|
courses | hecs/oldps
| higher education home | higher
education links
publications | issues | research | scholarships | statistics | universities
Contents |
Next
National Review of Nursing Education
Midwifery Education
Literature Review and Additional Material
(Revised Edition)
Conclusion
Australia is part of global trends leading to shortages of workers in
traditional female professions. At the same time, many non-European
Western countries are trying to work out the ‘best’ way to educate
midwives.
Australia shares many issues and concerns with other western countries
and health systems. These include:
-
The need for support and education for midwives to address
new models of care;
-
The development of midwifery teaching and learning
frameworks;
-
Financial support for student midwives and the issue of
fees;
-
Debate and resolution of the supernumerary versus employed
status of student midwives;
-
Agreed and valid midwifery competency assessment/s;
-
The attrition and the retention of midwives in practice;
-
Debate and resolution of the part-time/full-time study
issue;
-
Processes of selection of students;
This report has raised serious concerns regarding inconsistencies
within this country across our states and territories regarding the
education and regulation of Australian midwifery. The lack of professional
coherence, adequate funding mechanisms and a vehicle for national
leadership has led to a situation where there are serious concerns about
the standard of midwifery education in Australia, particularly when
comparisons are made with midwifery education in other western countries.
We demonstrate that concerns raised by Barclay in her 1986 analysis of
midwifery education and practice have remained consistent and have been
exacerbated by the move to university based education.
The lack of appropriate regulatory control allowed hospitals previously
and universities today to remain free of scrutiny and accountability. The
reviewers suggest that although there were problems while hospitals were
in control of educating midwives, in many places they took ownership of
midwifery education and were able to meet their workforce and clinical
competency requirements. Many students were part of large women’s
hospitals who focussed their education on practice and workforce needs.
Midwifery now exists in nursing schools in universities and not all of
theses are able to provide the leadership, focus or resources necessary to
achieve acceptable outcomes.
Information collected for this review leads the authors to conclude
that although university education is an important achievement, inadequate
regulation and the lack of monitoring associated with this development has
led to the following situations:
-
Industry lost its power in relation to the numbers of midwives being
educated and clinical practice requirements;
-
The midwifery professional body has little influence on midwifery
education standards and there is no national coherence regarding policy
and the funding of midwifery education;
-
Midwifery educators tend to be isolated from practice areas;
-
The lack of midwifery specific regulation has increased
inconsistencies in the accreditation of programs and standards.
In specific terms this report has highlighted the following issues:
-
Workforce shortage and mal-distribution of age groups in
Australian midwifery with workforce needs not being addressed by current
courses enrolments;
-
Problems of attracting students into full fee paying
programs and financial burdens for midwifery students that are
exacerbated in supernumerary courses;
-
Inconsistencies within midwifery course accreditation
requirements and regulation of practice in Australia;
-
Lack of nationally agreed and applied standards of midwifery
education;
-
Insufficient professional and industry influence over
courses and student selection procedures in Australia;
-
Industry concerns that some programs do not prepare
competent or employable graduates;
-
Increasing incompatibility of Australian midwifery education
with international standards;
-
Attrition rates in some programs and areas are excessive and
enrolments are low suggesting problems of quality and credibility in
these programs;
-
Insufficient control and monitoring of the transfer of
midwifery education to universities by professional and regulating
authorities;
-
Problems addressing the needs of rural Australia, especially
Indigenous communities within current courses, though there are some
important exceptions;
-
Retention strategies for graduates are not well designed or
developed;
-
Strategies for midwifery educational reform in Australia are
originating from the professional body currently, but there are no
national or State and Territory commitments or incentives to comply with
this initiative;
-
The continuing education of midwives in Australia remains ad
hoc and there are no incentives or requirements for maintenance by
organisations or individuals;
-
There are promising examples of flexible delivery of
midwifery education, but issues of quality control need careful
monitoring;
-
Competency standards and assessment standards are not
nationally agreed or applied;
-
Regulation for midwifery education and practice is of
variable quality and not consistent;
-
Nursing educational priorities have taken precedence in
educational institutions and regulating bodies, therefore decisions and
leadership have not necessarily reflected the professional midwifery or
industry needs as well as is required.
Outline of models of good practice
Models of good practice are presented in the Review and are summarised
here.
-
Examples of high quality post (nursing) graduate midwifery programs
that meet the needs of the midwifery workforce, including examples of
creative teaching and learning methods and an evidence based approach to
midwifery education;
-
The Australian three-year Bachelor of Midwifery program national
development process and the developments of national standards for the
accreditation of these three-year programs that could also apply to
Graduate Diploma programs;
-
Exemplars of quality education programs to address the needs of rural
communities;
-
International midwifery education, developments in service provision
and standards;
-
Innovation in teaching and learning and industry collaboration.
Lessons for policy approaches
This review highlights important considerations for policy approaches,
which can be summarised thus:
-
There are serious implications involved in imposing postgraduate fees
on entry to a new discipline that is an essential component of safe
health care;
-
There are difficulties establishing national standards associated
with the jurisdictional independence of Boards in each State and
Territory and no commitment to consistency of accreditation of midwifery
education;
-
There is a need for policy support for the 'direct entry' option to
achieve the same professional qualification as postgraduate courses for
nurses in a shorter time through the Australian Bachelor of Midwifery,
particularly in light of recruitment issues and international
compatibility;
-
Health services need to take responsibility and provide a commitment
to collaboration with other key stakeholders in relation to student
learning (eg. providing student placements in a range of midwifery
models as well as situations involving medical and high risk care, to
ensure the range of skills of graduates);
-
There needs to be combined education and health service commitment to
the value and logistics of setting up of joint clinical and teaching
posts and education for preceptors/facilitators/mentors;
-
Active support and incentives are required for rural students and
Aboriginal and Torres Strait Islander students;
-
There is an urgent need to specifically regulate midwifery education
and practice and for the development and application of national
standards for midwifery education and practice within jurisdictions;
-
Research is needed to investigate, monitor and evaluate the
introduction of the Bachelor of Midwifery and compare and standardise
outcomes with a strengthened and improved national approach and
standards for the midwifery education of nurses.
Contents |
Next
top
|
