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midwifery midwifery Exploring horizontal violence Carolyn Hastie alking down the corridor at work on Thursday, 20th of July 1995, I was told by one of the midwives that Jodie Wright’s mother had called and wanted to speak with me. She had left her number for me to ring her back. As I walked to the phone, wondering what Jodie’s mother wanted, I thought fondly of Jodie and the workshop we had both attended a couple of months earlier. The two-day workshop on parenting education had been great fun, 15 of us from different units had attended. Over the two days, we had all discussed our ideas and passion for midwifery. We talked for hours about women-centered care, the joys and difficulties of midwifery, the dynamics of the health system and our feelings about all aspects of our work. We discussed our dreams and our frustrations with our work. W Jodie was very memorable. She was a young, enthusiastic, new graduate midwife. We discovered during our conversations that Jodie read everything she could get her hands on. In her first year of midwifery practice, Jodie had already attended several midwifery-oriented workshops and seminars; she was very open and shared her ideas and experiences with us. She voiced many of the concerns and feelings of disappointment with the system and the attitudes of senior midwives at her workplace that I had heard from other students and new graduate midwives throughout my midwifery career. I remembered thinking how passionate and caring she was, and I had instantly recognised how her experiences reflected the degree of threat her enthusiasm and joy for midwifery and women-centered care would generate in the established midwifery culture. It’s interesting how thoughts can travel at lightning speed. In the few minutes I took to reach the phone and ring Jodie’s mother, I had revisited our workshop and run through the conversations we’d had. I was aware of my feelings of distress that often arise for me when I consider or am confronted with the brutality that often exists towards each other in my beloved profession. Jodie’s mother’s voice was halting. She told me that on Monday evening Jodie had killed herself. At about 5pm she had put a hose from the exhaust pipe in through the window into the interior of her car, shut the door and turned on the engine. As Jodie sat in the car dying, she wrote her suicide note. midwifery “In corporations, fear, anxiety, a sense of isolation, apathy and despair are the results of spiritual poverty, and their effects on us are similar to the disease, starvation and death in refugee camps.” Barbara Shipka (1993:14) “…I don’t want to do this anymore. I’m sick of trying and getting thwarted. I’m almost too scared to try harder or try something else just in case I will feel the same. I love my work, unfortunately some of the senior people there don’t seem quite as enthused. I don’t feel trustworthy or equal to them even though I would not want to be like them. They sit on their bums! I love working with women and baby’s (sic). They are all individuals…” Her parents wanted to talk. Jodie’s mother told me Jodie always shared whatever was happening with her. Of late, she had been talking about her frustrations and difficulties at work. Following the workshop, she had talked enthusiastically of her discussions with me. I was in charge of a maternity unit at that time. She had told her parents that the sort of changes she wanted to see were possible because I was implementing them where I was working. In the midst of their distress, they were trying to understand what would have caused their daughter to end her life. They wanted to know what would lead Jodie to mention the senior midwives in her suicide letter. I don’t remember much of that initial conversation. I agreed to meet with them. I went to Jodie’s parents’ place the next weekend. They lived about one hour from me and several hours away from where Jodie had been living and working. I remember the awkwardness of that initial meeting. I remember the sadness, the emotional pain and the courage of her family as they struggled to understand the midwifery culture and come to terms with their daughter’s act. I remember the anger, the feelings of deep distress and the sense of futility I felt as I watched them going down every possible avenue seeking understanding, clarity and change within that particular institution. Jodie’s parents sought to highlight the problems within the health care system for new graduates generally. They spoke with Jodie’s midwife colleagues, visited the hospital, the health department, spoke with the state’s premier, the state’s nurses registering authority, the papers, local government members and a national magazine seeking answers and to expose a problem they came to recognise as endemic in our culture. MIDIRS Midwifery Digest 16:1 2006 25 Exploring horizontal violence Hostility, innuendoes, false accusations, minimising and subterfuge were behaviours displayed by official people during the search for meaning and understanding by Jodie’s parents. I was told by various contacts within the health service hierarchy that it was said by officialdom that I was ‘using those poor grieving people for her (my) own political agenda’. This was an obvious tactic to play down the issues, as I had been asked by the parents to help them. In one instance, Jodie’s parents asked me to accompany them to a meeting with the local member, the Chief Executive Officer of the hospital and the social worker of the hospital where Jodie had been working. Once at the meeting site, the parents were invited in and then were refused permission for me to accompany them into the meeting. They told me after the meeting that they felt intimidated and patronised. They felt that their concerns had been trivialised, and they were told that things would seem bad because they were ‘grieving parents’. They were also told that Jodie’s general mental health was the problem, the officials commenting about Jodie’s early teenage issues with bulimia. Distancing, projection and counter transference of issues were psychological ploys used by officialdom when discrediting the possibility of an unhealthy or toxic work environment being a factor in Jodie’s suicide. The coal miners used to take a canary down into the mines to detect when the mine air was unable to sustain life. The canary was carried in their cages down low on the ground level. When the canary stopped singing (Barrentine 1993:9), the miners knew that the canary had died because the air at the floor level was toxic. Miners knew the toxicity would rise and kill them all if they stayed. They had to get out of the mine. Jodie’s suicide reminded me of the story of the miners’ canary. Her desperate act and her suicide note were signs of toxicity in her place of work. Towards the end of her parents’ search, they discovered the hospital had been the subject of a Health Department review in the previous September, because ‘the existing organization structure for (the hospital) has had an unsuccessful history to date’… ‘nursing services’ ‘…despite the introduction of the Nurses Career Structure…the personal growth and professional development of nursing staff has been stifled’. The report went on to say: ‘nurses at (hospital) have repeatedly identified to the Director of Nursing, their concerns about the need for leadership and direction, the rigid management style, need for a more participative management style, lack of autonomy over their work area and poor communication, yet all these concerns still exist today. This has contributed to the extremely low morale amongst nurses, high level of absenteeism approximately 4.4% and turnover rate (39%).’ (Reference unpublished) The findings of the review had not been released and were not available to the staff. No action on the 56 recommendations of the review had been undertaken when Jodie committed suicide. The report was not mentioned at any time during Jodie’s parents’ discussions with any official. When news of the report and its findings reached the parents, no official wished to discuss it. Jodie’s parents rightly questioned whether their daughter would have died if action had been taken earlier. Toxicity in the nursing and midwifery culture has been termed horizontal violence (Duffy 1995, Roberts 1983). Current literature includes it in the more general term of 26 MIDIRS Midwifery Digest 16:1 2006 workplace bullying. I undertook a pilot study in 2000, exploring the issues of horizontal violence with new graduate midwives. During the interviews and my reading, I became aware of deeper and broader dimensions to the experiences new graduates were having. It became apparent that there were personal and system issues that impacted on experience for new midwives and led to them embracing or abandoning midwifery as a career. I was intrigued to find extraordinary courage, resilience, insight and yet, often hopelessness, a sense of isolation and despair among many new graduates. It is with this rich background of human tragedy, courage and passion for change that I am compelled to explore these issues more deeply through an ongoing research process. It is vitally important to find solutions to negative workplace issues and to assist maternity care systems to provide emotionally and spiritually healthy supportive environments for new graduates. The following is a distillation from transcripts of seven interviews, two focus group discussions and one-on-one discussions with new graduate midwives. The comments document a deepening and expanding understanding of horizontal violence and its impact on individuals. Every respondent indicated that horizontal violence (HV) or workplace bullying (WB) involved senior midwives interacting negatively with junior members of staff. As one respondent replied, ‘the attitude and treatment from other workmates, like other certified midwives that you’re working with… negative behaviour… the way that people speak to you… like downgrading or in a negative tone… they look down on you… it’s just overall treatment’. Another respondent saw HV and WB as a way for senior midwives to emotionally and psychologically ‘assert their authority over you’. One saw HV and WB as sabotage of learning opportunities, thus reinforcing a medical model and another said it was a ‘a way of releasing their frustrations… they build up their frustrations and then release it as anger on their fellow workmates that are on the same level or considered lower’. Two respondents said that it was senior midwives ‘making life difficult for you’ because ‘they know they have it over you’. Analysis of the interviews indicated that horizontal violence involved ‘verbal criticism from the peer group’ plus ‘negative’ non-verbal behaviour. For two respondents, the tone of voice used was very significant in the way people were, in one respondent’s words, ‘talking down to somebody’. The other said ‘tone and the way they word things’ was a problem. It could be, she continued, ‘like just brushing you off… or being very aggressive and invading your space… when they talk to you… just sort of stand over you’. One respondent related how ‘one midwife… would not even talk to you when you came on if you were allocated to work with them. They’d just walk off and you just basically had to follow and they were very snappy in their tone like “you should know this” and “why don’t you know that?”…not very supportive’. Non-verbal behaviour is seen by six of the respondents as a source of very powerful ‘put down’ messages. Respondents talked about ‘blank’ or ‘disinterested looks’ or ‘lack of looking’ at the junior staff member when that junior staff member was attempting to talk with the senior midwife. Mention was made of the ‘non eye contact … plenty of that Exploring horizontal violence Respondents indicated that they felt vulnerable concerning clinical decision-making when women were in labour and cited experiences of having their management of various clinical situations attacked, or had observed it happening to someone else. As one respondent related, her feelings and experience of being attacked: ‘…really freaked me out, but those sort of situations where people attacking management were quite common I found… junior staff being attacked really for management decisions and not being supported. Even when the outcomes are fine and it’s just a different way of reaching the same goal’. Feeling left out, not included and not accepted was mentioned as an issue experienced by four of the respondents. In response to the question ‘when this happened to you, how did you feel?’, one respondent said ‘…not part of the place… you feel really isolated and useless’. Another respondent said that horizontal violence was ‘all about exclusion’. This midwife had observed that: ‘say it’s time for morning tea, getting everybody who’s on shift to come into the tearoom but somehow forgetting to get the person who they’re bullying. Or making attempts to make sure everybody else is able to come to tea but maybe only just mentioning it in passing “Oh we’re going to tea now” and then when they arrive, packing up and saying “Well we’ve had our morning tea, you just take your time”. Leaving them there on their own’. According to three of the respondents, horizontal violence is so subtle it’s difficult to identify for the person experiencing it. One respondent gave an example of what she had observed, ‘people leaving the (tea) room when they come in or sitting in a particular way… facing away’, positions or actions that exclude the person being victimised. Horizontal violence was also experienced as something that happened behind people’s backs by four of the respondents. For example, ‘talking about what they do to other workers in a negative way but not actually directly taking up the issue with the person that they’ve got a problem with. So I’ve found that it’s generally subtle ways, very subtle ways that are hard to pinpoint, that are difficult for the person who’s receiving the violence to actually label because it’s like filling up a bathtub with drops of water’. The metaphor of a bath filling up with water to represent horizontal violence illustrates the subtlety of the experience. Observing it happening to someone else prompted one respondent to say ‘I think that I can’t stand it, but I’m also aware of the pecking order in the culture and as a sort of new member or less experienced member, I don’t feel like I’ve got a power base to challenge it a lot of the time… and so I’m in a bind then, I feel caught between wanting to speak out against it but also wanting to protect my position as well. So I think it sort of self perpetuates and I think the nature of the violence is often so subtle that even as somebody witnessing it, you’re just sort of seeing glimmers of things and as with the person who’s experiencing the violence, there’s not a lot to pinpoint’. The subtle nature of horizontal violence led to a situation where, as three of the respondents explained, they questioned whether it was ‘just me’. As one respondent put it ‘you just feel as if… I don’t know… I think it’s just me, but I feel as if they’re watching you… criticising in their minds’. midwifery happens’; and ‘facing away’ by four of the respondents as significant factors in leading to feelings of worthlessness in new graduate midwives. One said she experienced senior midwives ‘ignoring you, (they) just pretend that you don’t even exist when you walk up and say hello’. Three respondents mentioned how senior midwives would walk away as they were talking to them, for example, one respondent said ‘I’ve had people literally turn their gaze away and walk away from me’. Another commented ‘their non verbal stuff is pretty big… really disapproving, like crossing arms, just the really impassive sort of expression on the face… really, really judgemental pose… the “I can hardly be bothered listening to you look”… they just don’t act like you’re worth the attention’. What signified as verbal ‘put downs’ was expressed by one respondent as ‘They might correct something that somebody does in front of the client or another worker. So they’ll be quite overt about saying “Oh, actually we don’t do it like that here” or “I better check that”. You know, maybe observations or that your choice of managing a particular situation, the choice of drugs that you might give somebody if you were choosing analgesia’. ‘Being watched’ excessively was mentioned by three of the respondents as a form of horizontal violence, because as one respondent put it ‘they used to always come and ask me what I was doing or what was happening in my room. But it was on a really regular basis and it was like, I thought initially, what have I done? Or is she trying to get me? Is she trying to catch me out on something?’. Another respondent related a situation where a junior midwife, who ‘had stories circulating about her practice being substandard’ was subjected to a ‘sort of over vigilance of her practice. So the more they watched her, I guess the more they were able to find fault with what was going on with her practice… so I think that over vigilance was part of the horizontal violence because I know from my experience that I seem to fit in ok and I don’t feel like there was anybody closely supervising me. And there was a lot of my practice that I think probably would’ve been found faulty if people had actually been watching me. Whereas with this other woman, she was being watched constantly’. Another respondent commented that when someone is mentioned as a ‘problem’, that ‘person becomes someone who is watched by a lot of people’. The tearoom is a place of high visibility and was mentioned by three of the respondents as a site where horizontal violence is experienced or observed. A comment from one respondent is representative: ‘you hear things in the tearoom, you know, so and so did this and this, you know, the gist of what they’ve done… just what they’ve done or haven’t done… mainly judgemental… lots of bitching… and you feel for that person’. Every interview respondent mentioned that horizontal violence acted to make them ‘fit in’ and was fiercest with people who were perceived as different and therefore a threat. One respondent spoke about a male midwife who was ‘under ten times as much scrutiny as everybody else and instead of encouraging it and opening up the profession and to grow and see what perspective he can bring into it, they’re punishing him because he’s a male’. One respondent related a story concerning someone who ‘came from a background that no one really appreciated and she was heckled that much and given little support… that she actually quit’. Two respondents said they MIDIRS Midwifery Digest 16:1 2006 27 Exploring horizontal violence ‘toed the line’, one saying she couldn’t afford to get in the ‘black book’. One respondent, who had been a nurse specialist before doing midwifery said ‘regardless of what you’ve done and your past experience, it has absolutely no relevance to becoming a midwife whatsoever. It helps you to do little things, but people who work in speciality areas I believe are threatened by other people’. This respondent said she was ‘a bit frail after the course’ she had been ‘watched and attacked a bit’ and still felt ‘delicate’ in her role as a new graduate midwife. Another respondent explained the way she adapted to the midwifery environment. ‘And it’s almost sometimes that they’re looking for conflict. Like in the last week because I’ve been nearly full-time, I could have had about five different (fights)… and sometimes I think it’s up to us too to realise not to get on the defensive because you realise that you are a new grad and you’re in a different perception. You’re in a different environment and your perception of it has to be non-defensive. So you have to be not ready to defend your actions. But sometimes it’s really, really hard when they find little things to pick on’. Another respondent related how ‘…they don’t trust you. Even if they’ve worked with you and know what you’re capable of and what your limitations are, they still make it very hard and you don’t feel like that you’ve got the support and the same amount of respect that they have. That’s probably the big thing for horizontal violence I think. As a new midwife, is like that you’ve got to start off at this bottom rung and crawl your way up to the top and be made to suffer every step of the way because that’s the way the people before you have had to do it’. The same respondent said that horizontal violence reinforced a medical model by sabotaging opportunities for mentoring or facilitating learning: ‘they’ll take away the confidence basically of the person that’s trying to learn and keep putting it back into their restraints of working in the hospital’. Another said ‘you learn by doing it wrongly and getting told after…’. Self-criticism was common following incidents of horizontal violence. For example, for one respondent, feeling victimised and unsupported, said ‘I did exactly what they did to me, I did to myself. I turned on myself and was really hard on myself and chewed myself out about it for days and days and days. Instead of putting it into the perspective I should’ve put it into like it’s hard to do that… into something I could learn from and say maybe I was treated this way because of such and such and such. Instead of doing that and getting on with everyday stuff. Like every day at work it would be in the back of my mind and I’d be actually making other stupid mistakes because I was so preoccupied with this one thing. Instead of being able to put it to the side, learn from it and move on you’re just continually been drawn back into it and it stops you from progressing into the next level and learning more I think. Things like just really thinking about how incapable I was. About thinking, oh well, it must be all my fault, that there is some defect in my personality. Just had really, really bad thoughts like emotionally about myself. Just any time I made a little mistake with something else it didn’t matter if it was even in any other area of my life, it was still, oh my God, that’s just another thing that I’m bad at. Like it’s amazing how even though it’s a work thing, it flows over 28 MIDIRS Midwifery Digest 16:1 2006 into everything else if you’re not getting that support professionally. Like it does impact on other areas of your life which is not good. Mainly just bad thoughts about my abilities and my coping mechanisms and that led to me thinking I’m not cut out to do this. Do I want to do this? Because I know, I mean you’ve had heaps of thank you cards, heaps of things like that, like good, positive reinforcements. Suddenly none of that mattered. Like all the good stuff that I had achieved just didn’t matter… I basically got to the point where it had made me physically sick because I had worried about it so much that I just had to put in my own head — right, enough is enough.’ Insecurity caused by a lack of midwifery experience stopped three midwives from addressing an experience of horizontal violence, as evidenced by one of the respondent’s remarks. ‘I think I really should’ve, even at the desk, tried to defend my position. But I don’t feel qualified enough to do it. I feel like I’m still learning and I know that there are several ways of looking after somebody and because I’m learning I don’t believe that I would automatically always choose the right way to do it. So that’s my fear, not fear but I guess insecurity that I don’t feel secure enough with my practice to always stand up for myself. But I guess in that situation I know that there was nothing I did wrong and I should have stood up for myself and I wish that I had but also don’t think it would have achieved much even if I had. I guess what I would want would be for (senior midwife) or whoever to acknowledge that I wasn’t doing something unsafe or I wasn’t doing something unreasonable and that they shouldn’t be yelling at me in front of other people. But I don’t think that they would do that. I’ve had conversations with people, a whole group of them went down to a conference and listened to a talk on horizontal violence and we were chatting about it on night duty and I was saying yeah, it’s pretty rife here and they said “Do you think?” Like total denial about….’ None of the respondents were satisfied with their reactions to the experiences of horizontal violence, but their responses to the question ‘Would you do anything differently now?’ indicated that for three respondents, there was a lack of confidence to do anything different. One respondent said ‘Not yet. Because I just still feel like I don’t know enough’. For the other four, things had shifted because as one respondent said ‘I have a hell of a lot more confidence in my abilities now. I let them speak down to me and push me down into that little hole, whatever you want to call it. But I would stand my ground a lot more now because I’ve learnt heaps in the last twelve months. I know that I’m still only on the beginning of the continuum sort of thing but I’m at a point now where I’m a year older and life experience wise I’m more confident in myself anyway. But I wouldn’t let them push it all on me and I would stand my ground’. Each respondent was asked ‘In what ways do you think your experiences have affected the way you work?’ The responses were varied. For one, ‘It’s turned me off delivery suite and that’s where I wanted to be but I know that at this stage of the game I don’t feel secure enough in my practice and I just don’t feel strong enough as a person to cope with it.’ Exploring horizontal violence For another, however, ‘I’m a lot more decisive now. I don’t um and arh and that’s a bit sad in some ways because I used to be able to like to discuss things with people and I used to do that as a student and that was acceptable and as a new grad that was acceptable with the right people. But now I don’t show them my hesitation because if they see any hesitation they play on it. Not everybody just a few. So I’m a bit more careful about when I work with people. If I’m not sure of something, instead of asking, I’ll go and look it up or I’ll go round to (another part of the unit) and I know someone there will discuss it with me without putting me down… I keep to myself a bit more… I tend to be a lot more perceptive of the students. I observe how they are and make sure they’re okay because I know how bad I felt and particularly when I came back (as a new graduate).’ For one respondent, ‘I try and not to let it affect the way I deal with women because I think at the end of the day that’s what we’re there for and the women that we’re dealing with, pregnant women and women who are giving birth are expecting us to do what is best for them. So I try not to let the influence of other people affect me. But there are occasions where you acquiesce to a more powerful member of staff so that you do kind of fit in with them and just flow, not causing ripples. Perhaps maybe working with somebody who has specific ideas about how to manage pain in labour or how to manage a woman’s progress in labour and… so you’re often consulting with them about what’s happening in the room that you’re working in. And as a junior midwife I like to refer to the senior midwife I’m working with and if it’s their suggestion to get the doctor to augment the labour or it’s preferable to give narcotic analgesia or to organise an epidural even though my personal philosophy might not be to do that. I may take their advice partly because I have to rely on the fact that they’re more experienced than me and also that it will make for a more harmonious workday. But a lot of the time I’m not influenced heavily by that.’ The respondents identified a set of characteristics that were more common for midwives who used tactics associated with horizontal violence. For one respondent ‘they tell the people that they’re looking after what’s happening. They make their decisions about their management… if you had an argument with them, they’d eat you up… I just don’t think that you cross them really’. Another respondent described her way of managing her emotions: ‘One of things that I really think which I don’t know whether this is true or just the way I try to make myself feel better, is I box them all and think okay you’re obstetric nurses and you’re scared of what you’re doing so therefore they’ve got to control the woman labouring, they’ve got to control the delivery, they’ve got to control the staff that are working around them. That kind of thing. And I don’t know whether that’s true or that’s just my coping mechanism to box them like that but they do tend to be the delivery suite midwives. People who are CNS (Clinical Nurse Specialist) status or have a bit of responsibility I suppose so I guess that’s why they want to control it because they want to get off at the end of the shift and know that everything was okay. And most of them are not One person was particularly clear regarding her observations of the mindset of these midwives. ‘ …they still are the ones jumping up and down saying “We want to be autonomous within our own rights, we’re midwives not nurses. But yet they’re the ones who cling to the whole structure of the medical model. And it’s just like as soon as anything unfamiliar or challenging or threatening comes upon them, they’ll stick back to the policies and procedures of the obstetric mould. Like I know they’re within those confines because they’re in the hospital but it’s like none of them … would stand up and challenge it and say “Well just because it’s the way it is, does that mean it’s the right sort of thing?” It’s just the way it’s done so it’s the way it’s done. They use (policies and procedures) to boost themselves up and say this makes me a better practitioner because I do it this way. Instead of saying I’m a better practitioner because I question everything I do. There are huge comparisons drawn continually between those of us who have trained in the uni system and those who were trained in the hospital system. Not everybody by any means, but a minority who have trained in the hospital system who are very suspicious and very anti-uni. But I can honestly say that we might have had the disadvantage of not having the practical experience but I think the fact that I think a lot more constructively and I pull a lot more things to pieces and don’t just accept things because I’ve been to uni. I don’t always do it at work but I always think it. Like it’s always going through my mind. It’s just because of the level that I might actually be on at work that you can’t actually do anything about it. That instead of just accepting things like that labour needs augmenting because the Resident says it does because they say “This is the way we do it at xxx Hospital”. They can give women more information about what alternatives they’ve got and say “You have the choice of this, this, this and this”. Instead of saying this is their choice because this is what they do at xxx Hospital. midwifery Another ‘learnt something about communication in that situation… it’s made me a lot more conscious of it’. university trained which I don’t know how that would influence… but they tend to be ‘old school’ nurses.’ I don’t really think they do that (inform women) to a great degree. I’ve seen that happen and those who are core staff there who have been there for a long time and have the confidence to speak to doctors and stand their mind, it’s like they’re teaching the Residents and stuff who are coming through, yes, it’s alright to have the attitude and to try and always be the one step above the women. And say, they’re like rehashing that this is what you do because you’re a doctor. This is what you tell them… so the doctors are thinking that it’s alright to keep that going. Because they’d see their top dogs acting like that. They’re just mirroring their behaviour I guess… it’s a whole mindset sort of things. They’re the first people to knock. They’re the first people to deny, like if a situation arises they’re the first ones to cover their own backs and to deny any sort of involvement. They’ll push it off onto someone else. If they’re challenged by anything they’ll hide behind whatever they can… they won’t take it upon themselves to think. They just take it as a criticism. If it’s challenging it’s having a go at them personally. They don’t have the ability to step sideways and look at things. Maybe they see things two dimensionally I guess is what I mean. There’s not the ability to step to the MIDIRS Midwifery Digest 16:1 2006 29 Exploring horizontal violence side and look at things from the other alternative. I find that they’re often just really rigid personality wise… they like the safety net of the hospital system and they like knowing their space and their role and they like everybody else to know what their role and everything is… and they reinforce that just by the negative behaviours… but I guess they must have a lack of confidence in themselves to think like that anyway, if they can’t handle being challenged… that’s one huge thing that I think I’ve taken in over the last twelve months is that it’s not necessarily my problem… they are just really resistant to change… but I think that goes more with the taking everything personal because change is a bad thing. Like it threatens them and their place in the whole big wide world. I guess so that yeah, just really resistive to any change. I mean you’ve got to have bad changes to get positive changes because you’ve got to learn.’ not be scared to fail at something… to be better at something else… to make positive changes for everybody I think is probably the biggest thing.’ The following is a representative set of answers from one respondent regarding the characteristics of those midwives who were helpful and supportive in the clinical setting. It is important for each of us to reflect on our practice and behaviour and ask ourselves ‘am I open and easy to talk to? Do I admit I can make mistakes? Do people live in fear of me or am I someone people can feel comfortable to be themselves with? Am I aware of my own behaviour? Am I open to receiving feedback? Am I part of the problem or part of the solution?’. ‘…extremely open, really easy to talk to. No matter how busy they are, if they don’t have time then… they’ll let you know that you’re still important and that they’ll make time later to go over things. So you don’t feel like you’re a hassle or a burden to them… that they actually want to help you learn something. If something happens it’s like “ yes it’s happened, lets deal with it, lets move on”. It’s not the end of the world. They’re there as more than just professionals. They’re there as someone to talk to if you need that. If you need that sort of way of letting go. They’re not afraid to be themselves. They don’t put their mask on when they come to work. They admit that they can make mistakes and be human and that makes them a lot more likeable and good to work with. And just gets the whole idea of team work together. Things work a lot more cohesively I think if you can get that sort of rapport with your workmates rather then living in fear of them. Probably just the way that they’ll open themselves up and just not be resistant to change and 30 MIDIRS Midwifery Digest 16:1 2006 Another respondent said the midwives she gets her support from ‘are the ones who just sit back and let the woman do it all! …they are just there and basically, always say “I’m here to help you, you tell me what you want” and they’re the people that I’ve learnt off’. While I would love to be able to say that things have changed since I did these interviews in 2000–2002, I have found that this is not the situation. These comments, from the letters, emails, phone calls and face-to-face conversations I have had over the last five years with student and new graduate midwives from all over Australia are still relevant and are representative of the current climate within midwifery. References Barrentine P ed (1993). When the canary stops singing: women’s perspectives on transforming business. San Francisco: Berrett-Koehler Publishers. Duffy E (1995). Horizontal violence: a conundrum for nursing. Collegian, Journal of the Royal College of Nursing Australia 2(2):5-17. Shipka B (1993). Corporate poverty: lessons from refugee camps. In: Barrentine P ed. When the canary stops singing: women’s perspectives on transforming business. San Francisco: Berrett-Koehler Publishers. Roberts SJ (1983). Oppressed group behaviour. Implications for nursing. Advances in Nursing Science 5(4):21-30. Hastie C. MIDIRS Midwifery Digest, vol 16, no 1, March 2006, pp 25-30. Original article written by Carolyn Hastie, Midwifery Manager, Belmont Birthing Service, Australia. © MIDIRS 2006.