PSYCHOLOGICAL WELL-BEING OF THE NURSE-MIDWIFE WORKFORCE: A THEORETICAL PROPOSITION
Certified nurse midwives provide cost-effective, high quality maternity care for low-risk women.1 Despite this, only 7.9% of births in the U.S. were attended by midwives in 2011.2 of the approximately 13,000 licensed CNMs3, only 5,460 are employed as nurse-midwives according the Bureau of Labor. 4 Simultaneously, there is a shortage of maternity care providers. According to the American College of Obstetricians and Gynecologists, in 2011 nearly half of U.S. counties did not have and obstetricians and gynecologists.5 In April 2014, the Maternity Shortage Act was introduced in the House of Representatives to address the lack of maternity care providers in specific rural and urban areas.6Attention to the of the midwifery workforce is essential to maternity care in the U.S.
Organizational psychologists have demonstrated correlations between work environment, professional psychological well-being (i.e. burnout and work engagement), and organizational outcomes.7,8,9 Nurse researchers have corroborated these findings in nursing populations. Job characteristics correlated to engagement and burnout include bullying exposure, supportive practice environment, and nurse-physician relationship.10,11 Additionally, nurse researchers found that burnout and engagement were predictive of organizational11 and patient outcomes.12
Theory
The Job Demands-Resources model (JD-R) is a framework with which to evaluate the relationships among work environment, professional psychological well-being, and the effects on outcomes.13The relationships are broken down into two processes. The Health Impairment Process proposes that job demands contribute to burnout that negatively affects outcomes. The Motivational Process posits that resources are correlated to work engagement and positively affect outcomes. Additionally, the JD-R allows for a mediating effect with resources mediating the relationship between demands and burnout and demands mediating the relationship between resources and engagement.
A systematic review of the literature was conducted using databases CINAHL, PubMed, Web of Science, and PsychInfo to identify research into the professional psychological well-being of midwives. Key words entered included “midwife”, “midwives”, “burnout”, “work engagement”, and “job engagement”.
Results
The review revealed that there is a little research regarding the professional psychological well-being of midwives. There are two studies on work engagement14,15 and seven on burnout 16,17,18,19,20,21 among midwives. The contemporary literature was conducted exclusively outside of the U.S.
The demands and resources addressed in the literature included fixed variables, such as patient volume, and malleable variables, such as autonomy. Two of the studies investigated outcomes correlated to the professional psychological well-being of midwives. Researchers correlated engagement with the midwife’s perceptions of quality of care and the midwife’s general health.14 Using a longitudinal design, resarchers investigated the midwives’ intention to leave and actual departure from midwifery employment.21
Gaps In The Empirical Literature
This systematic review revealed a lack of evidence into work engagement and burnout among CNMs in the U.S. The gaps include the organizational demands and resources unique to the midwifery workforce and the implications on patient and organizational outcomes. This knowledge is essential in order to develop evidence-based practice environments that foster growth of the midwifery workforce and increase access to cost-effective, high quality maternity care.