研究报告称美国助产士的职业倦怠率较高

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A new study indicates 40% of midwives in the United States are burned out or stressed and exhausted, putting them at risk for making medical errors and missing necessary patient care. Burnout also leads to less professional engagement, reduced productivity, absenteeism and resignations, according to new research published in the leading journal, Health Services Research.

Almost a third of all certified nurse-midwives and certified midwives in the United States participated in the study-;making it one of the largest burnout studies of a single profession ever conducted. In the study, midwives reported a higher rate of burnout than maternity nurses and about the same levels of stress as OB/GYNs.

Our findings indicate that a supportive practice climate, specifically effective leadership, organizational participation and supporting the unique perinatal care provided by midwives, is essential to burnout prevention."

Brie Thumm, PhD, CNM, RN, MBA, FACNM, Study Lead Author and Assistant Professor at the  College of Nursing, University of Colorado

While many speculate that the stress and exhaustion are due to working long hours or having too many patients, the researchers actually found the predictors of burnout to be poor leadership and support. Midwives cited a lack of professional recognition, staff and resources, control over clinical practice and practice autonomy, and a negative work environment. But researchers also found reason for optimisim. They say those problems can be fixed with cost-effective, straightforward changes in the practice environment.

"Workforce development initiatives should therefore aim to cultivate midwifery leadership and ensure there is a midwife on key decision-making committees to drive how we care for pregnant people and their families," she wrote.

Another predictor of burnout identified by the researchers was a lack of support for the midwifery model of care. Midwifery care puts the birthing person in the center of the care team with shared decision making and promotes low-intervention birth. Midwifery care is associated with lower rates of cesarean birth, pre-term birth, low birth weight infants, and neonatal mortality. Therefore, strategies to prevent burnout can also improve birth outcomes, the authors conclude.

Critical to health care

The study was the first investigation of midwifery burnout in the U.S. since 1986. The researchers include Dr. Thumm and Denise Smith, PhD, CNM, FACNM both from CU Nursing, Allison Squires, Phd, RN, FAAN of New York University Rory Meyers College School of Nursing; Ginger Breedlove, PhD, CNM, APRN, FACNM, FAAN of Grow Midwives; and Paula Meek, RN, PhD, FAAN, ATSF of the University of Utah College of Nursing. The research was part of Thumm's graduate dissertation. Data was collected by anonymously surveying midwives around the United States.

Shortage of maternity care providers

The finding that two in five midwives are burned out is significant. With an increasing shortage of maternity care providers around the US, midwives are needed more than ever to fill a gap in the workforce. Nearly half of all of the counties in the US don't have any maternity care providers, according to the report. The midwifery workforce can also reduce the workload on physicans and their levels of burnout.

Yet today, only 13,000 Certified Nurse-Midwives attend 9.8% of births nationwide. The study highlights that many of those remaining midwives are burned out and thinking of quitting.

"Increasing the numbers of practicing midwives is an important strategy toward correcting access to care issues and improving maternal health outcomes. However, midwifery burnout is a barrier to growing the midwifery workforce, and is associated with workforce instability and adverse patient outcomes," the researchers wrote.

No evening anxiety

Not all of the midwives in the study were dissatistifed with their jobs. Midwives who worked mostly nights were happier than those who worked any time during the day. The researchers suggest that's because evening workers have more automony and deal with fewer competing work obligations like meetings and outpatient care. In fact, the more time midwives spent with the patients, the survey found the less stressed out they were. Midwives attending births at home where they have more time with patients were more content in their work compared to midwives attending births in other settings.

With their findings, the researchers encourage policy makers and administrators to invest in better practices that support the midwifery model of care, including midwives in decision-making, and improving staffing and support from colleagues. Those kinds of simple changes could relieve their stress, prevent them from leaving the workforce, and encourage others to become midwives to create a robust U.S. midwifery workforce to improve maternal health care.

Source:

University of Colorado Anschutz Medical Campus

Journal reference:

Thumm, E. B., et al. (2021) Burnout of the US midwifery workforce and the role of practice environment. Health Services Research. doi.org/10.1111/1475-6773.13922.

全文翻译（仅供参考）

一项新研究表明，美国 40% 的助产士已经精疲力竭或压力过大，精疲力竭，使她们面临发生医疗错误和错过必要的病人护理的风险。根据发表在领先期刊《健康服务研究》上的新研究，职业倦怠还会导致职业参与度降低、生产力降低、旷工和辞职。

美国所有认证助产士和认证助产士中几乎有三分之一参加了这项研究——使其成为有史以来对单一职业进行的最大的职业倦怠研究之一。在这项研究中，助产士报告的倦怠率高于产科护士，压力水平与 OB/GYN 大致相同。

我们的研究结果表明，支持性的实践氛围，特别是有效的领导、组织参与和支持助产士提供的独特围产期护理，对于预防职业倦怠至关重要。”

Brie Thumm, PhD, CNM, RN, MBA, FACNM, 研究主要作者和科罗拉多大学护理学院助理教授

虽然许多人推测压力和疲惫是由于长时间工作或有太多病人，但研究人员实际上发现倦怠的预测因素是领导力和支持不佳。助产士指出缺乏专业认可、人员和资源、对临床实践和实践自主权的控制以及消极的工作环境。但研究人员也找到了乐观的理由。他们说，这些问题可以通过在实践环境中进行具有成本效益的直接改变来解决。

“因此，劳动力发展计划应旨在培养助产士的领导能力，并确保关键决策委员会中有助产士，以推动我们如何照顾孕妇及其家人，”她写道。

研究人员确定的另一个职业倦怠预测因素是缺乏对助产护理模式的支持。助产护理将分娩者置于护理团队的中心，共同决策并促进低干预分娩。助产士护理与较低的剖宫产率、早产率、低出生体重婴儿和新生儿死亡率有关。因此，作者总结道，防止倦怠的策略也可以改善生育结果。

对医疗保健至关重要

该研究是自 1986 年以来对美国助产士倦怠的首次调查。研究人员包括来自纽约大学护理学院的 Thumm 博士和 Denise Smith, PhD, CNM, FACNM，纽约大学 Rory Meyers College 的 Allison Squires, Phd, RN, FAAN护理学院；Ginger Breedlove, PhD, CNM, APRN, FACNM, FAAN of Grow Midwives；和犹他大学护理学院的保拉米克，RN，博士，FAAN，ATSF。该研究是 Thumm 研究生论文的一部分。数据是通过匿名调查美国各地的助产士收集的。

产科护理人员短缺

五分之二的助产士精疲力竭的发现意义重大。随着美国各地产科护理提供者的日益短缺，助产士比以往任何时候都更需要填补劳动力缺口。报告称，美国近一半的县没有任何产科护理提供者。助产士劳动力还可以减少医生的工作量和他们的倦怠程度。

然而今天，全国只有 13,000 名认证护士助产士接生了 9.8% 的分娩。该研究强调，许多剩余的助产士已经筋疲力尽并考虑辞职。

“增加执业助产士的数量是纠正获得护理问题和改善孕产妇健康结果的重要策略。然而，助产士倦怠是增加助产士劳动力的障碍，并且与劳动力不稳定和不良患者结果有关，”研究人员写道。

没有晚上的焦虑

并非所有参与研究的助产士都对自己的工作不满意。大部分在夜间工作的助产士比白天任何时间工作的助产士更快乐。研究人员认为，这是因为夜班工作人员拥有更多自主权，并且处理的会议和门诊护理等竞争性工作义务更少。事实上，助产士与患者相处的时间越多，调查发现她们的压力就越小。与在其他地方接生的助产士相比，在家里接生的助产士在那里有更多时间陪伴病人，他们对工作更满意。

根据他们的发现，研究人员鼓励政策制定者和管理人员投资于支持助产士护理模式的更好实践，包括助产士参与决策，并改善人员配备和同事的支持。这些简单的改变可以减轻她们的压力，防止她们离开劳动力队伍，并鼓励其他人成为助产士，以创建一支强大的美国助产士队伍，以改善孕产妇保健。

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