Midwifery Return to Practice Programme

Midwifery Return to Practice Programme

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CONTENTS CONTENTS... 3 INTRODUCTION... 4 Background information... 4 Aim... 5 Target audience... 5 Eligibility... 5 Tenure during Return to Practice programme... 5 Proposed Program Outline... 6 REFERENCES... 10 ACKNOWLEDGEMENTS... 10 Appendix 1: Individual Learning Contract... 11 Appendix 2: Education Plan - Return to Practice Programme... 12 Appendix 3: Individual Check List... 13 Appendix 4: Evaluation of Preceptor by Preceptee... 14 Appendix 5: Programme Evaluation... 15 A Guide to Abbreviations: APC CDHB CWH MCNZ RTP NICU Annual Practicing Certificate Canterbury District Health Board Christchurch Women s Hospital Midwifery Council of New Zealand Return to Practice Neonatal Intensive Care Unit P a g e 3 Ref. 6712 Authorised by: Director of Midwifery, CWH Issued: March 2013

CDHB Midwifery Return to Midwifery Programme Welcome to the CDHB. The following booklet is a guide to help facilitate you through your Midwifery Return to Practice (RTP) Programme. Introduction Background information Demand for midwives has increased by approximately 4% per annum since the early 1990s, driven mostly by institutional changes such as midwives gaining professional autonomy in 1990 (Midwifery Council of New Zealand, 2006). The Canterbury region's population grew by 39,000 between 2001 and 2004 (Statistics New Zealand, 2006). One third of this increase can be directly attributed to births. This growing birthrate will add to the increased demand for midwives within this region. Issues of retaining and recruiting midwives result in high financial costs and low staff morale which may, in turn, affect patient care. Workforce issues are being addressed by District Health Boards New Zealand (DHBNZ), Midwifery Council and New Zealand College of Midwives with a number of tangible initiatives to ensure as a profession we are able to facilitate safe and effective care to pregnant women and their babies, whilst also sustaining a healthy and productive workforce. Maternal and Child health is of significant public health importance (WHO, 2007). The issue of women and newborn health affects every family, community and society in New Zealand and the world. This programme seeks to address the challenges of workforce issues faced by the Canterbury region in providing a sustainable midwifery workforce which can help to improve both maternal and newborn health outcomes. New Zealand women need skilled carers in pregnancy and childbirth. Midwives are the essence of midwifery care through all steps not only providing the core of the care in the maternity service in New Zealand, but also have an important role to play in health and wellness promotion and education for the woman, her family and the community. The World Health Organisation (WHO) maintains that midwives are the most appropriate and cost effective health care provider to be assigned to the care of normal pregnancy and normal birth, including risk assessment and the recognition of complications (WHO, 2006). The WHO also recommends that it is essential that policy makers put systems into place to improve provider performance, which in turn benefits all mothers, babies, families, communities, health care systems and the profession itself (WHO, 2006). Ensuring there are adequate midwives to care for women in their pregnancy and birth helps to work towards meeting the Millennium Development Goals of reducing maternal deaths by three quarters and reducing child mortality by two thirds by 2015 (WHO, 2007). P a g e 4

Aim To aid the Midwifery Council of New Zealand (MCNZ) in meeting the national new return to practice policy (2011) to: - Encourage midwives to return to the midwifery workforce. - Support returning midwives to achieve the Midwifery Council requirements for a competency based APC across the midwifery scope of practice. - Provide midwives with a clinical program which updates, refreshes and assists them to maintain skills and knowledge essential to practice. - Support midwives to continue to enjoy midwifery and to provide a good service - Assist returning midwives to maintain continuing professionalism and accountability within the full scope of practice. - Increase the midwifery workforce thereby increasing efficiency and standard of care as well as improving staff morale. Target audience The MCNZ Return to Practice policy (2011) defines three levels of return to practice and specifies the requirements for each level as follows: Category A: Category B: Category C: Those midwives that have been out of practice between 3-5 years Those midwives that have been out of practice between 5-8 years Those midwives that have been out of practice for more than 8 years Eligibility Registered Midwife in New Zealand Tenure during Return to Practice programme Midwives engaged on the Return to Practice programme will be assisted with compiling a clinical programme as required by the MCNZ. As such they will be required to complete the CDHB visiting agreement declaration and requirements (e.g. proof of indemnity and MRSA screening) prior to commencement. P a g e 5

Proposed Program Outline The RTP programme is designed to support midwives who are in category A, B and C. The programme is co-ordinated by the Midwifery Educators and supported by the Director of Midwifery and CDHB core midwifery staff. The programme is to support midwives who fall into the programme requirement descriptions. Midwives in categories A and B can complete a RTP programme in either the community or within a DHB. Pre-registration components that are required will affect Category C. In this case a pre-registration midwifery education provider will be involved in developing the individual education plan that will be submitted to midwifery council for approval. Category C midwives are also required to complete clinical time in both areas of practice, The CDHB RTP clinical programme aims to be a supportive individualized learning experience facilitating increased independence and self confidence to foster safe midwifery practice and decision making. A summary of the RTP Plan is outlined below: 1. MCNZ notification. 2. MCNZ ascertain academic and clinical requirements. 3. Clinical Placements. 4. Education Programme, 5. Submission of evidence to MCNZ and application for Annual Practising Certificate. 6. Return to Practice. P a g e 6

Step 1: MCNZ notification All midwives are required to contact the MCNZ and notify them of their intention to RTP. In all instances a midwife must apply to MCNZ for an interim practicing certificate. This will show on the practising certificate and also on the online register. Step 2: MCNZ requirements (academic and clinical) The MCNZ ascertain academic and clinical requirements, this is based on the category, as per the RTP policy (2011) and the midwife s Individual assessment; including self assessment against competencies. The MCNZ outline the required courses in the policy, this is available at www.midwiferycouncil.health.nz/publications You will need to consider what knowledge, skills, attitudes and experiences you have that enable you to meet the competencies, and provide appropriate evidence. All criteria that cannot be met must be identified; along with the theory and practice experiences the midwife believes will be required in order to meet the gap(s) in her competence. (MCNZ, 2005) It is expected that before MCNZ issue an interim practicing certificate midwives provide a detailed plan of where and when they will complete the educational requirements and where clinical placements will be completed. Step 3: Clinical Placements Once MCNZ has issued your Interim Practising Certificate, contact the RTP Programme Coordinators to arrange the dates for your clinical placements. As a DHB we will facilitate any clinical placements required within the DHB. Please note Midwives completing category B and C will require a competency assessment as a part of the clinical programme. A separate matrix is available from the MCNZ. For the purposes of the RTP programme each midwife requires a degree of supervision. A named clinical preceptor will be allocated to you during each of your clinical placements. Due to the constraints of rostering, this preceptor may not be working with you for every shift of your RTP but we will aim for you to work together for a minimum of 3 shifts a fortnight. Your chosen preceptors have a broad clinical experience within the midwifery scope of practice. They are recognized as being midwives who: - Have a good working relationship with their peers. - Are sensitive to the individual learning needs of preceptees. - Respect and support the individual. - Completed a formal preceptor programme Use the templates provided in Appendix 4, or your own method of feedback, to evaluate your preceptorship period. Your preceptor would appreciate your comments for recording in her own portfolio. Step 4: Education Programme P a g e 7

Your education requirements will have been discussed as part of your Individual learning contract with the MCNZ. The DHB do facilitate a number of education workshops. All education sessions will need to be booked via the midwifery educators. A calendar of all scheduled education and prices is available. You may identify further education opportunities during your RTP Programme and these can be discussed with your preceptor and/or Programme Co-ordinator. Some of these education sessions will be necessary to comply with the requirements of MCNZ Recertification Programme, both the compulsory and elective education components. If you have not already commenced a professional portfolio, this would be an ideal time to start compiling evidence on your practice. A personal planner would be useful to record your progress on the Recertification Programme. The MCNZ are available to assist you to understand the Recertification Requirements. Your preceptors, educators and senior ward staff will be important resources during your RTP placements. You may find the following list of written resources helpful. Please ask if you struggle to locate any of them o Maternity Guidelines (available on CDHB intranet and internet) o Infection Control folder o Fluid and Medication Management (Volume 12) available on intranet o Human Resources folder on intranet o Notes on Injectable Drugs (Clean Utility Room) o Current Notices and articles folders o Communication books o Ward DVD s, videos o Midwifery Resource Library (Midwifery Educator s office) o Christchurch School of Medicine Library o K2 online CTG monitoring package o NZCOM Midwifery Handbook for Practice o NZCOM Midwifery Standards Review Handbook o Breastfeeding (Renfrew, Fisher, Arms) o Breastfeeding Matters (Maureen Minchin) o WHO/UNICEF Code on Promoting, Protecting & Support Breastfeeding o WHO/CHD Evidence for the Ten steps to successful Breastfeeding o Evidence-Based Guidelines for Breastfeeding Management during the first fourteen days (ILCA) o Infant Feeding Guidelines for NZ Health Workers (MOH) o Midwifery: Preparation for Practice 2010Pairman, Pincombe, Thorogood, Tracy o Pharmacology for Midwives 2010 Jordan, S o www.nzformulary.org.nz o www.nzulm.org.nz (Universal list of medicines o www.medsafe.govt.nz o www.pharmac.org.nz o www.druginformation.co.nz o Drugs in Pregnancy and Lactation (Briggs, Freeman, Yaffe) o Various client handout pamphlets o MIDIRS and Midwifery News P a g e 8

Step 5: Submission to MCNZ On completion of the MCNZ requirements you will be required to send all relevant documentation to the MCNZ Education Committee. This will include your completed Competency Assessment Report (if required), Individual Learning Contract and proof of completion of any education requirements. Step 6: Return to Practice At the end of the programme, if you successfully gain an APC you may wish to apply for a permanent position at the CDHB or pursue other career options such as self employed Lead Maternity Carer (LMC). P a g e 9

References Department of Labour (2006) MIDWIFE: Occupational Skill Shortage. Accessed on 20 th November 2007 at http://www.dol.govt.nz/pdfs/jvm-prof-mid-2005.pdf Midwifery Council of New Zealand (2005) Return to Practice Programme for Midwives policy document. Accessed on 28 th April 2010 at http://www.midwiferycouncil.org.nz/content/library/return_to_practice_programme_for_midwi ves.pdf Midwifery Council of New Zealand (2006) Pre-Registration Midwifery Education Review Report. Accessed on 19 th November 2007 at http://www.midwiferycouncil.org.nz/content/library/mcnz_education_report3.pdf Midwifery Council of New Zealand (2011) Return to Practice Programme for Midwives Policy Document. Midwifery Council of New Zealand. Statistics New Zealand (2006) Christchurch Quarterly Review. December 2006. Accessed on 21 st November 2007 at http://www.stats.govt.nz/nr/rdonlyres/fc5e2b4d-291c-4342-a9ac- DFDA757E8BDA/0/Dec2006QRRChristchurchSAMPLE.pdf World Health Organisation (2006) The World Health Report 2006 Working Together for Health, World Health Organisation. Accessed on 19 th November 2007 at http://www.who.int/whr/2006/en/ World Health Organization (2007) Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. WHO. Taranaki Health Board (2008). Return to Midwifery Return to Practice programme. Taranaki District health Board. Acknowledgements Many thanks to Dianna Murray at Capital and Coast Health for sharing the Return to Midwifery Program and ideas so readily. Many thanks to Taranaki District Health Board for sharing their valuable information and documentation. Ref 6712 Authorised by: Director of Midwifery, Christchurch Women s Hospital Issued: March 2013 Revised as per MCNZ Dec 2012 P a g e 10

Appendix 1: Individual Learning Contract Proposed Individual learning contract for. Return to Practice Category. Based on FTE.. Clinical placements: Maternity ward.. weeks (..hrs), to include Ward clinical experience may include: Antenatal care including admission and discharge Postnatal care including admission and discharge Breastfeeding advice and referral to LC Newborn baby checks and baby care Postoperative care Sign/date when achieved: Birthing suite... weeks ( hrs), to include Ward clinical experience may include: Assessment area (antenatal including induction of labour) Normal labour and birth Premature labour and birth LSCS theatre and recovery Birthing rooms Acute observation unit Management of woman with complex needs e.g. comorbidities, pre eclampsia, insulin dependant diabetic Epidural management Obstetric emergencies Instrumental births Multiple births (twins) Induction of labour Caring for woman with fetal loss Maternity Outpatients..weeks ( hrs), to include Clinical experience may include: High risk clinic MIPS (Methadone in Pregnancy Programme) Clinic Diabetes clinic Fetal maternal medicine Day assessment unit Primary Units Other clinical opportunities: P a g e 11

Appendix 2: Education Plan Return to Practice Programme Name:. Clinical Placement dates: Component Location/Date/Time Tick ( ) when booked Technical Skills workshop Newborn Life Support Adult CPR update (including Maternal Collapse) Breastfeeding update National Screening Unit 5 modules Smoking cessation Family violence Learnonline.health.nz NZCOM NZCOM Electronic Fetal Monitoring NZ Maternity Systems Pharmacology and Prescribing Online from Otago Poly or AUT Cultural Competence IT update CDHB Caresys (Patient Management) and Éclair (Lab results) training on Thursday mornings 9-12.30 at Chch Hospital book via midwifery educators Ext 85730 Guidelines for Pre-eclampsia and Diabetes Look up CDHB internet under Maternity Guidelines Any other identified needs P a g e 12

Appendix 3: Individual Check List Name:.. Tick ( ) / Date / Comments Interim APC photocopied Visiting Agreement signed by RTP midwife Visiting Agreement forwarded to DOM for signing Indemnity insurance cover sighted (NZCOM or NZNO) Has copy of MCNZ competency template for sign off ID card application form Network User set up form Booking for Caresys and Éclair training MRSA swabs sent Charge midwives informed of placement dates Preceptor timetable for first placement then note in diary when rotates each placement P a g e 13

Appendix 4: Evaluation of Preceptor by Preceptee Evaluation of preceptor by preceptee (p2) Name of Preceptor: Name of Midwife receiving preceptorship: Did you have consistent and appropriate access to your Preceptor? Yes No If No, please explain or comment: Please tick ( ) the box which best describes your experience My Preceptor: Excellent Very Good Satisfactory Expected me and made me feel welcome Identified previous knowledge and skills I had & set goals with me for further development Had a good knowledge of the clinical, environmental and woman s needs & helped me understand and develop my skills Used effective clinical teaching skills Was approachable and communicated clearly. Was confident in utilizing clinical situations to assist my learning Evaluated my knowledge, skills and understanding by seeking feedback and participation Assisted me in identifying others who could support my learning Role modeled professional midwifery practice & woman-centred care Offered regular specific, constructive feedback Demonstrated competent safe midwifery care Advanced my development by creating learning opportunities in my work environment Provided a safe learning environment/relationship Describe the attributes that you appreciated in your Preceptor Needs Improvement What would you like done differently Any other comments/feedback Signed: Date: P a g e 14

Appendix 5: Programme Evaluation We would be grateful if you could answer the following questions regarding the CDHB RTP Programme. We are keen to know whether the Programme is effective and will endeavor to make changes where problems are identified. 1. How did you find out about the CDHB RTP clinical programme? 2. How useful were the written guide and orientation packages? 3. What did you find most useful about the programme? 4. Are there any ways in which you feel the programme could be improved? 5. In which areas did you achieve continuity with your preceptors and in which areas was this more difficult? 6. What frequency do you think is appropriate for focus meetings with preceptors during an RTP programme? 7. Did you find the RTP Programme Co-ordinator was available when you needed her? 8. Were there any barriers to achieving the goals set out in your Individual learning contract? Please feel free to comment further overleaf. Return the completed evaluation to your Programme Coordinator. Thank you! P a g e 15