An examination of midwives’ views of the educational, clinical and practical value of undertaking/completing a program of study that leads to endorsement to prescribe scheduled medicines

Introduction
The Australian Nursing and Midwifery Accreditation Council requires all nursing and midwifery programs to undergo reaccreditation every five years to ensure currency. For programs leading to endorsement to prescribe scheduled medicines, the program must be “equitable”, “flexible”, “effectual” and “accessible.” As the landscape of midwifery and health care continues to change, it is essential that existing programs that lead to endorsement as a midwife are critically evaluated both from educational and clinical application perspectives.

Objective
To examine midwives’ views of the educational, clinical and practical value of undertaking/completing a program of study that leads to endorsement to prescribe scheduled medicines.

Methods
Using a purpose developed survey, we sought feedback from midwives who had or were planning on completing a program leading to endorsement. The survey collected participant demographics, their experiences of undertaking a program leading to endorsement and the barriers and challenges faced in utilising endorsement in their context of practice. Ethical approval was gained.

Results
Of the 39 midwives who responded, 95% (n=37) had completed a program leading to endorsement - 46% (n=17) received a non-award/completion certificate, 38% (n=14) a graduate certificate/diploma and another 16% (n=6), masters. Of the total participants, 75% (n=27/36) had worked as an endorsed midwife; the majority in private practice (n=21/27, 78%). With respect to programs leading to endorsement, midwives found the content on pharmacology and script writing the most useful but indicated that more emphasis on antenatal care would have been beneficial. Midwives also highlighted that mentorship during their program of study would have assisted them to navigate the challenges of using their endorsement. From a clinical application perspective, participants described the challenges of navigating jurisdictional formularies – some had access to all medicines (including schedule 4 and 8), while others were limited to a select few. Almost all participants described that they had or were able to, order pathology, radiology and common screening tests. The largest barrier to utilising endorsement was the requirement to have a collaborative agreement. Midwives described resistance and reluctance from both doctors and entities to enter into these agreements and as such, stated they were “pointless”, “confusing” and “demeaning.” However, this was offset by the autonomy, flexibility, relationships and satisfaction afforded by their work.

Conclusion
Midwives surveyed in this study found benefit in completing a program leading to endorsement however, they expressed significant challenges and barriers when it came to utilising this extended practice. While some of these challenges stemmed from the program of study, a large proportion surfaced when midwives sought out collaborative agreements, access to formularies, and attempted to navigate jurisdictional inconsistencies. Midwives who hold endorsement are calling for change. Our findings add to the limited literature base and will inform changes to the provision of educational programs while providing more evidence for practice change.