This mixed-methods study examined Family Systems Care (FSC) implementation through a 1-day educational session combined with 4 months of guided application of FSC knowledge and skills in obstetrics and gynecology settings. Nurses and midwives’ ( n = 47) attitudes toward families and their practice skills with families were assessed before the educational intervention began (Time 0), after the completion of the 1-day educational session (Time 1), and after 4 months of the FSC guided implementation phase that included coaching and mentoring (Time 2). Four focus groups with the nurses and midwives explored their FSC implementation experiences. Participants reported an initial drive to implement FSC, which faltered over time. A perceived fit to the needs of families in obstetrics and gynecology, a supportive context, and facilitated learning on the units promoted FSC uptake. Participants understood FSC as: (a) involving family members in care, a practice they felt confident about; (b) assessing families’ situations, needs, concerns, which were practices that were new and stressful; and (c) offering family nursing interventions, which they felt insufficiently prepared for. Practice skills in FSC increased after the 1-day educational session but decreased to baseline after the FSC guided implementation phase. Attitudes of the nurses and midwives toward the families did not change. Following the education and guided implementation, participants’ ability to work with families in a relational, systemic way could not be fully established or sustained.

Background Health systems around the globe are struggling to recruit qualified health professionals. Work-related stress plays an important role in why health professionals leave their profession prematurely. However, little is known about midwives’ working conditions and intentions to leave their profession, although this knowledge is key to work force retention. Therefore, we aimed to investigate work-related stress among midwives working in Swiss maternity hospitals, as well as differences between midwives and other health professionals and the stressors associated with midwives’ intention to leave the profession. Methods We conducted a data analysis of two cross-sectional studies encompassing midwives working in labour, postpartum and/or gynaecology wards of 12 public Swiss maternity hospitals. Data was collected by self-report questionnaire assessing potential stressors and long-term consequences of stress at work. Data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression modelling. Results A total of 98 midwives took part in the study and one in three midwives reported doing overtime sometimes-always. Also, the score for work-private life conflicts was significantly higher among midwives than among other health professionals, with the exception of physicians (M = 37.0 versus 50.2, p < .001). Midwives’ meaning of work score (M = 89.4) was significantly higher than that of other health professionals (e.g. nurses (M = 83.0, p < .001) or physicians (M = 82.5, p < .01)). Generation Y midwives showed a significantly higher intention to leave their organisation than did the baby boomers (Mean scores 29.3 versus 10.0, p < .01). Results of the regression model revealed that if midwives could compensate for their overtime in the same month, their intention to leave the profession was lower (OR = 0.23, p < .05). Additionally, the more midwives were affected by work-private life conflicts (OR = 3.01, p < .05) and thoughts about leaving their organisation (OR = 6.81, p < .05), the higher was their intention to leave their profession prematurely. Conclusions The comparison with other health professions and the higher intention to leave the profession of younger midwife generations are important findings for heads of institutions as well as policy makers, and should stimulate them to develop strategies for keeping midwives on their staff. More extensive studies should implement and test interventions for reducing work-related stress and increasing the job and occupational satisfaction of midwives.

INTRODUCTION Job satisfaction of midwives is important to prevent skill shortage. Those working in midwife-led models of care work more independently and have more responsibility. No previous study investigated if a self-initiated and self-responsible project could enhance job satisfaction of midwives working in a medical-led maternity unit. The aim of this study was therefore to assess job satisfaction before and after the implementation of such a project. METHODS This is longitudinal observational study at three time points using quantitative and qualitative methods. A total of 43 midwives working in a Swiss labor ward participated in the online surveys and in the focus group discussions. The surveys comprised questions from validated instruments to assess job satisfaction. Descriptive and multivariable time series analysis were used for quantitative and content analysis for qualitative data. RESULTS Adjusted predicted scores decreased between t 0 and t 1 , and subsequently increased at t 2 without reaching baseline values (e.g. 'professional support subscales' between t 0 and t 1 : (0.65; 95% CI: 0.45-0.86 vs 0.26; 95% CI: 0.08-0.45, p=0.005) and between t 0 and t 2 (0.65; 95% CI: 0.45-0.86 vs 0.29; 95% CI: 0.12-0.47, p=0.004). Focus group discussions revealed four themes: 'general job satisfaction', 'challenges with the implementation', 'continuity of care' and 'meaning for the mothers'. Midwives perceived the additional tasks as stressors. CONCLUSIONS The implementation of new projects might enhance work-related stress and consequently have negative impacts on job satisfaction in an early phase. Heads of institutions and policy makers should recognize the needs of support and additional resources for staff when implementing new projects.

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Background: Job satisfaction of midwives is important to prevent skill shortage. Those working in midwife-led models of care were more satisfied than those working in standard care. Job satisfaction in the context of a midwife-led project was not researched previously. The aim of this study was to investigate job satisfaction before and after the implementation of a midwife-led intervention.Methods: Longitudinal observational study at three time points using quantitative and qualitative methods. A total of 43 midwives working in the labour ward participated in the online surveys and 5-7 in the focus group discussions. The surveys comprised questions from validated instruments. Descriptive and multivariable time series analysis were used for quantitative and content analysis for qualitative data.Results: Adjusted predicted scores decreased between t0 and t1 and subsequently increased at t2 without reaching baseline values (e.g ‘professional support subscales’: between t0 and t1: (0.65, 95% CI [0.45, 0.86] versus 0.26, 95% CI [0.08, 0.45], p=0.005) and t0 and t2 (0.65, 95% CI [0.45, 0.86] versus 0.29, 95% CI [0.12, 0.47], p=0.004). Focus group discussions revealed three themes: “Job satisfaction”, “Challenges with the implementation” and “Continuity of care”. Midwives perceived the additional tasks as stressors. Conclusion: The implementation of new interventions might increase work related stress and decrease job satisfaction in an early phase. This effect was stronger than the one of acquiring more autonomy and responsibility. Heads of institutions and policy makers should recognise the needs of support and additional resources for staff when planning new projects.