UTS Professor of Midwifery Caroline Homer was part of the research project that developed the new midwifery competency standards. She spoke to Kate McDonald of Nursing Review.
Tell me about the background to the project.
We started in the middle of last year and it's been coming for a long time. In the 90's there were competency standards that were developed for midwives by the Australian College of Midwives (ACMI) but they were not universally adopted around the country. Some states like Tasmania and Victoria embraced them in their regulation, the NSW Registration Board developed their own and other states said you had to be competent on the nursing competencies and we don't care about the midwives. It was a mess.
Are the standards nationally applicable?
They haven't been signed off in each jurisdiction as yet as they were only signed off by the Australian Nursing and Midwifery Council late last year. They've done the rounds of the [registration] boards but I don't think they've had sign off with all of them. They are currently with the College of Midwives for endorsement as well.
Movement within the jurisdictions is obviously a good idea.
It's a very good idea. And it's also recognising that the last five years has seen a lot of changes in midwifery, one of which is we now have direct entry bachelor of midwifery students so it's not sensible and nor is it appropriate that those people fulfil (nursing) competencies because they are not nurses. And equally for many people like myself - I'm an unsafe nurse. I haven't worked as a nurse for a long time. Again, it's not sensible for me to be trying to meet nursing competencies when I work as a midwife. It's a much cleaner way that we say you are a midwife, that's how you practice, this is what you should do. You could probably say that midwives were reasonably similar across the country; it's just what the registrations board in her state required. In some states you had to sign off saying you were competent according to something, in some states it was the ACMI competencies and in some it was some that they had made up. In NSW you still don't have to sign off that you are competent at all, on anything, as a midwife or a nurse, as the regulation hadn't got that far yet, but we expect that to change.
Did you look at international trends in competencies?
We looked at New Zealand, because we have a trans-Tasman agreement so it's important that our competencies were in line with them and we had the New Zealand College of Midwives review our competencies to make sure that we are on the right track. (We studied) the UK NMC (Nursing and Midwifery council) standards, we also looked at the Canadian and some of the European ones.
Will the standards be used to test midwives?
No, the way they are used is initially by universities and education providers to make sure that the midwives they are training can meet those competencies at the end. Then they are used in performance appraisal, as self-assessment between employee and employer. Midwives are increasingly using competency standards and we would hope that they would use these ones. It is mainly a self-assessment tool, although in some states like Tasmania they do audits where they ask midwives to provide evidence of competence, and that's also a self-assessment or assessment with a peer midwife or employer.
Is this a further step towards midwifery becoming a separate profession from nursing?
It is certainly recognised now around the country that midwifery is a separate discipline (although) the competencies in structure are quite similar. There are four domains, which there are in the ones for the registered nurse and enrolled nurse, and some of them - like the first one, legal and professional - share a lot of similarities. It seems logical that those legal things are going to be the same, but throughout the competencies you see that they are quite different, which does reflect what midwifery is.
Do you think nurses will continue to study midwifery as well?
I think it's becoming less. (There are) regulations in three states recognising it as a separate discipline and it's coming across the board. In rural areas it may remain the case but in many rural areas they are changing the way they provide care, so instead of midwives also running the emergency department midwives are just doing midwifery, taking a caseload of women in that area. We hope that there will always be nurses who want to do midwifery but I think the numbers who will end up doing both, particularly in metropolitan areas, it will be less.
The Australian Midwifery Competency Project was undertaken by researchers from the UTS Centre for Midwifery, Child & Family Health, the University of South Australia and Edith Cowan University. For more information, email Caroline.Homer@uts.edu.au.