title: Midwifery scope of practice among staff nurses: a grounded theory study in Gujarat, India.
abstract: BACKGROUND
  midwifery is a part of the nursing profession in India. This current study explores and describes the midwifery scope of practice among staff nurses.
  
  
  METHODS
  a grounded theory approach was used to develop a model. Twenty-eight service providers from the maternity sections of public health facilities, selected through purposive and theoretical sampling were interviewed in-depth. Unstructured observations in the labour wards were also used for developing the model.
  
  
  RESULTS
  the midwifery practice of staff nurses was limited in scope compared to international standards of midwifery. Their practice was circumstance driven, ranging from extended to marginal depending on the context. Their right to practice was not legally defined, but they were not specifically prohibited from practice. As a consequence, the staff nurses faced loss of skills, and deskilling when their practice was restricted. Their practice was perceived as risky, when the scope of practice was extended because it was not rightfully endorsed, the nurses having no officially recognized right to practice midwifery at that level. The clinical midwifery education of nursing and midwifery students was marginalized because the education of medical students was given priority, and the students only got exposed to the restricted practice of staff nurses.
  
  
  CONCLUSIONS
  unclear definitions of the right to practice and the scope of practice have led to the un-utilized potential of staff nurses practising midwifery. This is detrimental because India faces an acute shortage of qualified personnel to meet the need in providing human resources for maternal health.
authors: Centre for Management of Health Services, Indian Institute of Management, Ahmedabad, India. Bharati.Sharma@ki.se
authors: Bharati
authors: B
authors: Sharma
authors: Eva
authors: E
authors: Johansson
authors: M
authors: M
authors: Prakasamma
authors: Dileep
authors: D
authors: Mavalankar
authors: Kyllike
authors: K
authors: Christensson
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000458:organization & administration*; D008429:Maternal Welfare; D008880:Midwifery / Q000193:education / Q000458:organization & administration; D017146:Models, Organizational; D020380:Needs Assessment; D009721:Nurse Midwives / Q000592:standards*; D057184:Practice Patterns, Nurses' / Q000458:organization & administration / Q000592:standards; D011247:Pregnancy