The International Council of Nurses (ICN), when celebrating International Nurses Day in May 2022, cited that "the greatest threat to global health care is the workforce shortage."1 This statement follows the ICN's Policy Brief The Global Nursing Shortage and Nurse Retention published in 2021.2 An estimated 13 million nurses will be needed just to fill the existing gaps and not increase the number of nurses where there are already glaring holes.2 This shortage is not limited to generalist nurses but trickles down to specialty areas like neonatal nursing. For instance, in the UK before the COVID-19 pandemic really started in January 2020, additional neonatal nurses were needed for adequate staffing.3

Ironically in 2015 I wrote on the neonatal nursing workforce shortage citing that nurses were still seen as expenditures and not investments.4 Unfortunately, this is still the case today where nursing's contribution to healthcare costs and outcomes id not quantified. The COVID-19 pandemic has decimated healthcare and educational budgets leading drastic cuts. Nurses in many countries have gone on strike-Finland and Australia, for example, to call attention to poor working conditions and concerns for patient safety and quality of care.

The COVID-19 pandemic also forced many nurses to reevaluate their work-life balance. Shaw and colleagues5 in 2021 conducted a thematic analysis of personal reflections of neonatal nurses to determine what impact COVID-19 has had on these nurses, especially in relationship to family-integrated care and the restrictions on families' presence in the neonatal intensive care units. The researchers found that the neonatal nurses felt vulnerable; they worried about quality of care; they saw their role as a protector of the babies and families and of themselves; and they relied on peers to maintain resilience.5 Nurses are feeling burned out and exhausted. They express anger at not being able to provide the care they so desire. Moral distress is real.

In addition to the COVID-19 pandemic, the war between Russia and Ukraine has impacted the nurses in those countries as well as it has resulted in supply chain issues globally. Obtaining equipment and medical supplies including these needed for the small and sick newborn is difficult. The United States has certainly had its share of supply chain issues ranging from getting hospital equipment, teaching/simulation equipment for the educational and clinical training programs, and the added problem of the formula shortage. The supply chain problem future is unclear, and it appears that the inadequate provision of needed materials might negatively affect neonatal care nationally and globally.

Neonatal nurses in low-resourced countries have long coped with staffing and commodities, resource shortages.6 However, even high-resourced countries are feeling the pinch. The World Health Organization (WHO) and many other organizations are finally taking steps to include neonatal nursing as a major workforce issue that must be addressed to improve health outcomes for the small and sick newborn.7 The WHO emphasizes the need to create a new cadre of neonatal nurses as well as upgrade the education of the existing workforce.7 This statement is important as it recognizes that the number of qualified neonatal nurses must increase and that many nurses in the neonatal area have received little specialized training regarding the small and sick newborn. While this training has been available for many years in high- and some middle-income countries, it has not been the case in many countries considered as low-resourced or low-income. Well-educated neonatal nursing workforce and adequate supplies are key factors for quality neonatal care.

As Fraser8 points out, nurses for 20 years have been ranked as the most trusted health professional and we celebrate that during nurses' week-but to what end? No longer can we continue to just celebrate our role in healthcare 1 week a year. Nor can we ignore the factors driving nurses out of the profession. We must tell our stories of what it is like on the frontlines. We must push governments and policymakers to stop paying nurses compliments without addressing working conditions, staffing patterns, equity in wages, upgrade the educational of nurses working in neonatal care, and just as parents/families have been deemed essential partners in care, neonatal nurses must be viewed as essential to high-quality, cost-effective care.

So, how do we advocate for ourselves? Do not wait for an invitation to express your opinion about care needs-write about it, speak about, and network with other health professionals. Join professional organizations that are involved in policy changes. At the unit or hospital level, be a part of the "team" that is deciding how care is rendered or staffing decisions are made. The United States has encouraged nurses to join boards of healthcare corporations, health departments, and local community boards that focus on health issues. The "perfect storm" in healthcare has created opportunities along with the myriad of challenges. Let's take full advantage of using our expertise, raising our voices, telling our stories, and partnering with families who value our role in healthcare to change the future of nursing. You can do it! The time is now.

-Carole Kenner, PhD, RN, FAAN, FNAP, ANEF

Carol Kuser Loser Dean & Professor

The College of New Jersey

Ewing, New Jersey

Chief Executive Officer

Council of International Neonatal Nurses, Inc (COINN)

Yardley, Pennsylvania

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