Introduction

These principles are founded on the whole multidisciplinary team (MDT) recognising and respecting the scope and professional boundaries of each other’s roles, that clearly define how midwives deliver midwifery care and nurses deliver nursing care.

It has been developed with a range of stakeholders to support maternity service leaders within their workforce planning, setting out how they can optimise the valuable contribution adult nurses can make to multidisciplinary maternity care. It is based on the understanding that no registered nurse should be used to replace the role of a midwife. Instead, nurses should work within their professional boundaries to support midwives as part of MDTs in maternity services. As with all workforce planning, where new roles are introduced, these roles need to be underpinned by Quality Impact Assessments (QIA).

The use (‘use’ is utilised in this document to mean both the employment and deployment of nurses in maternity services) of adult nurses in maternity services should not be considered as a stopgap measure when there are midwifery staffing shortfalls, nor to replace a midwife, but rather to enhance current provision of care. This document specifies principles for the role of adult nurses caring for women as part of MDTs in maternity services. It recognises that midwives are fully accountable as the lead professional for the care and support of women and newborn infants, and have specific responsibility for continuity and coordination of care (Domain 1 in Standards of proficiency for midwives – The Nursing and Midwifery Council). By employing adult nurses as part of the MDT, care should not become fragmented, and the risk to safety should be clearly assessed. Nurses working in this multidisciplinary context add value through working within their scope of practice, and to the NMC Standard of proficiency for registered nurses. As a registered professional, whether delegating a task, or receiving a delegated task, a registered professional is accountable for their own conduct and practice (Delegation and accountability – supplementary information to the NMC code).

Context

Midwifery is a distinct profession with a protected function and title, preserved in law – “A person other than a registered midwife or a registered medical practitioner shall not attend a woman in childbirth” (Article 45 – The Nursing and Midwifery Order 2001). Midwives’ expertise is needed in the whole pregnancy and maternity pathway.

Interdisciplinary and multiagency* working is key to providing safe, personalised care in maternity services. It ensures that the right staff are trained with the right skills, within their scope of practice to deliver the most appropriate care in the right place at the right time (Supporting NHS providers to deliver the right staff, with the right skills in the right place at the right time, National Quality Board (2016)). This document highlights the value of midwives and nurses working together, as appropriate, maximising their skills and expertise to ensure women and their families receive the best possible care, whilst prioritising people, practicing effectively, preserving safety, and promoting professionalism and trust (Read the Code online, The Nursing and Midwifery Council).

* Multidisciplinary teams offer a mechanism to ensure care is both person-centred and meets the needs of individuals receiving care. The teams are composed of a range of expertise and skills possessed by different professionals, working together to enhance care to achieve the best possible outcomes. In maternity services these can include (but are not limited to) midwives, maternity support workers, obstetricians, anaesthetists, neonatologists, allied health professionals and in some specific areas, adult nurses. 

The NMC Standard of proficiency for midwivesx states that midwives recognise their own strengths, as well as the strengths of others. Midwives provide ongoing midwifery care as part of the interdisciplinary team, and are responsible for ensuring timely collaboration with, and referral to, interdisciplinary and multiagency colleagues, particularly where additional care is needed for women and their newborns.

Document purpose

This document sets out safe practice principles for adult nurses working as part of MDTs in maternity services, ensuring they are welcomed into maternity services, are supported in practice by a robust governance structure detailing their roles, responsibilities, and scope of practice, and receive appropriate training, pastoral care and support. It is the responsibility of providers to agree the operational details of implementation. It is recommended that this document is read alongside those referenced throughout this paper, as they can support this process.

Working to national policy and reviews (see box below), this document considers how adult nurses can be effectively deployed as part of the MDT in maternity services and sets out principles to ensure adult nurses contribute to and support the delivery of safe, effective care. It is founded on the whole multidisciplinary team recognising and respecting the scope and professional boundaries of each other’s roles, that clearly define how midwives, nurses and others from the MDT, collaborating together, supports safe practice. This approach enables the staff in the MDT to focus on providing high quality care to mothers and families.xvi

*National policy and reviews:

• National Quality Board (2016) Supporting NHS providers to deliver the right staff, with the right skills in the right place at the right time
• NICE: Overview | Safe midwifery staffing for maternity settings
• NHS England (2019) The NHS Long Term Plan
• GOV.UK: The Kirkup Review (2022). Maternity and neonatal services in East Kent: ‘Reading the signals’ report
• National Quality Board (2016) Supporting NHS providers to deliver the right staff, with the right skills in the right place at the right time 

Scope of this document: adult nurses

There are four fields of nursing: adult, children’s, learning disability and mental health. Their contribution is highly valued throughout the life course, but this document is specifically about adult nurses working as part of the MDT in maternity services. The roles of nurses caring for babies in neonatal or transitional care settings and maternity support workers (MSWs) are also outside scope of this document.

Maternity support workers (MSWs) are an integral part of the maternity workforce and play an important role in supporting midwives and the wider maternity MDTs, women and their newborns through pregnancy, labour and during the postnatal period. Whilst not registered with the NMC, MSWs have their own Competency, Education and Career Development Framework.

Adult nurses in Maternity services work predominantly in theatre, recovery, and High Dependency Unit (HDU) or enhanced care and often have acquired specialist skills to do so; examples have also been seen of nurses facilitating immunisation clinics in maternity services. Wherever trusts deploy nurses to work as part of MDTs in maternity services, the nurses must work within their scope of practice and with a clearly defined job description.

Principles of safe practice

NHS England has developed six principles to describe clear parameters for the management of adult nurses as part of MDTs in maternity services and local decision making. They set out how adult nurses can practice within the full capacity of their scope to care for women in maternity services whilst maintaining safe and role-appropriate practice.

It is recognised that, in an emergency situation, all members of the MDT working in a clinical area would be involved in caring for both mother and baby, within their scope of practice.

These principles should inform local decisions about how adult nurses can operate within their scope of practice, to provide care for women as part of MDTs in maternity services.

1. Adult nurses should be welcomed and supported into maternity services as part of the multidisciplinary team (MDT).

Adult nurses can work safely and effectively as part of the maternity MDT to support their midwifery colleagues and the wider multidisciplinary team. It is the pastoral responsibility of maternity service leaders and managers to ensure that there is scope for adult nursing career development, progression, and retention, including access to the shortened midwifery programme.

2. A clear governance structure must be in place to support adult nurses working as part of MDTs in maternity services.

Good governance is imperative to support and optimise the contribution of adult nurses working as part of MDTs in maternity services. It should be underpinned by local governance documents.

Each service varies in its approach, but adult nurses as a staff group should be included as a defined group in a section under the organisational safer staffing policy and/or workforce strategy, and organisational training needs analysis guidance or practice development offer of that maternity service.

The following descriptions for what documents underpin good governance and safe practice are illustrative not exhaustive.

Documents underpinning good governance and safe practice will cover:

• roles and responsibilities; scope of practice, including clear job descriptions.
• escalation
• leadership and line management
• training updates/mandatory training/clinical supervision
• pastoral support/appraisal/including career progression (within maternity this will include access to the shortened midwifery programme).

3. Maternity leaders must be able to clearly articulate and justify how adult nurses are used and contribute within the staffing of their MDTs in maternity services.

It is important that service leaders understand their workforce and have an agreed methodology for how many of each staff group are needed to have a balanced workforce and ensure safe practice – this will be specific to each trust.

Directors of Midwifery/Heads of Midwifery must be able to describe clearly how their workforce is structured and why this specific structure has been planned for and implemented. This includes management of staff when there is need for escalation.

To ensure robust accountability, boards must also understand the methodology these decisions are based on and share this information from board to ward.

4. Organisations should support access to the shortened programme to midwifery training for adult nurses with a particular interest.

Supporting adult nurses that are interested to undertake the shortened midwifery programme will not only increase the number of midwives in the workforce, but it can also promote retention of adult nurses and midwives – see Maisie’s example below.

5. Adult nurses working as part of the MDT in maternity services should be given clear information on accessing Professional Midwife Advocates (PMAs).

Professional Midwifery Advocates (PMA) provide “…a fundamental leadership and advocacy role deploying the A-EQUIP model (advocating for education and quality improvement). The role supports staff through a continuous improvement process that aims to build personal and professional resiliencexix”. Each service should include information about how PMAs are accessible to the whole MDT including nurses working within maternity services.

The work of the PMA is department/work specific and therefore it is more appropriate that the PMA works with members of the MDT within maternity services. However, if a nurse wishes to work with a PNA, this should be supported, wherever possible.

6. Organisations should identify where it is appropriate for adult nurses to be involved in pre-registration education as practice supervisors, as part of the MDT.

Nurses do not have a role in acting as practice assessors for student midwives; and therefore, cannot sign-off student midwife proficiencies. However, in line with the Standard for student supervision and assessment (SSSA)xx, nurses may contribute to the multidisciplinary training of midwives, by taking on the role of practice supervisors where students need to experience specialised skills, that are within the nurse’s scope of practice, such as learning about managing a seriously ill woman in HDU enhanced care or in the context of additional care needs.

Publication reference: PRN00167