1. Section Editor(s): Kenner, Carole PhD, RN, FAAN, FNAP, ANEF, IDFCOINN
  2. Carol Kuser Loser Dean & Professor
  3. Boykova, Marina PhD, RN
  4. Associate Professor

Article Content

The state of healthcare globally remains precarious postpandemic. The growing workforce shortages across health professions coupled with the continued traumatic effects of delivering care under suboptimal conditions are impacting patient safety and quality of care. Nurses, midwives, physicians all reported staffing shortages, less time spent with patients/families, and increased stress to be factors impacting care.1 Many negative workforce scenarios related to postpandemic side effects continue to capture the headlines. Yet, there are many positives that came out of the pandemic that need to be addressed.


Parental and professional mental health issues now permeate the literature. Resources to promote trauma-informed care and resilience/well-being in healthcare workers/parents of newborn infants are more common now than in prepandemic era. Professional collaborations are growing, in part, out of the teamwork that occurred during the worst pandemic days when healthcare workers tried to provide the best care possible in these days-and survive themselves. Other factors influencing the collaborations are the budget constraints, rising healthcare and living costs, and, for professional associations, dwindling membership. To achieve more work-life balance, fewer people are willing to take leadership positions or join their professional organizations. Despite these challenges, professional associations are advocating for better work environments, staffing, and mental health supports for their stakeholders.


Globally, professional associations are banding together to promote one strong voice to address healthcare quality and patient safety. There is a greater recognition for the need for professional associations and parent organizations to work together to find better healthcare solutions and not just endorse each other's documents/protocols/guidelines. Partnerships project strength when they cocreate position statements, advocacy briefs, recommendations for standards of care aimed at improved health outcomes for neonates and families and support healthcare professionals too. Too often, we work in silos or our professional organizations only address an issue such as staffing/skill mix instead of working together with other organizations looking for solutions for the same issues impacting quality care.


The pandemic has also taught us that while face-to-face meetings are ideal to promote collaboration, virtual meetings can be a very helpful substitute of in-person meetings. Virtual meetings afford the opportunity for individuals and organizations to work together across the globe with the time and expense of travel. For instance, the Alliance of Global Neonatal Nursing (ALIGNN) represents a collaboration of the Academy of Neonatal Nursing (ANN), Association of Women's Health, Obstetrics, and Neonatal Nurses (AWHONN), Caring for Hawaii Neonates, Council of International Neonatal Nurses, Inc (COINN), and National Association of Neonatal Nurses (NANN) to address issues that each organization is hearing from its membership; for example, dwindling staff resources, concerns over how to effectively provide care. While all are member-driven organizations, the common goal of improving health outcomes for women, mothers, and infants and families (and supporting nurses) motivates us to work together on common issues such as quality of care, healthcare policies, and present/future healthcare workforce. Collectively, we have a stronger, more powerful voice to effect change.


International partnerships are of a vital importance as we should (and must) learn from other countries' best practices. The US healthcare system and some of the population's health indicators are not necessarily the best ones in the world. For instance, COINN as an international group of neonatal nurses partners with many organizations to work on workforce, policy, education/training, and practice issues. Examples of these collaborations include the codeveloping of the new edition of Born Too Soon2 report that involved members from the International Federation of Gynecology & Obstetrics (FIGO), International Pediatric Association (IPA), World Health Organization (WHO), Partnership of Maternal, Newborn, Child, & Adolescent Health (PMNCH), London School of Hygiene & Tropical Medicine (LSHTM), and many others. Experts from the organizations (named earlier) worked closely together to address the issues of preterm births and its consequences for the societies all over the globe. Another document cocreated by the same partners plus the International Confederation of Midwives (ICM), International Council of Nurses (ICN), International Stillbirth Alliance (ISA), United States Agency for International Development (USAID), and many others is the "Global Advocacy and Implementation Guide"3 to call attention to the often undocumented number of stillbirths that occurs globally whose families often fail to receive adequate support. This document represents an interdisciplinary advocacy tool kit that will hopefully have a broader impact through the partnerships than it would have had if only one organization had developed it.


Why are these partnerships and collaborations important? In essence, each organization has its own professional network, its own followers, its own social media platforms that amplify the messages and highlight the work they do. There is also an organizational rivalry for members, unfortunately-and it is understandable as the organizations must do something to survive and sustain themselves. However, we cannot achieve the common "good health" if we are not collaborating with other organizations and not sharing our ideas or assets-we must consolidate our efforts to change practices and policies. Only when we are together, we are stronger. Showing a unified voice on issues helps push the issue to the forefront of the news cycles. As nurses, we must claim the fact that we are the front line of healthcare, the advocate that spends the most time with newborns and their families. But we do not and should not work in isolation. Working together does not diminish us. It does not lessen what we bring to the table. It increases our impact. It demonstrates that none of us should live/work alone. When we are in the neonatal intensive care unit, we work as a team, no captain of the ship mentality, for the good of the newborn and family. The same is true when it comes to policy initiatives and organizational collaborations. We all want better outcomes. As often said in graduation speeches to new graduating nurses, at the end of the day we should all remember the important role we play in patient and families lives. We are privileged to be there at their most stressful times-the hour of birth and the moment of death. We are part of a team dedicated to providing high-quality care. If we remember that goal-high-quality care, the "turf issues" go away! We are "TEAM HEALTHCARE," and we want to support those we serve.




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


-Marina Boykova, PhD, RN


Associate Professor


School of Nursing and Health Professions


Holy Family University


Philadelphia, Pennsylvania


Non-executive Board Member


Council of International Neonatal Nurses, Inc (COINN)


Yardley, Pennsylvania




1. Kolie D, Semaan A, Day L-T, Delvaux T, Delamou A, Benova L. Maternal and newborn healthcare providers' work-related experiences during the COVID-19 pandemic, and their physical, psychological, and economic impacts: findings from a global online survey. PLoS Glob Public Health. 2022;2(8):e0000602. doi:10.1371/journal.pgph.0000602. [Context Link]


2. World Health Organization. Born Too Soon: Decade of Action on Preterm Birth. Geneva, Switzerland: World Health Organization; 2023. Accessed July 24, 2023. [Context Link]


3. International Stillbirth Alliance Stillbirth Advocacy Working Group. Preventing and Addressing Stillbirths Along the Continuum of Care: A Global Advocacy and Implementation Guide. Version 1. Millburn, NJ: International Stillbirth Alliance Stillbirth Advocacy Working Group; 2023. Accessed July 24, 2023. [Context Link]