- Email: [email protected]
Neonatal Nursing Workforce: A Global Challenge and Opportunity
Newborn & Infant Nursing Reviews 15 (2015) 165–166
Contents lists available at ScienceDirect
Newborn & Infant Nursing Reviews journal homepage: www.nainr.com
Neonatal Nursing Workforce: A Global Challenge and Opportunity Carole Kenner, Ph.D., RN, FAAN ⁎ Council of International Neonatal Nurses, Inc., 2110 Yardley Road, Yardley, PA 19067 School of Nursing, Health, and Exercise Science, The College of New Jersey, 2110 Yardley Road, Yardley PA, 19067
a r t i c l e
i n f o
Keywords: Neonatal Workforce Global
a b s t r a c t As the United Nations Millennium Development Goals (MDGs) move to Sustainable Development Goals (SDGs) to ensure that progress continues and is sustainability, the quality and quantity of the workforce is being examined. The neonatal nursing workforce is an elusive concept as there are many challenges to accurately measuring the number of neonatal nurses working globally. Yet, the ability to describe the workforce-supply and demand is important as neonatal outcomes are directly linked to access to health professionals who are adequately trained. This article will describe the health care workforce and the need to re-examine the changing healthcare needs globally. © 2015 Published by Elsevier Inc.
Today’s healthcare needs are shifting from an acute care, episodic focus to a population health/public health model that calls for universal healthcare globally. Disease management is shifting to health promotion and disease prevention, areas that nurses have addressed for many years. Neonatal nurses teach families about follow up appointments, how to protect against infections, feeding, and many other things that are aimed at prevention of complications. Neonatal nurses are the primary health professional providing direct care and stabilizing newborns especially during that “golden minute” after birth. Yet, the healthcare workforce including nurses is often seen as an expenditure verse and investment.1 This point of view is changing, slowly.
growth. These analytical models are possible because registered nurses must report to their board of nursing or professional licensure agency whether or not they are employed full time or part time and where they are employed each time the nurse renews a license. This information however, is general and while a specialization is reported to the licensing agency, it is often not reported, for example to the level of a neonatal nurse. If an advanced practice nurse-one with a master’s or doctoral degree who holds a license at this level or holds certification, then data on the area of specialization are available. Is this true globally?
Global Workforce Data United States Exemplar In the United States (U.S.) the American Association of Colleges of Nursing (AACN) predicts that there will be a shortage of more than one million nurses by 2022 2 This shortage is in part due to the large number of projected retirements and the growth in the demands due in part to an aging population. Another factor that is contributing to the shortage is the recognition of the role nurses play in patient safety and outcomes.3–5 As these studies demonstrated, patient outcomes suffer as does patient safety when there are fewer, well qualified nurses available to provide direct care. 3–5 Nursing’s costs are generally the largest portion of a healthcare system’s expenditures so despite the link to patient outcomes, they are still viewed by many institutions as an expenditure versus an investment. This may change as more and more states are attempting to examine reimbursement for at least advanced practice nurses. In the U.S. too, it is possible to look at the actual numbers of nurses employed state by state and predict where demands are out numbering
⁎ Tel.: +1 405 684 1476. E-mail address: [email protected]. http://dx.doi.org/10.1053/j.nainr.2015.09.006 1527-3369/© 2015 Published by Elsevier Inc.
The workforce data available globally varies from country to country. In some countries there is no licensure or registration. In other countries registration occurs when a diploma or degree is conferred. However if a nurse decides not to work as a nurse this may not be reported. For the neonatal specialization there is no common definition of what constitutes a neonatal nurse. Is this a person who is trained as a nurse and works with healthy newborns? Is this a nurse who has special education beyond basic training and works with premature or sick neonates? Is this a generalist nurse that has received on the job training to occasional care for a sick neonate? With no licensure and no clear scope of practice or definition of a neonatal nurse or even a defined scope of practice in some countries, it is difficult to determine who is a neonatal nurse. The Council of International Neonatal Nurses, Inc. (COINN) with funding from AbbVie Inc. (North Chicago, IL) attempted to create a workforce database to have nurses enter their own data. Some nurses did begin this process but the challenges were great. Again the definitions of neonatal nursing, the scope of practice, the knowledge and skills, and the education varied widely. Also many nurses admitted they were not permitted to enter their data unless they had permission from their employer or a physician. Despite these challenges COINN is going to continue to attempt answer the questions: “Who are the
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C. Kenner / Newborn & Infant Nursing Reviews 15 (2015) 165–166
neonatal nurses? Where do they work? How are they educated? and How many are needed and where?”
Impact on Neonatal Outcomes Just like the studies cited earlier, it is recognized that neonatal outcomes are better when there are enough, well trained neonatal nurses available. With the Millennium Development Goals and now the Sustainable Development Goals it is critical that the areas of highest burden of the under five child mortality, most of which is attributable to neonatal mortality be linked to the number and quality of training of neonatal nurses. The time is critical to make this link but solid evidence is needed. The world now recognizes that there will be no health if there is no workforce.6 Dr. Margaret Chen, WHO Director-General, stated in a keynote address at the 2015 International Council of Nurses (ICN) meeting in Seoul, South Korea “Given the enormous complexity of health challenges faced as the world transitions to the post-2015 era, no one, including WHO dares to ignore the full contribution that the nursing professional can make.”7 Dr. Chen also cited the research done by nurses regarding transitions in care was leading to cost savings and more efficiency. 7 This work is also being done with transitions from NICUs to home and to primary care settings. There is mounting evidence that neonatal nurses make a tremendously difference globally. But the questions remain: Who are the neonatal nurses? Where do we work? What do we do? These questions must be quantified in order to approach the analytics that the United States presents for generalist nurses. How do we accomplish this for the neonatal nursing global community?
Conclusion The links between patient safety and outcomes and nursing care are now supported by evidence. More of this work has been done in the adult population than with neonates and neonatal nurses. Yet neonatal nursing science is making progress. There is growing recognition that we must quantify the number of neonatal nurses, the training they receive, where they work, and where they are needed most. Many barriers exist to achieving answers to these questions. The timing is right to overcome these challenges as we move into the Sustainable Development Goals with workforce and outcomes inextricably linked. References 1. Global Health Workforce Alliance, World Health Organization (WHO). Synthesis paper of the thematic working groups. Health Workforce 2030: towards a global strategy on human resources for health. Geneva: WHO. 2015. 2. American Association of Colleges of Nursing (AACN). Nursing shortage. Available: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage. [Accessed August 8, 2015]. 3. Tubbs-Cooley HL, Cimiotti JP, Silber JH, Sloane DM, Aiken LH. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf. 2013;22:735-42. 4. Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control. 2012;40:A1-A34. 5. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. NEJM. 2011;364:1037-45. 6. Global Health Workforce Alliance. A universal truth: no health without a workforce: third global forum on human resources for health report. Available:http://www.who.int/ workforcealliance/knowledge/resources/hrhreport2013/en/2013. [Accessed August 8, 2015]. 7. Chen M. WHO Director-General addresses international conference of nurses. Available:http://www.who.int/dg/speeches/2015/international-conference-nurses/en/ 2015. [Accessed: August 8, 2015].
Contents lists available at ScienceDirect
Newborn & Infant Nursing Reviews journal homepage: www.nainr.com
Neonatal Nursing Workforce: A Global Challenge and Opportunity Carole Kenner, Ph.D., RN, FAAN ⁎ Council of International Neonatal Nurses, Inc., 2110 Yardley Road, Yardley, PA 19067 School of Nursing, Health, and Exercise Science, The College of New Jersey, 2110 Yardley Road, Yardley PA, 19067
a r t i c l e
i n f o
Keywords: Neonatal Workforce Global
a b s t r a c t As the United Nations Millennium Development Goals (MDGs) move to Sustainable Development Goals (SDGs) to ensure that progress continues and is sustainability, the quality and quantity of the workforce is being examined. The neonatal nursing workforce is an elusive concept as there are many challenges to accurately measuring the number of neonatal nurses working globally. Yet, the ability to describe the workforce-supply and demand is important as neonatal outcomes are directly linked to access to health professionals who are adequately trained. This article will describe the health care workforce and the need to re-examine the changing healthcare needs globally. © 2015 Published by Elsevier Inc.
Today’s healthcare needs are shifting from an acute care, episodic focus to a population health/public health model that calls for universal healthcare globally. Disease management is shifting to health promotion and disease prevention, areas that nurses have addressed for many years. Neonatal nurses teach families about follow up appointments, how to protect against infections, feeding, and many other things that are aimed at prevention of complications. Neonatal nurses are the primary health professional providing direct care and stabilizing newborns especially during that “golden minute” after birth. Yet, the healthcare workforce including nurses is often seen as an expenditure verse and investment.1 This point of view is changing, slowly.
growth. These analytical models are possible because registered nurses must report to their board of nursing or professional licensure agency whether or not they are employed full time or part time and where they are employed each time the nurse renews a license. This information however, is general and while a specialization is reported to the licensing agency, it is often not reported, for example to the level of a neonatal nurse. If an advanced practice nurse-one with a master’s or doctoral degree who holds a license at this level or holds certification, then data on the area of specialization are available. Is this true globally?
Global Workforce Data United States Exemplar In the United States (U.S.) the American Association of Colleges of Nursing (AACN) predicts that there will be a shortage of more than one million nurses by 2022 2 This shortage is in part due to the large number of projected retirements and the growth in the demands due in part to an aging population. Another factor that is contributing to the shortage is the recognition of the role nurses play in patient safety and outcomes.3–5 As these studies demonstrated, patient outcomes suffer as does patient safety when there are fewer, well qualified nurses available to provide direct care. 3–5 Nursing’s costs are generally the largest portion of a healthcare system’s expenditures so despite the link to patient outcomes, they are still viewed by many institutions as an expenditure versus an investment. This may change as more and more states are attempting to examine reimbursement for at least advanced practice nurses. In the U.S. too, it is possible to look at the actual numbers of nurses employed state by state and predict where demands are out numbering
⁎ Tel.: +1 405 684 1476. E-mail address: [email protected]. http://dx.doi.org/10.1053/j.nainr.2015.09.006 1527-3369/© 2015 Published by Elsevier Inc.
The workforce data available globally varies from country to country. In some countries there is no licensure or registration. In other countries registration occurs when a diploma or degree is conferred. However if a nurse decides not to work as a nurse this may not be reported. For the neonatal specialization there is no common definition of what constitutes a neonatal nurse. Is this a person who is trained as a nurse and works with healthy newborns? Is this a nurse who has special education beyond basic training and works with premature or sick neonates? Is this a generalist nurse that has received on the job training to occasional care for a sick neonate? With no licensure and no clear scope of practice or definition of a neonatal nurse or even a defined scope of practice in some countries, it is difficult to determine who is a neonatal nurse. The Council of International Neonatal Nurses, Inc. (COINN) with funding from AbbVie Inc. (North Chicago, IL) attempted to create a workforce database to have nurses enter their own data. Some nurses did begin this process but the challenges were great. Again the definitions of neonatal nursing, the scope of practice, the knowledge and skills, and the education varied widely. Also many nurses admitted they were not permitted to enter their data unless they had permission from their employer or a physician. Despite these challenges COINN is going to continue to attempt answer the questions: “Who are the
166
C. Kenner / Newborn & Infant Nursing Reviews 15 (2015) 165–166
neonatal nurses? Where do they work? How are they educated? and How many are needed and where?”
Impact on Neonatal Outcomes Just like the studies cited earlier, it is recognized that neonatal outcomes are better when there are enough, well trained neonatal nurses available. With the Millennium Development Goals and now the Sustainable Development Goals it is critical that the areas of highest burden of the under five child mortality, most of which is attributable to neonatal mortality be linked to the number and quality of training of neonatal nurses. The time is critical to make this link but solid evidence is needed. The world now recognizes that there will be no health if there is no workforce.6 Dr. Margaret Chen, WHO Director-General, stated in a keynote address at the 2015 International Council of Nurses (ICN) meeting in Seoul, South Korea “Given the enormous complexity of health challenges faced as the world transitions to the post-2015 era, no one, including WHO dares to ignore the full contribution that the nursing professional can make.”7 Dr. Chen also cited the research done by nurses regarding transitions in care was leading to cost savings and more efficiency. 7 This work is also being done with transitions from NICUs to home and to primary care settings. There is mounting evidence that neonatal nurses make a tremendously difference globally. But the questions remain: Who are the neonatal nurses? Where do we work? What do we do? These questions must be quantified in order to approach the analytics that the United States presents for generalist nurses. How do we accomplish this for the neonatal nursing global community?
Conclusion The links between patient safety and outcomes and nursing care are now supported by evidence. More of this work has been done in the adult population than with neonates and neonatal nurses. Yet neonatal nursing science is making progress. There is growing recognition that we must quantify the number of neonatal nurses, the training they receive, where they work, and where they are needed most. Many barriers exist to achieving answers to these questions. The timing is right to overcome these challenges as we move into the Sustainable Development Goals with workforce and outcomes inextricably linked. References 1. Global Health Workforce Alliance, World Health Organization (WHO). Synthesis paper of the thematic working groups. Health Workforce 2030: towards a global strategy on human resources for health. Geneva: WHO. 2015. 2. American Association of Colleges of Nursing (AACN). Nursing shortage. Available: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage. [Accessed August 8, 2015]. 3. Tubbs-Cooley HL, Cimiotti JP, Silber JH, Sloane DM, Aiken LH. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf. 2013;22:735-42. 4. Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control. 2012;40:A1-A34. 5. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. NEJM. 2011;364:1037-45. 6. Global Health Workforce Alliance. A universal truth: no health without a workforce: third global forum on human resources for health report. Available:http://www.who.int/ workforcealliance/knowledge/resources/hrhreport2013/en/2013. [Accessed August 8, 2015]. 7. Chen M. WHO Director-General addresses international conference of nurses. Available:http://www.who.int/dg/speeches/2015/international-conference-nurses/en/ 2015. [Accessed: August 8, 2015].