RCN Competences Neonatal

RCN Competences
Competence, education and careers in neonatal nursing: RCN guidance
Acknowledgements
It is hoped that this RCN competency framework will be useful for all health care professionals working within neonatal nursing. The Royal College of Nursing and the working group would like to thank everyone who has been involved in their development, particularly Debra Teasdale that led this important initiative. Fiona Smith RCN Adviser in Children and Young Peoples Nursing Document review group Debra Teasdale, Lead for RCN Career and Education Competence Document Development, RCN Paediatric and Neonatal Intensive Care Community Steering Committee Member, Head of Health,Wellbeing and the Family, Canterbury Christ Church University, Kent Doreen Crawford, RCN Paediatric and Neonatal Intensive Care Community Steering Committee Senior Lecturer, De Montfort University Denise Gray, Education Project Manager, NHS Education for Scotland Alison Gibb, British Association of Perinatal Medicine Ruth Moore,Vice Chair, Neonatal Nurses Association Project Manager NIC/PIC - Staffordshire, Shropshire & Black Country Newborn Network East Tina Pollard, Chairperson, Neonatal Nurses Association Clinical Service Manager Neonates,Addenbrookes Hospital, Cambridge Jackie Stretton,West Midlands Neonatal Pilot Project Manager Institute of Health and Society, University of Worcester Alison Wright, Scottish Neonatal Nurses Group Chairperson Senior Nurse Neonatal Services/ANNP Ninewells Hospital
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ROYAL COLLEGE OF NURSING
RCN competences:
Competence, education and careers in neonatal nursing: RCN guidance Contents
Introduction - The background - A framework fit for purpose - Supporting the non-registered neonatal workforce - Who enters neonatal nursing? What might assist recruitment of the future workforce? 1 A competence and education framework to support careers in neonatal nursing in the UK - Overview - Summary table - The application of level of practice to the neonatal workforce - Ensuring an inclusive approach - Curriculum content and practical experience - Professional development opportunities 2 Competences for neonatal nursing - Communication and interpersonal relationships - Personal, professional and people development - Health, safety and security - Service development - Quality - Equality, diversity and rights - Responsibility for patient care 3 Core clinical skills for neonatal nurses - Fluid, electrolyte, nutrition and elimination management - Neurological and pain management - Respiratory and cardiovascular management - Skin, hygiene and infection control management - Temperature management - Bereavement management - Investigations and procedures - Equipment 2 2 3 3 4 5 5 6 7 8 9 9 11 11 13 14 15 16 17 18 20 20 22 23 24 24 25 26 27 Conclusions Appendices 1. Staffing summit working group members 2. Exemplar job descriptions - Trainee advanced neonatal nurse practitioner - Advanced neonatal nurse practitioner - Senior advanced neonatal nurse practitioner 3. Mapping of competences against NHS knowledge and skills framework dimensions 4. Summary of recommendations References Glossary of acronyms 42 43 44 45 27 28 28 29
RCN COMPETENCES NEONATAL NUR SING
Introduction
In February 2008, a neonatal staffing summit was organised by the Royal College of Nursings (RCN) children and young peoples nursing adviser. Neonatal nursing representatives from all four countries of the United Kingdom (Appendix 1, p.28) (UK) met to discuss and debate the neonatal nurse staffing issues identified in reports during the previous 12 months. The issues identified included the need to recruit and retain nurses from a variety of backgrounds and to ensure that all those undertaking additional education to develop qualified in specialty status, have the same level of knowledge and skills. In addition, it was recognised that neonatal nurses require parity in pay and career opportunities. As a result of the meeting the RCN published A right to care a position statement on neonatal nurse staffing (RCN, 2009) which was developed collaboratively and encompassed the recommendations from all parties at the meeting. One key recommendation was to establish a UKwide competence and education framework to ensure equity in the expectations of neonatal nurses at different levels/stages of careers and in different geographical locations. This guidance presents a framework which should be used by nurses, employers, managers, higher education institutes and policy leads. The development group also considered the changes that are required within the current system to improve recruitment, career progression, educational provision and competence in this demanding specialty.A number of recommendations are made throughout (and summarised in Appendix 4) to assist in the successful application of the framework within UK neonatal services. competency and core skills framework for Scottish neonatal nurses (SNNG, 2005). This framework drew on previous work within Scotland (National Health Service [NHS] Education for Scotland [NES], 2002; SNNG, 2004) which was originally supported by a scholarship from the General Nursing Council for Scotland (Education) Fund (1983) and Margaret Callum Rodger Midwifery Award. In the latest version (SNNG, 2005), the introduction of the Knowledge and Skills Framework (KSF) for the NHS (2004) allowed career pathways/progression to be demonstrated. The SNNG working group, which contributed to the development of the competency and education framework, represented all those involved in neonatal care as it included clinical, managerial and neonatal nurse educator staff from across Scotland. The intention was for it to be used by those Scottish higher education institutes that provided post-registration neonatal education. In England, the SNNG (2005) framework was recognised for its clarity and foresight in the development of neonatal nurses career structure. Following a detailed consultation with local neonatal stakeholders, the framework was used during the revalidation of neonatal education within the higher education institution in England (Canterbury Christ Church University, 2005). In the absence of any English,Welsh or Irish guidance the SNNG (2005) competency framework was adopted as it broadly mirrored local expectation for those who were to undertake and complete the local neonatal education modules leading to recognition as a neonatal nurse. Subsequently, and with minor adjustments, the SNNG (2005) framework has been successfully used as a benchmark of the expected standardised outcomes for competence and core skill development for local nurses undertaking education to allow recognition of being qualified in specialty. The framework has also been used for neonatal nurses new to the area to help improve their knowledge and practice to the required local standard. It is acknowledged that a number of neonatal units/networks have developed similar educational and career pathways, however, since the SNNG (2005) framework utilises the KSF (NHS, 2004) which has been implemented across the UK, it is considered to be easily transferable and understandable in both practice and in higher education environments.
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The background
The concerns raised at the neonatal staffing summit mirrored some of those previously expressed within the Scottish neonatal community over the last eight years (Scottish Neonatal Nurses Group [SNNG], 2003, 2004; Kerr, 2003). In addition, the situation in Scotland was complicated by pay inequities between midwives (who had provided a substantial portion of the neonatal workforce) and neonatal nurses (SNNG, 2004). As a result, the SNNG developed a document to define a
The RCN, and those involved in the creation of this UK-wide career and education framework for neonatal nurses, are very grateful for the extensive work done by Scottish neonatal nurses and the SNNG during the last eight years, and acknowledge that their work forms the backbone of this new document.
followed by a supporting narrative within the descriptions of Benners levels of practice (Benner, 1984).All three sections (Overview, Competences for neonatal nursing, and the Core skills for neonatal nursing) have been updated acknowledging the following: recent policy changes G new/re-iterated NHS drivers G the changing face of neonatal care G the experience of application of the SNNG (2005) framework within the English and Scottish Higher Education environment. Although the framework makes reference to neonatal nurses, this term is used inclusively to describe both nurses and midwives who are qualified in specialty to work within neonatal care.
G
A framework fit for purpose

To ensure currency, the original Scottish work (SNNG, 2005) has been reviewed, adapted and developed to form this document by representatives from the neonatal nursing community across the UK. This was undertaken in two phases. The initial review and amendments were agreed with representatives from the Neonatal Nursing Summit Group between November 2008 and April 2009. This was followed by a nationwide consultation period where further minor amendments were made. A second consultation and review (see Appendix 1, p.28) occurred during September 2010 prior to RCN approval and publication. The draft content had already influenced publications such as: Toolkit for high quality neonatal services (DH, 2009), A career and development for neonatal nurses in Scotland (NES, 2010) and Standards for hospitals providing neonatal intensive and high dependency care (BAPM, 2010). The second consultation ensured that this 2011 document is congruent with these publications and reflects contemporary opinion. This phase has also supported a mapping exercise of this work against the Skills for Health career framework. In addition, the nationally agreed job profiles available for NHS employers under the Agenda for Change (AfC) agreement were examined.Whilst there are a range of job profiles available in the profile library to support parity in pay scales across AfC Bands 4-7 (including for practice educator roles), there are gaps in the library in areas that would support specific roles such as the progressive nature of advanced neonatal nurse practitioner (ANNP) development. This document presents an exemplar job description to address this issue and to assure parity in pay and conditions across the UK at all levels of neonatal nursing practice (see Appendix 2, p.29), reflecting the nature of advanced level nursing practice as defined nationally (DH, 2010). An overview of the RCN competence and education framework to support careers in neonatal nursing in the UK is represented in table format in Section 1 (page 5),
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Supporting the non-registered neonatal workforce

Whilst this guidance focuses on recommendations for the registered professional workforce, it is recognised that the neonatal workforce includes non-registered support roles (nursery nurses and assistant practitioners). Individuals in such roles operate under the direct supervision of a neonatal nurse and contribute positively to babies and families receiving care within the special care category. To work within the neonatal environment, support workers must also meet acceptable standards by undertaking additional training and development to acquire skills in neonatal care. Initially, this should be at a minimum level of S/NVQ 3 and should match appropriate performance indicators: for example, the Skills for health maternity support worker competence summary (Skills for Health, 2010). In this context, career progression opportunities need to be assured for all sectors of the workforce (Leitch, 2006). Following the initial embedding of knowledge to support the transition into neonatal care, individuals and their organisations may decide that the assistant practitioner role would be mutually beneficial. The employee could then access a foundation degree programme, with neonatal managers determining which of the lower level core clinical skills are appropriate to the local neonatalspecific environments. These core clinical skills can then be slotted in within the work-based elements of the local foundation degree to support the development of practice competence. This approach will help progression into professional nursing or midwifery careers, since the foundation degree will allow admission to professional
registration programmes and continuous career development as indicated within the Skills for Health career framework (2006). Exemplars of how this can be translated into neonatal environments are already emerging, for example, in NHS West Midlands (2010).
disparity should be addressed at local level. The following recommendations are made for those employing newly qualified nurses and midwives: newly qualified nurses or midwives who are offered employment within neonatal care should have access to a full preceptorship package as well as a full range of future neonatal nursing career opportunities G a contract of employment may offer rotational placement through the neonatal unit for the first 18 months. In England, problems with updating skills to maintain midwifery practice have frequently led to those with dual qualifications opting to lose their midwifery professional status. However, the historical educational shift to direct entry midwifery means that newly qualified midwives wanting to develop a career within neonatal care must be able to update to maintain their professional status (NMC, 2004). Anecdotal evidence suggests that whilst the midwifery skills employed within neonatal nursing are deemed sufficient for the purposes of updating in some areas, this is not uniformly accepted.As a result midwives are dissuaded from pursuing a neonatal career.When employing either newly qualified or established midwives in neonatal care, it is recommended that:
G
Who enters neonatal nursing? What might assist recruitment of the future workforce?
Neonatal nurse recruits have historically come from a variety of different professional groups and many would argue that this enriches the neonatal teams (Blake and Teasdale, 2008). This variety is reflected in the education level/qualification part of the framework. However, it is acknowledged that registered childrens nurses (RN Child) are considered the most desirable candidates since their training encompasses core knowledge for effective nursing of the child and family (RCN, 2003). Midwives are also educated to effectively care for a neonate who requires special care and their parents. In Scotland, the predominant professionals within the neonatal workforce have, until recently, been midwives (SNNG, 2005). Many units in the UK continue to employ and attract those trained as registered general nurses (RGN) or RN (Adult) who have limited, if any, direct neonatal experience during their pre-registration professional education. Although midwives and childrens nurses experience neonatal care during the required pre-registration educational programme, the level of neonatal input varies. This inconsistency is compounded since placement opportunities on neonatal units may be limited due to the competitive pre- and post-registration curriculum. To address the long-term needs of neonatal nurse recruitment the following recommendations have been made for the education of pre-registration childrens nurses and midwives: all pre-registration childrens nurse and midwifery programmes must include a course of study focusing on the care of the sick or compromised neonate G this should be complemented by a neonatal placement opportunity of not less than four weeks (for example, in transitional care areas, special care/neonatal units). There is a disparity in the recruitment policies across the UK, where employers refuse to accept newly qualified midwives but accept newly qualified RN (Child) or RN (Adult) as recruits (Blake and Teasdale, 2008). This
G
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the organisation has a clear policy to allow for statutory midwifery updating within normal working time in the neonatal unit so as to help maintain registration as a midwife. Finally, when employing newly qualified staff or staff with no experience of neonatal care:
G
all new members of staff who enter into neonatal care are viewed as novices regardless of their background. This last recommendation reflects the starting point identified within the work of Benner (1984), which underpins the levels of practice described within the framework.Additionally, this approach reflects the backdrop to neonatal care where careers progress at different speeds depending on external factors. This continuum of development for the neonatal nurse acknowledges that, whilst some nurses will move systematically through the stages and take on leadership roles, others may accelerate through the levels of practice due to prior experience. Finally, some staff may chose to remain at a particular stage according to personal and professional need, continuing to make valuable and relevant contributions within their sphere of competence.
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A competence and education framework to support careers in neonatal nursing in the UK
Overview
Table 1 (p.6) provides a visual representation of how neonatal nurses are able to develop from the point of registration across Benners stated levels of practice. Career progression through these levels of practice is achieved through three elements. 1. Knowledge acquisition demonstrated though specific programmes of education either within or external to higher education. 2. Using this knowledge to demonstrate competence (which has been linked to the KSF (NHS, 2004). 3. The practical development of core clinical skills (which relate directly to responsibility for patient care). The development of this framework reflects current good practice and the requirements for career progression within health care settings (Skills for Health, 2006). It aims to ensure equity in the career and educational opportunities available to meet the needs of neonatal nurses, the employing organisation and the wider neonatal community as a whole.As a result it is recommended that: this framework is used throughout the UK to inform workforce development and educational plans in practice environments G the associated competences, core clinical skill set and matched educational requirements should be used at practice level and by HEIs to underpin and benchmark local provision. As such the competences in this document are described in more detail than the broad statements within the Toolkit for high quality neonatal services (DH, 2009), which will be beneficial during any audit of local neonatal services following the introduction of the specialist neonatal care quality standards (NICE, 2010).
G
The Benners level of practice entry point into the structure will vary depending on an individuals prior experience, skill set and educational attainment. To ensure equality in recruitment and career development practices across the UK it is recommended that: employers should be encouraged to use the knowledge, level of educational achievement, and specified skill set to support the development of job descriptions and specifications G the framework may also be used to map prior experience and competence to determine individual development needs and potentially accelerate career progression. The educational aspects reflect expected entry qualification for each level of the framework, continuing professional education for contemporary practice, and the requirements for progression to allow transition to higher level of practice/competence.
G
Summary table
Table 1. Overview of RCN competence and education framework to support careers in neonatal nursing Benner Level of practice Minimum professional /educational entry requirements
Registered nurse (RN) (Child or Adult)or registered midwife (RM) Diploma /degree qualification.
Continuous professional development
Competence level and broad description of level of practice/role
SfH career framework*
Novice/ advanced beginner
Preceptorship programme for newly qualified staff. Induction/foundation education in neonatal care. To remain in role 1. Work toward degree qualification (if diplomate). 2. One year post qualification - NMC approved mentorship course. 3. Continuous updating to remain contemporary.
Achieves and maintains competence and core skills for new entrants. Initially - acquires basic skills and knowledge for practice for supervised practice in special care. Once practice level has reached consistently high standards this role may extend to high dependency care under supervision, prior to undertaking post registration qualification.
Level 5 Practitioner
The nurse may remain at this level, maintaining competence but should be encouraged and supported to develop further to prepare for the specialist course. - Undertake post-registration qualification in neonatal nursing (special, high dependency and intensive care) to support development of competence and core skill as neonatal nurse (QIS) status. - Works towards neonatal nurse (QIS) competence and core skills under direct supervision of NMC qualified mentor in high dependency and intensive care environments. RN (Child/Adult) or RM Post registration neonatal qualification Engaged with degree level study NMC mentor. To remain in role 1. Consolidates knowledge and skills development. 2. Continuous updating to remain contemporary. 3. NMC approved sign-off mentorship programme. Achieves and maintains neonatal nurse (QIS) competence and core skills. The neonatal nurse is qualified to work within all areas of neonatal care. Level 6 Senior practitioner
Competent
The neonatal nurse may remain at this level, maintaining competence or may choose to develop further. Undertake study in neonatal nursing at honours degree/postgraduate level to support development of competence and core skill at experienced neonatal nurse status and potential role development. Works towards competence and core skills for experienced neonatal nurses under the supervision of an experienced expert nurse with sign-off mentor qualification. RN (Child/Adult) or RM Post registration neonatal qualification NMC sign-off mentor qualification Honours degree qualification or recognition of prior experiential learning in clinical, education, leadership or management roles. To remain in role 1. Consolidates knowledge and skills development. 2. Continuous updating to remain contemporary. 3. NMC approved practice educator/lecturer programme for those leading in-house/HE education. Achieves and maintains competence and core clinical skills for experienced neonatal nurses. Experienced neonatal nurses work in prescribed nursing roles such as neonatal transportation, shift management roles (eg, ward charge nurse/sister), development care lead, lactation support, community outreach practitioner, practice development/clinical educator. Level 7 Advanced practitioner Level 6 Senior practitioner
Proficient
The neonatal nurse may remain at this level, maintaining competence or may choose to develop further. - Undertake postgraduate study to support future role development and the development of competence as an expert neonatal nurse. - For clinical practice role development works towards core skills for expert neonatal nurses (or locally determined equivalent) under supervision (expert nurse with an NMC approved sign-off mentor qualification or an appropriately qualified member of the medical team) RN (Child/Adult) or RM Post registration neonatal qualification NMC mentor/practice educator qualification Educated to Masters level Recognition of prior experiential learning in clinical, education, leadership or management roles. To remain in role 1. Consolidates knowledge and skills development. 2. Continuous updating to remain contemporary. 3. Access to doctoral and post doctoral study to advance neonatal nursing in the future. Achieves and maintains competence for expert neonatal nurses. For those in clinical practice expert roles, achieves and sustains core clinical skills set as specified within expert level or as locally determined. Expert neonatal nurse roles include neonatal unit manager, neonatal practice development, facilitator/researcher, established advanced neonatal nurse practitioner, neonatal nurse consultant.
Level 7 Advanced practitioner
Expert
Level 8 Consultant
* The career framework levels do not equate directly to Agenda for Change pay bands.
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The application of level of practice to the neonatal workforce

Benner level The novice/advanced beginner: new entrant For those with no prior experience of the sick or compromised neonate following initial registration, this would be the point of entry into the RCN career and educational framework to support neonatal nursing across the UK. All newly qualified entrants to the neonatal nursing will require a period of preceptorship in order to make the transition from student to accountable practitioner (NMC, 2006). Preceptorship programmes should be aligned with local induction programmes to help the new entrant become familiar with local policies and procedures. During preceptorship and beyond, these novices would be supported whilst developing the competences and core clinical skills needed to help them provide basic care within special care situations. This practical development would be complemented by the acquisition of additional knowledge via in-house, network or HEI study sessions so creating a foundation of knowledge to support initial and subsequent career development (DH, 2009). An established nurse or midwife in this career level (one year post-registration) would be expected to commence work towards an NMC recognised mentorship qualification. They would then be in a position to mentor student health care professionals during neonatal placements in their specified area of expertise (NMC, 2008a). Nurses and midwives working at this level would not be expected to work routinely with complex neonates in any care category and, although they should have insight into high dependency/intensive care, they would not be equipped to provide these levels of care without direct supervision.
Career progression
Benner level Competent: the neonatal nurse (QIS) Progression to neonatal nurse status can happen after successfully completing a post-registration course of study and demonstrating the competences and core clinical skills as a neonatal nurse QIS. Although the term neonatal nurse is not recordable on the professional register, it is essential from a workforce perspective that the knowledge, skills and competences inferred by this status are transferable across the UK. Therefore the theoretical component of the specialist education needed to be a neonatal nurse should be based within the UK HE sector, which is subject to rigorous quality control to ensure a standardised level of attainment. Such courses of study will be consistent with HE undergraduate degree level, specifically focused on the neonate across all the care categories as defined nationally (BAPM, 2001). Currently, in England, neonatal modules of study within higher education are generally 40-60 HE credits at HE level 5 or 6, which reflects the requirements in Scotland where courses are 40 credits at SCQF level 9.As there is a move towards an all-graduate nursing/midwifery profession it is recommended that:
G
future provision of specialist education to support the neonatal nurse should be offered at a minimum of undergraduate degree level.
This will help those with diploma or equivalent qualifications, gained in the UK or abroad, attain degrees and promote graduate status for nurses1 .All nurses who undertake this level of study and skill acquisition should be recognised within the neonatal community as neonatal nurses in line with previous recommendations (NES, 2002).
Career progression
Those who aspire to advance their career should be encouraged to work towards the requirements for the competent level of practice by undertaking a recognised post registration specialist neonatal education course. This will involve developing care knowledge and skills within high dependency and intensive care environments under direct supervision of a nurse who is qualified in specialty (QIS), plus the attainment of competence and core skill set of the neonatal nurse QIS.
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The neonatal nurse may choose to remain within the competent level of practice, embedding education and continuing to demonstrate knowledge, competence and core clinical skills of the neonatal nurse QIS. Neonatal nurses will assume personal responsibility for continuing professional development to support practice (NMC, 2010a). Neonatal nurses will teach and supervise learners in the skills within their range of competence, so must work towards a
1 Whilst postgraduate study may be undertaken by graduate novices, this is not considered essential, and there is anecdotal evidence to suggest that undergraduate study is more acceptable to NICU due to the novice nature of the nurses in clinical practice. One solution is for novice graduate nurses to be accommodated by undertaking 60 credits at a nationally defined level to gain a specific HEI award, e.g., Graduate Certificate in Neonatal Care or transfer credit towards an honours degree.
recognised NMC mentorship qualification (with sign-off responsibility reflecting the principles already evident within pre-registration assessment [NMC, 2009a]). The neonatal nurse can progress if they engage in additional experience and education to achieve the knowledge, competence and core clinical skill set for the experienced neonatal nurse who operates at the proficient level of practice. Typically, this will require completion of the undergraduate degree programme of study. Benner level Proficient: the experienced neonatal nurse Experienced neonatal nurses function at this level of practice and will provide effective management of all levels of neonatal care. They are sufficiently experienced to act independently within a multidisciplinary/multiagency context and include roles such as:
G G G G G G
Benner level Expert: specific and independent neonatal nursing roles Experienced neonatal nurses may choose to further develop their knowledge, skills and competence to this level to become an expert neonatal nurse who is able to function in an independent role.An expert nurse will be involved in national guidance, debate and policy. Roles at this level may include the following: neonatal manager providing service management for a defined area G neonatal practice development facilitator/researcher promoting best practice, including undertaking clinical research G advanced neonatal nurse practitioner providing total care for a caseload of babies, achieved through an accredited educational programme and working within a designated advanced neonatal nurse practitioner role G neonatal nurse consultant championing strategic policy development.
G
neonatal transportation shift management, for example, ward charge nurse/sister development care lead lactation support community outreach practitioner practice development/clinical educator.
Expert neonatal nurses will have undertaken postgraduate study to support and develop their roles.Whilst all operate at expert level of competence, only clinical practice experts would be operating at expert level of the core skills as this is not a requirement for those whose role have diverted from direct provision of neonatal care.
Career progression
The experienced neonatal nurse will have completed an academic degree that supports an individuals higher level functioning in the neonatal unit. Such an award may give them eligibility to record a professional qualification of Specialist Practitioner . In collaboration with medical staff, the experienced neonatal nurse will assess, plan, implement and evaluate the overall management of babies requiring all levels of neonatal care; will assess and manage critical and clinical events to ensure safe and effective care, summoning appropriate assistance as necessary; and will facilitate learning by others in the neonatal unit (NMC, 2008a).
Career progression
Experts will engage with appropriate CPD opportunities to remain up to date (NMC, 2010a) and assist in the education and development of the future workforce as required locally (NMC, 2008a). To further develop expertise and enhance neonatal care will involve the completion of a masters degree and/or commencing a doctoral study.
Ensuring an inclusive approach

Whilst the framework identifies a clear role for HEIs, this should not preclude those who have undertaken a locally provided in-house course from gaining recognition of the status as a neonatal nurse who demonstrates the competent level of practice. It is recommended that:
G
Experienced nurses working at the proficient level of practice would, like all others, be required to maintain practice (NMC, 2008b) and will demonstrate competence and core clinical skills as an experienced neonatal nurse. However, those that aspire to the expert practice level will do postgraduate higher education study leading towards a masters degree qualification. The experienced nurse can also work towards developing the competence and core clinical skills associated with expert roles in neonatal nursing.
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local HEIs and neonatal intensive care unit (NICUs) should work in partnership to develop the Accreditation of Prior Experiential Learning (APEL) routes available within HEI regulations to allow acknowledgment of neonatal education packages within a recognised HEI based programme of study. This will help ensure that a
neonatal nurse isnt disadvantaged by the organisational approach.
Curriculum content and practical experience

This document does not include a specified curriculum of content for each level, but it is recommended that the content of any theoretical programme of study offered to support development at any level in the framework should: reflect contemporary and evidence-based practice concurrent with the level of practice being aspired to G ideally be determined by partnership, working between the HEI and local neonatal providers G take account of professional and subject benchmarks as these become available G be organised as a package to span the requirements for the full range of nursing care across each neonatal care category (BAPM, 2001).
G
those undertaking the development of practice are formatively and summatively assessed by a mentor who meets the NMC requirements for the profession G that prior experience is mapped against the competence set to help acceleration across the career framework where possible.
G
It is essential that all courses of study should produce neonatal nurses who are able to: operate effectively within the dynamic environment of care G care effectively and advocate for the babies and the family G care for themselves and others within the multidisciplinary team.
G
Professional development opportunities

There is a statutory requirement to ensure that individuals update their practice in order to ensure currency of the professional qualification. This is reflected in the structure at all levels. It is recommended that: strategic education and development plans should encompass this. In the UK this should be led by networks. The organisation is similar but geographically determined in Scotland,Wales and Northern Ireland G events could also be considered by the local HEIs to contribute towards academic credits under the Accreditation of prior experiential learning (APEL) system as above G individual practice must remain contemporary so networks should explore rotational opportunities for staff between units to support this (where geographically possible) G mechanisms, such as the NHS staff passport, be utilised effectively to allow development opportunities between NHS providers.
G
It is also recommended that modules or courses of study contributing towards any programme of study should:
G
meet the needs of those across the career continuum by offering flexibility.
For example, nurses who choose to remain employed solely within the special care or high dependency environments should be able to complete discrete elements/ modules of study to meet their needs, whilst other nurses wishing to develop full neonatal nurse status are able to access additional study. In order for the nurse to reach the required level of practice which is underpinned by the competence and core skill set it is recommended that: the individual is concurrently accommodated in a practice environment which provides a level of care which complements the focus of study and allows sufficient time to develop the required competence. This should be specified within any prerequisite for HE study - arranging this would be the responsibility of the sponsor/employer G all units must have established mechanisms for preceptorship/mentorship, which may include medical colleagues where appropriate G HEIs develop formal assessment of practice tools to support the programme of study (which should be based on the competence and core clinical skill set) to ensure equity in practice outcomes across the UK
G
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It is recognised that all nurses involved in the delivery of neonatal care must conduct themselves in a professional manner, to include: confidentiality; empathy; informationgiving, and liaising with other staff. Effective communication with parents, carers, staff and other colleagues is essential at all levels of nursing practice through:
G
active listening and acknowledging
responding and explaining G questioning and negotiating G analysing and facilitating.

G
At all levels, nurses should be aware of how to contact relevant colleagues when required and understand the barriers and boundaries to effective communication. Planning, assessment and evaluation are essential parts of all care and the decisions taken at all levels.Accurate record keeping and documentation is a fundamental part of all nursing, and midwifery practice and are important tools in promoting high quality care. Records and documents must be legible, accurate, concise and up to date, and comply with the NMC standards (NMC, 2009b). At all levels, the nurse must be able to initiate and maintain accurate care plans and document the outcomes of nursing and other interventions. In neonatal environments nurses and midwives need to work in partnership with parents, families and carers. Arguably, this is implicit within the professional education of child nurses and midwives; however, it is recommended that:
G
additional input regarding partnership working with parents, families and carers should be available for all nurses and midwives during the initial preceptorship period.
This is especially important since neonatal nurses are in a unique position to act as an advocate for the neonate and can play a vital role in child protection. In addition, all neonatal environments should aspire to develop and sustain a culture of personal development, lifelong learning and support. It is recommended that: clinical supervision is separate to managerial supervision within neonatal units as a way to promote development and reflective practice on a personal level G in addition, the unit processes should provide meaningful opportunities for regular team debriefing, such as neonatal and perinatal audit meetings.
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Competences for neonatal nursing
The development of competences are integral to the neonatal nurse career development as seen above. In order to fit in with current NHS career structure and development, the competences were derived with guidance from the KSF (NHS, 2004) core dimensions. Aspects of family-centred and developmental care are part of the core dimensions which are presented under the following headings:
G G G G G G G
Communication and interpersonal relationships

Including data processing and management, production and communication of information and knowledge, and the design and production of visual records. The neonatal nurse will use a wide range of media to communicate effectively with babies, parents, carers and health care workers. The neonatal nurse will demonstrate interpersonal behaviour and skills conducive to developing and maintaining therapeutic and professional relationships. Elements G Communicate effectively with babies, families, relatives, carers and other professional colleagues. G Act as the neonates advocate. G Maintain effective and supportive communication within the neonatal nursing team and with other professionals. G Contribute to creating an environment that fosters open communication and trust with families and colleagues. G Liaise with health care professionals and individuals in other disciplines from within and outside the organisation to support quality patient care. Tools G All forms of communication oral, written, electronic, body language, tone of voice. G Active listening. G Facilitating. G Advising and counselling. G Influencing and persuading.
communication and interpersonal relationships personal, professional and people development health, safety and security service development quality equality, diversity and rights responsibility for patient care.
The competences included under each heading overlap with several of the specific dimensions of the NHS (2004) KSF, therefore these are included as subheadings throughout (see Appendix 3, p.42).
7 Appendix 3 Mapping of the proposed competences to NHS (2004) KSF

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Competences for the four levels of neonatal nursing practice

New entrant Understand the importance of effective communication. Demonstrate the ability to communicate effectively and efficiently with colleagues. Communicate tactfully, maintaining trust, integrity and confidence. Use effective communication strategies to work with babies and in partnership with parents/carers, give them all information necessary to help informed choice, to meet the needs of the neonate. Collect, collate, record, input and report routine and simple data and information. Maintain accurate and up to date records. Neonatal nurse (QIS) Develop a rapport and communicate effectively within the neonatal team and with other health care. professionals, about routine and daily activities, overcoming differences that may exist. Promote effective communication with babies, families and colleagues. Within the realm of allocated responsibility influence and teach others. Structure, analyse, interpret and report factual data and information and supervise others in the maintenance of accurate and up to date records. Check information, confirm accuracy, recognise discrepancies and take appropriate action. Experienced neonatal nurse Process, modify and manage data and information. Write complex reports. Prepare and deliver presentations. Establish and maintain communication with individuals and groups about complex and difficult neonatal matters, overcoming any problems. Actively support and lead initiatives to ensure optimal communication of local and national policy directives and information relevant to neonatal care. Persuade, motivate, influence and negotiate with a wide range of people to assist with decision-making and action as required. Analyse, interpret and report information and knowledge related to ideas and concepts. Expert neonatal nurse Influence strategic policy making at local and national level. Lead meetings, give presentations and influence a wide range of individuals and groups at strategic level to take action and make changes. Receive and process complex, sensitive and contentious information, initiating actions required. Establish and maintain communication with various individuals and groups on complex, wide ranging, potentially stressful topics related to neonatal services. Enable effective communication to overcome barriers. Design/develop strategies to process and manage data and information. Analyse, synthesize and present knowledge and information about complex subjects and concepts to influence key decisions.
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Personal, professional and people development

The neonatal nurse will assume responsibility for personal professional development, demonstrating a commitment to lifelong learning and activities that enhance knowledge, skills, values and attitudes required for safe and effective neonatal nursing practice. Elements G Practice at all times within current legislation, professional rules, codes and guidelines. G Provide ongoing evidence of competence through maintenance of a personal professional portfolio. G Develop self and others. G Contribute to practice development through active participation in clinical working groups. G Contribute to the development of the philosophy of shared governance within the neonatal team. G Facilitate and actively participate in clinical support activities and orientation of colleagues and learners. Tools G Formal learning. G On-the-job training opportunities. G E-learning. G Access to specific training and awards. G Networking. G Clinical supervision. Competences for the four levels of neonatal nursing practice
New entrant Contribute to own personal development. Be aware of limitations of skills, scope of professional practice in neonatal nursing, exercise accountability and seek advice and support accordingly. Demonstrate a commitment to continuous professional development and actively participate in the appraisal process. Actively participate in teaching programmes and facilitate learning . Recognise signs of own negative stress and seek appropriate support. Neonatal nurse (QIS) Develop knowledge and skills to remain current in practice, disseminating new knowledge and skills for wider benefit. Identify own limitations and/or knowledge and skill deficits, formulate a plan of action and organise development opportunities to enhance continuous professional development. Recognise limitations of others, provide support, information and teaching to others to help their development. Recognise signs of negative stress in others, offer support and work towards alleviation of tension. Experienced neonatal nurse Develop own knowledge, skills and practice and contribute to the development of others. Act as a resource of specialist knowledge and clinical practice. Foster an environment that encourages staff development, supporting and counselling staff as necessary. Develop, deliver and evaluate staff development programmes that support the achievement of clinical skills, leadership and best practice in neonatal nursing. Expert neonatal nurse Demonstrate knowledge of public policies and participate in professional activities that relate to the advancement of neonatal nursing practice. Develop and evaluate own and others knowledge and practice across professional and organisational boundaries. Identify and deliver strategies to ensure the provision of education and development programmes to meet the needs of the neonatal service. Support the development of a culture in which professionals learn together . Support the development of a culture in which individuals are valued and interprofessional learning is encouraged.
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Health, safety and security

The neonatal nurse will use a range of policies, procedures and protocols that optimise a safe and secure environment that supports neonatal practice. Elements Maintain and promote health, safety and security. Demonstrate knowledge of and comply with local and national health and safety legislation, infection control policies, and clinical governance and risk management regulations. Contribute to maintaining a safe and secure environment. Tools G Health and safety legislation and policies. G Infection control policies. G Clinical governance. G Risk management. G Moving and handling. G Staff governance. G Training/mandatory updates as defined in employers health and safety policies and procedures. Competences for the four levels of neonatal nursing practice
New entrant Be aware of, and comply with, local and national health and safety legislation, infection control policies, and clinical governance and risk management regulations. Assist in maintaining a safe and secure environment. Identify potential risks in the workplace and take appropriate action to minimise risk. Participate in the preparation and maintenance of neonatal equipment. Identify emergency situations, summon help and act within own level of expertise. Neonatal nurse (QIS) Actively implement local and national health and safety legislation, infection control policies, clinical governance and risk management regulations, and integrate these into practice. Manage emergency situations, summon appropriate help, and act within own level of professional competence. Monitor and maintain the health, safety and security of self and others in the neonatal unit. Prepare and maintain equipment. Experienced neonatal nurse Support others to deal with emergency situations. Carry out risk assessments related to neonatal care and manage those risks appropriately. Ensure all appropriate measures are taken in relation to infection control. Act as a role model and promote best practice in health, safety and security. Prepare and maintain equipment and ensure staff training is current and up to date. Contribute to staff training. Expert neonatal nurse Ensure the working environment complies with organisational, professional and legal requirements and guidelines. Monitor safe work practices. Assume line management responsibility for accident/ incident reporting and monitoring. Develop a culture that actively improves health, safety and security. Promote risk management strategies in the neonatal unit. Acknowledge/identify training needs of staff, negotiate resources, facilitate training to meet needs. Ensure best practice in health, safety and security, including adequate training for staff. Develop and provide appropriate training opportunities. Assess the need for, and manage the purchase of, equipment to support neonatal care.
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Service development
Including logistics, facilities maintenance and management, partnership, leadership, management of people, and management of physical and/or financial resources. The neonatal nurse will demonstrate knowledge of effective inter-professional working practices that respect and utilise the contribution of all members of the health care team. The neonatal nurse will contribute effectively to the planning and organisation of neonatal care services to maximise the provision of a high quality service to babies, parents, families and carers. Elements G Demonstrate ability to co-ordinate, organise and prioritise workload. G Demonstrate leadership skills within the neonatal nursing practice. G Maintain collaborative working relationships with the multidisciplinary team, the general public and external agencies.
Manage resources effectively. G Be receptive to new developments in the provision of neonatal care. G Participate in clinical governance initiatives.
G
Tools
G G G G G G G G G
Setting goals and objectives Supervising and facilitating Delegating Equipment Operational planning Budgeting Controlling and monitoring Administration Leading, managing and developing staff
G G G G G G G
Coaching and mentoring Visioning Resources Time management Prioritising Project planning People management

New entrant
Assist in maintenance and development of the neonatal service. Act as a role model for junior colleagues and learners and supervise learners as appropriate within predetermined parameters and provide feedback. Comment on policies, procedures or possible developments. Participate in partnership working within the neonatal unit. Assist with the logistics of moving babies and equipment within the service. Recognise the need to organise and prioritise workload as part of a team, taking note of activities within the neonatal unit. Be aware of, and maintain, the physical resources in the neonatal unit. Be aware of, and efficiently use, the financial resources in the neonatal unit.
Neonatal nurse (QIS)

Supervise junior staff within predetermined parameters and provide feedback. Develop leadership potential within the clinical environment, acting as a role model for staff and peers. Participate in partnership, working with individuals, groups and others within the neonatal unit. Within the realm of allocated responsibility, effectively manage resources in the neonatal unit. Within the realm of delegated responsibility, contribute to the development of neonatal care. Plan own time and prioritise over a daily and weekly time-scale. Organise the logistics to move babies and equipment.
Experienced neonatal nurse

Actively contribute and participate in the development of neonatal services. Provide effective professional leadership, facilitating change and developing the service in response to changing health care needs. Proactively organise and participate in resource and neonatal unit management, maximising resources and contributing to the management and development of staff. Highlight and instigate action plans to manage deficits in resources. Deputise for the line manager. Be involved in the recruitment/selection and personal professional development of staff. Develop and sustain working with individuals, groups, agencies and others involved in neonatal care. Propose policy/service changes. Allocate, delegate, co-ordinate, monitor and assess work of the team and individuals. Plan and organise several complex neonatal care activities. Organise and prioritise conflicting workload demands. Prioritise the movement of babies and equipment.
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Expert neonatal nurse

Develop strategies and policies for neonatal service development at local and national level. Monitor staff development. Lead a team with complex work activities by establishing objectives and standards. Develop, sustain and evaluate partnership working with individuals, groups, agencies and others involved in the provision of neonatal care. Develop, implement and evaluate policies and strategies for recruiting, deploying, developing and retaining staff. Demonstrate a critically analytical approach to strategic decision making and judgements related to neonatal care. Provide leadership and management in neonatal nursing through effective role modelling, offering vision for the advancement of neonatal nursing. Empower neonatal nurses in practice and stimulate co-operation and enthusiasm within the neonatal nursing team. Prepare, develop and monitor financial and material resource for a range of complex neonatal care activities. Identify success criteria and establish monitoring systems for neonatal nursing practice. Plan and manage projects related to service development. Develop strategies to ensure safe and efficient movement of babies and equipment. Secure physical and financial resources and establish strategies for their use.
Quality
Including research and development. The neonatal nurse will demonstrate commitment to evidence-based practice, using research, quality standards and clinical audit tools. The neonatal nurse will demonstrate critical thinking approach to problem solving to enhance neonatal care. Elements G Actively use a problem solving approach to care delivery and the needs of the neonate. G Utilise research skills, critically appraise and evaluate neonatal practice. G Contribute to the maintenance of an environment within the neonatal unit where research, quality and clinical audit are valued. G In collaboration with the multiprofessional team, audit standards of care delivery. G Use decision-making skills. Tools G Creative thinking. G Decision making. G Research. G Audit. G Evaluation. G Making recommendations. G Reflective practice. Competences for the four levels of neonatal nursing practice
New entrant Adopt a questioning/reflective attitude towards clinical practice, seeking and utilising best evidence guidelines in the provision of care to babies and their families. Assist with audit, research and development projects. Neonatal nurse (QIS) Adopt a critical approach to clinical practice and encourage questioning/reflection in others to promote a culture of best practice in neonatal care. Identify areas for practice development, suggest improvements utilising local mechanisms and assist where appropriate with the change process. Demonstrate skills and understanding of audit methodology, principles and evidence based practice. Experienced neonatal nurse Assess and analyse information to solve problems. Make recommendations that have a positive impact on neonatal care. Instigate and facilitate research and audit. Proactively foster a culture of enquiry and facilitate change to integrate best evidence into neonatal care. Expert neonatal nurse Make decisions and develop solutions to problems that involve clear risk and may have no clear answer. Make significant decisions that have a direct impact on the medium or long-term performance of the neonatal unit. Analyse and develop solutions for complex professional, clinical or managerial problems. Identify areas for research in clinical practice. Participate in and/or lead research projects in collaboration with others. Participate in the systematic review of protocols, treatment plans and outcomes to determine their effectiveness in meeting established standards of care.
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Equality, diversity and rights

The neonatal nurse will practice within a legal, professional and ethical framework that includes local guidance, employer guidance, policies and procedures, ensuring that their own actions support and promote equality, diversity and rights. Elements Know, understand, use and integrate into practice all current legislation, rules and codes that are relevant to neonatal nursing practice, including: Code of Professional Practice G Midwives Rules and Standards G The Children Act, Safeguarding Framework and local procedures G International Convention on Human Rights/The Rights of the Child.
G
Tools G Creative thinking. G Decision making. G Research. G Audit. G Evaluation. G Making recommendations. G Reflective practice. G Mandatory training and updates. Competences for the four levels of neonatal nursing practice
New entrant Assist in maintaining an environment in which everyone including babies, parents/carers, families and colleagues is treated equitably and with respect. Act in a manner that supports equality, diversity and rights of all individuals. Act as an advocate for babies rights. Recognise and respect the preferences and beliefs of the family/carers. Reflect on and challenge personal assumptions and ways of working. In relation to child protection, be aware of role and responsibilities and activate safeguarding procedures when necessary, seeking support as required. Neonatal nurse (QIS) Reflect on and challenge assumptions and ways of working of others. Support an environment in which everyone including babies, parents/carers, families and colleagues is treated equitably and with respect. Provide parents with the information required for them to make informed decisions regarding their baby. Experienced neonatal nurse Promote an environment in which everyone is treated equitably and with respect. Enable parents to make informed decisions regarding their baby and support them in their decisions. Identify the potential for and take action to prevent or rectify discrimination and compromise of rights. Interpret and challenge ways of working and develop appropriate solutions. Act as an advocate on behalf of those whose rights have been compromised. Expert neonatal nurse Actively develop and promote an environment in which everyone is treated equitably and with respect. Develop anti-discriminatory policies/procedures and provide appropriate support services for babies, parents, carers and staff that comply with legislation, professional regulations and best practice. Monitor effectiveness of equality, diversity and rights policies and procedures throughout the neonatal unit. Regularly review implementation, effectiveness and compliance with equality and diversity legislation.
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Responsibility for patient care

Including assessment of, addressing individuals, improvement of, and the protection of, health and wellbeing needs, biomedical investigation and the reporting, measuring, monitoring and treating of physiological conditions through the application of specific technologies. The neonatal nurse will, within agreed parameters, apply knowledge, clinical judgement, and a range of skills to provide safe, effective care to babies and their families/carers. Elements
G
Tools
G G G G G G G G
Education and training. Health promotion. Guidelines, protocols, policies and standards. Biomedical investigations and reporting. Neonatal care assessment tools. Quality standards. Legislation. Specific technologies.
Develop and maintain a sound knowledge base relevant to neonatal care. Develop and maintain own clinical competence. Critically appraise own level of competence, identifying areas for further development. In collaboration with the family and the multidisciplinary team, assess, plan, deliver and evaluate neonatal care that reflects individual physical, social, cultural and spiritual needs. Ensure that the most appropriate, individual clinically effective neonatal care is achieved within the confines of available resources. Implement care under the direction of current unit and professional policies, procedures and guidelines, and the law. Demonstrate effective decision making in the context of current role. Use health promotion strategies to support and advise parents and families. Ensure care is taken to safeguard babies and their families/carers at all times. Ensure written documentation is clear, concise, timely, and complies with professional and local guidelines and standards. Demonstrate an awareness of current developments in neonatal practice. Demonstrate that neonatal practice is embedded in evidence/best practice. Maintain and improve quality in all areas of neonatal practice.
G G
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New entrant Develop a sound knowledge base relevant to neonatal nursing. Provide quality basic routine neonatal care within clearly defined guidelines. Respond to the needs of the neonate and the family, providing quality care using current information and knowledge. Undertake routine assessment tasks related to the health and wellbeing of the neonate. Assist in delivering programmes of neonatal care to support future health and wellbeing, including delivery of specific health promotion information/teaching. Perform routine tests and tasks related to neonatal investigations and reporting. Assess, intervene, evaluate and report the outcomes of planned care. Ensure actions assist the maintenance of high quality neonatal care. Use core clinical skills and develop critical reasoning skills to provide safe and effective care to babies in partnership with parents/carers and the multiprofessional team. Contribute to practice development. Be accountable for own practice. Be responsible and accountable for overall care delivery for a defined group of babies with indirect supervision. Neonatal nurse (QIS) Plan, implement and evaluate nursing care to meet the health and wellbeing needs of the neonate when the condition is stable. Assist in the care of the neonate whose needs are complex and ever changing. Use critical judgement and reasoning to facilitate and deliver care to babies in partnership with parents/carers and the multi-professional team. Recognise and take appropriate action when the neonates condition is becoming unstable or is deteriorating, including referral and initiation of emergency interventions. Apply technology for measurement, monitoring and treatment, interpret and respond to the needs of families/parents/carers. Assist parents/carers and other staff to assess babies health, wellbeing and related needs. Maintain a comprehensive knowledge and skills base that relate to neonatal nursing. Act as a resource to colleagues. Supervise care delivery of junior colleagues. Ensure actions promote quality and alert others to relevant quality issues Anticipate the need for, plan and participate in , programmes of care to support future health and wellbeing including, audiology and ophthalmic screening, vaccination, discharge planning and delivering specific health promotion information/teaching. Ensure actions promote quality and alert others to relevant quality issues. Supervise care delivery of junior colleagues. Apply technology for measurement, monitoring and treatment. Experienced neonatal nurse Manage the implementation of quality care/service. Act as a role model, providing support and guidance to others in implementing care. Assess, plan, deliver and evaluate neonatal care to address needs that are complex and ever changing. Plan, analyse, interpret and report biomedical investigations within own level of practice. Plan, monitor and quality assure the application of technology for measurement, monitoring and treatment. Contribute to quality improvement. In partnership with parents/carers and the multi-professional team, use highly developed/specialist knowledge and clinical skills in the neonatal unit to create a culture and climate that is proactive and responsive to meet the health care needs of babies. Supervise the care given by junior colleagues. Expert neonatal nurse Develop and maintain knowledge, skills and competence to the level of the expert who is able to function in an independent role. Develop practice in applying technology for measurement, monitoring and treatment. Develop practice in biomedical investigation and reporting. Demonstrate a critically analytic approach to strategic decision making and judgements related to neonatal care. Continuously monitor activities against quality standards, anticipate factors that may reduce quality and take effective action to address them. Develop, implement and evaluate initiatives and strategies to improve the quality of neonatal care. Improve quality of neonatal care through practice review. Develop and implement strategies for neonatal care, include standards, policies and guidelines for care delivery. Develop policies and strategies to improve the health and wellbeing of babies. Foster a proactive care culture Seek opportunities to add value to care provision. Role model effective leadership in neonatal nursing and contribute to creating a vision for the advancement of neonatal nursing, stimulating cooperation and enthusiasm in neonatal nursing. Empower neonatal nursing practice by publishing locally, nationally and internationally.
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3
Core clinical skills for neonatal nurses
To achieve the competences expected for each of the four levels of neonatal nursing practice (new entrant to expert), the neonatal nurse must develop specific skills. The skills required are diverse (DH, 2010 pg. 53), may be transferable across several competences, and will change over time, therefore the working group chose to restrict the clarification of core clinical skills in this document to those that specifically relate to patient care within the competence Responsibility for patient care. The categorisation of skills previously used (NES, 2002) have been recently revised by the British Association of Perinatal Medicine (http://www.bapm.org/ ) in relation to a review of Qualified in Speciality components. The latter recognised clinical practice elements unique to the neonatal nurse and as a result the clinical headings have been amended as follows: fluid, electrolyte, nutrition and elimination management G neurological, pain and stress management G respiratory and cardiovascular management
G G G G G G
skin and hygiene management management of thermoregulation managing and supporting the family investigations and procedures as applied to neonatal nursing equipment as applied to neonatal nursing.
The neonatal nurse must have the knowledge and the ability to rationalise the strategy chosen in the application of all clinical skills. For all levels: all elements of all skills and knowledge reflect and demonstrate current evidence-based practice G skills and knowledge achievement includes demonstration of safe administration of relevant drugs in all situations, in accordance with professional policies, and the ability to assess and evaluate responses G skills exist within situations where babies require safe care during invasive and non-invasive investigations and procedures.
G
Fluid, electrolyte, nutrition and elimination management

New entrant Neonatal nurse (QIS) Experienced neonatal nurse Initiate management and follow guidelines. Expert neonatal nurse Investigate, prescribe and manage treatments for any GI problems, and problems with urinary tract function and bilirubin elimination. Recognise normal gastro- Recognise abnormal gastrointestinal intestinal function, urinary and urinary tract function, abnormal tract function and bilirubin bilirubin elimination, acting on elimination, reporting deviations. deviations. Implement interventions to sustain homeostasis according to unit guidelines. Assist the mother to breastfeed according to evidence base/unit guidelines. Assist and support mothers to breastfeed. Inform and advise on storage of breast milk, breastfeeding, hand and mechanical expression and supplementary methods of feeding. Inform and advise parents/carers on all aspects of other enteral feeding methods.
Participate and involve others in research and development of practice to promote breastfeeding.
Devise, audit and review guidelines for best practice in partnership with medical staff. Devise, audit and review guidelines for best practice in partnership with medical staff.
Assist parents/carers in other enteral feeding techniques.
Use evidence-based practice for enteral feeding.
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Fluid, electrolyte, nutrition and elimination management (continued)

New entrant Safely carry out all forms of enteral feeding (except breast) according to evidence base/unit guidelines. Neonatal nurse (QIS) Monitor the need for nutritional supplements. Refer to specialist neonatal nutrition advisor (eg dietician, speech and language therapist) Assess enteral feeding needs, devise plan and review appropriately. Experienced neonatal nurse Devise procedures/guidelines for enteral feeding. Monitor and evaluate, audit and review implementation. Expert neonatal nurse
Administer nutritional supplements according to prescription. Safely administer intravenous therapy according to unit guidelines, recognising and reporting deviations/ complications. Set up, maintain and discontinue intravenous/intra-arterial therapy. Maintain central lines. Intervene appropriately to reduce/avoid deviations/ complications. In specific situations, insert peripheral intravenous lines. Supervise insertion of intravenous lines by others. Manage appropriate treatment for deviations/complications.
Prescribe nutritional supplements as required. Review the need for nutritional supplements.
Establish intravenous and intra-arterial access. Remove central lines. Instigate and prescribe treatment. Select and prescribe appropriate fluid management. Devise, audit and review guidelines for best practice in partnership with medical staff. Calculate and prescribe fluid intake according to clinical condition and environment.
Monitor input and output.
Measure and interpret intake and output, accessing hydration status. Calculate intake requirements according to clinical condition and environment within guidelines. Monitor growth and development through measurement of weight and head circumference. Identify deviations from expected growth and refer as requried. Interpret results of blood glucose measurement. Implement interventions for blood glucose regulation according to locally agreed protocols. Act on deviations from normal growth and development and refer appropriately.
Measure weight and length.
Investigate, prescribe and manage treatments for problems with weight or head circumference.
Obtain capillary blood sample to measure and monitor blood glucose levels, reporting deviations. Care for baby receiving blood transfusion.
Ensure implementation of evidence-based guidelines.
Interpret and instigate appropriate management and further investigation. Devise, audit and review guidelines for best practice in partnership with medical staff.
Initiate phototherapy according to NICE jaundice guidelines. Care for the baby requiring phototherapy. Care for the baby receiving exchange and partial exchange transfusion.
Prescribe phototherapy according to clinical need. Investigate cause of pathological hyperbilirubinemia. Prescribe blood and blood products according to national and local policies. Perform exchange and partial exchange transfusion. Devise, audit and review guidelines for best practice in partnership with medical staff.
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Neurological, pain and stress management

New entrant Recognise normal behaviour in babies of different gestations, including sleep/awake states. Report deviations from normal. Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Initiate referrals based on need. Recognise expected reflexes and Provide anticipatory behaviour of babies of differing guidance and support for gestational ages. staff to recognise Recognise deviations from physiological and expected reflexes and behaviours behavioural differences. associated with neurological deficits and report results. Recognise physiological and behavioural differences between stress, distress, discomfort, pain, convulsions and drug withdrawal. Utilise a validated, gestational age-relevant pain assessment tool. Interpret outcomes of pain assessment.
Complete available/appropriate assessment tools and report findings.
Devise, audit and review guidelines for best practice in partnership with medical staff Initiate appropriate treatment. Review care and management strategies to avoid/minimise the impact of adverse events. Devise, audit and review guidelines for best practice in partnership with medical staff.
Anticipate potentially adverse events and minimise their impact.
Implement strategies that minimise noxious and painful experiences. Alleviate baby's discomfort, pain and stress using pharmacological and non-pharmacological methods. Recognise and report subtle signs of pain. Implement strategies that minimise painful experiences.
Recognise and report overt signs of pain. Provide routine nursing care to alleviate pain and stress to the neonate. Recognise behaviour associated with neonatal abstinence syndrome (NAS). Provide routine nursing care to alleviate effects of NAS.
Devise protocols to reduce stress and relieve pain.
Audit stress relief and pain reduction protocols.
Interpret the outcomes of assessment of NAS. Implement strategies that minimise the adverse effects of NAS. Provide support and guidance for staff/carers involved in the care associated with maternal drug dependency and NAS. Initiate referrals relating to ongoing need and support in relation to NAS.
Develop strategies for staff regarding maternal drug dependency and NAS involving multidisciplinary/agency groups. Initiate referrals based on need.
Use developmental care strategies: including environmental aspects, positioning and handling.
Assess the neonatal environment in relation to neurodevelopment. Implement strategies that minimise the adverse effects of the neonatal environment on neurodevelopment. Adapt strategies to meet the needs of specific babies.
Promote the use of developmental care strategies.
Initiate referrals based on need.
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Respiratory and cardiovascular management

New entrant Recognise normal respiratory/ cardiovascular function. Report deviations from normal. Neonatal nurse (QIS) Recognise and measure deviations from normal respiratory and cardiovascular function. Interpret trends in the results of blood gas analysis. Intervene to restore/maintain homeostasis. Recognise the need for, and request assistance in relation to, basic life support. Perform basic life support. Assist with advanced resuscitation and stabilisation. Intiate oxygen therapy via the incubator, head box, nasal cannulae and facially. Initiate respiratory support via the use of nasal continuous positive airways pressure (CPAP). Safely care for the baby requiring all methods of mechanical ventilation including CPAP. Experienced neonatal nurse Interpret trends and evaluate management, including blood gas analysis. Expert neonatal nurse Define normal limits. Instigate appropriate investigations and management.
Observe resuscitation of the neonate. Initiate basic life support measures. Recognise need for and request assistance.
Team lead in basic life support situation and stabilisation. (In some situations perform the role of an advanced resuscitator).
Perform and lead advanced resuscitation.
Safely administer oxygen therapy via the incubator, head box, nasal cannulae and facially, including adequate humidification as prescribed.
Adjust respiratory support according to need within local guidelines.
Initiate and manage respiratory support. Devise, audit and review guidelines for best practice in partnership with medical staff.
Use safe and effective oral and nasal suction techniques.
Assess the need for suction of respiratory secretions. Use safe and effective oral and nasal suction techniques. Use safe and effective endotracheal tube /tracheostomy suction techniques. Perform chest physiotherapy techniques as prescribed. Recognise the need for intubation/extubation. Perform extubation. Assist with elective/emergency intubation. Assist with the insertion/removal of chest drainage. Provide care for neonate with chest drain in situ.
Review and evaluate the effectiveness of physiotherapy and suction interventions.
Prescribe chest physiotherapy. Initiate referrals based on need. Devise, audit and review guidelines for best practice in partnership with medical staff.
Perform intubation.
Insert, secure and remove chest drainage. Devise, audit and review guidelines for best practice in partnership with medical staff .
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Skin, hygiene and infection prevention management

New entrant Implement correct hand washing and other infection prevention measures as per local guidelines. Ensure compliance with infection prevention guidelines. Perform aseptic and nontouch techniques. Examine skin and mucous membranes, eyes and cord base for deviations from normal and report. Implement treatment for deviations as prescribed. Neonatal nurse (QIS) Educate family/carers in correct hand hygiene techniques. Ensure compliance with infection prevention guidelines. Experienced neonatal nurse Devise, audit and review guidelines for best practice in partnership with medical staff. Expert neonatal nurse Audit compliance with best practice in relation to infection control measures. Research evidence-based practice to support guidelines for infection prevention.
Assess skin integrity anticipating the baby at risk of iatrogenic skin damage. Implement strategies to prevent iatrogenic damage and potential injury. Utilise strategies to maintain hygiene and skin integrity, including stoma care. Recognise expected wound healing processes. Apply therapeutic dressings. Refer to specialists as required eg stoma care.
Prescribe, manage therapies to promote skin integrity. Devise, audit and review guidelines for best practice in partnership with medical staff.
Use appropriate measures to maintain hygiene and skin integrity, including stoma care.
Devise, audit and review guidelines for best practice in partnership with medical staff. Prescribe treatments. Refer as appropriate.
Management of thermoregulation
New entrant Assess neonatal body temperature using appropriate method and site report deviations from normal. Neonatal nurse (QIS) Assess neonatal body temperature using appropriate method and site. Monitor central and peripheral temperature gap. Anticipate the baby at risk of temperature deviations. Intervene to prevent temperature deviations. Implement strategies to correct temperature deviations. Experienced neonatal nurse Devise, audit and review nursing guidelines for temperature monitoring. Expert neonatal nurse
Use appropriate strategies to maintain body temperature within normal limits, including environmental aspects, clothing and equipment.
Devise, audit and review nursing guidelines for temperature regulation strategies.
Devise, audit and review guidelines for best practice in partnership with medical staff. Investigate and treat temperature deviations.
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Managing and supporting the family

New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse
Recognise the impact of the neonatal environment on family functioning. Recognise families feelings of grief and loss. Assess the individual needs of the family. Identify the level of support needed by family members and agree the plan of care with the family and health care practitioners. Plan a strategy of integration of of families needs into care. Actively promote practipation in care. Provide memory making for all families from admission. Involve and support families in decisions surrounding care. Support practices which promote families spending time with their baby according to their individual circumstances. Recognise the needs of siblings, grandparents and the extended family network. Act as advocate for the baby and family. Work with the family and external agencies in relation to identified interventions required linked to safeguarding of children. Identify specific ongoing needs of the family. Establish health promotion and education for the family in preparation for discharge/transfer. Employ strategies that reduce the impact of stress on the family. Recognise and respect language, cultural and religious beliefs, and family composition. Provide support mechanisms for the family following an emergency/incident. Sensitively care for the family and baby with a life-limiting condition with support and guidance from senior staff. Sensitively care for the dying baby and the parents with support and guidance from senior staff. Plan in collaboration with the family the place of death of the baby. Seek support when the situation is outside your level of comfort and confidence. Access the units network of support available at time of a neonates death. Sensitively care for the baby who has died and the bereaved parents in accordance with local and national bereavement protocols with support and guidance from senior staff. Initiate ongoing support for the family through formal and informal networks including local and national charitable and government organisations. Support and guide Initiate and staff caring for the facilitate dying neonate. sensitive discussion with parents and senior medical staff.
Support and guide Initiate and staff caring for the facilitate neonate and sensitive parents after discussion neonates death. with parents Devise and senior bereavement medical staff. protocol.
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Investigations and procedures as applied to neonatal nursing

New entrant Perform routine diagnostic and therapeutic procedures according to protocols and guidelines. Implement prescribed management. Neonatal nurse (QIS) Recognise the significance of results and seek appropriate management. Experienced neonatal nurse Instigate appropriate management. Expert neonatal nurse Request specimens and samples. Prescribe appropriate management according to results. Devise, audit and review guidelines for best practice in partnership with medical staff. Perform non-invasive and invasive procedures.
Assist in the care of babies requiring special care undergoing non-invasive investigations and procedures.
Assist in the care of a neonate requiring high dependency and intensive care, undergoing noninvasive and invasive investigations and procedures. Assist in the care of babies requiring high dependency and intensive care undergoing blood sampling. Perform venepuncture according to local guidelines. Perform arterial and central line sampling. Interpret blood pressure recordings.
Assist in the care of babies requiring special care undergoing blood sampling. Perform capillary blood sampling.
Insert arterial, percutaneous central venous catheter and central lines.
Measure blood pressure using non-invasive techniques, reporting deviations from normal.
Set up arterial blood pressure transducer. Measure arterial blood pressure.
Prescribe appropriate therapy to maintain homeostasis.
Care for neonate receiving blood Care for neonate receiving transfusion. exchange and partial exchange transfusion.
Prescribe blood and blood products according to national and local policies. Perform exchange and partial exchange. Review therapeutic response and act accordingly within local guidelines. Prescribe and administer drugs via all routes, according to national and local policies. Plan, implement and evaluate drug therapies. Evaluate therapeutic response/side effects and act accordingly.
Administer drugs via oral, topical, rectal and intramuscular routes, according to professional and local policies. Assess the therapeutic response. Identify side effects and report appropriately.
Administer drugs via IV route according to professional and local policies. Assess the therapeutic response. Identify side effects and act appropriately within local guidelines.
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Equipment as applied to neonatal nursing

New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Clean and store Clean and store equipment equipment necessary for necessary for the care of the care of babies babies requiring high requiring special care in dependency and intensive accordance with local and care in accordance with manufacturers local and manufacturers instructions. instructions. Set up and test Set up and test equipment equipment necessary for necessary for the care of the care of babies babies requiring high requiring special care in dependency and intensive accordance with local and care in accordance with manufacturers local and manufacturers instructions. instructions. Efficiently and safely use Efficiently and safely use equipment necessary for equipment necessary for the care of babies the care of babies requiring requiring special care in high dependency and accordance with local and intensive care in accordance manufacturers with local and instructions. manufacturers instructions. Interpret significance of equipment alarms for babies requiring special care, and respond appropriately. Interpret significance of equipment alarms for babies requiring high dependency and intensive care, and respond appropriately. Troubleshoot equipment problems. Devise guidelines for the setting up and testing of equipment.
Devise guidelines for the safe use of equipment.
Assess the need for equipment used in neonatal care and advise appropriately.
Devise, audit and review guidelines for best practice in partnership with medical staff for alarm parameters.
Conclusion
The career and educational framework for neonatal nursing in the UK is underpinned by the development of knowledge, competence and specific core skills as detailed in this document. However, the success of this document in supporting career development will depend on: adoption within neonatal /HEl environments G changes to established educational provision G a review of employment practices.
G
In short, if neonatal nurses are prepared and developed effectively and comparably, then this will have wide-ranging benefits for individuals, for organisations and, most importantly, for the infants and families cared for across the UK. In addition to the framework, a series of recommendations have been presented here which require action from all involved in neonatal care . The consultation process indicates that these will be received positively in the main. Due to the pace of change in neonatal care this document will require review and updating within the next five years.
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Appendices
Appendix 1: Staffing summit working group members
Fiona Smith RCN Adviser in Children and Young peoples Nursing (Chairperson) Jackie Baker, Senior Nurse, Maelor Hospital,Wrexham, Wales Pamela Boyd, Senior Sister, Royal Gwent Hospital,Wales Andy Cole, Chief Executive, BLISS Doreen Crawford, RCN Paediatric and Neonatal Intensive Care Community Steering Committee Member, Senior Child Nursing Lecturer, De Montfort University Marian Campbell, Belfast Trust, Northern Ireland Moira Gray, Scottish Neonatal Nurses Group Chairperson, Practice Development Centre,Wishaw General Hospital, Wishaw Claire Greig, Scottish Neonatal Nurses Group Executive Member, Senior Lecturer, Edinburgh Napier University Philomena Farrell, Belfast Trust, Northern Ireland Neil Marlow, President, British Association for Perinatal Medicine Tina Pollard, Chairperson, Neonatal Nurses Association Clinical Service Manager, Neonates,Addenbrookes Hospital, Cambridge Katy Swaine, Childrens Rights Alliance for England Debra Teasdale, RCN Paediatric and Neonatal Intensive Care Community Steering Committee Member, Head of Health,Wellbeing and the Family, Canterbury Christ Church University, Kent Sheila Thorne, BLISS Document review group (September 2010) Debra Teasdale, Lead for RCN Career and Education Competence Document Development RCN Paediatric and Neonatal Intensive Care Steering Committee Member Head of Health,Wellbeing and the Family, Canterbury Christ Church University, Kent Doreen Crawford, RCN Paediatric and Neonatal Intensive Care Community Steering Committee Senior Lecturer, De Montfort University Denise Gray, Education Project Manager, NHS Education for Scotland Alison Gibb, British Association for Perinatal Medicine Ruth Moore,Vice Chair, Neonatal Nurses Association Project Manager NIC/PIC - Staffordshire, Shropshire & Black Country Newborn Network East Tina Pollard, Chairperson, Neonatal Nurses Association Clinical Service Manager Neonates,Addenbrookes Hospital, Cambridge Jackie Stretton,West Midlands Neonatal Pilot Project Manager Institute of Health and Society, University of Worcester Alison Wright, Scottish Neonatal Nurses Group Chairperson Senior Nurse Neonatal Services/ANNP Ninewells Hospital
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Appendix 2: Exemplar job descriptions2

Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7
Job purpose
ANNP - KSF Band 8a
Senior ANNP - KSF Band 8b
This ANNP role is distinct from nursing but arises from extended nursing practice. The role incorporates the traditionally medical role enabling a holistic approach to neonatal care providing advanced clinical skills to babies and supporting families within the neonatal service. The ANNP works in collaboration with the senior nurse neonatal services (or equivalent) and consultant neonatologist/paediatricians: the trainee ANNP will be undertaking a period of masters level academic study whilst simultaneously gaining clinical experience under direct supervision of experienced ANNPs or senior medical staff. This will facilitate working towards: providing specialised clinical care at an advanced level to a neonate and family, making complex autonomous diagnosis and management decisions about patient care, using advanced skills and knowledge acting as an educator, highly specialised clinician, consultant, auditor and researcher providing specialised advice and support within the neonatal sphere participating in the formulation and updating of neonatal guidelines demonstrating and maintaining advanced newborn life support resuscitation skills by acting as a member of the neonatal resuscitation team, taking lead role as required advising junior medical staff, midwifery/nursing staff, medical, nursing and midwifery students, acting as an educational resource ensuring that evidence-based practice is promoted establishing interchanging roles with junior medical staff on a regular, planned basis by working in partnership to ensure the neonate receives the most appropriate specialist care, regardless of the unpredictability of the workload participating in the safe transfer of the neonate where appropriate participating at meetings at unit, directorate and senior management level at the request and on behalf of the directorate management providing specialist advice to the multidisciplinary team.
The ANNP role encompasses that of educator, expert clinician, consultant, auditor, researcher and developer. In collaboration with the senior nurse neonatal services and consultant paediatricians the advanced neonatal nurse practitioner (ANNP) will: have specialist knowledge of neonates across a range of clinical issues, underpinned by the theory and practice acquired through an ANNP education programme at masters level provide expert clinical care and management of the neonate and his/her family, making complex autonomous decisions utilising expert practice have responsibility for the assessment of care needs, development, implementation and evaluation of programmes of care, to deliver optimal medical and nursing care will be expected to work across role boundaries, providing comprehensive holistic care sensitive to the needs of babies and families accessing neonatal services in the network act as a role model and provide leadership, clinical support and expert advice to junior medical, nursing/midwifery staff and students participate in the provision of specialist education and training programmes for health care professionals and other professional groups dealing with neonates across the network be responsible for a designated group of senior nurses within the NICU to identify their educational and training requirements via appraisal, clinical supervision and personal development plans.
The ANNP role encompasses that of educator, expert clinician, consultant, auditor, researcher and developer. The ANNP works strategically and in collaboration with the senior nurse neonatal services and consultant paediatricians. The ANNP should: maintain highly specialist knowledge of neonates across a range of clinical issues, underpinned by the theory and practice acquired through an ANNP education programme at masters level ensure clinical excellence by providing expert clinical care at an advanced level to neonates and their families, making complex autonomous diagnosis and management decisions about patient care, using advanced skills, knowledge and expert practice manage the unpredictable workload and multidisciplinary team within the neonatal service, working interchangeably with middle grade medical staff on a frequent basis, working across role boundaries to ensure neonates receive the most appropriate expert, specialist care have responsibility for the assessment of care needs, development, implementation and evaluation of highly specialist programmes of care, to deliver optimal medical and nursing care act as a role model and provide leadership, clinical support and expert advice to medical, nursing/midwifery staff, students and other staff in the multidisciplinary team take the lead role in providing advanced neonatal resuscitation across a range of settings develop and deliver specialist education and training programmes for health care professionals and other professional groups dealing with neonates across the network lead on research, clinical audit, quality, practice development and clinical governance initiatives pertinent to the wellbeing of neonates and their families and the provision of neonatal services provide expert knowledge and advice at a strategic level, both locally and nationally offer support and development to a designated group of senior nurses and ANNPs within the NICU, identify their educational and training requirements via appraisal, personal development plan and supervision.
2 The information presented has been collated from job descriptions presented at the September 2010 document review meeting
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Appendix 2: Exemplar job descriptions (continued)
Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Dimension The post holder:
ANNP - KSF Band 8a
The post holder:
The post holder:
will be mentored and initially works across professional boundaries, works autonomously, across shadowed by an experienced ANNP under the direction of the consultant professional boundaries, being and/or senior medical staff, paediatrician/neonatologist. accountable to the consultant progressively working towards Participates within the Medical/ANNP neonatologist/paediatrician. becoming an autonomous rota, along with ST1, ST2 and FY2 Participates in the middle grade practitioner, prioritising own colleagues, deputising occasionally for medical/ANNP rota workload and being accountable the specialist registrar (ST3 and for the direct delivery of care above) carries the senior medical trainee /ANNP pager covering NICU, postnatal works across professional carries the medical pager covering wards and labour suite, as well as boundaries, undertaking duties of NICU (21 cots), postnatal wards and accepting referrals from community, an advanced practitioner under the labour suite, as well as accepting providing support and advice to the direction of the ANNP or consultant referrals from community. All areas are first on bleep holder (ANNP or FY2 neonatologist/paediatrician. This covered simultaneously out of hours. ST2 medical staff) includes participating in medical ANNPs will attend clinics carrying out rotas under supervision appropriate assessment, diagnosis will attend clinics carrying out and management of babies referred appropriate assessment, diagnosis teach and deliver core specialist from community post discharge and management of babies referred neonatal training and education to from community post discharge nursing/midwifery staff and works autonomously within the students to ensure safe, evidencenursing structure, developing the works autonomously within the based practice is delivered service, occasionally contributing to nursing structure, developing the the nursing clinical rota, critically service, occasionally contributing to attends neonatal clinical appraising and undertaking research the nursing clinical rota, critically emergencies in all areas, delivering and audit to ensure best practice and appraising and undertaking research advanced resuscitation skills and standards and audit to ensure best practice and stabilisation of the infant prior to standards transfer to the neonatal unit, while is responsible for initial assessment, being supported by an experienced investigation, diagnosis, prescription is responsible for assessment, practitioner until competence is and evaluation of treatment plans. investigation, diagnosis, prescription achieved They will work autonomously to and evaluation of treatment plans, provide first-line high quality clinical, frequently teaching, giving support, emergency and supportive care in the will use high levels of judgement, guidance and advice to junior management of neonates and their problem solving and decision doctors/ANNP undertaking initial families in frequently dynamic and making in the assessment, assessment and formulation of stressful situations investigation, diagnosis, management plans prescription and evaluation of highly specialised treatment plans. attends all clinical emergencies will work autonomously to provide specific to neonates. This care may first-line high quality clinical, takes place in different environments emergency and supportive care in the and the areas covered by the neonatal management of neonates and their transport service, including, labour families in frequently dynamic and suite, NICU, postnatal/antenatal stressful situations wards and community midwifery units, requiring collaboration with multiple attends all clinical emergencies staff groups. specific to neonates. This care takes place in different environments throughout the designated area and extends to the areas covered by the neonatal transport service, including, labour suite, NICU, postnatal/antenatal wards and community midwifery units, requiring collaboration with multiple staff groups.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Professional The post holder works as a trainee ANNP within the statutes and guidelines governed by the Nursing and Midwifery Council (NMC), under direct supervision during the training period. The trainee ANNP will: comply with local and national guidelines and policies be an accountable and responsible professional, managing self, his/her own practice and that of others within an ethical and legal framework that ensures the interest of neonates and their families come first act as an ambassador for the NNU, ANNP and the neonatal specialty ensure that written nursing and medical documentation is clear, concise, up to date and chronological, and complies with NMC Standards of Record and Record Keeping act as an advocate on behalf of babies and families convey the role of the ANNP to staff and parents liaise with ANNPs throughout the local network or region, ensuring advanced practice and national guidelines are comparative and research based.
ANNP - KSF Band 8a
The post holder works as an ANNP within the statutes and guidelines governed by the Nursing and Midwifery Council (NMC). The ANNP will: comply with local and national guidelines and policies be an accountable and responsible professional, managing self, his/her own practice and that of others within an ethical and legal framework that ensures the interest of neonates and their families come first act as an ambassador for the NNU, ANNP and the neonatal specialty ensure that written nursing and medical documentation is clear, concise, up to date and chronological, and complies with NMC Standards of Record and Record Keeping act as an advocate on behalf of babies and families convey the role of the ANNP to staff and parents liaise with ANNPs throughout the local network or region, ensuring advanced practice and national guidelines are comparative and research based.
The post holder works as a senior ANNP within the statutes and guidelines governed by the NMC. The SANNP will: comply with local and national guidelines and policies the ANNP is an accountable and responsible professional, managing self, his/her own practice and that of others within an ethical and legal framework that ensures the interest of neonates and their families come first act as an ambassador for the neonatal unit, ANNPs and the neonatal specialty ensure that written nursing and medical documentation is clear, concise, up to date and chronological, and complies with NMC Standards of Record and Record Keeping act as an advocate on behalf of babies and families conveys the role of the ANNP to staff and parents network with consultant nurses and ANNPs nationally, ensuring advanced practice and national guidelines are comparative and research based across regions and networks.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Clinical The trainee ANNP will: use highly specialised clinical and theoretical knowledge to undertake a comprehensive health history and examination of any neonate in order to diagnose and treat the neonate (including the prescription of drugs as necessary) work in partnership with the consultant neonatologist, developing medical and nursing patient management plans for a case load of babies, that deliver a holistic approach to the care of neonates throughout the patient pathway from admission to discharge regularly weigh up differential diagnosis and the potential range of treatment options, selecting from variable options, some of which may be contentious. Use specialised clinical and theoretical knowledge to assess the immediate health status of the neonate review identified/perceived problems, analyse complex information and take responsibility for decisions made, ensuring that the care provided to all neonates is safe and effective attend high-risk deliveries and other emergencies as an autonomous practitioner, ensuring that neonates receive safe and effective advanced resuscitation carry the emergency neonatal bleep/pager during consolidation period on completion of relevant academic programme, undertake non-medical prescribing including calculating, prescribing, administering and evaluating the effects of drug and fluid therapies in accordance with local policies initiate and authorise blood transfusions and volume expanders as clinically indicated, in accordance with local policies order and interpret X-rays and diagnostic investigations to ensure accurate diagnosis and treatment of the neonate. Act on results and develop management plans participates in, and perform, advanced procedures for ill and premature neonates participates in the stabilisation,
ANNP - KSF Band 8a
The ANNP will: assess the health-related needs of babies and families by identifying and initiating appropriate steps for effective care, exercising higher levels of judgement and clinical decision making under the direction of multidisciplinary neonatal clinical guidelines under the direction of senior medical staff and in collaboration with nursing colleagues, the post holder has responsibility for clinical management of infants requiring neonatal care within the designated area use advanced knowledge and highly specialised clinical skills to take a comprehensive health history, examine, diagnose and treat neonates and their families within the parameters of neonatal clinical guidelines and protocols calculate, prescribe, administer and evaluate effects of drug therapies recognise abnormalities, early signs of illness and act accordingly and follow up evaluation of care initiate and order laboratory and other diagnostic investigations, including Xrays, collect specimens as required, interpret results and alter medical management plans accordingly provide care to very sick, unstable babies in the neonatal unit or during retrieval and transport episodes, using complex life support therapies participate in neonatal transport on call rota initiate and manage emergency resuscitation of the newborn in labour suite and NICU maintain and build on effective communication with parents/carers, relatives, and other members of the multidisciplinary team to ensure that appropriate information is shared and the needs of babies and their families are met communicate with various individuals, specialties and professionals on complex neonatal matters to ensure effective co-ordination of clinical treatment support the multidisciplinary team to involve parents/carers and relatives in planning and delivery of individualised care be involved in antenatal discussions regarding care of mother and neonate when an abnormality of pregnancy is
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The senior ANNP will: assess health-related needs of babies and families by identifying and initiating appropriate steps for effective care, exercising higher levels of judgement and clinical decision making, using multidisciplinary neonatal clinical guidelines use highly developed specialist knowledge and advanced clinical skills to undertake a comprehensive health history and examination of any neonate in order to diagnose and treat the neonates (including the prescription of drugs as necessary) frequently weigh up differential diagnosis and the variety of potentially contentious treatment options, which require the post holder to weigh up possibilities and justify the clinical rationale. Initiate further investigations and treatment plans from a range of options, analysing response and altering plans as necessary, as further data become available to ensure care is safe and effective develop comprehensive medical and nursing patient management plans for a case load of neonates, that deliver a holistic approach to their care throughout the patient pathway from admission to discharge recognise abnormalities, early signs of illness and act accordingly, ensuring full range of investigations in instigated and follow-up action taken, including evaluation of care programmes attend high-risk deliveries as the lead practitioner, ensuring that neonates receive safe and effective resuscitation carry the emergency neonatal bleep/pager, acting as the senior responder non-medical prescribing including calculating, prescribing, administering and evaluating the effects of drug and fluid therapies in accordance with local policies initiate and authorise blood transfusions and volume expanders as clinically indicated, in accordance with local policies order and interpret X-rays and diagnostic investigations to ensure accurate diagnosis and treatment of the neonate. Interpret and act on results and develop management plans
Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Clinical (continued) transfer and admission of the extremely ill neonate to, or from, the neonatal unit, including complex life support therapies ensure that parents are aware of their neonates condition and provide complex communications and support to parents participate in palliative care for neonates, leading to a pain-free, dignified ending to life provide intensive support, advice and care for families of neonates who are receiving terminal care co-ordinate referral to other services, e.g. physiotherapist, occupational therapist, dietician, surgeon, cardiologist or any other service which is vital to the appropriate care of the neonate contribute to health promotion activity, raising awareness of health and wellbeing to promote healthy lifestyle choices for the benefit of neonates and their families.
ANNP - KSF Band 8a
identified comply with and promote policies relating to child protection if holding a qualification in midwifery (who have submitted their intention to practice to the NMC) carry out postnatal examinations and provide maternity care in the transitional care area. ANNPs who have no qualification in midwifery or a lapsed qualification, will provide support and advice on referral pathways to midwives caring for mothers in transitional care initiate, provide and support others to care for the terminally ill or dying baby and their family, and undertake last offices make appropriate referrals to specialist services and consultants. This will include referring to consultants and specialists outside neonatal services (orthopaedics, ophthalmology, radiology, plastics, genetics, surgery) dictate discharge and referral letters to GPs and specialty consultants.
perform advanced procedures for ill and premature neonates if required lead in the stabilisation, transfer and admission of the extremely ill neonate to or from the neonatal unit, including complex life support therapies maintain and build on effective communication with parents/carers, relatives, and other members of the multidisciplinary team to ensure that appropriate information is shared and the needs of babies and their families are met participate in palliative care for neonates, leading to a pain-free, dignified ending to life. Provide intensive support for families of neonates who are receiving terminal care as a clinical expert, act as a resource for the multidisciplinary team communicate with various individuals, specialties and professionals on complex neonatal matters to ensure effective co-ordination of clinical treatment co-ordinate referral to other services, e.g. physiotherapist, occupational therapist, dietician, surgeon, cardiologist, or any other service which is vital to the appropriate care of the neonate lead health promotion activity, raising awareness of health and wellbeing to promote healthy lifestyle choices for the benefit of neonates and their families be involved in antenatal discussions regarding care of mother and neonate when abnormality of pregnancy identified dictate discharge and referral letters to GPs and specialty consultants.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Managerial and leadership The trainee ANNP will: prioritise own workload and delegate work to others act as a role model and provide specialist advice and clinical support to neonatal staff and the multidisciplinary team when required comply with policies relating to child protection and protection of vulnerable adults, instigating actions and developing management plans share responsibility with senior clinicians and managers for clinical governance issues, including, clinical risk management and staff governance attend internal and organisational meetings to promote the development of neonatal services and to disseminate information and action plans to colleagues liaise with colleagues and managers to ensure that sufficient resources are available to meet clinical need promote equality and diversity.
ANNP - KSF Band 8a
The ANNP will: lead and co-ordinate the nursing and junior medical staff within the NICU, organising and prioritising workload to ensure that the interests of babies and their families are met foster an environment that encourages staff development, supporting, appraising and counselling staff in partnership with the multidisciplinary team, lead the development, implementation and maintenance of policies, procedures and guidelines for the neonatal service. Ensure adherence to these in order to deliver the highest possible level of patient care within available resources as a senior practitioner, support the multidisciplinary team to ensure that the appropriate clinical skills and competences are used effectively to meet the needs of the baby and family participate in performance reviews of nursing and medical staff. Where appropriate, counsel staff regarding performance participate in recruitment of staff share responsibility for clinical and staff governance with senior nursing and medical colleagues investigate and deal sensitively with complaints and clinical incidents within their remit, making recommendations to prevent recurrence participate in internal and external committees relating to neonatal services in order to contribute to the development of future service provision.
The senior ANNP will: collaborate with nursing and medical colleagues to ensure effective use of resources to provide 24-hour cover as the clinical lead of the resident team, ensure the management of neonates in their care is assessed, planned, implemented and evaluated, and that there is consultation and involvement of relevant staff groups and parents/carers lead and co-ordinate the nursing and medical staff within the NICU, organising and prioritising workload to ensure that the interests of babies and their families are met as a senior practitioner, support the multidisciplinary team to ensure that the appropriate clinical skills and competences are used effectively to meet the needs of the babies and families provide a high level of expert leadership to neonatal unit staff, acting as a role model and providing expert advice and clinical support comply with policies relating to child protection and protection of vulnerable adults, instigating actions and developing management plans share responsibility with senior clinicians and managers for clinical governance issues, including clinical risk management and staff governance attend, or take a lead in, local and national meetings to promote development of neonatal services and disseminate information to colleagues liaise with colleagues and managers to ensure that sufficient resources are available to meet clinical need participate in recruitment and induction of nursing and medical staff and students promote equality and diversity participate in performance review of nursing and medical staff. Where appropriate, counsel staff regarding performance share responsibility for clinical and staff governance with senior nursing and medical colleagues investigate and deal sensitively with complaints and clinical incidents within their remit, making recommendations to prevent recurrence input data into patient records (paper and electronic), ensuring quality of records are maintained. Use electronic databases to source information and maintain records.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Education The trainee ANNP will: identify own educational and training support needs maintain a professional development portfolio teach and deliver core specialist neonatal training, and participate in the supervision of medical trainees, midwives and nurses. They will also provide a supportive learning environment, which promotes continuous professional development and lifelong learning teach specialist neonatal skills to staff and parents/carers, for example, neonatal resuscitation, home oxygen, nasogastric feeding, stoma care and suction.
ANNP - KSF Band 8a
The ANNP will: in partnership with other staff and education institutes, contribute to the formulation of the on-going educational agenda for all grades and disciplines of staff participate in the delivery of specialist education programmes within a core curriculum for institutes of higher education participate in on-going personal development and professional education of all members of the neonatal nursing team, using mentorship, objective setting and appraisal, helping nursing staff to meet their education needs direct and support the provision of clinical practice for pre and post registration nurse/midwife learners, junior medical staff and students, to fulfil curriculum requirements and ensure that appropriate educational opportunities are provided develop, deliver and evaluate staff development programmes that support the achievement of clinical skills, leadership and best practice in neonatal care within NICU and postnatal environments teach, advise and coach parents and carers about their babys condition and treatment options contribute to health promotion activity raising the awareness of health and wellbeing to promote healthy lifestyle choices for the benefit of the neonate and their family.
The senior ANNP will: identify own educational and training support needs maintain a professional development portfolio devise personal and professional development packages for colleagues, undertaking appraisal and objective setting in association with unit management, develop, update and evaluate service training plan participate in teaching and supervision of ANNPs, medical trainees, midwives and nurses. Act as an expert practitioner to provide a supportive learning environment, which promotes continuous professional development and lifelong learning participate in on-going personal development and professional education of all members of the neonatal nursing team, using mentorship, objective setting and appraisal, helping nursing staff to meet their education needs develop, deliver and participate in, and evaluate, formal specialist educational and development programmes to nursing/midwifery and medical staff, including those provided by higher education institutes. Use computers and multimedia technologies as appropriate participate in national meetings and conferences, delivering presentations to audiences, which may include large groups from varying backgrounds act as a role model and mentor to ANNPs, junior medical staff, nurses/midwives and students teach specialist neonatal skills to staff and parents/carers, for example, neonatal resuscitation, home oxygen, nasogastric feeding, stoma care and suction act as formal clinical superviser for colleagues undertaking professional development programmes.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Quality, research and development The trainee ANNP: creates an environment conducive to research and evidence-based neonatal care and encourage its implementation initiates audit, participates in research within the NNU, and encourage others to do so. Uses the results to make changes to practice where indicated evaluates newly generated research findings. As part of the neonatal team, disseminates findings and incorporates them into practice using advanced knowledge and skills to influence best practice initiates, develops, implements and reviews specific guidelines and clinical management plans ensures standards are maintained, monitored, and reviewed in adherence with local, national and NMC guidelines supports initiatives in clinical practice which deliver advanced levels of neonatal care contributes to, and take an active role in, key clinical research and audit projects.
ANNP - KSF Band 8a
The ANNP will: ensure awareness and encouragement of best practice, lead and participate in research and audit programmes, recognising the need for and promoting evidence-based practice create an environment for research and evidence-based nursing and encourage its implementation lead practice development initiatives through participation in clinical working groups in NICU and the network develop and continually review clinical guidelines to promote best practice in neonatal care/management in NICU work within an ethical and legal framework using defined policies, procedures, standards and protocols of the department, organisation and the network to promote safe and effective care and report quality issues to the multidisciplinary team actively participate in clinical governance, clinical effectiveness and risk management, be proactive in implementing organisational agendas and strategies be responsible for maintaining patient records within the agreed standards to ensure the care management plan is communicated to parents/carers and the health care team, and is reflective of their current care needs ensure the team maintains standards of record keeping seek views of families and carers to improve the health care experience for service users.
The SANNP will: create an environment conducive to research and evidence-based neonatal care and ensure relevant changes are implemented initiate audit and research within the neonatal unit and supervise others to undertake audits. Use the results to facilitate changes to practice where indicated present at national conferences and within peer-reviewed journals devise own audit plan for several audits on an annual basis, feeding the plan into neonatal annual objectives, generating a report on audits undertaken for annual neonatal report evaluate newly generated research findings. Disseminate findings and incorporate them into practice using advanced knowledge and skills to influence best practice in line with GCP standards (good consent practice), seek consent from parents and recruit neonates to multicentre randomised controlled trials and other research projects. Use online randomisation software and research databases to complete recruitment process initiate, develop and implement and review specific guidelines and clinical management plans ensure standards are maintained, monitored, and reviewed in adherence with local, national and NMC guidelines initiate evidence-based changes in clinical practice which deliver advanced levels of neonatal care lead practice development initiatives through participation in clinical working groups in NICU and the network develop and continually review clinical guidelines to promote best practice in neonatal care/management in NICU and throughout the network seek the views of families and carers to improve the health care experience for service users use IT systems to generate proposals and reports, leading on practice development initiatives.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Decision making and judgement The trainee ANNP: is accountable for their own practice; therefore answerable for all actions and omissions, regardless of advice or direction from other professionals acts decisively under supervision as clinical lead in complex situations independently analyses, interprets and compares a range of options and differential diagnosis to resolve clinical problems has the authority, within the boundaries of their developing knowledge and skills, to order investigations and prescribe specialist treatment following analysis of the results and without recourse to medical staff will use own initiative and act independently within the boundaries of their own existing knowledge and skills will recognise when additional supervision is needed and seek advice appropriately is accountable for optimal use of resources balanced against the needs of each individual neonate has the freedom to act and make clinical decisions, guided by precedent and clearly defined policies, procedures and codes of conduct (in accordance with NMC regulations, clinical and staff governance framework and the EU clinical trials directive).
ANNP - KSF Band 8a
The post holder is expected to: be accountable for their own practice; therefore answerable for all actions and omissions, regardless of advice or direction from other professionals make daily complex clinical and professional autonomous decisions (without direct supervision) regarding the clinical management of babies. This will include the provision of expert advice to the multidisciplinary team justify clinical decision making on a patients health care, through stringent monitoring of the patients condition and acting on clinical judgement act as a patients advocate to ensure their rights are upheld be accountable for optimal use of resources, balanced against the needs of each individual neonate be free to act and make clinical decisions, is guided by precedent and clearly defined policies, guidelines, procedures and codes of conduct in accordance with NMC regulations recognise staff performance issues and appraise accordingly.
The post holder is expected to: make daily complex clinical and professional autonomous decisions (without direct supervision) regarding the clinical management of babies. This will include the provision of expert advice to the multidisciplinary team act decisively as clinical lead in time-sensitive situations, leading the multidisciplinary neonatal team and independently anticipating and resolving clinical problems justify clinical decision making on a patients health care, through stringent monitoring of the patients condition and acting on clinical judgement will make highly complex judgements about multiple aspects of care and treatment which may result in conflicting and/or unclear diagnoses consider differential diagnosis and the variety of potentially contentious treatment options, which require the post holder to weigh up different possibilities and justify the clinical rationale. They will be required to initiate further investigations and treatment plans from a range of options, analysing response and altering plans as necessary as further data becomes available. has the authority and is expected to order investigations and prescribe treatment following analysis of the results without immediate recourse to medical staff be accountable for their own practice, therefore answerable for all actions and omissions, regardless of advice or direction from other professionals be an autonomous practitioner with the freedom to act and initiate actions to implement medical and nursing patient management plans for a case load of neonates act as the patients advocate to ensure their rights are upheld be free to act and make clinical decisions, is guided by precedent and clearly defined policies, procedures and codes of conduct (in accordance with NMC regulations, clinical and staff governance framework and the EU clinical trials directive) to judge, as clinical lead within the resident team, the competence of other multidisciplinary team members, assigning responsibility to others appropriately to use initiative and acts independently within the bounds of their existing knowledge and skills will exercise judgement in recognising when supervision is required and seek advice, asking for help from consultant staff as appropriate be accountable for optimal use of resources balanced against the needs of each individual neonate
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Most challenging parts of the job Studying at masters level and learning new skills while accepting increased responsibility. Attending high risk deliveries and caring for critically ill neonates, whilst simultaneously prioritising other work demands. The unpredictability of the workload and the dynamic change from routine to emergency with no prior notice. Adapting to the change in role and making complex and high level independent clinical decisions. Complex nature of the job and the emotional demands within the specialty, for example, when caring for critically and terminally ill neonates. Supporting parents, families and colleagues in difficult and emotional circumstances. Requiring an awareness of the support mechanisms for women/families with complex health or social issues which impact on the management of the neonates care. Gaining the confidence of stressed parents who are perceived as being aggressive and abusive. Dealing with stressed staff and managing conflict in the workplace.
ANNP - KSF Band 8a
Integrating professional role boundaries. Attending high-risk deliveries alone and leading resuscitations. Fulfilling the role of clinical expert and acting as a resource to colleagues. Motivating and inspiring staff. Providing the highest standards of care whilst addressing the equality and diverse needs of the families. Implementing change effectively in a multidisciplinary environment. Time management. Responding to unexpected patient activity, demand and changing clinical status of individual neonates. Making referrals to support mechanisms for women/families with complex health or social issues which impact on the management of the neonates care. Gaining the confidence of stressed parents who are perceived as being aggressive and abusive. Dealing with stressed staff and managing conflict in the workplace.
Integrating professional role boundaries. Leading resuscitation at high-risk deliveries and having the responsibility for the care of critically ill neonates, whilst simultaneously prioritising and managing other work demands for the service. Fulfilling the role of clinical expert and acting as a resource to colleagues. The unpredictability of the workload and the dynamic change from routine to emergency with no prior notice. Making highly complex and high level independent clinical decisions at a level of experienced medical staff. Complex nature of and emotional demands within the specialty, for example - when caring for critically and terminally ill neonates and supporting parents, families and colleagues in difficult and emotional circumstances. Supervision, training and development of medical and ANNP staff in all aspects of their work. To motivate and inspire staff. To provide the highest standards of care whilst addressing the equality and diverse needs of the families. To implement change effectively in a multidisciplinary environment. Time management. To respond to unexpected patient activity, demand and changing clinical status of individual neonates. Giving presentations at local and national conferences, teaching sessions and meetings.
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Trainee advanced neonatal nurse practitioner (ANNP) - KSF Band 7 Main duties Communications and relationships
ANNP - KSF Band 8a
Physical, mental, emotional and environmental The ANNP provides care and management for infants born on the on the edge of viability (~ 500g birthweight) and those who are extremely sick and unstable. The ANNP undertakes procedures that require extreme manual dexterity, accuracy and using highly developed skills, as well as intense concentration in an emotionally charged, hot and busy environment. Physical skills Whilst the following provide an insight into expected procedures, these will be determined locally. Venepuncture Capillary blood sampling Insertion/withdrawal of umbilical catheters Insertion of percutaneous catheters Insertion of intraosseous needle Connection/calibration of invasive blood pressure transducer Sampling from indwelling umbilical catheters Perform direct arterial sample aspiration Blood gas analysis Endotracheal intubation/ extubation (emergency and elective) Implementing/managing respiratory support, including ventilation Cold light transillumination of the chest Insertion/removal of chest drain Insertion and removal of urinary catheters Suprapubic aspiration of urine Lumbar puncture Examination of the newborn Physical skills Whilst the following provide an insight into the expected procedures, these will be determined locally. Advanced maintenance of neonates airway (resuscitation and intubation) Ventilation management Extubation Prescribing of drug and fluid therapies Administer intravenous injections, intravenous infusions and intramuscular injections Intravenous additives Intravenous cannulation/ venepuncture Insertion of long-lines, umbilical venous and arterial lines Radial arterial lines/arterial puncture Transillumination Needle thoracentesis Chest drain insertion/management and withdrawal Blood cultures Lumbar punctures Suprapubic bladder aspiration Insertion of urinary catheters Placement of gastric tubes Blood gas analysis Arterial blood gas sampling/ monitoring Blood pressure monitoring (invasive and non-invasive) Specimen collection (nasopharyngeal, endotracheal, swabs) Urinalysis Stoma care Cranial ultrasound Physical skills Whilst the following provide an insight into the expected procedures, these will be determined locally. Advanced maintenance of neonates airway (resuscitation and intubation) Ventilation management Extubation Prescribing of drug and fluid therapies Administer intravenous injections, intravenous infusions and intramuscular injections Intravenous additives Intravenous cannulation/venepuncture Insertion of long-lines, umbilical venous and arterial lines Radial arterial lines/arterial puncture Transillumination Needle thoracentesis Chest drain insertion/management and withdrawal Blood cultures Lumbar punctures Suprapubic bladder aspiration Insertion of urinary catheters Placement of gastric tubes Blood gas analysis Arterial blood gas sampling/monitoring Blood pressure monitoring (invasive and non-invasive) Specimen collection (nasopharyngeal, endotracheal, swabs) Urinalysis Stoma care Cranial ultrasound Physical demands Performing highly complex medical procedures while standing in a restricted position over incubators and cots. Extensive walking/prolonged standing for majority of shift. Adapting to changing shift patterns. Use of computer keyboards and VDU screens. Frequent lifting, moving of moderate weights including equipment weighing more than 25kg for short periods.
Physical demands Performing complex medical procedures whilst standing in a restricted position over incubators and cots. Extensive walking/prolonged standing for majority of shift. Adapting to changing shift patterns Use of computer keyboards and VDU screens. Frequent lifting, moving of moderate weights, including equipment weighing more than 25kg for short periods.
Physical demands Performing highly complex medical procedures while standing in a restricted position over incubators and cots. Extensive walking/prolonged standing for majority of shift. Adapting to changing shift patterns. Use of computer keyboards and VDU screens. Frequent lifting, moving of moderate weights including equipment weighing more than 25kg for short periods. Frequent moving of cots and incubators.
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ANNP - KSF Band 8a
Physical, mental, emotional and environmental (continued) Physical demands Frequent moving of cots and incubators. Frequent bending at awkward angles to assist breastfeeding mothers. Frequent bending at awkward angles over cots to carry out nursing procedures. Transporting sick or preterm infants receiving respiratory support using a transport incubator/resuscitaire which require manipulation en route. Shifts frequently in excess of 10 hours. Irregular breaks. Breaks which are not bleep/pager free. Physical demands Frequent bending at awkward angles to assist breastfeeding mothers. Frequent bending at awkward angles over cots to carry out nursing procedures. Transporting sick or preterm infants receiving respiratory support using a transport incubator/resuscitaire which require manipulation en route. Shifts frequently in excess of 10 hours. Irregular breaks. Breaks which are not bleep/pager free. Running to respond to emergency situations. Working and adapting to a changing shift pattern adversely affects Circadian rhythms. Mental demands Concentration required due to the nature of the ANNP role. Complex clinical decision making. Frequent direct and indirect interruptions from parents, relatives, bleeps. Complex prescription, calculation and administration of drugs. Working for prolonged periods of time, concentrating on an acutely ill infant. Neonatal transports. Recognising and responding to ethical issues due to the nature of the post. Time management. Dealing with unpredictable workload. Challenging inappropriate and poor clinical practice. Maintenance of precise and accurate records. Change management. Physical demands Frequent moving of cots and incubators Frequent bending at awkward angles to assist breastfeeding mothers. Frequent bending at awkward angles over cots to carry out nursing procedures. Transporting sick or preterm infants receiving respiratory support using a transport incubator/resuscitaire which require manipulation en route Shifts frequently in excess of 10 hours. Irregular breaks. Breaks which are not bleep/pager free. Running to respond to emergency situations. Working and adapting to a changing shift pattern adversely affects Circadian rhythms.
Mental demands Concentration is required on every shift while undertaking intricate clinical care to neonates, including invasive procedures with little or no margin for error. The clinical condition of babies requiring neonatal care can change very quickly and requires meticulous attention to detail to ensure that any changes in condition are acted on immediately. This can result in an unpredictable workload, changing from one task to another to deal with changes in condition. Concentration to undertake complex calculation of drugs in minute doses. Maintaining work/life balance. Providing telephone support and advice to remote areas without direct access to the patient.
Mental demands Concentration is required on every shift while undertaking intricate clinical care to neonates, including invasive procedures with little or no margin for error. Frequent requirement for concentration is required as the workload is unpredictable and subject to very frequent interruptions from colleagues, parents and bleeps. Intense concentration required for prolonged periods when dealing with resuscitation, stabilisation and management of acute emergencies, balanced against other competing priorities. The clinical condition of babies requiring neonatal care can change very quickly and requires meticulous attention to detail to ensure that any changes in condition are acted on immediately. This can result in an unpredictable workload, changing from one task to another to deal with changes in condition. Concentration to undertake complex calculation of drugs. Maintaining work/life balance. Providing telephone support and advice to remote areas without direct access to the patient. Being lead clinician and making complex decisions about cases and priorities.
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ANNP - KSF Band 8a
Physical, mental, emotional and environmental (continued) Emotional demands Dealing on a daily basis with distressing and highly emotive situations involving neonate, parents, siblings and the extended family, for example, death of a neonate, breaking bad news, supporting distressed parents, their families and staff. Coping with the fluctuating anxieties of parents of unstable neonates. Conveying distressing news and dealing with severely challenging behaviour. Diffusing potential complaints. Dealing with complaints. Dealing with verbally abusive parents, relatives and visitors. Coping with the erratic, unpredictable behaviour of parents involved in substance misuse. Emotional demands Communicating with distressed/anxious/worried parents/carers and other relatives. Caring for and supporting others to care for dying babies and their families. Imparting bad news to parents and families. Caring for babies who are very sick and unstable, or who have a poor prognosis. Caring for babies with neonatal abstinence syndrome (drug withdrawal), and their parents/carers who may display challenging behaviour. Supporting parents/staff who may be emotionally fragile. Supporting novice neonatal nurses and junior medical staff in the intensive care environment. Dealing with staff/ family complaints. Dealing with child protection issues. Emotional demands Dealing on a daily basis with distressing or highly emotive situations involving neonate, parents, siblings and the extended family, for example, death of a neonate, breaking bad news, attending resuscitations, supporting distressed parents, their families and staff. Attending traumatic neonatal resuscitations where there is a poor outcome, or dealing with a sudden collapse of a previously well neonate within the neonatal unit. Frequently coping with the fluctuating anxieties of parents of unstable neonates. Frequently caring for babies who are very sick and unstable, or who have a poor prognosis. Conveying distressing news and dealing with very challenging behaviour. Diffusing potential complaints. Dealing with complaints. Dealing with verbally abusive parents, relatives and visitors. Coping with the erratic, unpredictable behaviour of parents involved in substance misuse who may display challenging behaviour. Frequently supporting parents/staff who may be emotionally fragile. Dealing with child protection issues. Environmental demands Constantly working in a hot environment (>24) which is necessary to maintain the body temperature of small neonates nursed in cots. Frequent daily exposure to body fluids, hazardous and infectious materials. Using complex medical equipment involving noxious gases, for example, nitric oxide. Exposure to phototherapy lights. Holding patients for radiological investigations. Working in personal protective equipment. Lone working. Extremes of temperature. During transport: working in confined, cramped conditions adverse weather conditions motion sickness travelling in hazardous conditions.
Environmental demands Constantly working in a hot environment (>24) which is necessary to maintain the body temperature of small neonates nursed in cots. Frequent daily exposure to body fluids, hazardous and infectious materials. Using complex medical equipment involving noxious gases, for example, nitric oxide. Exposure to phototherapy lights. Holding patients for radiological investigations. Working in personal protective equipment. Lone working. Extremes of temperature. During transport: working in confined, cramped conditions adverse weather conditions motion sickness travelling in hazardous conditions.
Environmental demands Constantly working within a hot environment (>24) which is necessary to maintain the body temperature of small neonates nursed in cots. Frequent daily exposure to body fluids, hazardous and infectious materials. Using complex medical equipment involving noxious gases, for example, nitric oxide. Exposure to phototherapy lights. Holding patients for radiological investigations. Working in personal protective equipment. Lone working. Extremes of temperature. During transport: working in confined, cramped conditions adverse weather conditions motion sickness travelling in hazardous conditions.
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Appendix 3: Mapping of competences against NHS knowledge and skills framework dimensions (NHS, 2004)
Competences Communication and interpersonal relationship, including: data processing and management production and communicating of information and knowledge design and production of visual records. Personal, professional and people development Knowledge skills framework dimensions Core dimension - 1 Information and knowledge - IK 1 Information and knowledge - IK 2 Information and knowledge - IK 2 /3
Core dimension - 2 Learning and development - G 1 Development and innovation - G 3 Core dimension 3 Core dimension - 4 Estates and facilities EF1 /2 Core dimension - 4 Core dimension - 4 People management - G 6 Financial management - G 4 Core dimension - 5 Information and knowledge - IK 2 Core dimension 6 Promotion of health and wellbeing and prevention of adverse effects on health and wellbeing dimension - HWB 1-10. Health and wellbeing - HWB 1, 2, 3, 4, 5, 6 and 7. Health and wellbeing - HWB 8, 9 and 10.
Health, safety and security Service development, including: logistics, facilities and maintenance management partnership leadership management of people management of physical and/or financial resources. Quality, including: research and development. Equality, diversity and rights Responsibility for patient care, including: assessment, addressing and improving the health and wellbeing of babies, families and carers biomedical investigation and reporting measuring, monitoring and treating physiological conditions through application of specific technologies.
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Appendix 4: Summary of recommendations

1. Assisting future recruitment to, and retention of, the neonatal nursing workforce G All pre-registration childrens nurse and midwifery programmes must include a course of study focusing on the care of the sick or compromised neonate. G This should be complemented by a neonatal placement opportunity of not less than four weeks during the preregistration programme (for example, in transitional care, special care/ neonatal units). G When newly qualified nurse/midwives are offered initial employment within neonatal care, they must have access to a full preceptorship package and the full range of future neonatal nursing career opportunities. G Contracts of employment may offer rotational placements through the neonatal unit for the first 18 months. G The organisation has a clear policy to allow for midwifery statutory updating, to facilitate continued registration as a midwife, within normal working times in the neonatal unit. G All new members of staff who enter into neonatal care are viewed as novices regardless of their background. 2. Using the career and education framework a partnership approach G This framework is used throughout the UK to inform workforce development and educational plans in practice environments. G The associated competences, core clinical skill set and matched educational requirements should be used at practice level and by HEIs to underpin and benchmark local provision. G Future provision of specialist education to support the Competent neonatal nurse (for example, qualified in specialty as a Level 2 neonatal nurse) should be offered at a minimum of undergraduate level. G Employers should be encouraged to use the knowledge, level of educational achievement, and specified skill set to support the development of job descriptions, job specifications and, consequently, short-listing criteria. G Local HEIs and NICUs should work in partnership to develop the Accreditation of Prior Experiential Learning (APEL) routes available within HEIs regulations to allow acknowledgment of neonatal education packages within recognised HEI-based programmes of study, to ensure that no neonatal nurse is disadvantaged by the organisational approach. 3. Developing curriculum content for postregistration neonatal nurse education G Must reflect contemporary and evidence-based practice equal to the level of practice being aspired to. G Should ideally be determined by partnership working between the HEI and local neonatal providers. G Should be organised as a package to span the requirements for the full range of nursing care across each neonatal care category. G Should meet the needs of those across the career continuum by offering flexibility. G The individual should be concurrently accommodated in a practice environment which provides a level of care which complements the focus of study and allows sufficient time to develop the required competence. This should be specified within any prerequisite for HE study - arranging this would be the responsibility of the sponsor/employer. G All units must have established mechanisms for preceptorship/mentorship, which may include medical colleagues where appropriate. G HEIs develop formal assessment of practice tools to support the programme of study (which should be based on the competence and core clinical skill set) to ensure equity in practice outcomes across the UK. G Those undertaking the development of practice are formatively and summatively assessed by a practice mentor who meets the NMC requirements for the profession. 4. Continuous professional development for neonatal nurses G Strategic education and development plans should encompass this. In the UK this should be lead by networks. The organisation is similar but geographically determined in Scotland,Wales and Northern Ireland. G CPD events could also be considered by the local HEI to contribute towards academic credits under the APEL system as above. G Individual practice must remain contemporary so networks should explore rotational opportunities for staff between units to support this (where geographically possible). G Additional input regarding partnership working with parents, families and carers should be available for all nurses and midwives. G Clinical supervision is separate to managerial supervision within neonatal units as a way to promote development and reflective practice on a personal level. G In addition, the unit processes should provide meaningful opportunities for regular team debriefing, such as neonatal and perinatal audit meetings.
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References
Benner, P (1984) From novice to expert: excellence and power in clinical nursing practice. California: AddisonWesley Publishing Company. Blake, D and Teasdale, DT (2008) Supervision of midwives in neonatal environments the mists of uncertainty. Journal of Neonatal Nursing 14, (1) 22-27. British Association of Perinatal Medicine (2001) Standards for hospitals providing neonatal intensive and high dependency care (Second Edition) and categories of babies requiring neonatal care. London: BAPM. British Association of Perinatal Medicine (2010) Service standards for hospitals providing neonatal care (Third Edition). London: BAPM. British Association of Perinatal Medicine (2012) Matching knowledge and skills for Qualified In Speciality (QIS) Neonatal nurses: A core syllabus for clinical competency. London: BAPM Canterbury Christ Church University (2005) A document for revalidation; The Dip HE/BSc interprofessional health and social care continuing professional development framework. Canterbury. CCCU local publication. Department of Health (2009) Toolkit for high quality neonatal services. London: DH. Department of Health (2010) Advanced level nursing: a position statement. London: DH. Kerr, L (2003) Midwives in neonatal units. Unpublished. Available from Lynne Kerr, Clinical Manager, Neonatal Unit, Royal Infirmary of Edinburgh. Leitch, S (2006) Leitch review of skills. Prosperity for all in a global economy - world class skills. London: The Stationery Office. NHS West Midlands (2010) West Midlands women and children workforce development project; pre-registration neonatal pathway pilot project report. Available from Jackie Stretton, Project Lead.West Midlands Neonatal Pilot Project Manager Institute of Health and Society, University of Worcester National Health Service Education for Scotland (NES) (2002) A route to enhanced competence in neonatal nursing. Edinburgh: NES. National Health Service Education for Scotland (NES) (2010) Scottish Neonatal Nurse Group: a career and development framework for neonatal nurses in Scotland. Edinburgh: NES.
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National Health Service (2004) Knowledge and Skills Framework and the development review process. London: NHS. National Institute for Heath and Clinical Excellence (2010) Specialist neonatal care quality standard. London: NICE. Nursing and Midwifery Council (2004) NMC Circular 35/2004. Maintaining midwifery registration in neonatal units. London: NMC. Nursing and Midwifery Council (2006) NMC Circular 21/2006. Preceptorship guidelines. London: NMC. Nursing and Midwifery Council (2008a) Standards to support learning and assessment in practice (Second Edition). London: NMC. Nursing and Midwifery (2008b) The code: standards of conduct, performance and ethics for nurses and midwives. London: NMC. Nursing and Midwifery (2009a) Additional information to support the implementation of NMC standards to support learning and assessment in practice. London: NMC. Nursing and Midwifery Council (NMC) (2009b) Record keeping: guidance for nurses and midwives. London: NMC. Nursing and Midwifery Council (2010a) The prep handbook. London: NMC. Nursing and Midwifery Council (2010b) Regulation of Advanced Nursing Practice, London: NMC.Accessed Nov 2010. Available at; http://www.nmc-uk.org/Aboutus/Policy-and-public-affairs/Politics-andparliament/PMs-Commission-on-the-future-of-nursingand-midwifery/Regulation-of-advanced-nursing-practice-/ (Accessed 7 May) Royal College of Nursing (RCN) (2003) Preparing nurses to care for children and young people. London: RCN. Publication code 001 997. Royal College of Nursing (RCN) (2009) A right to care: a position statement on neonatal staffing. London: RCN. Scottish Neonatal Nurses Group (2003) Staffing survey. Unpublished.Available from Miss Moira Gray, Chairperson, SNNG, Practice Development Department, Wishaw General Hospital.
Glossary of acronyms
Scottish Neonatal Nurses Group (2004) Report on neonatal nurse staffing and career pathways. Unpublished.Available from Miss Moira Gray, Chairperson, SNNG, Practice Development Department,Wishaw General Hospital. Scottish Neonatal Nurses Group (2005) The competency framework and core clinical skills for neonatal nurses. Unpublished.Available from Miss Moira Gray, Chairperson, SNNG, Practice Development Department, Wishaw General Hospital. Skills for Health (2006) Career framework for the NHS, Bristol: Skills for Health.Available at: www.skillsforhealth.org.uk/careerframework (Accessed 7 May 2011). Skills for Health (2010) Maternity care of the newborn maternity support worker competency set, Bristol: Skills for Health.Available at: www.skillsforhealth.org.uk/competences (Accessed 7 May 2011).
AfC ANNP APEL Agenda for Change Advanced neonatal nurse practitioner Accreditation of Prior Experiential Learning British Association of Perinatal Medicine Continuing professional development Department of Health Good consent practice Higher education institute Job descriptions Knowledge and Skills Framework National Health Service Education for Scotland National Institute for Heath and Clinical Excellence Neonatal intensive care unit Nursing and Midwifery Council Qualified in specialty Registered midwife Registered nurse Scottish Credit and Qualifications Framework Skills for Health Scottish Neonatal Nurses Group
BAPM CPD DH GCP HEI JDs KSF NES
NICE
NICU NMC QIS RM RN SCQF
SfH SNNG
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April 2012 Review date March 2017 Published by the Royal College of Nursing 20 Cavendish Square London W1G 0RN 020 7409 3333 RCN Online www.rcn.org.uk RCN Direct www.rcn.org.uk/direct 0345 772 6100
The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies
Publication code 004 118 ISBN 978-1-906633-71-4

RCN Competences Neonatal

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Competence, education and careers in neonatal nursing: RCN guidance

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