Conectar
This reflection examines the past 50 years of Indigenous nursing, highlighting both progress and persistent inequities. Fifty years ago, Indigenous nurses were largely invisible within the profession, their voices marginalised and their cultural backgrounds undervalued. Although numbers have grown, Indigenous nurses, particularly Māori in Aotearoa New Zealand, remain significantly underrepresented in the workforce relative to population need. Enduring structural and systemic barriers continue to impede recruitment, retention and the integration of Indigenous worldviews into nursing curricula and practice. This commentary refers to historical and contemporary contexts that shaped this landscape, including colonisation, racism and the suppression of Indigenous knowledge. It acknowledges significant milestones such as Dr. Irihapeti Ramsden's leadership in establishing Kawa Whakaruruhau and Cultural Safety, while also noting the political backlash that diluted its original focus on Māori health inequities. Indigenous nurses, past and present, bring culturally grounded, relational and holistic approaches to care, bridging the clinical and cultural worlds and building trust with Indigenous communities. Their growing scholarly contributions and international collaborations—such as the Indigenous Global Research Alliance in Nursing—are advancing Indigenous methodologies and evidence. While gains have been made, the future requires culturally responsive pipelines and collective commitment to addressing inequity, racism and structural injustice in nursing.
To critically examine the policy logic of the EU-funded WHO Nursing Action Initiative and assess its capacity to address the structural drivers of Europe's nursing workforce instability, with a specific focus on retention governance as the missing determinant of sustainability.
Although Europe reports high aggregate numbers of nurses, persistent workforce shortages are driven not by insufficient supply but by systemic governance weaknesses that undermine retention. The Nursing Action Initiative provides the first coordinated, multi-country framework aligned with the WHO's 2023–2030 strategic priorities, yet several structural gaps, including the absence of binding retention metrics, enforceable safe staffing standards, harmonized advanced practice pathways, interoperable workforce intelligence, and mandatory accountability, limit its transformative potential. A shift from production-centric policies to a retention-driven governance architecture is therefore essential.
The Nursing Action Initiative represents an important step toward strengthening European nursing workforce policy, but its success will depend on Member States' willingness to implement structural reforms that ensure safe staffing, protect nurses' well-being, expand autonomous practice roles, and stabilize workforce distribution. Without a robust architecture of retention governance, neither the sustainability of Europe's nursing workforce nor the resilience of its health systems can be assured.
This commentary advances the policy debate by framing retention as the central determinant of workforce sustainability. It calls for urgent political commitment to move the Nursing Action Initiative beyond aspirational coordination and toward enforceable, system-level reform capable of delivering lasting improvements in workforce stability and quality of care across the European Union.
Skin-to-Skin Contact or Kangaroo Mother Care is an evidence-based intervention proven to enhance breastfeeding rates, improve cardiorespiratory stability and promote neurodevelopment in neonates. While established as a standard of care for stable term infants and increasingly recognised for preterm infants, the implementation of sustained skin-to-skin contact faces significant systemic and clinical challenges, particularly within the intensive care environment. This editorial argues that the focus must shift from when skin-to-skin contact is permitted to how sustained skin-to-skin contact can be universally integrated as a non-negotiable core practice, even for extremely preterm infants. Addressing practical barriers, such as staff training, equipment design, parental support and perceived clinical instability, is essential to realise the full potential of sustained skin-to-skin contact to optimise neurodevelopmental and physiological outcomes for all neonates, closing the gap between compelling evidence and inconsistent global practice.
FreshRSS 