their work when done well, with the use of frequent appraisals. It is also recommended that the upper manager increase their visibility in the MOUs in order to touch base with midwives on the floor. Furthermore, it is recommended to conduct debriefing sessions with midwives on a regular basis and involve midwives in decisions concerning their off-duties and allocations. During these discussions, training plans for learning and development may be developed in advance.
Description
A Dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, in fulfillment of the requirements for the degree of Master of Science in Nursing