Aotearoa New Zealand, graduate midwives: What keeps them working in the tertiary hospital (core) environment? An Appreciative Inquiry.

AbstractThis thesis explores what influences Aotearoa New Zealand graduate midwives to remain working in a tertiary hospital after completing their first year of practice. There is currently a global and national shortage of midwives, with midwifery services that are offered in tertiary hospitals under strain because of chronic understaffing and increased demand. In 2021, there were 3,283 registered midwives in Aotearoa New Zealand, with 48% employed in a hospital setting, and only 19% of those working as tertiary hospital midwives (Midwifery Council of New Zealand, 2020). Hospital midwives (also called core midwives in Aotearoa New Zealand) are employed by regional health entities devolved from the Ministry of Health, who provide maternity care in primary, secondary, or tertiary maternity facilities. In tertiary hospitals, they form part of a multi-disciplinary specialist team for women with complex and/or rare maternity needs. Using the Appreciative Inquiry qualitative research method, this study explores why graduate midwives decide to stay working in a tertiary hospital. Appreciative Inquiry is a strength-based research philosophy, which focuses on a positive approach for the development of knowledge and change. Data collection was through semi-structured interviews with participants. The Appreciative Inquiry four concepts: discovery, dream, design and destiny were interwoven into the interview questions and data was analysed using thematic analysis. The analysis revealed four main themes that influenced job satisfaction and retention. The four themes that supported intention to stay were: the nature of tertiary work, the sense of control tertiary midwifery provided, support from immediate midwiferyivcolleagues and the obstetric team, and the ability to provide meaningful care to women whose pregnancy had become complex. The themes strongly influenced graduate midwives to remain working in a tertiary hospital, despite short staffing issues and the stress of complex high-risk midwifery. It is anticipated that the findings from this research will add a valuable contribution to the body of work around midwifery workforce retention, particularly the sustainability and retention of midwives working in tertiary hospitals. Keywords: Aotearoa New Zealand; Midwives; Graduate midwives; Core midwives; Tertiary Hospitals; Job Satisfaction; Appreciative Inquiry.