The devastation and distress caused by the global COVID-19 pandemic has been immeasurable. Its impact on an already overstretched and under-resourced NHS and its staff is unprecedented. During the past year, health and care staff have found themselves working tirelessly under increasing pressure to meet the changing requirements for healthcare delivery and education amidst the impact of COVID-19.
Thousands of staff returned to the NHS, or were fast tracked into posts, in response to the crisis (Anandaciva, 2021) and the introduction of the Nursing Midwifery Council (2021) emergency standards enabled final year nursing and midwifery students to undertake extended placements to support the NHS workforce. Many higher education institutions offered students the options of working full-time in practice to help support service needs with online learning continued through virtual classrooms, while those students unable to work in practice moved exclusively to online learning.
Within this article, we reflect upon the experiences and learning achieved through the final year of a midwifery course and students' transition to becoming newly qualified midwives. These reflections which occurred with a midwife educationalist and two newly qualified midwives are presented here from a student's perspective of how they were able to successfully negotiate and adapt to working within a changed NHS while successfully completing their midwifery course. Learning points identified are placed within the broader context of emotional wellbeing, creating a compassionate culture for students as well as the importance of collaboration and teamwork.
From the start, the rapidly changing nature of the pandemic meant that clinicians, educationalists and students alike were facing a new and constantly evolving situation together. Student midwives working in practice within their final year of training when the pandemic struck learnt very quickly how to adapt to uncertainty on a daily basis. The transition to online learning was challenging as guidelines and educational parameters were adapted in response to the rapidly escalating pandemic. The opt-in and opt-out of practice pathways were developed for the benefit of NHS Trusts and students alike, and decisions needed to be made promptly, which often involved a plethora of personal, social, emotional and financial aspects to consider for students at a time where there was great uncertainty.
For those students able to work full-time in practice, they faced similar risks of exposure and contracting the virus to other members of the multi-professional team. Bradfield et al (2021) suggested that midwives, doctors and midwifery students were most likely to be concerned about occupational exposure to COVID-19 through working within a healthcare setting than those attending these environments to receive care. From a student's perspective, a benefit of this mutual risk exposure was the perception that it resulted in a level playing field where student's felt their voices were heard and considered as part of the wider team.
This perception contributed to the keen sense of pride students felt in being identified as a key worker and working for the NHS, heightening a sense of belonging and providing a lifeline as students reflected upon how fortunate they were to be actively participating in keeping people safe. For mature students who had, in some cases, made sacrifices to pursue their career in midwifery, this also provided a sense of validation to family members and friends regarding the path they had chosen to embark upon. This reaffirmed their decisions to leave successful careers and stable incomes to work towards fulfilling their chosen career as a midwife.
The sense of belonging experienced by students along with perceiving that their contribution was valued by members of the clinical team was deemed highly significant by students who felt privileged to be able to work in practice and contribute meaningfully during the pandemic. Students considered themselves as integral members of the multi-professional team, collaborating closely to anticipate and resolve the daily challenges faced within the workforce. One such example was the practicalities of transferring SARS-CoV-2-positive women into or within a hospital environment, ensuring essential infection control while providing optimal emotional support for these vulnerable women. These reflections are in contrast to the findings of an Australian cross-sectional study where students (n=147) reported that they felt expendable in terms of their value and contribution, manifested in essential equipment such as personal protective equipment not always being available to them and experienced considerable emotional stress as they observed what they considered to be compromised midwifery care (Kuliukas et al, 2021a).
The wider midwifery literature places emphasis on workplace culture and the importance of providing a welcoming, supportive environment for enhancing student experiences and creating a rich learning environment (Arundell et al, 2017; Cummings et al, 2017). Within this reflection, students found that opportunities to experience continuity of placement environment was an additional benefit derived from working during the pandemic, as they worked for longer periods in specific areas rather than their usual 2–6-week placements. Such working practices, particularly during a period of intense pressure, helped to consolidate midwife and student midwife relationships, and was facilitative of team building, appearing to enhance confidence on both an individual and team level.
The development of positive working relationships between student midwives and midwives has been found to help increase students' knowledge and capacity for future learning (Young, 2012; Dewer et al, 2020). Using an appreciative inquiry approach, Dewer et al (2020) sought to understand the factors contributing to an enhanced student midwife experience. The authors mapped data according to the Senses Framework (Nolan et al, 2006) which included the following elements: sense of security, sense of belonging, sense of continuity, sense of achievement and sense of purpose. Feeling valued and receiving recognition for their existing skillset empowered students to feel comfortable and brave enough to speak up and ask questions, thus increasing their capability for further learning (Dewar et al, 2020).
These findings echo the work undertaken by Michael West and colleagues (2014; 2017; 2020) which emphasises the importance of clinical workplaces developing an infrastructure which supports the psychological wellbeing of staff members, recognising the direct link that exists between staff wellbeing and high quality, safe, compassionate care provision. Figure 1 summarises the ABC framework of nurses' and midwives' core work needs (West et al, 2020) which emphasises the basic needs that must be fulfilled to enhance healthcare professionals wellbeing at work. In particular, students' experience was enhanced by feeling valued, respected and supported, and experiencing effectiveness in their work to deliver valued outcomes.
Figure 1. The ABC framework of nurses' and midwives' core needs (adapted from West et al, 2020)
For those students unable to practice, different challenges were faced which included anxiety and a loss of confidence from not working clinically and concerns about falling behind with practice hours and the achievement of clinical skills and competencies. Moving to online learning and being isolated from their peer support groups made learning difficult and contributed to a sense of loss of identity as a midwifery student, something that most students found very important (Luyben et al, 2020; Kuliukas et al, 2021a; 2021b). While online learning had many advantages, including the ability to access learning materials from home and a reduction in costs and time spent travelling, students found the lack of face-to-face teaching detrimental in certain aspects. For those students living alone, a lack of face-to-face opportunity for social interactions increased their feelings of isolation at a time when they were already struggling to adjust, potentially triggering more serious mental health problems (Lischer et al, 2021).
The first year as a newly qualified midwife is a critical time where midwives are most at risk of leaving the profession and it is important that we reflect upon the lessons learnt during this period to help foster a constructive and positive adaptation to adverse circumstances. Final-year students found having the opportunity to learn consistently by working within the same environment for a sustained period increased their confidence and promoted feelings of self-worth. It enabled students to feel connected to their wider environment, provided a sense of purpose and was facilitative of the positive midwife-student midwife relationships which are so important in enhancing student wellbeing and supporting students to adapt positively to challenging circumstances. Students reflected that these experiences were critical in helping prepare them for the realities of life as a newly qualified midwife.