Throughout my career as a maternal-newborn nurse, I have witnessed nursing shortages, but I have never seen anything like the current staffing shortages and courageous efforts by nurses and health care leaders to maintain quality maternal newborn care during the pandemic (American Nurses Association, 2021; Semaan et al., 2020). In response to challenges being faced by nurses and health care facilities in my home state of Kentucky (KY), the Kentucky Nurses Association (KNA) and the Kentucky Organization of Nurse Leaders held a virtual press conference to discuss results of a survey of >850 nurses from KY. The survey cited the top ranked reasons for the nurse shortage in KY as lack of sufficient nursing staff, not enough pay, physical exhaustion, fear of transmitting COVID-19 to family and friends, lack of support staff, and lack of support from other nurses and management. Various solutions were suggested: KNA asked the state to allocate $100 million for recruitment and retention efforts, bonuses for local nurses, loan forgiveness for nurses in underserved areas, getting retired nurses to return to work, and marketing to make nursing appealing (KNA, 2021). Will these strategies be enough to recruit and retain nurses? That is yet to be determined.

Issues with job satisfaction and work environment specific to maternal newborn care have previously been described. Using data from 2015, Clark and Lake (2020a, 2020b) described prevalence of job dissatisfaction and burnout among maternal newborn nurses and association of job dissatisfaction and burnout with missed care. The 2020 study sample included 1,165 nurses from 166 units in California, New Jersey, Pennsylvania, and Florida. One-third of nurses, on average, gave their units an overall safety grade of "excellent," but this decreased to less than one-sixth of nurses in units with poor work environments. Overall, 65% of nurses reported their mistakes were held against them. A good work environment, compared with poor, was significantly associated with fewer nurses grading safety as poor ([beta] -35.6, 95% CI -42.9 - -28.3). The 2021 study was an analysis of the 2015 RN4CAST survey data and the American Hospital Association's 2015 Annual Survey. Robust logistic regression models at the nurse level examined association of job dissatisfaction and burnout with missed care. One-quarter of nurses screened positive for burnout, and almost one-fifth reported job dissatisfaction. Although 56.4% of nurses reported any missed care, 72.6% of nurses with job dissatisfaction and 84.5% of nurses with burnout reported any missed care (p < .001).

Despite leadership and support from professional organizations, workplace issues for maternal-newborn nurses existed before, and have been exacerbated by, the pandemic. Will financial resources be enough to solve the problem? It seems unlikely. To evolve as a maternal newborn nursing specialty, it is important to learn from nurse leaders about their successes with ensuring continued healthy work environments and job retention of expert maternal newborn nurses. I look forward to hearing those voices.

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