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Regulator Finds Poor Workplace Cultures in Maternity Care

Poor workplace cultures are affecting quality of care and staff retention in NHS nursing and midwifery services, according to a report by the Nursing and Midwifery Council (NMC).

It comes after a series of reviews into maternity care at trusts including Shrewsbury and Telford and East Kent. These cases were of "grave concern" to all involved in maternity services and the report reflected some of the issues raised in the inquiries, the NMC said.

"Recurring Themes" When Care Goes Wrong

The report detailed some "recurring themes" when maternity care went wrong. These included delays in escalating care in emergencies; poor communication between colleagues, and with women and families, and staff not speaking up when they witnessed something that was not right.

"It is clear that organisational factors get in the way of professionals providing the kind of care that women have a right to expect," the authors said. However, also evident was that the actions of individual professionals were often "shaped" by the culture and environment in which they worked, with "bullying, excessive workloads, burnout, and unsupportive management being contributory factors in major failings of care across different sectors".

Andrea Sutcliffe, NMC chief executive and registrar, said: "On the rare occasions that care goes wrong, it's often down to common factors getting in the way of the safe, effective, and kind care [that] people have a right to receive."

Racism Persists

The NMC highlighted that its register had become more ethnically diverse, with over one in four (28%) of nurses and midwives registered to work in the UK coming from Black or minority ethnic backgrounds – up from 18% in 2018. 

However, Black and minority ethnic staff were more likely to experience abuse and discrimination, with a "detrimental impact on care delivery", and this was factor affecting staff retention. Some new international recruits shared their experiences, which included not feeling respected or treated the same as colleagues, as well as being the target of racist and derogatory language.

Lack of Support for New Recruits

New starters across the professions "aren't always getting the standard of support they needed to feel confident in their roles", warned Ms Sutcliffe. In addition, the authors reported that the support for new recruits was "inconsistent".

'Preceptorship' programmes - designed to support all new professionals into their workplaces – were being delivered "haphazardly", with wide variation in the way they were organised and supervised by different employers, the authors pointed out. This resulted in "only a minority" of new professionals feeling highly satisfied with their preceptorship experience.

Commenting on the report's findings, Birte Harlev-Lam, executive director midwife at the Royal College of Midwives, said: "No health professional goes to work to do a bad job and we must all act when workplace cultures stop safe and high-quality care from happening. Crucial to this is supporting staff early in their careers and staff from overseas. They should not face racism or discrimination from anyone, especially their colleagues, and when this does happen, we must root it out."

Nicola Ranger, chief nursing officer at the Royal College of Nursing, said: "It is very concerning that newly qualified nurses feel unsupported and pressurised to provide care above their skill level. Early career nurses require greater support, and we must listen in their concerns and develop initiatives to improve the situation."

Dr Habib Naqvi, chief executive of the NHS Race and Health Observatory, welcomed the acknowledgement that racism affected retention of nursing and midwifery staff as well as patient care. Nurses and midwives "should not have to encounter incidents of racial abuse and discrimination from colleagues or patients", he stressed.

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