Evaluating the roles of workload and practice climate in workforce retention across the midwifery career lifespan: A latent profile analysis of early-, mid-, and late-career US midwives.

Problem: Retention of midwives across the career lifespan is essential to address workforce shortages.

Background: While workplace factors are demonstrated to affect job satisfaction and turnover intention, there is little research investigating how workplace factors affect midwives at different career stages.

Aim: To examine the effects of workload and practice climate on job satisfaction and turnover intention at different career stages.

Methods: In a secondary analysis, we split a sample of US midwives into early-, mid-, and late-career stages. We used latent profile analysis to create profiles (called "classes") of workload (volume of women/individuals receiving care and acuity) and practice climate. Job dissatisfaction and turnover intention were compared between classes by career stages.

Findings: Across all career stages, classes with negative practice climates had significantly higher turnover intention and job dissatisfaction, regardless of patient volume or acuity. Among early career midwives, high workload was not associated with high turnover intention or job dissatisfaction in the context of positive practice climates. The highest proportion of mid- career participants were in the class with high turnover intention and job dissatisfaction, while in the early career subsample the largest proportion was in the class with low dissatisfaction and low turnover intention.

Discussion: Across all career stages, the practice climate was the primary driver of turnover intention and job dissatisfaction. Practice climate is particularly important for early-career midwives working in high-volume settings. Mid-career midwives are an under-studied group at risk of leaving the profession.

Conclusion: Efforts to retain the midwifery workforce would benefit from tailoring retention strategies to midwives at different career stages.