‘You're a third year now…’ is a phrase frequently cited as a reminder that student midwives in their final year of the pre-registration programme are on a ‘countdown’ to qualification, and the associated responsibilities of autonomous practice.
The Nursing and Midwifery Council (NMC, 2009: 21) Standards for pre-registration midwifery education state that ‘student midwives must be proficient in all NMC Standards by the end of their training in order to practise safely and effectively without the need for direct supervision. The standards are divided into four domains:
The standards also state that pre-registration midwifery programmes must be at least 3 years, or the equivalent to 156 weeks full-time. However, anecdotal evidence of students' experiences suggests that there is a culture of expectation that they should be proficient from the start of year 3, even though they are only two thirds of the way through their training. While this expec tation may be viewed positively, in that men tors are confident in their students' abil ities, it is important that students feel supported if they either per ceive a task to be outside of their sphere of practice or do not feel confident and com petent to under take it, without the fear of recrim ination. With England alone currently facing a deficit of nearly 3500 midwives, the recent Royal College of Midwives (RCM, 2016) survey on why midwives leave is uncom fortable reading. The top five reasons given in the survey for midwives leaving the profession were:
In this context, it has never been more important for student midwives to successfully complete their studies to join the depleting workforce.
Students' experiences
Despite the significant challenges facing the midwifery profession, there is optimism. The following quotes are from students at the University of Northampton who have recently commenced their third year of training, who were invited to share their thoughts about embarking on the final year of study. There is a clear sense of achievement, motivation, excitement and relief at reaching the final year of the pre-registration programme—although, admittedly, this is tempered by a sense of apprehension with regard to their responsibilities as senior students and, subsequently, as newly qualified midwives.
‘In terms of being a third year, everyone—literally, everyone— says, “That's gone so quickly… Ooh it's getting serious now isn't it? This time next year you'll be qualified!” I suppose you know that more is going to be expected of you. You can't really get away with saying, “I'm a student midwife, I'm not really sure” anymore! It's a scary thought because you're meant to be performing most clinical skills, whilst supporting the woman and her family, all the while maintaining documentation. I had my first shift as a third year on labour ward recently and felt like I didn't have enough hands! Having said that, though, when there was a postpartum haemorrhage, I felt so much more useful—I knew where things were and how I could help. This is in stark contrast to my first year where I observed, terrified, and second year where I was not confident enough to take an active role without someone telling me to.’ (Victoria Ivimey-Cook)
‘When going into third year, alarm bells start to ring—“Am I going to qualify? Do I want to get a first or a 2:1? Am I really ready?” Having a year out between second and third year, well, the bells are louder. There is this massive speculation that you will know from day one how to hold a clinic on your own, or to deliver a baby with your mentor only supervising. OK, you may be lucky enough to have this confidence from second year which you can develop on. Me? I have none. Having a year out then coming into third year is like someone giving you IKEA flat-pack furniture and expecting you to build it without the instructions—it's hard! Which part goes where? Am I supposed to have an extra screw? Who knows, but all I can say for now is that I will keep trying to build it over and over again until all the pieces fit together.’ (Hannah Glasgow)
‘When mentors say, “You're now in your third year,” I'm simultaneously proud and terrified! Beginning [the] third year has felt overwhelming and exciting all at once. I'm so fearful about applying for a job—I would love to work at my host site. I have a million things running through my head.’ (Caitlin Carter)
‘It's hard to put those feelings into words when you start third year. When you walk onto the ward it's like your first day of placement all over again, you feel like a first year, out of your depth. Your achievements aren't quite as obvious to the outside world; you aren't delivering your first baby or commencing your first cardiotocograph by yourself. It might not look like you did anything “exciting” on that shift, but to be able to get home and know that you successfully led the care of eight women and their babies is a huge personal milestone. To be asked a series of questions by an anxious new mother and know the answers to all of them is empowering and totally new. It doesn't really feel like the final year of training, but the beginning of your career as a qualified midwife.’ (Amy Leggett)
‘Going into the third year and going into practice—the only word that can sum it up is “daunting”. On my first day as a third year in community, I was just as nervous as my first day on shift as a first year, because I felt like I was expected to know it all. I think we put a lot of pressure on ourselves because we are seen as the most “experienced” students.’ (Natalie Eddington)
‘When mentors say you're in your third year, you think that it's like passing your driving test and when you've been given a car—you have so much more freedom, which is great, but sometimes you wish that dual controls were installed! On the one hand, you can see the light at the end of the tunnel: employment, money, first house, adulthood, more spare time. On the other, it's like you don't want your umbilical cord to be cut from your mentor… the responsibility is exciting but, occasionally, overwhelming.’ (Beth Burns)
Conclusion
It is clear that the final year of pre-registration midwifery education elicits complex emotions in student midwives, ranging from a sense of pride in their achievements to apprehen sion at the magnitude of their future responsibilities as a registered midwife. The challenge for education and placement providers is to support students to remain motivated throughout their studies and ensure that they feel well supported, particularly in their final year as they ‘cut the cord’ and enter the world of midwifery practice.
‘I was just as nervous as my first day on shift as a first year, because I felt like I was expected to know it all. I think we put a lot of pressure on ourselves because we are seen as the most “experienced” students’