This study describes and evaluates a structured program for orientation of new graduate registered nurses in a setting that has increased the number of new graduate RNs hired in recent years. It describes the elements of a supportive environment for new RNs and brings attention to the need to develop support and recognition of nurse preceptors, who are noted to be the cornerstone of support for new RNs as they make the transition from student to accomplished professional.

The shortage of health workers worldwide has been identified as a barrier to achieving targeted health goals. Task shifting has been recommended by the World Health Organization to increase access to trained and skilled birth attendants. One example of task shifting is the use of cadres of health care workers, such as nurses and auxiliary nurse-midwives, who can successfully deliver skilled care to women and infants in low-resource areas where women would otherwise lack access to critical health interventions during the childbearing years. Midwives for Haiti is an organization demonstrating the use of task shifting in its education program for auxiliary midwives. Graduates of the Midwives for Haiti education program are employed and working with women in hospitals, birth centers, and clinics across Haiti. This article reviews the Midwives for Haiti education program and presents successes and challenges in task shifting as a strategy to increase access to skilled maternal and newborn care and to meet international health goals to reduce maternal and infant mortality in a low-resource country.

The results of this study are significant to international health care organizations that use volunteer health care professionals to provide services. The results support a growing body of knowledge that international health aid organizations may use to strengthen the preparation, support, and effectiveness of volunteer health providers.

We applaud the efforts by Floyd and Brunk in their article on using task shifting in Haiti to find a creative, cost-effective, temporary solution to providing needed care in an area with poor maternal health outcomes. 1 Although the authors provide the agreed upon definition of a skilled birth attendant (ie, physician or midwife as defined by the International Confederation of Midwives [ICM]), they appear to incorrectly refer to their graduates as meeting that definition (Table 1 in Floyd and Brunk article 1 ). The graduates of the described education program meet a list of competencies (Table 2 in the Floyd and Brunk article 1 ). These are not consistent with the ICM Essential Competencies for Basic Midwifery Practice, 2 and the education program does not meet the ICM Global Standards for Midwifery Education. 3 We believe that the graduates should be considered providers with important midwifery skills that are meeting a need in hard-to-reach communities in Haiti. However, they should not be seen as a permanent solution in lieu of developing a fully qualified midwifery workforce comprised of fully qualified midwives as defined by ICM, and other fully qualified health professionals providing midwifery care. We recognize the challenges to establishing quality midwifery education programs, including the need to develop collaborations with regulators and governments that can be difficult to forge. 4 Midwifery education programs consistent with ICM standards should be our ultimate goal in order to improve the health of women and their infants and families.