Why UK midwives intend to stay in or leave the midwifery profession: A conceptual model of push, pull and mooring factors

PROBLEM: Retention and recruitment of midwives is of global importance as workforce shortages impede the quality and safety of care provided. BACKGROUND: Midwives' intentions to leave the profession require examination in a post COVID-19 pandemic context, yet their data is often conflated with nurses. AIMS: To a) measure UK midwives' intentions to leave midwifery, b) explore the reasons behind them using qualitative methods, and c) map these reasons to create a model of push, pull and mooring (PPM) factors. METHODS: This convergent parallel mixed-methods study included UK midwives (n = 575) who completed an online survey consisting of a three-item scale paired with open text response options. Items were scored on a 7-point Likert scale. Mean composite intention scores were calculated. Framework analysis was used to make sense of the qualitative data collected. FINDINGS: The composite mean score for intention to leave midwifery in the sample was 4.15 (SD 1.87). Themes related to midwives' intention to leave included: Too much pressure (stressful, poor mental health); Poor workplace cultures; Planned retirement or career change; Feeling undervalued; professional constraints and preserving physical health. Themes related to midwives' intention to stay included: No perceived alternative; Their ability to move away from clinical midwifery practice; Being new to the profession; Considering the alternatives to midwifery but staying as the hours and money are good; Professional identity overriding the rough days, and Job satisfaction. Distinctively, our findings reveal a paradox in that although professional identity acts as a pull factor, its connection to burnout and excessive endurance demonstrates that it is not uniformly advantageous. DISCUSSION: Drawing from PPM theory, we present the first conceptual model of PPM factors for midwifery. The presenteeism identified poses threats to quality and safety. CONCLUSION: Findings offer important opportunities to minimise push factors, enhance pull factors and strengthen mooring factors for optimal recruitment and retention in Midwifery.