Reflecting on the preceptorship year

The preceptorship year is a time of transition for a newly qualified midwife, aimed at providing a period of support as they transform from a student to a fully-fledged autonomous practitioner (Royal College of Midwives, 2022). Although programmes may differ, over the cause of 12 months, preceptees must follow a structured framework whereby training is undertaken, experience is gained and competencies are signed off by a preceptor. It has sometimes been referred to as the fourth year of studying (for direct entry midwives) and an extra year of being a student (for non-direct entry midwives), with the added bonus of getting paid.

My midwifery journey

I completed a direct entry midwifery training programme having previously achieved a Master's degree in biomedical sciences. My first of the 3-year degree programme was cut short by the COVID-19 pandemic lockdowns, which saw the end to hospital placements for 5 months and a switch to online learning. Although my university did their best to provide the required educational experience, it was challenging to acquire practical knowledge and skills.

At the end of my degree, I decided to apply for a job at the hospital in which I trained, leading some colleagues to occasionally forget that I was no longer a student midwife. A clear benefit of staying where I trained is that it was easier to transition because of prior knowledge of staff, hospital facilities, policies and practices. It was also easier for colleagues to understand my learning needs as a newly qualified midwife.

My preceptorship experience

Towards the end of my final year as a midwifery student, I had increasingly been forewarned of the dreaded ‘jump’ that came once one qualified. I took a 4-month break after completing my training, to celebrate my journey, while preparing for the start of my preceptorship by reading evidence-based literature and familiarising myself with hospital guidelines and local policies.

The 12-month preceptorship programme consisted of a series of rotations in the community, birth centre, delivery suite, antenatal and postnatal wards, in order to consolidate midwifery knowledge and skills. At the start, I was plagued with imposter syndrome, with each new rotation stirring up feelings of self-doubt in my ability to provide midwifery care for the women that were allocated to me. According to Peng et al (2022), imposter syndrome is common and entirely normal for newly qualified midwives. To overcome this, as suggested by Mak et al (2019), I found it helpful to measure my success instead of fixating on perceived weaknesses, which only generative anxiety. This may be in the form of a literal list to return and add to or simply self-acknowledgement. Talking to a trusted mentor, colleague or friend about these feelings also helps to put them into perspective, allowing focus on the facts.

Newly qualified midwives are entitled to a period of 4 weeks supernumerary status, allowing them to shadow a midwife at the start of each new rotation and to be inducted to the new work setting, as outlined by the Nursing and Midwifery Council (2019). My advice to newly qualified midwives is to ensure that they use this time to develop confidence. Staff shortages may require a newly qualified midwife to be redeployed to other areas or work independently. If this happens, it is important to discuss this with a preceptor and line manager.

What to expect

At the start of a preceptorship, the initial euphoria of having finally qualified and shedding the stabilisers of student hood eventually turns to reality. I suddenly found that the skills that I had refined to the point of second nature during training quickly disappeared once the responsibility rested on my shoulders. My advice would be to get experienced midwives' support with record-keeping to ensure fulfilment of the Nursing and Midwifery Council requirements and the organisation's policies. For someone who struggles with spelling (eg someone who is dyslexic), using spellchecking on electronic patient records or getting a mentor to read through notes before signing or saving them are both helpful. This reflection outlines a few tips that I found helped with my own transition.

Ask for help

It is a common misconception that you are expected to know everything once you qualify. This is simply not true. No matter how long you have been a midwife, you can still ask for help when needed, whether that be about hospital guidelines or advice on dealing with shift patterns and workload. We can all learn from each other's experiences.

Be proactive

The preceptorship year is a good time to push your comfort zone, because you are still closely supported, and early enough in your hopefully long midwifery career to adapt and learn.

Equally, do not be afraid to say no. You may be asked to do things that you are not comfortable with, and perhaps are not yet allowed to do, especially if there is a shortage of staff, which may put both your midwifery practice and the women in your care at risk. This might include being counted in the number of midwives, when one is supernumerary, being asked to care for more women and babies on the postnatal ward than you feel able to cope with. As a student, you may not have experienced looking after a whole bay alone and this sudden increase in work load and responsibility may make you uncomfortable. You may be asked to perform a procedure that you do not feel competent and confident to do.

Never be afraid or feel embarrassed to ask for support when needed. Ask for clarification when receiving a handover for a high-risk woman with a care plan you do not fully understand. Request supervision from a more experienced midwife and document any concerns you have in writing, including who you reported the concerns to and the advice received. The aim is to ensure that you deliver a high standard of midwifery care and the client has the safest outcome.

Pace yourself

While you should aim to complete your preceptorship as soon as possible, also remember that it is not a race. Do not feel pressured to complete your competencies at record speed. The preceptorship period is 12 months long for this very reason. This time is not simply for ticking off a check list, but to build on experience in each clinical area. Equally, if you feel you could benefit from more time or have not been able to get everything signed off, you are permitted to ask for additional time to achieve the required competencies.

Take time to reflect

Meeting often with your preceptor to discuss any concerns or clarify what needs to be signed off will ensure you stay organised and avoid becoming overwhelmed by the various workbooks and competencies you have to do. Taking time at the end of long work shift to reflect on what went well and things that need improvement can help fine tune your growth.

One way to achieve this is via the SWOT analysis, a technique used to identify strengths, weaknesses, opportunities and threats (Klein et al, 2019). This can help analyse one's strengths, helping to develop confidence, and identify areas for learning and development in order to set goals and devise a successful strategy for the future. It can also help to unveil opportunities, such as embracing the use of technology, shadowing and networking opportunities, and highlight threats to one's personal development. This article includes a SWOT analysis that I completed during my preceptorship programme (Box 1).

Box 1.SWOT analysis of preceptorship programme
Good communication skills

Gaining awareness of your strengths allows you to take full of advantage of these skills in order to gain the most from your preceptorship year. As someone who is highly self critical, I found a good way to analyse myself was through obtaining regular feedback from mentors, colleagues and clients, either by observation or asking directly. For example, after handover, a midwife reported that I had communicated clearly and concisely, via the situation, background, assessment and recommendations tool, about the care plan needed for the woman.

Communication is a vital skill to have during preceptorship, as it not only allows you to provide clear information to women and colleagues but also lets you express concerns to mentors. The safeguarding team commented on my professional curiosity when I followed up concerns surrounding a woman in my care who later disclosed allegation of domestic abuse. Furthermore, in line with prioritising people, I was able to discover the importance of being responsive to client needs when a woman and her partner said how much they appreciated my attempt to keep to her birth plan, despite having to have an emergency caesarean section.

Acknowledgement of one's weaknesses through self reflection can be a challenging and humbling task, but one that is vital in identifying aspects of your practice that could benefit from further development. I became aware of my fear of failure after an unsuccessful attempt at intravenous cannulation. The preceptorship year is a time to practice new skills where failure is to some degree expected and thus should be embraced as a learning opportunity. Being able to take criticism as a means of improving my practice instead of a personal attack of my faults or mistakes is something that I continue to build on. As a student, I discovered my perfectionism when putting meticulous detail into essays and assignments. This was something that I found to be both a benefit and hindrance in a career where every woman/birthing person, birth and pregnancy is unique. Although there is a set of gold standard of care that we all strive to follow, midwifery is a career of lifelong learning with constant discovery of new evidence-based knowledge; it is not just acquisition of skills to be mastered, but rather practice to be adapted and refined.

I was able to recognise and take advantage of opportunities available in the perceptorship period by listening to advice from more senior colleagues and input from other healthcare professionals. Working with a culturally diverse population of women allowed me to provide a truly inclusive practice and adapt my care to support women and their family's unique values, beliefs and traditions. It also provided the opportunity to provide care for people with conditions and challenges more common in ethnic minority groups, such as female genital mutilation.

While on rotation of the different placements, I had the opportunity to shadow midwives working across all areas of midwifery, allowing for a holistic overview of the practice and a deeper appreciation for the importance of continuity in the system. It was also a chance to decide where my passion was and where I may wish to specialise in the future. I found working closely with more senior members of staff while under supervision provided a safe space to strengthen skills such as suturing under guidance from a female genital mutilation specialist midwife or experienced doctor, so I can better care for women with perineal damage.

Overcoming threats that may prevent your growth and development during this critical year is highly important. Midwifery is currently suffering from a nationwide shortage of staff. Lack of staffing may mean that preceptees are not able to receive appropriate levels of supervision during their initial supernumerary period, setting the foundations for gaps in knowledge and delaying the time to achieve competencies. Newly qualified midwives may also be required to take on a more independent role prematurely, creating a sense of anxiety and a loss of confidence in their ability to do the job and contributing to attrition rates. Speaking with the practice educational team to ensure supernumerary days are reallocated or extended will ensure there is enough time to do this. Disruption to placement allocations because of hospital building work taking place meant that I was unable to work in the birth centre. However, asking the labour ward coordinators to be allocated to low-risk women on several shifts meant that I was still able to gain the relevant experience of caring for such women during labour.

Coaching and mentoring

In order to support my growth and development, I enlisted the support of a coach on the NHS ‘Looking After You Too’ programme for NHS staff from minoritised ethnic groups. The service offered individual coaching support to help coachees prioritise their needs while also taking care of others. Coaching supported me with the pressures and challenges of my role, enabled me to challenge my thinking and develop practical strategies to cope at work.

I was allocated to Ruth Oshikanlu, a coach and mentor who is a senior midwifery and health visiting leader. The coaching sessions were accessed virtually and tailored to my individual needs. Ruth provided me with the tools to realise and use knowledge and skills that I already had, empowering me to overcome both work-related and personal obstacles and become more confident in my midwifery practice.

Since starting coaching, I have seen an increase in my goal-setting and self-reflection skills, and am now more ambitious with my future career goals in midwifery, with a clear plan of how to achieve them. Ruth also signposted me to resources and connected me with more experienced nurses who I could shadow, such as a perineal/female genital mutilation specialist midwife to support me with suturing skills.

Wisseman et al (2022) suggested that mentorship is especially beneficial in preventing burnout, a leading cause of attrition rates in newly qualified midwives. It does so by providing alternative ways of dealing with challenging situations from someone who has been there before. It has been great having Ruth as a sounding board to support my career goals. My advice to all preceptees is to ensure that they get coaching and mentoring to support them through their preceptorship programme.

Hopes for the future

Midwifery is a highly challenging, yet incredibly rewarding, career, regardless of how long you have been qualified. As I approach the final few months of my preceptorship journey, I realise this is not the end but rather the start of my lifelong learning in midwifery. For those undertaking preceptorship, the 12 months will fly by, so make the most of them, seize every opportunity and enjoy yourself. Focus on the reason that you made it through your midwifery training programme to become a registered midwife. You have worked incredibly hard to make it this far, and it is only the beginning to making a difference to those you serve as a midwife.

Having almost completed my preceptorship programme and recently being given the opportunity to support the induction and training of more junior midwives, my advice to those mentoring and supporting newly qualified midwives is to have empathy, patience and compassion, and to see supporting preceptee midwives as an investment. Remember what it felt like to be a newly qualified midwife who did not feel competent and confident. Share your midwifery expertise to enable them to have a smooth transition to a successful career in midwifery, which will help with retention. This will contribute to an easier adjustment and set the foundations for a full and rewarding midwifery career.