The Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis, 2013) highlighted how service users were receiving substandard care where staff did not exhibit core values such as care and compassion. In response to the identification of this basic failing, Health Education England (HEE, 2016) published its national values based recruitment (VBR) framework to encourage higher education institutions (HEIs) to introduce the values of VBR into their recruitment process. VBR is defined by HEE (2016) as:
‘an approach which attracts and recruits students, trainees and employees on the basis that their individual values and behaviours align with the values of the NHS Constitution, alongside their skills and aptitude.’
The Nursing and Midwifery Council (NMC) states that, at the point of registration, student midwives should be able to ‘practise safely and effectively without the need for direct supervision’ (NMC, 2009: 23). The required competencies are divided into four domains:
The competencies are linked to the essential skills clusters of communication, the initial consultation between the woman and the midwife, normal labour and birth, initiation and continuance of breastfeeding, and medicines management (NMC, 2009). Policy dictates that the midwife should support women throughout the childbirth continuum to have a positive and life-enhancing experience (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010). In terms of service users' expectations, women cite theoretical knowledge and clinical competency as key attributes of a ‘good midwife’ (Power, 2015); however ‘soft skills’ such as good interpersonal skills and moral/ethical values are of equal importance to ensure women feel supported, empowered and informed. Women's opinions being treated kindly and respectfully, with their dignity being maintained, are key elements in a positive childbirth experience (Healthcare Commission, 2007; Borrelli, 2014).
What does the service need?
In 2016, the Chief Nursing Officer for England launched Leading Change, Adding Value: A framework for nursing, midwifery and care staff (Cummings, 2016). This framework builds on Compassion in Practice (Department of Health, 2012) which introduced the expected core values and behaviours of health-care staff, entitled ‘the 6Cs’ (care, compassion, competence, communication, courage and commitment). The new framework encourages midwives, nurses and care staff to lead change in improving the health and wellbeing of the nation by offering an inclusive service providing high-quality care for all. In order to achieve this, resources must be used efficiently. In so doing, staff will be adding value to the 6Cs to ensure better outcomes and experiences for service users with better use of the resources available to them.
‘ Women should feel that they have been part of the decision-making process and, as midwives, we need to ensure that they have a voice ’
As part of the Clinicians in the Classroom series of articles (Power and Briody, 2016) matron for intrapartum care, Paula Briody, discussed how she feels an important part of her remit is to take a proactive role in the recruitment process; since arriving in post in 2013, she has been a member of every midwifery interview panel at her Trust. Paula believes that it is the responsibility of managers to ensure the right midwives are recruited to a strong team to ensure women are provided with choices in care that is of the highest quality, is safe and is woman/family-focused. Equally, she believes the Trust has responsibilities for its employees and midwives should feel happy, supported and valued by their employers.
Paula states that her main objective when interviewing is to see and feel that midwives have a passion for midwifery, that they understand the importance of the 6Cs and how both positive and negative birth experiences will have long-lasting implications, not only on the woman but the whole family unit.
Newly qualified midwives must have a clear understanding of and belief in the physiology of birth, and an awareness of factors that will both optimise and inhibit this process. The questions asked during the interview process aim to explore whether candidates possess the right qualities. Paula believes that the clinical skills required when caring for women—e.g. monitoring fetal wellbeing, epidural management, setting up and monitoring intravenous infusions etc—can be taught; however, it is not so straightforward to ‘teach’ qualities and values such as being able to care and show compassion and courage.
Advocacy is so important and requires courage; these are advanced skills for a newly qualified midwife. Women can often feel vulnerable and disempowered during labour and birth, so it is important that midwives build relationships with women and their partners to create an environment during labour that will promote a positive birth outcome. It is crucial that midwives have an awareness of how feeling disempowered can have a long-term negative effect on a woman and, ultimately, her family. Women should feel that they have been part of the decision-making process and, as midwives, we need to ensure that they have a voice (Blunt, 2014). These qualities are assessed at interview by asking candidates to reflect on an experience when they acted as an advocate for a woman and/or family for whom they were caring.
In 2013, Paula's Trust secured some funding to improve the birth environment and some of the monies were used to develop a birth centre. This attracted a great deal of interest from out-of-area midwives, as it could provide a wide range of choice of working environment—from an obstetric unit for higher-risk pregnancies to the award-winning homebirth team and birth centre for women on the low-risk pathway.
This popularity was advantageous to the unit, as it is always exciting to have midwives from different units or areas join the team, sharing new ideas and bringing suggestions from practices they have seen work in their previous Trusts. However, one disadvantage of this popularity was that, one year, not all of the students who had their clinical placements at the Trust were able to secure a position. This led to Paula facilitating a regular session at the university to talk about preparation for interview in order to help students to be as fully prepared and, therefore, as competitive as possible for the limited number of vacancies. Some of the students share their interview preparation tips in Box 1.
Summary
It is clear that the contemporary midwife requires a wide range of skills and attributes to meet the diverse demands of the service user, government policy, the NMC and the employing organisation. Using values based recruitment, HEIs aim to recruit students who possess the core attributes which align to the values of the NHS Constitution (Department of Health, 2015), to then nurture and develop these values throughout the student journey. As students reach the end of their studies and approach qualification, they apply for preceptorship posts and prospective employers expect to hear evidence of how candidates have implemented the 6Cs in practice, as well as their academic achievement and clinical competency. Competition for securing a place on a midwifery undergraduate programme is fierce and, despite staff shortages, this competition is still evident when applying for jobs. The midwife of today must be ‘all singing, all dancing’—clinically competent and confident, kind and caring with a great brain to ensure practice is based on best evidence. To all student midwives about to qualify: congratulations on your huge achievement, and the very best of luck in securing your first post and becoming a member of this special profession.