Early Career Midwife Network (ECMN) Peer Support Request Form
Thankyou for your interest in ECMN Peer Support. Our peer support programme aims to connect student midwives and early career midwives with a peer supporter who can provide a safe, supportive space to talk about experiences, challenges and wellbeing. Please note: Peer support is not clinical supervision, mentorship, counselling or therapy. Peer supporters cannot provide clinical advice, legal advice or emergency support.
Name
*
First Name
Last Name
Email
*
example@example.com
Preferred pronouns (optional)
Are you:
*
Student midwife
Newly Qualified Midwife (0-2 years)
Early Career Midwife (2-5 years)
Other
Which UK region are you based in?
*
North East
North West
Yorkshire & Humber
East Midlands
West Midlands
East of England
London
South East
South West
Wales
Scotland
Northern Ireland
Prefer not to say
Other
What has prompted you to seek peer support? Please write as little or as much information as you would like (optional)
Which areas are you looking for support with? (Tick all that apply)
*
Transition to practice
Preceptorship
Confidence and self-belief
Workplace culture
Stress and wellbeing
Burnout
Work-life balance
Shift work
Difficult experiences at work
Career development
Returning to practice
Student placement experiences
Imposter syndrome
Working at a new Trust
Other
What are you hoping to gain from peer support? Please write as little or as much as you like (optional)
Would you prefer to be matched with:
*
Student midwife
Newly Qualified Midwife
Early Career Midwife
No preference
How would you prefer to connect with a peer supporter? (Tick all that apply)
*
Phone calls
Video calls
No preference
Please let us know dates and times of your availability for a peer support session
*
Is there anything you would like us to know before matching you with a peer supporter?
I understand that ECMN Peer support is not a crisis service, counselling service or clinical advice service.
*
Yes
I understand that my information will only be used for peer support matching purposes.
*
Yes
I consent to being contacted by ECMN for peer support.
*
Yes
Would you be happy for anonymous themes from your responses to be used to help improve support for Early Career Midwives?
*
Yes
No
How did you hear about ECMN?
*
Instagram
TikTok
Linkedin
University
RCM
Word of mouth
Other
Submit
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