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NZNO (Inc.) Submission to  
						
						
								the 
								Midwifery Council of NZ
						
				
				
				
		
		
				
						Second Scope of Practice: Midwifery Assistant Consultation document (August 2007) 
				
		
		
				
						Contact: Susanne Trim susannet@nzno.org.nz
				
		
		
				
						
								Introduction The NZNO represents over 39,000
				 members on both professional and industrial issues across the public, private and community sectors. NZNO has approximately 800 midwifemembers, the majority of whom work as employed midwives, either in a core, team or continuity of care capacity. NZNO also represents a small number of independent LMCs. NZNO has an activemidwifery network and midwife delegate support systemin major maternity facilities. NZNO also has an activeRegistered Obstetric Nurses network and Enrolled NursesSection. NZNO has consulted with its midwife andsecond level nursing members in preparation of thissubmission. The issue of a second level midwiferyassistant has excited considerable discussion and input.Recommendations The NZNO recommends that The Midwifery Council •Agree that the Consultation Document hadsignificant omissions which compromised scope of thediscussion and potentially biased the responses; • Undertake a full study of the clinical need of clients where it isenvisaged any proposed second level practitioner would beworking and then re‐ consult providing a range of options onhow the clinical need may best be met. This may includeusing other regulated practitioners besides that proposed inthe consultation document. NZNO recognises that this workmay fall outside the scope of the regulator but could beundertaken in conjunction with service providers andprofessional associations; • Collate a national stock take of the current use of midwiferyassistants and the activities that they undertake. Thisinformation should inform the debate on any future of a regulated midwifery assistant position; • Note that NZNO does not support the introduction of a regulated midwifery assistant scope of practice; • Note that NZNO agrees that urgent strategies need to be introduced to address the current workforce issues within maternity services. • Note that NZNO supports a skill mix inclusive of nursing in level 3 care. The Consultation Document Of note, was the omission in the consultation document of any discussion of the history in NZ of the skill mix in maternityservice facilities. This history is important in considering an appropriate response to the current situation and any proposal for anew category or regulated health professional. A second level health practitioner in maternityservices is not a new concept in NZ. Indeed, Karitanenurses (not regulated but with a nationally acceptedtraining programme), Registered Obstetric Nurses andEnrolled Nurses with a 6 month obstetric endorsementhave all had an important role to play in maternityservice delivery in the recent past. Many of NZNO’srespondents commented on the use and abuse of this importantsecond level midwifery workforce and the lack of job security as thecurrent shortages of the midwifery workforce are addressed. Historywill show the vulnerability of second level health professionals. Another regulated disciplinary group, not identified within the consultation document, is the Registered Nurse (RN). Manymaternity service providers have included RNs in the skill mix in thepast. Over time, these RNs were compelled to either retrain as aRegistered Midwife (RM) or have been redeployed out of maternityservice units as the new philosophical movement of midwiferypractice emerged in the early 1990s and the move was towards thelead maternity carer model which was woman‐ centred withcontinuity of carer. The consultation document fails to provide discussion aboutthe impact of the introduction of a second level regulated workforceon that philosophical foundation of NZ’s maternity model or thepotential of fragmentation of care. Nor does the consultation document present an analysis ofthe current need for care other than a shortage of midwives andanecdotal evidence that some assistants are supporting midwiferypractice in a variety of ways. It is the clinical need of the womenwhich should be driving discussion on a second level practitioner,and how that clinical need can best be met, not the fact thatunregulated assistants are already providing a level of care. Forexample, the feedback from NZNO midwives clearly identifies a needfor additional nursing resource to complement midwifery care intertiary level hospitals and not a new regulated midwifery assistant. Determining the Current Situation     The response form provided by the Midwifery Council is useful in determining the current use of midwifery assistantshowever this information could have been sourced by a maternityservice provider survey also.     The feedback from NZNO members indicates that assistants are used in a variety of ways, but mainly for “hotel”support activities and personal hygiene support for motherand child. Also they may be asked to assist a midwife in aparticular situation but that is under the direct supervisionand instruction of a midwife as they work in a tandem, not ina delegated authority type of situation. Establishing a Midwifery Assistant Role The NZNO does not support the introduction of a second level regulated midwifery assistant. However, NZNO does recognisethe need to address the current workforce issues within thematernity services urgently. Many of the members providing input to the NZNOsubmission identified that the current second level nursingworkforce should be considered rather than a new regulated midwifery scope. Proposals ranged from reinstatement of an 18month registered obstetric nursing training to a 6 monthendorsement on the Nurse Assistant programme. The emphasis wason having a core of nursing knowledge with an additional specificobstetric/infant care component. It is noted that these programmeswould be 12‐ 18 months of duration. Addressing the Workforce Issues NZNO agrees that the skill mix within maternity services needs to bestrengthened and that the current midwifery workforce shortage iscompromising quality care. The questions of recruitment andretention of midwives, clinical need and an analysis of the mostappropriate skill mix to meet that need should be the drivers of anyfuture midwifery workforce development, rather than the currentreactive proposal outlined in the consultation document. NZNO believes that the question of an apparentmidwifery shortage needs further analysis and that thequestion to be answered is “is there a midwifery shortage orjust an unwillingness of midwives to work in midwiferypractice?” An answer to this question may then raise arange of potential solutions to attracting midwives back intothe profession. Many members provided considered responsesabout the skill mix they see is required within their practicesettings. These included an increase in the level of nursing skillsrequired for complex maternity service provision. The potential useof second level nurses is identified in the section above. Theinclusion of RNs in the skill mix, particularly in level 3 care, wasidentified as providing a significant improvement in meeting theneeds of those with complex need. Many respondents also said thata proactive process to recruit RNs into midwifery training should bean aim of the Council’s with a shortened (12 month) programme tobridge to RM registration. Conclusion In conclusion, the NZNO recognises the current midwifery shortagebut believes that further work in identifying need and the range ofoptions to address that need should occur before discussion on theregulation of a midwifery assistant scope of practice. This is only onepossibility from a range of options many of which have been raisedby NZNO members.
		
				
						Sent in by NZNO and reprinted with permission