Highlighting NZNO midwives' concerns: this year has been one of unprecedented consultation with NZNO's midwife members. These members have had some particular concerns around demonstrating continuing competence to practise and NZNO has been advocating on their behalf.

This year--the centennial of midwifery regulation and the establishment of a new Midwifery Council to regulate midwives under the Health Practitioners Competence Assurance Act--has been a year of celebration, change and some anxiety for midwives, particularly for midwives employed by district health boards (DHBs). For NZNO it has been a year of unprecedented engagement with our midwife members, through the NZNO Midwifery Network, written consultation with each midwife member on our database and worksite meetings. Input into developing NZNO's positions on issues has been significant and valuable. The key professional issues for midwife members this year have been:

* NZNO's safe staffing campaign: what are the appropriate levels in maternity units for effective midwifery care?

* Scope of practice and competencies for midwives and what these mean for employed midwives working in, for example, neonatal units and post-natal areas.

* Competence-based annual practising certificates (APCs) and the Midwifery Council's discussion paper presenting its proposed re-certification process.

* Employer professional development and recognition programmes (PDRP) for midwives and their place in the future.

Safe staffing for maternity units

On release of NZNO's Nursing the system back to health: nurse to patient ratios earlier this year, a number of midwives indicated their willingness to assist in establishing appropriate ratios for maternity units. Of key concern was the widespread practice of counting mother and baby as one "unit", rather than two separate recipients of care, with different needs and the resulting unrealistic workloads for midwives. Also, night shift was identified as a particular concern, with very Low staffing levels, while mothers and babies needed the same level of care as during the day. A draft set of ratios was established and circulated to all members in May/June asking for feedback. The establishment of safe staffing levels for inpatient maternity services is complex. There are primary, secondary and tertiary services and within these services there may be antenatal, postnatal and delivery, or combined ante- and post-natal units. The midwifery care of both mother and baby needs to be considered in determining appropriate staffing levels. Women with complex medical problems or requiring post-operative care have greater acuity. Women presenting with poor obstetric histories or who have had no antenatal care require higher ratios.

The extensive feedback supported the proposed ratios with minor amendments. NZNO guidelines have now been established and forwarded to NZNO's multi-employer collective agreement team for action to achieve safe staffing levels for midwives.

Scope of practice and competencies

The midwifery scope of practice has now been gazetted. NZNO has received a number of calls from midwives working in abortion clinics, family planning, and sexual and reproductive health, and from direct-entry midwives working in neonatal services, concerned about whether they were practising within their scope of practice. NZNO contacted Midwifwery Council Registrar Susan Yorke, who has assured NZNO there would be further work undertaken and that currently these midwives were working within their scope of practice. NZNO wants to be involved in development on these matters.

Re-certification process

The proposed re-certification process for competence-based APCs outlined in the Midwifery Council's August discussion document resulted in NZNO seeking an opinion on the Legality of the exclusive arrangements the Council was putting forward. The proposed recertification programme had several components: the maintenance of a portfolio; participation in the College of Midwives' (COM) midwifery standard review process; compulsory and elective education; and frofessional development activities. The educationand professional development would be approved by Council and alocated points. The proposal meant that PDRPs offered by DHBs would not, by themselves, meet the competence requirements for APCs. NZNO's legal opinion was that an exclusive arrangement such as this would not be legal and the Midwifery Council was notified of this.

Concern over exclusivity

This is not a criticism of the COM's midwifery standards review process but a concern about the Council having an exclusive arrangement with the COM to review the practice of all midwives. NZNO's position that DHBs' PDRPs for midwives were an appropriate alternative mechanism to assure the public of competence has been expressed openly at a COM forum on professional development early this year, and, again when NZNO chief executive Geoff Annals and I met the Midwifery Council in June. Through a comprehensive national consultation process on the Council's proposal, NZNO midwives have overwhelmingly reiterated their support for a national DHB PDRP framework for midwives, based on the Council's competencies. NZNO's submission to the Council included support for compulsory updates three yearly for technical skills, neonatal resuscitation, adult CPR and breast-feeding. NZNO rejects the points system Council proposed for compulsory and elective education and professional development activities as restrictive, bureaucratic and costly. Instead, NZNO proposed a standards and approval process for the compulsory education updates requirement, establishing minimum hours for elective education and rejected the proposed professional activities requirement for the purposes of competence-based APCs. The full submission is available on NZNO's website (www.nzno.org.nz).

The Midwifery Council met in early October to review the submissions and determine the recertification process. Feedback on the submissions is avaiable on the website (www.midwiferycouncil.org.nz). and the final recertification programme was to be released in the middle of this month.