Use of a Theoretical Model to Evaluate and Strategically Scale-Up Midwifery Education and Workforce Público

Abstract

Introduction

In the U.S., a scale-up and redistribution of midwives can assist in reversing an increasing rate of maternal mortality and persistent reproductive health disparities. As the growing profession is challenged to integrate and benefit from students and midwives with diverse background experiences, ethnicities, and professional interests, building a solid body of knowledge about the workforce will facilitate more strategic recruitment, preparation, distribution, and retention of midwives.

Methods

This cross-sectional research used an online survey, developed using the framework of Social Cognitive Career Theory, to contact early-career midwives through the ACNM listserv and social media during the fall of 2016. Statistical analysis of 244 completed surveys allowed for discovery and linkage of data related to the following constructs: personal characteristics, background and proximal contextual factors, educational experiences, employment situations, career perceptions, and future plans.

Results

Early-career midwives report generally high levels of support and success from midwifery education, high degrees of clinical engagement at work, and high scores on measures of job satisfaction, organizational commitment, and work performance. Midwives' career plans indicate possible workforce distribution concerns. A comparison of midwives with and without prior RN employment or health care certification found that groups used different strategies to achieve similar workforce outcomes, although those without prior RN experience complete their educations at a younger age, do so more quickly, and are more likely to have a dual major/degree. A comparison of under-represented minority (URM) and non-minority midwives revealed some concerning differences in the educational experiences and career plans of URM midwives, in terms of support for culture, passing the certification examination on first attempt, and planning to reduce clinical hours.

Discussion

Knowledge gained from this research has the potential to focus the efforts of those working in clinical, education, and policy arenas to scale-up midwifery. Midwifery educational programs should continue to use innovative strategies to accommodate different streams of students. Full professional integration of URM midwives will require cultural humility, as well as a revision of our professional structures. Optimal growth and distribution of the profession may be facilitated by strategic governmental funding for midwifery education, organizational support for precepting efforts, and further workforce research.

Table of Contents

Table of Contents Chapter 1 - Introduction .....…………………………………………………………………….... 1 Table 1.1 ………………………………………………………………………………... 32 Table 1.2 ………………………………………………………………………………... 34 Figure 1.1 ………………………………………………………………………………. 35 Figure 1.2 ………………………………………………………………………………. 36 Figure 1.3 .......................................................................................................................................... 37 Figure 1.4 .......................................................................................................................................... 38 Chapter 2 - The effect of prior work experiences on the preparation and employment of early career midwives …………………………………………………………………………………...…..... 39 Table 2.1 ………………………………………………………………………………... 61 Table 2.2 ............................................................................................................................................ 63 Table 2.3 ............................................................................................................................................ 65 Table 2.4 ............................................................................................................................................ 66 Table 2.5 ............................................................................................................................................ 68 Table 2.6 ............................................................................................................................................ 69 Figure 2.1 ........................................................................................................................................... 71 Figure 2.2 ........................................................................................................................................... 72 Chapter 3 - Associations between ethnicity and learning experiences, workforce decisions and perspectives, and career plans of early-career midwives in the U.S. ....................................................... 73 Table 3.1 ............................................................................................................................................ 97 Table 3.2 ............................................................................................................................................ 99 Table 3.3 ........................................................................................................................................... 100 Table 3.4 ........................................................................................................................................... 101 Table 3.5 ........................................................................................................................................... 102 Figure 3.1 .......................................................................................................................................... 103 Figure 3.2 .......................................................................................................................................... 104 Chapter 4: Work environments, employment perceptions, and career plans of early-career nurse-midwives in the U.S. ..................................................................................................................................... 105 Table 4.1 ........................................................................................................................................... 130 Table 4.2 ........................................................................................................................................... 133 Table 4.3 ........................................................................................................................................... 135 Table 4.4 ........................................................................................................................................... 137 Table 4.5 ........................................................................................................................................... 139 Table 4.6 ........................................................................................................................................... 141 Figure 4.1 ......................................................................................................................................... 142 Figure 4.2 .......................................................................................................................................... 143 Figure 4.3 .......................................................................................................................................... 144 Figure 4.4 .......................................................................................................................................... 145 Figure 4.5 .......................................................................................................................................... 146 Chapter 5: Synthesis ...................................................................................................................................... 147

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Education, Higher Health Sciences, Nursing
Palabra Clave	nursing education Social Cognitive Career Theory ethnicity in midwifery midwifery workforce ethnicity in nursing Midwifery education
Committee Chair / Thesis Advisor	Sibley, Lynn M, Emory University
Committee Members	Kelley, Maureen, Emory University Hepburn, Kenneth, Emory University Higgins, Melinda K, Emory University Hagen, Kimbi, Emory University

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