Swedish midwives' perception of their practice environment – A cross sectional study

• There is shortage of midwives in Sweden and the work environment could be associated with attrition rates.
• Young age, short work experience and academic degree were associated with unfavorable work environment.
• Protective factors for assessing the work environment as unfavorable were high quality of life and high self-efficacy.

BackgroundThere is a shortage of midwives in Sweden. Evidence suggests that the work environment is likely to play a part in retention and attrition rates.ObjectiveTo explore the practice environment of Swedish midwives and factors associated with the perception of an unfavorable work environment.Methods475/1000 (48.6%) members of the Swedish Midwifery association completed a questionnaire including the Practice Environment Scale (PES). Differences in mean scores were calculated for the subscales of PES and midwives' background characteristics. Logistic regression was used to investigate factors most strongly associated with unfavorable working environment.ResultsThe two domains that showed significant differences in terms of participant characteristics were the Staffing and resources adequacy subscale and the Foundations of quality care subscale. Midwives younger than 40 years, those with less than 10 years' experience and those with an additional academic degree rated these two domains more unfavorably. Protective factors for assessing the work environment unfavorable were mainly internal such as high quality of life and high self-efficacy. Swedish midwives were most satisfied with the midwife–doctor relationship and least satisfied with their participation in work place or hospital affairs. Midwives suffering from burnout, those who provided hospital based care and those without leadership position were more likely to assess their work environment as unfavorable.ConclusionsThis study identified personal factors as well as work related factors to be associated with midwives' assessment of their practice work environment. Establishing healthy work places where midwives feel recognized and valued could prevent midwives from leaving the profession.