The experience of rural midwives in dual roles as nurse and midwife: ‘‘I’d prefer midwifery but I chose to live here’’ Karen Yates a, *, Jenny Kelly b , David Lindsay c , Kim Usher d a Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia b School of Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia c School of Nursing, Midwifery and Nutrition, James Cook University, Townsville, Australia d School of Nursing, Midwifery and Nutrition, Associate Dean Graduate Research Studies, James Cook University, Cairns, Australia Introduction Midwives are essential to good outcomes for mothers and babies. 1 In many rural and remote locations in Australia, midwives are often required to work in dual roles. They may work as nurse and midwife, at different times during a shift or on different days of the week. This geographic context presents midwives with many challenges including difficulty in maintaining competence in both midwifery and nursing; working in nursing roles and clinical areas for which they may have little interest; and a fear of working beyond their scope of practice. Unfortunately, the end result of these challenges is often dissatisfaction with the work environ- ment, a known factor in staff attrition. 2 There is increasing difficulty within rural and remote areas of Australia to maintain a skilled and competent workforce in the face of workforce shortages. There is also a need for rural and remote practitioners to be multi-skilled. 3,4 This issue is compounded for rural midwives, most of whom historically obtained nursing qualifications prior to midwifery qualifications, unlike the graduates who may now come from direct entry programs recently introduced in Australia. These practitioners often spend only a small percentage of their working day using midwifery skills, yet remain aware of the need to maintain those skills in the event a pregnant or birthing woman presents to the service. 5 Declining birth rates in rural areas, resulting from the policy which mandates that women must relocate for birth to larger regional or tertiary services, has been identified as a potential cause of the de- skilling of midwives in rural areas. 6,7 Reiger 8 has commented on the preference, particularly in rural areas, for the employment of midwives with a nursing background as a way to address staffing shortages. As the vast majority of midwives currently working in Australia have been educated as nurses prior to becoming midwives, they have tended to acquire a dual professional identity; one of both nurse and midwife. The role of the midwife in Australia, as in most countries around the world, is situated in the ‘wellness’ model of care, where pregnancy, birth and the postpartum period are viewed as normal life events. This is in direct contrast to the common nursing model of care, Women and Birth 26 (2013) 60–64 A R T I C L E I N F O Article history: Received 5 December 2011 Received in revised form 31 January 2012 Accepted 19 March 2012 Keywords: Midwives Rural Dual role Nurses Role conflict A B S T R A C T Objective: To explore and describe the experiences of working in the dual role as nurse and midwife in rural areas of far north Queensland, Australia. Method: The methodology was informed by Heidegger’s interpretive phenomenological philosophy and data analysis was guided by van Manen’s analytical approach. Data was generated by conversational interviews. Eight midwives working in a dual role as midwife and nurse were interviewed individually. Findings: Three themes were identified: Making choices between professional role and lifestyle: ‘‘Because I choose to live here’’; Integration of maternity and general nursing: ‘‘All in together this fine weather’’ and: ‘‘That’s part of working in a small place’’. Conclusion: Participants recognized that in rural areas it is important to be a multi-skilled generalist; however they were concerned that midwifery skills could be eroded or even lost with the diminishing amounts of midwifery work available. Appropriate re-structuring of maternity services could provide better use of the midwifery workforce in rural centres, and reduce the current problems associated with transferring birthing mothers to larger facilities. Further research is needed to examine the extent to which the requirement to work in a dual, or multifaceted role is an impediment to the recruitment and retention of midwives to rural areas. Crown Copyright ß 2012 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Australian College of Midwives. All rights reserved. * Corresponding author. Tel.: +61 07 42267475; fax: +61 07 42266789. E-mail address: karen_yates@health.qld.gov.au (K. Yates). Contents lists available at SciVerse ScienceDirect Women and Birth jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/wo mb i 1871-5192/$ – see front matter . Crown Copyright ß 2012 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Australian College of Midwives. All rights reserved. http://dx.doi.org/10.1016/j.wombi.2012.03.003