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Reality is on the blink again - Judy Hitchcock RN

“Reality is on the blink again”. It’s a timely phrase I heard today that summed up the state of

things; and UK prime minister, Boris Johnson, reluctantly resigning, has rather confirmed it.

I was reflecting on the fact that it is already 7 th July(!), an undeniable reality that the year is

racing by and chalking up an impressive catalogue of global and domestic disasters that any

self-respecting year would rather not have witnessed. The war in Ukraine has morphed into

a conflict with no resolution on the horizon, the global economy is lacking in confidence with

increasing interest rates and rising cost of living a concerning reality, but revoking the right to

an abortion to preserve life on the one hand, whilst maintaining the right to gun ownership

and the potential to taking a life, or lives, on the other, is an incongruous, grim reality and

proof positive that we are unquestionably living in tumultuous times. Turning on the news is

not for the faint hearted, with horrific mass shootings amongst the atrocities and shocking

incidents being rapidly fired at us, with barely time to absorb the significance of the update

before the next insult to our senses is delivered. Before I have even finished writing this

article, the assassination of the former Japanese prime minister, Shinzo Abe, is another

horrific shock reverberating around the world. What a sad day for Japan and for democracy.

What reality, what next?

Our daily focus has shifted from proactively moving forward, to defending the progress that

has been made and voicing our concerns about retrogressive consequences that are

emerging, either because of the policies introduced urgently during the early pandemic, or

because of acute absenteeism from the next reoccurring wave of sickness caused by

whichever variant is in the limelight. Sars- cov-2, that we are “learning to live with”. is

delivering a version of reality that we didn’t expect “learning to live with it” would bring. The

Ba 5 Omicron variant is proving to be an adversary worthy of a fourth vaccination, now being

hastily rolled out to those over thirty years old. A necessity in the light of another surging

wave of Covid cases, combined with the worst flu season for a few years, as it has resulted

in significant increase in loss of life, hospitalisations, and unprecedented absenteeism

across the whole employment spectrum, but particularly felt in the health service.

From the discussions and threads followed on Twitter and social media, it is a shared

experience globally; our health services are under the greatest pressures and stories of

burn-out and nursing shortages are hot topics and well documented on the COINN blog

page. The issues were apparent well before the Pandemic caused the cracks to further

damage the health service infrastructure. After an earthquake, buildings are deemed unsafe

when the structural integrity has been significantly damaged, but on we all go in the health

service, band aiding the problems and papering over the cracks, shifts covered more by

good will than good insight into planning and prioritising; although to be fair, the current wave

of absenteeism is so high that “providing the best care with the staff that we have got” is a

reality and a headache for all bed managers. But enough of stating the obvious, it’s time to

be mindful of the positives that are plentiful and to appreciate those who remain doggedly focussed on the needs of the most vulnerable in our societies, particularly neonatal infants. There has been some fantastic progress made in providing support for those caring for the sick and small newborn in low-income countries. A collaborative venture by NEST360 and UNICEF has achieved a newborn toolkit developed for the advancement of small and sick newborn care ( It has been uplifting to Join the webinars and hear the positive enthusiasm for working towards improving infant and maternal mortality, one of the sustainable development goals (SDGs.) The Standardised

Health Facility Assessments (HFA) focuses on the WHO level 4 for the “Every Newborn

Action Plan” (ENAP). HFA team training has been in Malawi, Kenya, Tanzania and Nigeria.

There are many Sick and Small Newborn Care (SSNC) level 2 units, but they are not all able

to deliver the same level of care deemed “level 2”. Using a systematic process, the focus

has been on the feasibility of the tool to establish level of care, for instance data collection

takes just one day to collect in each facility.

Similarly, there has been great progress in the development of neonatal nursing

competencies and mentoring nurses keen to advance their neonatal nursing knowledge.

Senior COINN board members have been instrumental in facilitating this education. Globally,

there is plenty of positive energy being harnessed for the advancement of Sick and Small

Newborn Care.

We also need to take care of neonatal nurses and clinicians for us to be able to give the best

care to our neonatal infants, not just by providing a safe skill mix at work, or enough days off for rest, but by providing ongoing in- service education and facilitating leave to attend

conferences, either virtually or in-person. With conferences still not as accessible as they were, accessing alternative neonatal resources has been enlightening, with webinars and podcasts providing a wealth of information and experiences shared. I have found listening to

‘The incubator’ podcast a great resource for motivational neonatal topics of interest, reviewing current research and interviews with significant neonatal giants of the discipline.

Having said that, the forthcoming ALLIGN neonatal conference in Hawaii October promises

to be a highlight and one to attend if you can. There’s nothing like attending in person and

networking for evidence-based gold standards in care, providing motivation and inspiration

to move forward, especially with promoting Family Integrated Care that has been negatively

impacted by restrictive guidelines during the height of the pandemic. Thankfully these are

easing, and families are being welcomed back into neonatal units again.

Then there’s World Prematurity Day on 17 November, when we acknowledge our premature infants and their families, inspiring us with their unfaltering resilience and hope for the future; we all need a boost of “hopium” to cope with current challenges, but our premmies and

their families know how to channel faith, hope, and trust in plenty. We need to do the same and move forward to the end of this year in the sincere hope that everything is gradually improving, even if not at the rate that we all would like. But first, 15 August is International Neonatal Nurses Day #INND (details shared in UKJNN

A day to appreciate neonatal nurses globally and to care about each other. We anticipate the care, advocate the care, facilitate the care, research the care, teach the care and deliver the care. It’s fitting that on International Neonatal Nurses Day we care about each other, particularly those Neonatal Nurses providing the best care that they can in under resourced countries. The neonatal care that you give to our most fragile infants is appreciated by

the whole neonatal team.

From those that have a difficult start, a very big “thank you” from every little heart.

Reality is on the blink again - Judy Hitchcock RN
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