Midwifery Return to
Practice Programme
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Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
CONTENTS
CONTENTS ....................................................................................................................................................... 3
INTRODUCTION ............................................................................................................................................... 4
Background information ................................................................................................................................ 4
Aim ................................................................................................................................................................ 5
Target audience ............................................................................................................................................ 5
Eligibility......................................................................................................................................................... 5
Tenure during Return to Practice programme............................................................................................... 5
Proposed Program Outline ............................................................................................................................ 6
REFERENCES ................................................................................................................................................ 10
ACKNOWLEDGEMENTS ................................................................................................................................ 10
Appendix 1: Individual Learning Contract ........................................................................................................ 11
Appendix 2: Education Plan - Return to Practice Programme ........................................................................ 12
Appendix 3: Individual Check List .................................................................................................................... 13
Appendix 4: Evaluation of Preceptor by Preceptee ......................................................................................... 14
Appendix 5: Programme Evaluation ................................................................................................................ 15
A Guide to Abbreviations:
APC
Annual Practicing Certificate
CDHB
Canterbury District Health Board
CWH
Christchurch Women‟s Hospital
MCNZ
Midwifery Council of New Zealand
RTP
Return to Practice
NICU
Neonatal Intensive Care Unit
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Authorised by: Director of Midwifery, CWH
Canterbury District Health Board Maternity Unit
Issued: March 2013
CDHB Midwifery Return to Midwifery Programme
Welcome to the CDHB. The following booklet is a guide to help facilitate you through your
Midwifery Return to Practice (RTP) Programme.
Introduction
Background information
Demand for midwives has increased by approximately 4% per annum since the early 1990s,
driven mostly by institutional changes such as midwives gaining professional autonomy in
1990 (Midwifery Council of New Zealand, 2006).
The Canterbury region's population grew by 39,000 between 2001 and 2004 (Statistics New
Zealand, 2006). One third of this increase can be directly attributed to births. This growing
birthrate will add to the increased demand for midwives within this region.
Issues of retaining and recruiting midwives result in high financial costs and low staff morale
which may, in turn, affect patient care. Workforce issues are being addressed by District
Health Boards New Zealand (DHBNZ), Midwifery Council and New Zealand College of
Midwives with a number of tangible initiatives to ensure as a profession we are able to
facilitate safe and effective care to pregnant women and their babies, whilst also sustaining a
healthy and productive workforce.
Maternal and Child health is of significant public health importance (WHO, 2007). The issue
of women and newborn health affects every family, community and society in New
Zealand and the world. This programme seeks to address the challenges of workforce issues
faced by the Canterbury region in providing a sustainable midwifery workforce which can help
to improve both maternal and newborn health outcomes.
New Zealand women need skilled carers in pregnancy and childbirth. Midwives are the
essence of midwifery care through all steps not only providing the „core‟ of the care in the
maternity service in New Zealand, but also have an important role to play in health and
wellness promotion and education for the woman, her family and the community. The World
Health Organisation (WHO) maintains that midwives are the most appropriate and cost
effective health care provider to be assigned to the care of normal pregnancy and normal
birth, including risk assessment and the recognition of complications (WHO, 2006).
The WHO also recommends that it is essential that policy makers put systems into place to
improve provider performance, which in turn benefits all mothers, babies, families,
communities, health care systems and the profession itself (WHO, 2006). Ensuring there are
adequate midwives to care for women in their pregnancy and birth helps to work towards
meeting the Millennium Development Goals of reducing maternal deaths by three quarters
and reducing child mortality by two thirds by 2015 (WHO, 2007).
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Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
Aim
To aid the Midwifery Council of New Zealand (MCNZ) in meeting the national new return to
practice policy (2011) to:
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Encourage midwives to return to the midwifery workforce.
Support returning midwives to achieve the Midwifery Council requirements for a
competency based APC across the midwifery scope of practice.
Provide midwives with a clinical program which updates, refreshes and assists them to
maintain skills and knowledge essential to practice.
Support midwives to continue to enjoy midwifery and to provide a good service
Assist returning midwives to maintain continuing professionalism and accountability
within the full scope of practice.
Increase the midwifery workforce thereby increasing efficiency and standard of care as
well as improving staff morale.
Target audience
The MCNZ Return to Practice policy (2011) defines three levels of return to practice and
specifies the requirements for each level as follows:
Category A:
Category B:
Category C:
Those midwives that have been out of practice between 3-5 years
Those midwives that have been out of practice between 5-8 years
Those midwives that have been out of practice for more than
8 years
Eligibility
Registered Midwife in New Zealand
Tenure during Return to Practice programme
Midwives engaged on the Return to Practice programme will be assisted with compiling a
clinical programme as required by the MCNZ. As such they will be required to complete the
CDHB visiting agreement declaration and requirements (e.g. proof of indemnity and MRSA
screening) prior to commencement.
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Authorised by: Director of Midwifery
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Issued: March 2013
Proposed Program Outline
The RTP programme is designed to support midwives who are in category A, B and C. The
programme is co-ordinated by the Midwifery Educators and supported by the Director of
Midwifery and CDHB core midwifery staff.
The programme is to support midwives who fall into the programme requirement
descriptions. Midwives in categories A and B can complete a RTP programme in either the
community or within a DHB. Pre-registration components that are required will affect
Category C. In this case a pre-registration midwifery education provider will be involved in
developing the individual education plan that will be submitted to midwifery council for
approval. Category C midwives are also required to complete clinical time in both areas of
practice,
The CDHB RTP clinical programme aims to be a supportive individualized learning
experience facilitating increased independence and self confidence to foster safe midwifery
practice and decision making.
A summary of the RTP Plan is outlined below:
1. MCNZ notification.
2. MCNZ ascertain academic and clinical requirements.
3. Clinical Placements.
4. Education Programme,
5. Submission of evidence to MCNZ and application for Annual Practising Certificate.
6. Return to Practice.
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Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
Step 1: MCNZ notification
All midwives are required to contact the MCNZ and notify them of their intention to RTP. In
all instances a midwife must apply to MCNZ for an interim practicing certificate. This will
show on the practising certificate and also on the online register.
Step 2: MCNZ requirements (academic and clinical)
The MCNZ ascertain academic and clinical requirements, this is based on the category, as
per the RTP policy (2011) and the midwife‟s Individual assessment; including self
assessment against competencies.
The MCNZ outline the required courses in the policy, this is available at
www.midwiferycouncil.health.nz/publications
You will need to consider what knowledge, skills, attitudes and experiences you have that
enable you to meet the competencies, and provide appropriate evidence.
“All criteria that cannot be met must be identified; along with the theory and practice
experiences the midwife believes will be required in order to meet the gap(s) in her
competence.”
(MCNZ, 2005)
It is expected that before MCNZ issue an interim practicing certificate midwives provide a
detailed plan of where and when they will complete the educational requirements and where
clinical placements will be completed.
Step 3: Clinical Placements
Once MCNZ has issued your Interim Practising Certificate, contact the RTP Programme Coordinators to arrange the dates for your clinical placements.
As a DHB we will facilitate any clinical placements required within the DHB.
Please note – Midwives completing category B and C will require a competency assessment
as a part of the clinical programme. A separate matrix is available from the MCNZ.
For the purposes of the RTP programme each midwife requires a degree of supervision. A
named clinical preceptor will be allocated to you during each of your clinical placements.
Due to the constraints of rostering, this preceptor may not be working with you for every shift
of your RTP but we will aim for you to work together for a minimum of 3 shifts a fortnight.
Your chosen preceptors have a broad clinical experience within the midwifery scope of
practice. They are recognized as being midwives who:
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Have a good working relationship with their peers.
Are sensitive to the individual learning needs of preceptees.
Respect and support the individual.
Completed a formal preceptor programme
Use the templates provided in Appendix 4, or your own method of feedback, to evaluate your
preceptorship period. Your preceptor would appreciate your comments for recording in her
own portfolio.
Step 4: Education Programme
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Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
Your education requirements will have been discussed as part of your Individual learning
contract with the MCNZ. The DHB do facilitate a number of education workshops. All
education sessions will need to be booked via the midwifery educators. A calendar of all
scheduled education and prices is available. You may identify further education opportunities
during your RTP Programme and these can be discussed with your preceptor and/or
Programme Co-ordinator.
Some of these education sessions will be necessary to comply with the requirements of
MCNZ Recertification Programme, both the compulsory and elective education components.
If you have not already commenced a professional portfolio, this would be an ideal time to
start compiling evidence on your practice. A personal planner would be useful to record your
progress on the Recertification Programme. The MCNZ are available to assist you to
understand the Recertification Requirements.
Your preceptors, educators and senior ward staff will be important resources during your
RTP placements. You may find the following list of written resources helpful. Please ask if
you struggle to locate any of them
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Maternity Guidelines (available on CDHB intranet and internet)
Infection Control folder
Fluid and Medication Management (Volume 12) available on intranet
Human Resources folder on intranet
Notes on Injectable Drugs (Clean Utility Room)
Current Notices and articles folders
Communication books
Ward DVD‟s, videos
Midwifery Resource Library (Midwifery Educator‟s office)
Christchurch School of Medicine Library
K2 online CTG monitoring package
NZCOM Midwifery Handbook for Practice
NZCOM Midwifery Standards Review Handbook
Breastfeeding (Renfrew, Fisher, Arms)
Breastfeeding Matters (Maureen Minchin)
WHO/UNICEF Code on Promoting, Protecting & Support Breastfeeding
WHO/CHD Evidence for the Ten steps to successful Breastfeeding
Evidence-Based Guidelines for Breastfeeding Management during the first fourteen
days (ILCA)
Infant Feeding – Guidelines for NZ Health Workers (MOH)
Midwifery: Preparation for Practice 2010Pairman, Pincombe, Thorogood, Tracy
Pharmacology for Midwives 2010 Jordan, S
www.nzformulary.org.nz
www.nzulm.org.nz (Universal list of medicines
www.medsafe.govt.nz
www.pharmac.org.nz
www.druginformation.co.nz
Drugs in Pregnancy and Lactation (Briggs, Freeman, Yaffe)
Various client handout pamphlets
MIDIRS and Midwifery News
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Authorised by: Director of Midwifery
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Issued: March 2013
Step 5: Submission to MCNZ
On completion of the MCNZ requirements you will be required to send all relevant
documentation to the MCNZ Education Committee. This will include your completed
Competency Assessment Report (if required), Individual Learning Contract and proof of
completion of any education requirements.
Step 6: Return to Practice
At the end of the programme, if you successfully gain an APC you may wish to apply for a
permanent position at the CDHB or pursue other career options such as self employed Lead
Maternity Carer (LMC).
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Authorised by: Director of Midwifery
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Issued: March 2013
References
Department of Labour (2006) MIDWIFE: Occupational Skill Shortage. Accessed on 20th
November 2007 at http://www.dol.govt.nz/PDFs/jvm-prof-mid-2005.pdf
Midwifery Council of New Zealand (2005) Return to Practice Programme for Midwives policy
document. Accessed on 28th April 2010 at
http://www.midwiferycouncil.org.nz/content/library/Return_to_Practice_Programme_for_midwi
ves.pdf
Midwifery Council of New Zealand (2006) Pre-Registration Midwifery Education Review
Report. Accessed on 19th November 2007 at
http://www.midwiferycouncil.org.nz/content/library/MCNZ_Education_Report3.pdf
Midwifery Council of New Zealand (2011) Return to Practice Programme for Midwives Policy
Document. Midwifery Council of New Zealand.
Statistics New Zealand (2006) Christchurch Quarterly Review. December 2006. Accessed on
21st November 2007 at http://www.stats.govt.nz/NR/rdonlyres/FC5E2B4D-291C-4342-A9ACDFDA757E8BDA/0/Dec2006QRRChristchurchSAMPLE.pdf
World Health Organisation (2006) The World Health Report 2006—Working Together for
Health, World Health Organisation. Accessed on 19th November 2007 at
http://www.who.int/whr/2006/en/
World Health Organization (2007) Maternal Mortality in 2005: Estimates Developed by WHO,
UNICEF, UNFPA and The World Bank. WHO.
Taranaki Health Board (2008). Return to Midwifery Return to Practice programme. Taranaki
District health Board.
Acknowledgements
Many thanks to Dianna Murray at Capital and Coast Health for sharing the Return to
Midwifery Program and ideas so readily.
Many thanks to Taranaki District Health Board for sharing their valuable information and
documentation.
Ref 6712
Authorised by: Director of Midwifery, Christchurch Women‟s Hospital
Issued: March 2013
Revised as per MCNZ Dec 2012
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Ref. 6712
Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
Appendix 1:
Individual Learning Contract
Proposed Individual learning contract for………………………………….
Return to Practice Category ……………….
Based on FTE …………..
Clinical placements:
Sign/date when achieved:
Maternity ward …..… weeks (………..hrs), to include
Ward clinical experience may include:
Antenatal care including admission and discharge
Postnatal care including admission and discharge
Breastfeeding advice and referral to LC
Newborn baby checks and baby care
Postoperative care
Birthing suite …..…. weeks (……… hrs), to include
Ward clinical experience may include:
Assessment area (antenatal including induction of labour)
Normal labour and birth
Premature labour and birth
LSCS theatre and recovery
Birthing rooms
Acute observation unit
Management of woman with complex needs e.g. comorbidities,
pre eclampsia, insulin dependant diabetic
Epidural management
Obstetric emergencies
Instrumental births
Multiple births (twins)
Induction of labour
Caring for woman with fetal loss
Maternity Outpatients …..weeks (………hrs), to include
Clinical experience may include:
High risk clinic
MIPS (Methadone in Pregnancy Programme) Clinic
Diabetes clinic
Fetal maternal medicine
Day assessment unit
Primary Units
Other clinical opportunities:
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Authorised by: Director of Midwifery
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Appendix 2:
Education Plan – Return to Practice Programme
Name: ……………………………………………………….
Clinical Placement dates: ………………………………
Component
Location/Date/Time
Tick () when
booked
Technical Skills workshop
Newborn Life Support
Adult CPR update
(including Maternal Collapse)
Breastfeeding update
National Screening Unit
– 5 modules
Learnonline.health.nz
Smoking cessation
NZCOM
Family violence
NZCOM
Electronic Fetal Monitoring
NZ Maternity Systems
Online from Otago Poly or AUT
Pharmacology and Prescribing
Cultural Competence
IT update
CDHB Caresys (Patient
Management) and Éclair (Lab
results) – training on Thursday
mornings 9-12.30 at Chch
Hospital – book via midwifery
educators Ext 85730
Guidelines for Pre-eclampsia
and Diabetes
Look up CDHB internet under
“Maternity Guidelines”
Any other identified needs
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Authorised by: Director of Midwifery
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Appendix 3:
Individual Check List
Name: ………………………………………………..
Tick () / Date / Comments
Interim APC photocopied
Visiting Agreement signed by RTP midwife
Visiting Agreement forwarded to DOM for signing
Indemnity insurance cover sighted (NZCOM or NZNO)
Has copy of MCNZ competency template for sign off
ID card – application form
Network User set up form
Booking for Caresys and Éclair training
MRSA swabs sent
Charge midwives informed of placement dates
Preceptor timetable for first placement then note in
diary when rotates each placement
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Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
Appendix 4:
Evaluation of Preceptor by Preceptee
Evaluation of preceptor by preceptee (p2)
Name of Preceptor: _____________________________________________________
Name of Midwife receiving preceptorship: ___________________________________
Did you have consistent and appropriate access to your Preceptor? Yes 
No
If No, please explain or comment:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please tick () the box which best describes your experience
My Preceptor:
Excellent
Very Good
Satisfactory
Needs
Improvement
Expected me and made me feel welcome
Identified previous knowledge and skills I had
& set goals with me for further development
Had a good knowledge of the clinical,
environmental and woman‟s needs & helped
me understand and develop my skills
Used effective clinical teaching skills
Was approachable and communicated
clearly.
Was confident in utilizing clinical situations to
assist my learning
Evaluated my knowledge, skills and
understanding by seeking feedback and
participation
Assisted me in identifying others who could
support my learning
Role modeled professional midwifery practice
& woman-centred care
Offered regular specific, constructive
feedback
Demonstrated competent safe midwifery care
Advanced my development by creating
learning opportunities in my work
environment
Provided a safe learning
environment/relationship
Describe the attributes that you appreciated in your Preceptor
What would you like done differently
Any other comments/feedback
Signed:
Date:
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Ref. 6712
Authorised by: Director of Midwifery
Canterbury District Health Board Maternity Unit
Issued: March 2013
Appendix 5:
Programme Evaluation
We would be grateful if you could answer the following questions regarding the CDHB
RTP Programme. We are keen to know whether the Programme is effective and will
endeavor to make changes where problems are identified.
1. How did you find out about the CDHB RTP clinical programme?
2. How useful were the written guide and orientation packages?
3. What did you find most useful about the programme?
4. Are there any ways in which you feel the programme could be improved?
5. In which areas did you achieve continuity with your preceptors and in which areas was
this more difficult?
6. What frequency do you think is appropriate for focus meetings with preceptors during an
RTP programme?
7. Did you find the RTP Programme Co-ordinator was available when you needed her?
8. Were there any barriers to achieving the goals set out in your Individual learning
contract?
Please feel free to comment further overleaf.
Return the completed evaluation to your Programme Coordinator.
Thank you!
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Ref. 6712
Authorised by: Director of Midwifery
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Issued: March 2013