At the end of 2022, maternity services across Melbourne were experiencing extreme difficulty filling their forward rosters with a shortfall of approximately 250 equivalent full time (EFT) midwives. It was a staffing shortage not seen in Victoria since the nursing and midwifery workforce crisis of the late 1990s.
In response, ANMF (Vic Branch) and Peninsula Health – with support from Safer Care Victoria and the Department of Health – collaborated to trial new midwifery workforce models, with the aim of investigating options to support and retain midwives, to bring midwives back to the bedside, and to reduce workloads.
Due to the extreme and urgent need, the aim of this trial was to achieve rapid development, rapid consultation and rapid implementation of all proposed initiatives. A positive working relationship between the health services, government and the ANMF made this possible, with only three weeks between the first meetings and the start of the trial.
Beginning in January 2023, the trail aimed to:
- support and retain existing workforce and bring midwives back to the ‘bedside’
- increase midwifery EFT and lessen the reliance or need for extended team models, double shifts and excessive overtime
- 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
- respond to the recent FUSHIA report
- to evaluate the initiative implementation on workforce retention, wellbeing and satisfaction
Members informed the trial
Before the trial began, ANMF surveyed about 250 midwifery members at three health services – Western Health, Monash Health and Peninsula Health – on three key issues: parental leave, flexible work arrangements and the availability to choose to work additional shifts and hours.
Members told us that initiatives to improve recruitment and retention needed to include:
- set shifts (e.g. permanent nights, shifts aligned with childcare, shorter shifts)
- set work areas, rather than rotating through all maternity service areas
- an increase in midwifery EFT to lessen the reliance or need for extended team models/double shifts and excessive overtime.
Other common themes included recognition of the newborn workload, a morning position solely focused on discharging, more self-rostering opportunities to balance childcare commitments, and allowing midwives more control over their clinical area rotation.
This feedback informed our advocacy in determining the initiatives within the trial.
What did we trial?
Building on the results of the survey and consultation with maternity services, only Peninsula Health trialled three specific initiatives between January and June 2023:
- A discharge support midwife: to assist with timely discharge, including performing baby checks, postnatal checks, managing relevant pharmacy requirements and assisting with birth outcome systems (BOS). This position (based on the Northern Health model) was to support the workload of discharging women in an environment of reduced length of stay and staffing shortfalls. They worked a short shift (five hours), at a time of their choosing, starting no earlier than 7am and finishing no later than 9pm.
- A birth suite/postnatal ward support midwife, 5pm– 11pm: to assist with the workload of the birth suite and postnatal 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: additional shifts were offered during the expanded hours of operation. It was expected that midwives would finish in-home visits by 8pm. Shift lengths for consideration and, in addition to those that were already rostered, included a combination of six- or eight-hour shifts.
- These shifts were outside the traditional 8:8:10 roster cycle and were for those wanting to re-enter the permanent workforce or pick up additional permanent shift/hours.
- Shifts were in addition to Safe Patient Care Act ratios and domiciliary staffing profiles. They were not required to be replaced in the event of unplanned vacancies.
- The position descriptions were developed in consultation with ANMF, the health services and Safer Care Victoria.
The discharge support midwife proved to be the most popular shift, with 40 shifts worked between February and July.
The birth suite/postnatal ward support midwife was worked approximately three times a month during the same period, with the most common shifts being 0800 to 1300 or 1000 to 1500. Feedback from members indicated that the trial 11pm finish time was too late, problematic for childcare and managing children’s bedtimes.
No extended domiciliary hours were worked.
What happens next?
Evaluation of the trial is underway, with ANMF and Peninsula looking at the possibility of permanent application of these measures and potential expansion across regional and metropolitan maternity services.
Perhaps one of the biggest lessons, and one that was learnt quickly during the pandemic, is that a positive working relationship between a health service and the union representing its midwives can mean rapid development of ideas, rapid consultation and rapid implementation to support the workforce, the patients and the health service.