As a long-time neonatal nurse and advanced practitioner with roots in Oxford and footprints across Africa, Asia, and the Middle East, I’ve finally found the courage to share part of my journey publicly.

I recently wrote a piece titled: “From Canvas Cots to Clinical Leadership”, reflecting on 30+ years of neonatal work — from rural clinics and transitional wards to advanced NICUs and global QIPs.

It touches on:

• Building leadership without formal authority

• Lessons from setting up family-centred models of care

• Navigating international systems, illness, and personal resilience

• And remembering why we began this journey in the first place

I thought it might resonate with fellow neonatal professionals here on 99nicu.

⸻

✍🏾 Article Body:

In the early days of my nursing career, I found myself tending to fragile newborns lying in canvas cots — improvised solutions in resource-limited settings where every life depended on creativity, conviction, and compassion.

That was the beginning of a journey that would take me across continents — from rural clinics in Ghana and the jungles of Vietnam, to the high-tech corridors of Sidra Medicine in Qatar and the John Radcliffe Hospital in Oxford. Along the way, my mission evolved, but my core remained the same:

“Every baby should be a wanted baby — and all wanted babies should be saved.”

👣 The Path Was Never Straightforward

There were moments of awe and pride — like helping implement early breastmilk initiation protocols, or creating a discharge planning toolkit for complex NICU cases. And there were deeply painful ones too — illness, burnout, under-recognition, and the feeling of being silenced while advocating for safer systems.

But I’ve learned that clinical leadership isn’t always a title. Sometimes, it’s the quiet insistence during handover. The audit that shows patterns no one wants to see. The lone voice pushing for zero separation. The refusal to accept that “this is just how it’s always been.”

🔄 From Bedside to Boardroom (and Back Again)

I’ve moved between clinical practice, training, QIPs, and public health — designing interventions that centre families, rethinking workflows, and embedding equity into neonatal systems.

These are the lessons I carry:
• Start small — big changes often begin with a post-it note or a kind word.
• Storytelling matters — data opens doors, but stories move hearts.
• Lift others — it’s not leadership if you’re walking alone.
• Don’t forget where you started — especially when you’re finally being heard.

✨ And Now…

I write this from my home in Oxfordshire, back where I began — reflecting, regrouping, and looking ahead. This isn’t just a personal story. It’s an invitation to others who’ve walked this path.

Have you ever looked back and realised how far you’ve come — and how much further you’re meant to go?

Let’s talk. Let’s change what needs changing. Together.

💬 I’d love to hear:

• What shaped your own NICU journey?

• How do you use your voice in quality improvement or care redesign?

• What small action made a big impact in your team?

Warm wishes from Oxfordshire,

Josephine Nana Abena Powell

Advanced Neonatal Nurse Practitioner | Clinical Educator | Global Health Clinician

Thanks 

it is always good to know, that there is a neonatology-community out there, that one could ask for help or just chat about anything! Thank you!

To a great 2024!

best wishes

bernhard

As you may recall, we planned our IRL #99nicuMeetup in April 2020, in Vienna, but had to cancel due to the Covid pandemic. Find that program attached

We have now started to think about running this event 15-17 Sept 2022 (and pre/post workshops 14th and/or 18th).

Please note that we have not set a definite date, we have no venue, we have not decided about location etc-etc. We just feel we want to meet up IRL again

What do you think about all this? How/where/when would you like to attend? Please also share your thoughts on the previous program, and feel free to share your thoughts on topics/speakers/workshops etc-etc!

Program.pdf

So, with a VPN-tunnel through Norway, it is possible to browse UpToDate as "logged in".

Just something I wanted to share here in the Lounge 😎 

Over the past three years, my career has been increasingly about administrative duties. I still maintain the same clinical time which is 1.5 FTEs (full time equivalents). 

October of this year, we added a new EMR/CPOE. 

And...of course, the pandemic. 

I am ashamed to write this, but hopefully my experience will help others. 

I have burn out. I wasn't even aware of it. I needed a sort of "intervention" by other physicians to point out that I was in fact suffering from, and exhibiting a lot of symptoms of burn out. These "symptoms" resulted in a very passive/aggressive behavior pattern over the past 2-3 months, culminating in me telling a set of nurses walking through the NICU without masks, "Please put on your masks. I am not f*cking around anymore." That little comment resulted in a meeting with the hospital CMO. 

After we discussed my behavior, the CMO basically just called me out. He said I was suffering burnout. He said I am one of many good physicians locally whose professional behavior has deteriorated during the last few months. He was good enough to point out that my bad behavior was at least motivated by concern for patient and staff safety, but that any further bad behavior, regardless of the motivation, could result in loss of hospital privileges. He pointed out that my behavior mirrored most of the physicians that he needed to counsel, and that thankfully I had not deteriorated into other more harmful symptoms like substance abuse, etc. Just some bad words said in anger. Regardless, it made the staff feel uncomfortable, and I need to be better. 

In discussing the issues with the CMO, then spending the evening (and this morning) researching physician burnout, I must admit, I am a little disheartened. The research suggests burnout is only getting worse, and unfortunately, the best research on the subject suggests that the biggest contributor to burnout, is also the thing that is least in a physician's control - essentially working within complicated systems that do not always make sense scientifically or clinically. A second large contributor was EMR/CPOE. 

Here are the personal issues I have identified:

1. I do not feel like I am being heard by administrators/managers. This has always been an issue, wherever I have been. However, during the pandemic, it has felt more acute and more urgent. 

2. I do not feel supported by the community I serve. There seems to be not only a viral pandemic, but also a pandemic of scientific illiteracy in the general public and many healthcare workers. 

3. I need to understand that we have all been living in a heightened state of awareness over the past few months. It is as if our sympathetic nervous systems have been in overdrive for months. I need to recognize that the sense of urgency I feel is likely exacerbated by this chronic fight/flight reaction and may in fact, be unwarranted. 

4. My support system is not what it used to be. Prior to the pandemic, three close friends and their families moved away. These were friends and colleagues with whom I could vent my frustrations without causing offense. During the pandemic, it has been very difficult to replace these confidants because social interaction has been very limited, even when we are in the same area. 

5. I actually have adapted to EMR and CPOE better than most. Likely this is because I have been through at least three "go live" episodes at big hospitals, thus I have come to accept that I need to just embrace the suck and do the best with the tools I have. 

6. It is not the things I say, but the way I say it. This is not just in the face-to-face conversations, but also in how I interact with others within the system. I need to remember that although I may supervise NNPs, RNs, RTs, etc., I am not their employer. When I note they are doing something wrong, many times, it is best just to bring it to the attention of their manager, rather than point it out to them face-to-face. Like it or not, I am working within a complicated system, and if their is no immediate danger in someone's actions, it is best just to use the chain of command. Also, I need to remember #3 above. 

7. I need to stop watching the news. Prior to the pandemic, I might skim through a daily news feed. Once the pandemic hit, it seemed news sources were just as aware of new developments as the scientific community. I found it useful to hear about a new study on the news, then search for and read the actual article(s) to increase my knowledge. The problem is, I got sucked into all the other nonsense. I do not think I am unique in this behavior, but I do need to recognize that I need as little exposure to "news" as possible right now; it fuels my frustration and heightens the fight/flight response. It is difficult to watch the daily death count, then walk into a complicated medical system, and accept hospital policies that are as much about consumer satisfaction and legal maneuvering as they are about patient, staff, and/or public safety.

8. I need to accept that many healthcare workers are not going to act in the interest of public health in their personal lives (see #2 above). 

I am one that believes the stages of grieving apply to many things other than death. As I have pondered it over the past couple days, I can see clearly how I went through stages of denial, anger, bargaining, and even sought treatment for depression this summer.

I have struggled with situational depression, off and on, through my life. Meds don't help me. The best thing for me is realizing depression is anger unrealized. 

I am grieving the loss of ideals that turned out to be false beliefs. I am stuck in the anger stage. Most of my anger is focused on the poorly managed pandemic in my homeland and within the walls where I work. I do not believe that I am alone amongst scientists and healthcare providers in feeling this anger. The problem is my reaction to that anger over the past couple of months. 

Another issue is that I do not want to sink into a depression about the injustices I see, but cannot change. One way that has helped me in the past is just to talk about it - not complain and accuse, but rather a real gut-wrenching discussion about how these injustices (real or perceived) affect me internally. 

Anyway, if this topic is not germane to this forum, and needs to get deleted, I understand. 

Would be nice to welcome some of the people from that group in our forum! I am sure they would settle in quickly and would love joining our discussions.

https://groups.yahoo.com/neo/groups/nicu-net/conversations/messages

...after plenty of configuration work and beta testing.

Please feel free to spread the word about this community for professionals in neonatal medicine!

Looking forward to read your discussions here at 99nicu!

Stockholm, 11th of May 2006

99nicu Team

Original paper in Science:

http://science.sciencemag.org/content/363/6430/eaau0780

Comments/thoughts?