Between January and June 2023, ANMF (Vic Branch), in collaboration with Safer Care Victoria, the Department of Health and several health services, will lead a new maternity workforce initiative trial with the aim of investigating options to support and retain midwives, to bring midwives back to the bedside, and to reduce workloads.
It’s no secret that there is significant midwifery vacancy across the metro midwifery workforce in particular, amounting to around 200–250 EFT collectively (not including personal or parental leave). In order to achieve work/life balance, manage fatigue and reduce the burden of night shift work, midwives are choosing to drop their hours or move from permanent to casual workforce.
All services are experiencing significant overtime and double shifts, or asking staff to extend to a 12-hour shift to cover gaps. All maternity services report that personal leave and unplanned vacancies are higher than in previous years. Managers/AMUMs and in-charge midwives on a shift-by-shift basis are making every attempt to fill vacancies but the situation is not sustainable and requires fresh approaches.
Current situation, and aims
The maternity workforce initiative trial (MWIT) builds on feedback received from members to address retention and reengagement with their workplace and the profession of midwifery. It is a joint ANMF, Safer Care Victoria and Department of Health project, in collaboration with services who have opted to take part. Currently the metro maternity services participating are:
- Northern Health
- Peninsula Health.
The trial’s aims will be to:
- establish a collective response to the current challenges
- support and retain existing workforce and bring midwives back to the ‘bedside’; reduce the load of work; provide more flexible options for midwives to enable either a return to permanent employment and/or additional hours if desired; and provide better opportunities for midwives to give the care they want to give
- have a centralised consultation mechanism to enable earliest possible adoption, and consistent implementation of the initiatives
- ensure clear and consistent messaging for midwives, managers and services about the purpose and timeframes for implementation of initiatives
- evaluate the initiative implementation on workforce retention, wellbeing and satisfaction. Northern Health will separately partner with La Trobe to evaluate the discharge support role (see below).
Initiatives
The trial will evaluate three specific initiatives – each in addition to ratios, or staffing profiles. These initiatives are:
- A discharge support midwife, to assist midwives with timely discharge, including performing baby checks, postnatal checks, managing relevant pharmacy requirements and assisting with BOS. The discharge midwife will not hold the responsibility for discharge and is there to assist only. The discharge support midwife will work a short shift (5 hours), at a time of the midwife’s choosing, starting no earlier than 7am and finishing no later than 9pm.
- A birth suite/post-natal ward support midwife, who will assist with the workload of the birth suite and post-natal units to improve workflow and reduce delay in induction of labour, support for breastfeeding women and post-caesarean care.
- Extension of domiciliary hours of operation – during daylight savings only – from 8am to 8pm. It is expected that midwives will finish in-home visits by 8pm. Shift lengths for consideration and in addition to those currently rostered may include short 6-hour shifts (for example: 8am–2.30pm, 12pm–6:30pm, 1:30pm–8pm).
These initiatives that services may wish to progress relate to shifts outside of the traditional 8:8:10 cycle for those who wish to re-enter the permanent workforce or pick up additional permanent hours.
These shifts are in addition to ratios, and will not be required to be replaced in the event of unplanned vacancies.
Key principles
- The maternity services are committed to maintaining ratios as a priority; staff will not be diverted from ratios to enable the initiatives.
- Initiatives will be aimed at increasing security of work to stabilise rosters while also providing additional and/or a different mix of hours that may better facilitate work/life balance in a flexible manner for midwives.
- Initiatives will attempt to decrease burnout for staff in order to assist in a decreased need for personal leave/overtime/double shifts.
- Additionally, Initiatives should result in improved experiencefor women.
- A consistent approach to evaluation at key points of the trial will enable better measurement of the efficacy of the initiative.
In addition to the maternity workforce initiative trial, ANMF (Vic Branch) secured a commitment from the re-elected Andrews government for a two-year trial, from 1 July 2023, of ‘a registered neonatal support nurse on each post-natal unit across three maternity services.’ Metropolitan sites for this election commitment trial will be selected from those participating in the workforce initiative trial.
