Where Are Neonatal Nurses in Global Strategies?

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By: Carole Kenner, CEO, Council of International Neonatal Nurses, Inc. (COINN); Marina Boykova, Research Coordinator, Council of International Neonatal Nurses, Inc. (COINN)

Carole Kenner neonatal nurse Marina Boykova neonatal nurseHaving worked as neonatal nurses and educators for more than three decades collectively, we know that newborns who are born prematurely or sick are linked to either maternal perinatal health or the intrapartum experience. According to WHO, 45% of all under five deaths occur during the neonatal period (the first 28 days of life). Most of these deaths are preventable. To change the statistics globally and to end preventable neonatal deaths, partnerships must be formed to train more personnel in maternal and newborn health. Parent groups along with professional organizations, task forces, nongovernmental and governmental agencies must develop a clear integrated plan to address the causes of these maternal and neonatal deaths.

Global strategies in maternal and newborn health

The WHO’s 2015 report “Strategies Toward Ending Preventable Maternal Mortality (EPMM)” calls for maternal and child health programming and interventions to be population-based with a focus on prevention and wellness promotion. This report acknowledges the link between maternal health and newborn outcomes by recognizing that these outcomes are related to the availability, accessibility, acceptability and quality of services (AAAQ). To examine outcomes, as the report states, there must be metrics to measure successful outcomes and data collected on both the mother and newborn. This report links to the Every Newborn Action Plan (ENAP), which calls for the saving of 3 million lives annually and the development of metrics to measure outcomes beyond just neonatal mortality rates.

ENAP, launched in June, 2014, was created with the input of more than 60 organizations and adopted by all 194 UN member states at the World Health Assembly in 2014. This action was the first time that newborn health made it on the World Health Assembly agenda. It also brought to light the work that had admirably been done to decrease preventable maternal deaths, such as the training of skilled birth attendants. The Partnership for Maternal, Newborn & Child Health (PMNCH) recently released the zero draft for consultation of The Global Strategy for Women’s, Children’s and Adolescents’ Health, a report outlining the need for reproductive, maternal, newborn, child and adolescent health (RMNCAH) programs that are leveraged at country-level to address both maternal and child mortality. But this is not enough.

Amplifying nurses’ voices

Nurses, a large segment of the health workforce, have for the most part been silent, or at least not active participants, in the construction of these plans. In the last few years, neonatal nurses have been asked to contribute only after much of the work has been done. Why is this so?

  • Neonatal nursing is a small, very specialized segment of nursing and health care
  • Neonatal nursing’s role in neonatal health outcomes is often not recognized, or measurable
  • Neonatal nurses in countries that bear the highest burden of poor neonatal outcomes have little to no power or voice as physicians generally play the pivotal role in not only health care decisions, but patient care

The time has come to change this situation. Neonatal nurses must be well-trained and well-educated. They must actively participate in advocacy for their patients and families. They must work with other disciplines, parents, NGOs, governmental agencies and policy makers to shape an integrated maternal, newborn and child health strategy. Neonatal nurses must and can serve on boards that are guiding this global work in order to bring a necessary perspective to the table.

It is time to move from theoretical papers to country- and local-level actions. Nurses must act. Neonatal nurses must unite with one strong voice to raise awareness of our contribution to improving health outcomes. All it takes is for us to use our neonatal nursing expertise and tell our stories. Visit the website of the Council of International Neonatal Nurses (COINN) to read about the three 2013 recipients of the International Neonatal Nursing Excellence Award: nurses who are truly making a difference.