Career, education and competence framework for neonatal nursing in the UK RCN guidance Acknowledgements
It is anticipated that this Royal College of Nursing (RCN) Rosie Kelly, Clinical Manager, Acute Paediatrics and neonatal competency framework will be useful for all health Neonatology South Eastern Health and Social Care Trust care professionals working within neonatal nursing. The Alex Mancini, Lead Nurse for Neonatal Complex, Palliative RCN and the working group would like to thank everyone and Bereavement Care, NICU Chelsea and Westminster involved with its development, particularly Fiona Smith, Foundation Trust, London RCN Adviser in Children and Young People’s Nursing, for Heather Nelson, Family Care Co-ordinator, Neonatal her strategic vision. Service, Nottingham University Hospital Trust A number of people from a variety of organisations, Lynne Paterson, Neonatal Nurse Consultant, South Tees including the British Association of Perinatal Medicine, the Hospitals NHS Foundation Trust and Nurse Lead, Northern Neonatal Nursing Association and the Scottish Neonatal Neonatal Network Nursing Group, gave willingly of their advice and time, notably Dr Bryan Gill, Sue Turill, Glenys Connolly and Róisín Alison Wright, Senior Nurse Neonatal Services and ANNP, McKeon-Carter. Without their invaluable enthusiasm, NICU Ninewells Hospital, Dundee passion, commitment and drive this task would have been Sharon Nurse, Senior Teaching Fellow, School of Nursing much harder. and Midwifery, Queen’s University, Belfast The working party volunteers who were involved in the Project leads development of this framework included representatives from all four UK countries. Doreen Crawford, Current Chair of the RCN Children and Young People (CYP) Acute Care Forum (which includes the Working party volunteers neonatal special interest community), Senior Lecturer Child Róisín McKeon-Carter, Senior ANNP and Service Line Health, De Montfort University, Leicester and Consultant Director Neonatology, Plymouth Hospitals NHS Trust Nurse Editor of the Nursing Children and Young People Journal Wendy Davies, Lead Nurse, Wales Neonatal Network Debra Teasdale, Head of Health, Wellbeing and the Family, Yvonne Freers, Clinical Reader, Simpson Centre for Canterbury Christ Church University, Kent Reproductive Health, Edinburgh
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© 2015 Royal College of Nursing. All rights reserved. Other than as permitted by law no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers or a licence permitting restricted copying issued by the Copyright Licensing Agency, Saffron House, 6-10 Kirby Street, London EC1N 8TS. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers. Royal colleGe of nursing
Careers for neonatal nurses
RCN guidance for nursing staff
Contents Introduction 4 Background 4
1. Competence and education framework to support careers in neonatal nursing in the UK 7 Overview 7
The application of ‘levels of practice’ to the neonatal workforce 11
2. Core competences for neonatal practice 14 Communication and interpersonal relationships 14
Personal, professional and people development 16
Health, safety and security 18
Service development 21
Quality 24
Equality, diversity and rights 26
Responsibility for patient care 28
3. Core clinical skills for the neonatal workforce 31
4. Curriculum/programme preparation and maintaining proficiency 49
References 106
3 Career, education and competence framework for neonatal nursing in the UK
Introduction Background England Neonatal care has come a long way in a short time. Health Education England (HEE) has stated that it is the Outcomes that could only have been dreamed of 10 to 15 NHS engine responsible for delivering better health and a years ago are, in many cases, now possible for infants of better health care workforce for England – including the extremely low birth weight. Alongside advances in education, training and personal development of every supportive technology and pharmacology there have been member of staff (HEE, 2013). Yet a search on the HEE equally worthy care innovations, including a range of website for neonatal care, education, pathway or benchmarks, standards and competences developed and programmes returns no results. designed to ensure safe and enhanced quality care (SNNG, 2005; DH, 2009; BAPM, 2010; RCN, 2012b; Scottish The Education outcomes framework (DH, 2013) was designed Government, 2013). to help the integrated health and care workforce meet the outcomes set out in the NHS, public health and social care The ethos of neonatal care emphasises close collaboration frameworks, and is central to the relationship between the with families in all neonatal health care settings and we Department of Health (DH) and the whole health care acknowledge the importance of family members in relation system. As yet, the indicators are not specific to neonatal to the health and wellbeing of infants (IPFCC, 2013). nurse education, but elements from the domains are We urge all neonatal units to action the BLISS Charter tool transferable, in particular those related to competence, (BLISS, 2013) as findings from a recent national survey capability, performance, values, behaviours and the (Picker Institute, 2011) indicated the need for improvement application of NICE clinical guidelines. on this point. Northern Ireland This document has been informed by numerous For many years, neonatal services in Northern Ireland (NI) influential drivers, from a variety of sources, and it collaborated closely using an informal network model to has been difficult to do justice to the breadth of information ensure consistency of practice and training across the available. As neonatal care is in a state of constant Province. In 2013, a managed clinical network became evolution and transition, this document will be updated operational as a result of recommendations in the Troop and developed in line with changes to the service and will Report (Independent review of incidents of pseudomonas include your feedback. aeruginosa infection in neonatal units, April 2012). The primary aim of the network is to enhance the future commissioning and delivery of safe, high-quality, sustainable neonatal services for all infants and their families within NI. This will include: advising on a review of cot capacity; implementation of clinical guidance; patient care pathways; communication pathways and user engagement. The network is supported by a regional transport team.
Nurse education has been delivered by a range of providers in Northern Ireland with Queen’s University providing neonatal modules, University of Ulster providing the non-medical prescribing course and the clinical education centre providing stand-alone training days. Some competency development has taken place through the introduction of the infection care audit tool for augmented care areas (Regional neonatal infection prevention and control audit tool, RQIA, Feb 2013) with a specific focus on
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neonatal units. Advanced neonatal nurse training is not Welsh mothers and infants receive appropriate care provided currently provided in Northern Ireland, but work is by skilled, trained staff. The network has published two underway to develop an advanced nurse practitioner course reviews of capacity (cots and staffing available) in 2012 and with specialist pathways in adults, paediatrics and neonates 2013 and has made recommendations to address nurse to be delivered in Northern Ireland. This work, it is hoped, shortages and improve staff skill levels. The network has a will also provide a career pathway for all nurses from key role in monitoring nursing establishments, staff in post generalist through specialist to advanced practice and and QIS qualification status on a six-monthly basis. consultant nurse. Since 2011, nurse establishments have improved in Wales A neonatal service review is due to be undertaken during and in 2013 the Review of nurse training and education in 2014 to consider staffing levels across the region. The focus Wales was published, along with the Education career will be on both medical and nursing establishments as well framework. Nurse education is delivered by the University of as cot capacity. South Wales and the University of Bangor. In South Wales the intensive care module is now available at Masters level. Scotland The non-registered workforce has been re-examined with a Early on, Scotland led the way in designing neonatal nurse comprehensive assessment of their roles and responsibilities. competency levels (SNNG, 2005). The competency document Best practice guidance and educational development for this developed by the Scottish Neonatal Nurses’ Group put the part of the workforce has been given to Health Boards. focus on the registrant and made several pertinent Neonatal competences have been developed for nurses recommendations, including the need to ring fence funding working in local neonatal units who rotate to intensive care to support neonatal nurse education. units for updating of skills and competences. In 2013, all units in Wales adopted a Neonatal Patient Acuity Tool which Scotland has developed a comprehensive career and measures nurse numbers against the acuity of infants and development framework for health care support workers helps to support safe levels of care. providing neonatal care in hospital settings which complements the existing career and development National networks and workforce skills framework for neonatal nurses in Scotland (SNNG and NES, Neonatal NHS services in England were first configured 2010; SNNG and NES, 2012). into networks in 2003. Following this there have been numerous changes and reconfigurations; in its review of The Scottish Government recognises that achieving and neonatal services in England, the National Audit Office maintaining elements of its neonatal care quality framework (2007) was unable to state whether or not networks had requires a competent nursing workforce in sufficient improved the overall value for money of the service. In 2010, numbers to comply with the quality statements. Work is Scotland followed suit with the establishment of three ongoing within NHS Education Scotland (NES) to consider regional networks. ways of ensuring a national approach to sustainable neonatal education at all levels. In line with the Scottish Government’s The RCN and Bliss continue to campaign for improved nursing and midwifery workload and workforce planning staffing levels (RCN, 2013b) and for an appropriate skills mix strategy, a national neonatal workload tool is completed by as outlined in the RCN toolkit (2009) and quality framework all neonatal units each day. (2013). As the neonatal workforce is a diverse team, education to equip the practitioner – regardless of level – is Wales important. Pockets of excellence have emerged such as the In Autumn 2010, a Wales Neonatal Network was established neonatal intensive care unit, transitional care ward nursery bringing together NHS health professionals and partners nurse and health care assistant preceptorship programmes from other organisations to ensure equitable, high quality, developed by the South West Peninsula Neonatal Network. clinically effective neonatal care is available to infants and their families in Wales. The Cavendish Review (2013) recommended that HEE should introduce a Certificate of Fundamental Care and a A primary aim of the network is to co-ordinate the Higher Certificate of Fundamental Care for all health care development of a sustainable neonatal service to ensure assistants (HCAs). To be meaningful to neonatal education,
5 Return to contents Career, education and competence framework for neonatal nursing in the UK
these would need to be tailored to the specialty and the level One of the system dynamics models of GP supply and care 2, 3 and 4 competences and the level 2, 3 and 4 pathways, including long-term conditions, maternity, and recommended education and training in section 4 of this neonatal cited in Table 2, comes from an area which has document could provide the basis for this. suspended the neonatal education pathway. This has resulted in students having to travel long distances for places Neonatal education requires strategic direction and on surviving programmes. leadership. The Council of Deans of Health is the representative voice of UK university health faculties which Once qualified in the specialty, registrants should not stand provide education and research for health care professionals. still. Reflecting the RCN Children and Young People’s Nursing Philosophy (in press) and the NMC requirement for With 85 member universities, the Council plays an revalidation, the RCN supports the need for continuing influential leadership role (Council of Deans for Health, professional development and specific post-registration 2013a) and is clearly interested in health care support worker education and training opportunities. The RCN has education and training needs (Council of Deans for Health, developed guidance for nurses who have extended and 2013b). National and UK-wide guidance on the education expanded their scope of practice (RCN, 2012b). Many of the and career path for HCAs/assistant practitioners is elements contained within the guidance are transferable. important as recommendations for this workforce to be regulated are growing (The Law Commission, 2012; RCN, Values and resilience 2012c; Mid Staffordshire enquiry, 2013; The Cavendish Although the neonatal service has largely escaped the Review, 2013). There is significant pressure on government criticisms which other care services have been exposed to, to take action and the regulation of unregistered neonatal recruitment to the specialty requires candidates to be workforce would reduce safeguarding risks for this compassionate and caring as reflected in the vision vulnerable cohort of patients. enshrined in Compassion in practice (DH, 2012), the RCN Principles of nursing (2010) and the quality ambitions of the This document goes beyond the minimum standards as Healthcare quality strategy for Scotland (Scottish defined by Skills for Health (2013) and although this Government, 2010). In Northern Ireland the following document contains no specific section on safeguarding, the documents are proving very influential:Quality 2020 competences and curriculum have been developed in line (DHSSPSNI, November 2011) and Maternity Strategy with the current recommendations. 2012-2018 (DHSSPSNI, July 2012).
Preparing registrants and health care Educating for resilience to protect against the risk of support workers compassion fatigue that can arise as a consequence of the At the time of writing, several neonatal programmes and numbers of infants that die on a neonatal unit is easier said pathways for providing registrants and health care support than done. Kain (2013) suggested that neonatal nurses may workers with the knowledge and skills required in neonatal have inefficient grief management skills and has urged for care has been suspended across the UK. In these times of the development of a framework to aid understanding of the financial austerity a number of higher education institutions nature of nurse grief. have taken the difficult decision to withdraw neonatal courses that were not viable financially. This will have Such a tool will take time to develop, but in the meantime serious implications for the future development of the this document contains educational strategies to support neonatal service, and in order to staff units and care for nurses who are caring for infants with palliative care. resident infants and families, managers are having to It also includes end-of-life care – see for example, Mancini become ever more resourceful and creative. et al (2014).
The Centre for Workforce Intelligence is the English and Welsh authority for workforce planning and development, providing advice and information to the health and social care system. It has developed a set of metrics to help planning models (CfWI, 2013) which are being ignored.
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• the associated competences, core clinical skill set and Competence and matched educational requirements should be used at practice level and by higher education institutes to education underpin and benchmark local provision. As such the competences in this document are described in more detail than the broad statements within the framework to Department of Health’s Toolkit for high quality neonatal services (DH, 2009) and the Neonatal care in Scotland: a quality framework (Scottish Government, 2013), which will support careers in be beneficial during any audit of local neonatal services following the introduction of the specialist neonatal care neonatal nursing in quality standards (NICE, 2010).
The Benner’s level of practice entry point into the structure the UK will vary depending on an individual’s prior experience, skill set and educational attainment. To ensure parity in recruitment and career development practices across the UK it is recommended that: • employers should be encouraged to use the knowledge, Overview level of educational achievement, and specified skill set to support the development of job descriptions and Table 1 overleaf provides a visual representation of how specifications neonatal staff are able to develop and progress from entry at • the framework can be used to map prior experience and HCA level 2. For registered nurses/midwives, in keeping competence to determine individual development needs with the previous framework (RCN, 2009), the Benner model and potentially accelerate career progression. demonstrating progression within levels of practice has been retained. Career progressions through these levels of The educational aspects reflect expected entry qualifications practice are achieved utilising the following elements: for each level of the framework, continuing professional • knowledge acquisition demonstrated through specific education for contemporary practice, and the requirements programmes of preparation or education either within for progression to allow transition to higher level of or external to higher education practice/competence. This is supported by narrative on the • relating this knowledge to the demonstration of following pages. competence which has been linked to the KSF (NHS, 2004; RCN, 2009; for links to the Welsh and Scottish competences see references).
The development of this framework reflects current good practice and the requirements for career progression within health care settings (Skills for Health, 2006; RCN, 2009). 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
7 Return to contents Career, education and competence framework for neonatal nursing in the UK Skills for Skills Health (SfH) career framework* Level 2 Level 3 4 Level Competence level and broad level and broad Competence description of level practice/role Achieves and maintains competence and and maintains competence Achieves perform at this level. to skills required core agreement service requirement, level With include to role expand may and approval as breastfeeding specialist such elements infant care neonatal or support worker, support the maternity for wards/children’s and departments.wards and and maintains competence Achieves practice at this level. to skills required core agreement service requirement, level With include to role expand may and approval neonatal as routine specialist such elements infant care neonatal or worker, phlebotomy infants/ support the special for care and wards children’s maternity wards/ departments. support 2 practice to level be required Will staff. and and maintains competence Achieves practice at this level. to skills required core agreement service requirement, level With include to role expand may and approval infant hearingspecialist such elements examinations. support 2 and 3 to level be required Will practice staff. Induction programme with and programme ofInduction commensurate preparation of the service. requirements the work staff and supervised mentorship New will practice until are skill require levels Engage with and practice 3 skills knowledge and obtain level assessed. modules. mandatory and portfolioAnnual updates of evidence demonstrating support learning to practice. incremental requirements. regulation future Possible programme with and programme ofInduction commensurate preparation of Mentorship the service requirements the work and previous experience. supervised Engage with 4 assessed, and obtain level until skills practice. are and practice modules. skills knowledge mandatory and portfolioAnnual updates of evidence demonstrating support learning to practice. incremental requirements. regulation Possible programme with and programme ofInduction commensurate preparation staff of New will the service requirements the work and previous experience. and supervised mentorship assessed. practice until are skillrequire levels course nursing to participation include options access on development Career as audiometry. programmes such alliedor health professional Continuous development Minimum professional/ Minimum educational entry requirements Assessed at interview/NVQ/SVQ at interview/NVQ/SVQ Assessed equivalent 2 or level certificate nurse Nursery prior experience Accreditation at interview/NVQ3/ Assessed equivalent or SNVQ3 diploma nurse Nursery prior experience Accreditation degree NVQ4/Foundation HNC/HND
Level of practice care Health support worker (HCSW) Nursery nurse health Senior supportcare worker (SHCSW) Nursery nurse Assistant practitioner Table 1. Overview to support and education framework nursing in neonatal careers of RCN competence Table
Return to contents 8 Royal colleGe of nursing Level 5 Practitioner 6 Level Senior practitioner 6 Level Senior practitioner Achieves and maintains competence and and maintains competence Achieves entrants. new skills for core basic skills and – acquires Initially supervised practice for for knowledge practice in special care. consistently has reached practice level Once high to extend may this role high standards supervision, prior under care dependency undertakingto post registration qualification. nurse and maintains neonatal Achieves skills. and core (QIS) competence practiceto is qualified The nurse neonatal within of all areas care. neonatal and and maintains competence Achieves neonatal experienced skills for clinical core nurse neonatal enhanced Considers nurses. practitioner programmes. neonatal experienced development Role roles in prescribed nursing work nurses transportation, shift as neonatal such ward example, (for roles management lead, care development nurse/sister), charge outreach community lactation support, practice development/clinical practitioner, educator. NMC-approved practice educator/lecturer programme for those leading programme for practice educator/lecturer NMC-approved in-house/HE education. Preceptorship programme for newly qualified staff. newly qualified programme for Preceptorship care. in neonatal education Induction/foundation in role: remain To (if degree qualification holder) diploma toward work 1. course mentorship – NMC approved post qualification year one 2. contemporary. remain updating to continuous 3. in role: remain To and skills development knowledge consolidates 1. contemporary remain updating to continuous 2. sign-off programme. mentorship NMC approved 3. in role: remain To and skills development knowledge consolidates 1. contemporary remain updating to continuous 2. 3. The best-prepared candidates candidates The best-prepared in as nurses be registered would of field the child practice and an in training willincrease numbers Ifof field adult be required. or practice is considered Holding midwife (RM). registered diploma/degree either entrant the qualification will need induction and a fast considerable track programme. RM or RN (Child/Adult) registration neonatal Post qualification Engaged with study degree level NMC mentor RM or RN (Child/Adult) neonatal Post-registration qualification NMC sign-off mentor qualification or degree qualification Honours ofrecognition prior experiential education, learning in clinical, roles management or leadership
Undertake post registrationUndertake qualificationnursing in neonatal (special, high dependencyto support care) and intensive developmentof competence skill nurse as a neonatal and core in specialtyqualified (QIS) status. in neonatal nursing at honours degree/postgraduate study levelUndertake support to development of competence skill at experienced and core neonatal nurse status and potential role development. For clinical practice role development works towards core skills for expert neonatal nurses (or locally determined equivalent) under supervision under locally expert skillsequivalent) (or determined for nurses neonatal (expert with nurse core an NMC towards works development practice role clinical For member qualified sign-off team). of the medical or an appropriately qualification mentor approved Novice/ advanced beginner Competent Proficient The nurse may remain at this level, remain The nurse maintaining competence may and supported be encouraged should but develop to the specialist further for prepare course. to • neonatal nurse (QIS) competence skills towards supervision under and core direct of NMC-qualified mentor in highWorks dependency• environments. care and intensive at this level, remain The neonatal nurse maintaining competence choose may develop to or may further. • competence experienced skills for and core towards neonatal nurses under the supervisionWorks • of an experienced expert nurse with sign-off mentor qualification. further. develop to choose may or maintaining competence at this level, remain may The nurse neonatal as an expert of nurse. neonatal and the development competence development role support postgraduate to future study • Undertake • is*It important to note that the career framework levels do not equate directly to Agenda for Change pay bands.
9 Return to contents Career, education and competence framework for neonatal nursing in the UK SfH career SfH career framework* Level 7-8 Level Advanced practitioner 8 plus Level Consultant Educator Researcher Executive board Senior level Competence level and broad level and broad Competence description of level practice/role Achieves and maintains competence for for and maintains competence Achieves expert nurses. neonatal practice expert those in clinical roles, For skills set clinical as core and sustain achieves specified expertwithin or as locally level determined. include Expert roles nurse neonatal practice neonatal unit manager, neonatal support/ facilitator/family development, established researcher, lead, safeguarding practitioner, nurse neonatal advanced consultant. nurse neonatal access to doctoral and post-doctoral study to advance neonatal nursing in nursing neonatal advance to and post-doctoral study doctoral to access the future To remain in role: remain To and skills development knowledge consolidates 1. contemporary remain updating to continuous 2. 3. Continuous professional development Continuous professional Minimum professional/ Minimum educational entry requirements RN (Child/Adult) or RM or RN (Child/Adult) neonatal Post-registration qualification educator NMC mentor/practice qualification nurse neonatal Enhanced practitioner degree level master’s to Educated equivalent or ofRecognition prior experiential education, learning in clinical, roles management or leadership
Level of practice Expert Table 1. Overview to support and education framework nursing in neonatal careers of RCN competence Table is*It important to note that the career framework levels do not equate directly to Agenda for Change pay bands.
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The application of ‘levels of SHCSWs working at this level would be expected to care for practice’ to the neonatal infants who require special care under the direct supervision of a registered practitioner or Level 4 assistant practitioner/ workforce nurse. At present not all UK countries use Level 3 health care support workers. Health care support worker (HCSW) Level 2 Assistant practitioner Level 4 For those with no prior experience of working within the For those who can provide evidence of previous experience health care sector or with experience outside maternity and and consolidation of practice as a SHCSW and who have the neonatal services, this would be the point of entry into the appropriate level of knowledge and skill and can RCN career and educational framework to support neonatal demonstrate the depth of understanding and ability to care nursing across the UK. for infants requiring special care.
All staff will be required to meet national mandatory In addition to meeting national mandatory induction induction standards and participate in local induction and standards, participating in local induction and orientation orientation programmes; for example, cleanliness programmes, and role-specific in-house education, all staff champions, breastfeeding support training, child protection will have the opportunity to attain neonatal specific and basic life support training. HCSWs working at this level education at NVQ4/foundation degree or equivalent. would be expected to care for the well infant, detect deterioration in the condition of the infant, support Within this role the assistant practitioner will have in-depth colleagues in diagnostic procedures and implement knowledge and understanding and a comprehensive skill treatments as instructed under the direct supervision of a base related to their practice. They will be expected to registered practitioner or Level 4 assistant practitioner. assess, plan, deliver and evaluate aspects of care of an infant At present not all countries in the UK use Level 2 health care requiring special and minimal high dependency care under support workers. direct or indirect supervision of a registered practitioner. The assistant practitioner will support and act as a mentor Senior health care support worker (SHCSW) and role model for HCSWs and senior HCSWs and offer help Level 3 and support to more senior colleagues. For those who can evidence previous experience and/or consolidation of practice as HCSW or appropriate level of Benner level – novice/advanced beginner: knowledge and skill to care for infants requiring special new entrant care, this would be the point of entry into the RCN career If using the Benner model – the novice to advanced beginner and educational framework to support neonatal nursing would define the new entrant to neonatal nursing. across the UK. For those with no prior experience of the sick or In addition to meeting national mandatory induction compromised neonate following initial registration, this standards and participating in local induction and would be the point of entry into the RCN career and orientation programmes, all staff will participate in educational framework for registrants to support neonatal role-specific in-house education; for example, develop nursing across the UK. awareness of subtle cues/behavioral changes concerning infant/family wellbeing, carry out familiar tasks with All newly qualified entrants to neonatal nursing will require minimal supervision and/or more specialised tasks and a period of preceptorship in order to make the transition duties delegated to them, use specialist equipment, from being a student to becoming an accountable recognise risk in relation to care provision and utilise practitioner (NMC circular 21/2006). Preceptorship assessment tools as appropriate, show awareness of patient programmes should be aligned with local induction advocacy, act as a role model for HCSWs and offer help and programmes which facilitate familiarisation with local support to more senior colleagues. policies and procedures.
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During preceptorship and beyond, these ‘novices’ would be education (HE) sector, which is subject to rigorous quality supported to develop the competence and core clinical skill control to ensure a standardised level of attainment. Such for new entrants to enable them to provide basic care within education and training programmes will be consistent with the special care situations. This practical development would higher education undergraduate degree level, specifically be complemented by the acquisition of additional knowledge focused on the neonate across all the care categories as via in-house, network or higher education institute study defined nationally (BAPM, 2001). In England, neonatal sessions – so creating a foundation of knowledge to support modules of study within higher education at the present initial and subsequent career development (DH, 2009; time are generally 30 and 60 HE credits at HE level 5 or 6. In Scottish Government, 2013). Scotland, these courses are 20 and 40 credits at SCQF level 10. As registered nursing/midwifery is now an all graduate An established nurse or midwife at this career level profession it is recommended that: (one-year post registration) would be expected to commence • future provision of specialist education to support the work towards a NMC-recognised mentorship qualification to ‘neonatal nurse/midwife’ should be offered at facilitate the experience of student health care professionals postgraduate degree level, but with flexibility of level to during neonatal placements in their specified area of facilitate the attainment of degrees for those who have a expertise (NMC, 2008a). diploma or equivalent qualification gained in the UK or abroad and this will support the progression towards an Nurses/midwives working at this level would not be all graduate status for nurse/midwife. All staff who expected to work routinely with complex neonates in any undertake this level of study and skill acquisition should care category. Although they should have insight into high be recognised nationally within the neonatal community dependency/intensive care they would not be equipped to as a neonatal nurses/midwives in line with previous provide these levels of care without direct supervision. recommendations (NES, 2002).
Career progression Career progression Those who aspire to advance their career should be The neonatal nurse/midwife may choose to remain within encouraged to work towards the requirements for the the competent level of practice, embedding education and competent level of practice by undertaking a post- continuing to demonstrate knowledge, competence and core registration specialist neonatal education and training clinical skills of the neonatal nurse/midwife QIS. Neonatal programme. This will involve developing care knowledge nurses and midwives will assume personal responsibility for and skills within high dependency and intensive care continuing professional development to support environments under direct supervision of a nurse who is contemporary practice (NMC, 2010). They will teach and qualified in specialty (QIS) and the attainment of supervise learners in the skills within their range of competence and the core skill set of the neonatal nurse QIS. competence, so must work towards a recognised NMC mentorship qualification with sign-off responsibility – so Benner level – competent: the neonatal reflecting the principles already evident within pre- nurse/midwife (QIS) registration assessment (NMC 2009a). Progression to neonatal nurse/midwife status can occur after successfully completing a post-registration education Progression can occur if the neonatal nurse/midwife engages and training programme and demonstrating the in additional experience/education to develop the skills competences and core clinical skills as a neonatal nurse/ required to achieve the knowledge, competence and core midwife qualified in specialty. clinical skill set for the experienced neonatal nurse who operates at the proficient level of practice. Typically this will Although the term ‘neonatal nurse/midwife’ is not require completion of a postgraduate programme of study. recordable on the professional register as yet, it is essential from a workforce perspective that the knowledge, skills and Benner model – proficient: the experienced competences inferred by this status are transferable across neonatal nurse/midwife the UK. Therefore, the theoretical component of the Experienced neonatal nurses/midwives function at this level specialist education required for operation as a neonatal of practice and will provide effective management of all nurse/midwife should be based within the UK higher levels of neonatal care. This level of nurse/midwife is
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sufficiently experienced to act independently within a national guidance, debate and policy. Roles at this level may multi-disciplinary/multi-agency context, and reflects roles include the following: such as: • neonatal manager – providing service management for a • clinical specialist defined area • neonatal transportation • neonatal matron – providing service and clinical • shift management roles (for example, ward charge management for a defined area nurse/midwife/sister) • neonatal practice development facilitator/researcher • development care lead – leading on and promoting best practice through patient safety and quality improvement initiatives, • lactation support including and undertaking clinical audit and research • community outreach practitioner • advanced and specialist roles – experts in specific areas • practice development/clinical educator. of neonatal care The experienced neonatal nurse/midwife has completed an • accessing and completing an advanced neonatal nurse academic degree that supports an individual’s higher level practitioner programme (ANNP*); equipping the ANNP functioning in the neonatal unit. Such an award may give to provide total care for a caseload of infants. The ANNP them eligibility to record a professional qualification of programme should be achieved through a UK-wide specialist practitioner. accredited educational programme and the ANNP should work within a designated advanced neonatal In collaboration with medical staff and advanced neonatal nurse practitioner role; this should help eliminate nurse practitioners, the experienced neonatal nurse/midwife variability between programmes and roles will assess, plan, implement and evaluate the overall • neonatal nurses/midwife consultants/educators management of infants requiring all levels of neonatal care; and researchers – championing strategic policy will assess and manage critical and clinical events to ensure development/equipping the neonatal work force of safe and effective care, summoning appropriate assistance the future and performing studies to push the as necessary; and will facilitate learning by others in the boundaries of care forward and making today’s dreams neonatal unit (NMC, 2008a). tomorrow’s reality.
Career progression All expert neonatal nurses/midwives will have undertaken Experienced nurses/midwives working at the proficient level postgraduate study to support and develop their roles. While of practice would, like all others, be required to maintain all operate at expert level of competence, only clinical contemporary practice (NMC, 2008b) and will demonstrate practice experts would be operating at the expert level of the competence and core clinical skills as an experienced core skills as this is not a requirement for those whose role neonatal nurse/midwife. has diverted from the direct provision of neonatal care.
However, those who aspire to the expert practice level will Career progression engage with postgraduate higher education study leading Experts will engage with appropriate CPD opportunities to towards a master’s degree qualification. Where future career remain contemporary within their role (NMC, 2010) and be development remains embedded within clinical practice, able to successfully revalidate. They should assist in the then the experienced nurse/midwife would also work education and development of the future workforce as towards developing the competence and core clinical skills determined locally (NMC, 2008a). The development of associated with the expert roles in neonatal nursing. greater expertise to enhance neonatal care will involve the completion of a postgraduate higher education and training Benner level – expert: this could include programme to master’s degree level and/or leading to a specific roles beyond neonatal nursing alone master’s degree qualification/doctoral study and post Experienced neonatal nurses may choose to further develop doctorial education where appropriate for the role. their knowledge, skills and competence to this level to become an expert neonatal nurse who is able to function in an independent role. The expert nurse will engage in * ANNP practitioners can also be midwives.
13 Return to contents Career, education and competence framework for neonatal nursing in the UK 2
Communication and Core competences interpersonal relationships for neonatal Including data processing and management, production and communication of information and knowledge, and practice the design and production of visual records.
The neonatal practitioner will utilise a wide range of media to communicate effectively with infants, parents, carers and The development of core competences can be seen as health care workers. The neonatal practitioner will integral to the neonatal practitioner’s career development as demonstrate interpersonal behaviour and skills conducive to seen in Section 1. In compliance with the NHS career developing and maintaining therapeutic and professional structure and development, the competences were informed relationships. by the Knowledge and skills framework (NHS, 2004) which cites the dimensions outlined below. Aspects of family- Elements centered and developmental care are embedded within the • Communicate effectively with infants, family, relatives, core dimensions which are presented under the following carers and other professional colleagues. headings: • Act as the infant’s advocate. • communication and interpersonal relationships • Maintain effective and supportive communication • personal, professional and people development within the neonatal nursing team and with other • health, safety and security professionals. • service development • Contribute to creating an environment that fosters open • quality communication and trust with families and colleagues. • equality, diversity and rights • Liaise with health care professionals and individuals in other disciplines from within and outwith the • responsibility for patient care. organisation to support quality patient care. The competences included under each heading overlap with several of the specific dimensions of the NHS (2004) KSF, Tools therefore these are included as subheadings throughout. It • All forms of communication – oral, written, electronic, is recognised that each unit will have developed their own body language, tone of voice. role profiles and that these may be more extensive or place • Active listening. different emphasis on certain aspects of the core • Facilitating. competences. • Advising and counselling. • Influencing and persuading.
Return to contents 14 Royal colleGe of nursing Expert nurse/midwife neonatal
Influences strategic local at and making policy Influences national level. and presentations gives meetings, Leads a influences ofwide range individuals and action and at strategic take groups to level changes. make and sensitive complex, and processes Receives initiating actions information, contentious required. and maintains communication Establishes with various on individuals and groups wide ranging and potentially complex, services. neonatal to related topics stressful overcome to communication effective Enables barriers. strategiesDesigns process and develops to data and information. and manage Analyses, synthesises and presents knowledge knowledge synthesises and presents Analyses, subjects and and information complex about keydecisions. influence to concepts • • • • • • • Level 4
Discusses the importance of and interacting communicating of with and members manner parents the in a professional multidisciplinary team. in practiceDemonstrates the principles of effective skills which communication and appropriate communication the whole family. consideration into takes it is and how the importance ofStates care family-centred the unit. on implemented at handover verbal accurate the abilityDemonstrates deliver to side. the cot information in accurate the abilityDemonstrates record to both written and electronically. patient records, the abilityDemonstrates interact with and families to parents setting. and difficult care in different and caring patients, to attitude empathy/compassion Shows and families. parents and courteous in an approachable, Communicates manner. professional of an understanding Demonstrates confidentiality the need for of it is maintained. information and how Should have the competence to facilitate an understanding of an understanding facilitate to the competence Should have the importance of and interpersonal communication relationships. • • • • • • • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Processes, modifies data and and manages Processes, information. and maintains communication Establishes with complex about individuals and groups overcoming matters, and difficult neonatal problems. any and influences motivates, Persuades, withnegotiates a wide range of people to assist with and action decision-making as required. Actively supports and leads initiatives to to supports and leads initiatives Actively of optimal communication local and ensure and information national policy directives pertinent care. neonatal to and reports information interprets Analyses, and concepts. ideas to related and knowledge • reports. complex Writes • presentations. and delivers • Prepares • • • • Level 3
Identifies the range of people likely to be involved in the the of to range be involved Identifies likely people potential identify and seek to process communication differences. communication with that is people in a form and manner Communicates with of culture, level their consistent understanding, of ways communicating. and preferred background on barriers effective to and reflects Recognises communication. of has the infant which Supports a culture communication of at the centre and family the process. and styles compassion caring, demonstrate which Models empathy. provides 2 colleagues) Level to responsibility some (With as appropriate. workers other to feedback of activities records consistent and complete accurate Keeps with policies and procedures. legislation, of confidentiality the need for information and Understands it is maintained. how Develops and maintain communication with people about and maintain communication Develops in difficult situations. and/or difficult matters • context. information in the relevant • Presents • • • • • • • Competent neonatal nurse/midwife nurse/midwife neonatal Competent (QIS) Develops a rapport and communicates a rapportDevelops and communicates within and with team the neonatal effectively about routine professionals, health care other differences overcoming activities, and daily exist. that may respectful communication effective Promotes families and with infants, processes colleagues. advocate act as the infant’s to the courage Has when appropriate. bad communicate to the confidence Has news. and reports interprets analyses, Structures, factual data and information and supervises of and in the maintenance accurate others records. contemporaneous accuracy, confirms information, Checks appropriate and take discrepancies recognises action. Within the realm of allocated responsibility, of the realm allocated responsibility, Within others. teaches and influences • • • • • • • Novice/advanced beginner: Novice/advanced new entrant Level 2 Needs to be able to communicate with a range of communicate be to able a people to on Needs and the them to range of in a form that is appropriate matters and parents stress under be parents These may situation. whose is not English. language compassion demonstrate as to a way in such Communicates the dignity and preserve of with respect, the and empathy, family. is not going when communication as to Should be sensitive well and be mindful of in practice and seek early scope their support. with consistent records and complete accurate Keeps policies and procedures. legislation, in every section. handover verbal accurate Demonstrates the importance of effective Understands communication. the abilityDemonstrates communicate to colleagues. and efficiently with effectively maintaining trust, tactfully, Communicates integrity and confidence. strategies to communication effective Uses withwork infants and in partnership with giving information them parents/carers, to necessary informed choice, facilitate to meet the needs of the infant. strategies empathise to communication Uses the caring environment. and reports inputs records, collates, Collects, and simple data information. routine and contemporaneous accurate Maintains records. Appreciates the need for confidentiality of confidentiality the need for information and Appreciates it is maintained. how • Manages barriers to effective communication. barriers effective to • Manages • • • • • • • • • • • Communicates effectively with a range of effectively Communicates a range people on of matters. • • Competences practice for the levels of neonatal
15 Return to contents Career, education and competence framework for neonatal nursing in the UK
Personal, professional and people development
The neonatal practitioner 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 • Practice at all times within current legislation, professional rules, codes and guidelines. • Provide ongoing evidence of competence through maintenance of a personal professional portfolio. • Develop self and others. • Contribute to practice development through active participation in clinical working groups. • Contribute to the development of the philosophy of shared governance within the neonatal team. • Facilitate and actively participate in clinical support activities and orientation of colleagues and learners.
Tools • Formal learning. • On-the-job training opportunities. • E-learning. • Access to specific training and awards. • Networking. • Clinical supervision.
Return to contents 16 Royal colleGe of nursing Expert nurse/midwife neonatal
Demonstrates knowledge of knowledge Demonstrates policies public activitiesand participates that in professional of the advancement nursing neonatal to relate practice. own and others’ and evaluates Develops professional and practice across knowledge and organisational boundaries. the strategiesensure to delivers and Identifies of provision and development education meet the needsprogrammes of to the service.neonatal of in Supports the development a culture learn together. professionals which of in Supports the development a culture and inter- valued individualswhich are learning is encouraged. professional • • • • • Level 4
Demonstrates they recognise their own limitations and level of own and level their limitations theyDemonstrates recognise meet learning learning personal ability plans to and develops needs. of an insightDemonstrates the level into skills and experience they improve. need where to and areas in practice limitation their and can identify identify to able Is learning plan their needs via development personal their (PDP). their develop to practice the use ofDemonstrates reflective skills. of and skill for the knowledge aware theyDemonstrates are grade.their actively possible they have that wherever Demonstrates participated knowledge in learning opportunities develop to and skills. Develops the competence to facilitate an understanding of an understanding facilitate to the the competence Develops and people development. professional importance of personal, • of an understanding • Shows all aspects of confidentiality. • • • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Develops own knowledge and skills to remain remain and skills to own knowledge Develops new disseminating in practice, current wider and skills for benefit. knowledge own knowledge and/or limitations Identifies of a plan formulates action and skill deficits, opportunities to and organises development professional continuous enhance development. of the limitations provides Recognises others; to others to support/information/teaching help development. their signs of in others, Recognise stress negative alleviation support towards offers and work of tension. • • • • Level 3
Can reflect constructively on the feedback from others and can and others from feedback the on constructively reflect Can and skills applying well they knowledge their are how evaluate work. meet current their to own needs and sets own personal development Identifies with in discussion reviewer. their objectives development and development own personal for responsibility Takes portfolio. development maintains own personal use of effective learning opportunities withinMakes and and evaluating effectiveness their the workplace, outside information. relevant feeding back and skills knowledge their and apply develop to others Enables in practice. of that is the development in a manner others to Contributes with policies and procedures. legislation, consistent support to the opportunities to in the workplace Contributes see it as a learning environment. to others Develops oneself and contributes to the development of oneself the development Develops others. to and contributes • of post. their and the requirements the demands • Meets • • • • colleagues. junior and more and supports parents • Teaches • • Competent neonatal nurse/midwife nurse/midwife neonatal Competent (QIS) Develops own knowledge, skills and practice own knowledge, Develops of the development others. to and contributes staff that encourages an environment Fosters supporting and counselling development, staff as necessary. staff and evaluates delivers Develops, programmes that support the development and leadership ofachievement skills, clinical best practice nursing. in neonatal Acts as a resource of and specialist knowledge as a resource Acts practice. clinical • • • • Novice/advanced beginner: Novice/advanced new entrant Level 2 Responds positively to the constructive feedback from others others from feedback the constructive to positively Responds their and enhance develop to in seeking areas and is proactive of in the development the serviceown skills and interests within post. current their on learningwhat has in their helpful been and Reflects date. to development review of part developmental an active in the annual Takes the post for descriptors/outline against role their own work learning for areas suggests with and proactively reviewer their year. in the coming and development part an active in learning opportunities of and parents Takes others. of the effectiveness learning opportunities and alerts Evaluates problems. benefits and to others of record/portfolio own their an up-to-date Keeps progress. developmental of of limitations aware ofIs skills and scope practice nursing, in neonatal professional and and seeks advice accountability exercises support accordingly. continuous to a commitment Demonstrates and actively development professional participate in the appraisal process. signs of and Recognises stress own negative support. seeks appropriate Actively participates in teaching programmes participates in teaching Actively learning. and facilitates • • • • • • • • Develops own knowledge and skills and provide information to information to and skills and provide own knowledge Develops help development. their to others • development. own personal to • Contributes • Competences practice for the levels of neonatal
17 Return to contents Career, education and competence framework for neonatal nursing in the UK
Health, safety and security
The neonatal practitioner will utilise 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 • Health and safety legislation and policies. • Infection control policies. • Clinical governance. • Risk management. • Moving and handling. • Staff governance. • Training/mandatory updates as defined in employer’s health and safety policies and procedures.
Return to contents 18 Royal colleGe of nursing Level 4
Demonstrates that they have completed in-house mandatory completed that theyDemonstrates have safety and security. health, and statutory including training, the abilityDemonstrates support team to nursing the neonatal ofin the assessment risks actual and potential in the self for workplace and others. risk and support tools assessment the access to where Knows risk in using validated tools. assessment team neonatal and secure safe and assists in maintaining a healthy, Promotes and fittings in the fixtures – checking environment working of maintaining levels heating, nursery, dependency low lighting and ventilation. of systems safe Demonstrates day-to-day in their working of selfpractice for as a result implemented and others the correct undertaking example, for risk relevant assessments; disposable of waste. and non-clinical clinical use of appropriate Demonstrates security and alarms, systems of members visitors and other of the the monitoring parents, example, for multidisciplinary unit; the neonatal to team challenging visitors. and confidentiality of negligence, clinical Should be aware issues. safeguarding child and of report accidents knowledge Demonstrates to how incidences. team the neonatal to of refer knowledge Demonstrates to how risks. actual about potential or when concerned safety and minimise risk health, to to ways Demonstrates security include: may which time and quiet on care developmental the need for Recognises unit. the neonatal of unit evacuate the neonatal to what take action aware to Is should the need arise. protecting with to regard whatDemonstrates take actions to situations. self violent and aggressive from and others Competence to facilitate a greater understanding of understanding a greater the facilitate to Competence safety and ensuring the health, and skills required knowledge staffwellbeing of and visitors. the infant, • • • • • • • • • • practices hand hygiene safe 1. moving and handling infant’s/equipment 2. alarm systems 3. skills parenting monitoring 4. use. and equipment equipment cleaning 5. • • • Level 3 safe hand hygiene practices and use of hand hygiene safe protection personal equipment modelling designed minimise risks behaviours role to to infant and families.
Participates in the mandatory and statuaryParticipates training including safety and security health, sessions. safeguarding, the child sessions. lead some May safety and minimise risk health, to to ways Demonstrates security include: may which strategies care the units developmental Supports and enforces the nursery to time. quiet the adherence and monitors work activities in processes and the risks involved Identifies and support the risks. manage strategies best to how on safe they are and practices and ensures areas work Monitors safety and health, to that they conform hazards, from and free and guidelines. procedures security policies, legislation, how identifies the necessary risks, to action in relation Takes action to and takes safety and securityhealth, can be improved effect. this into put Promotes, monitors and maintains best practice in health, safety and maintains best practice in health, monitors Promotes, and security. • • 1. moving and handling infants/equipment 2. alarm systems 3. skills parenting monitoring 4. use. and equipment equipment cleaning 5. handling safe of EBM and infant formula 6. health maintenance personal 7. 8. • • • • Level 2 safe hand hygiene practices and use of hand hygiene safe protection personal equipment
Can demonstrate ways to minimise risk to health, safety and minimise risk health, to to ways demonstrate Can security include: may which time’ ‘quiet and care’ ‘developmental the need for Recognises unit. the neonatal on and use risk and support tools assessment the access Can risk in using validated tools. assessment team neonatal the safety infants and their for of the environment Monitors families. in their and assesses the potential risks involved Identifies self for activitieswork and processes and others. of in the management the actions an initiate required Can situation. emergency vigilant that may Is in reporting problems actual potential or safety and security health, theyput at risk how and suggests might be addressed. Attends and completes the in-house mandatory and statutory and completes Attends safety and health, safeguarding, training the child including security sessions. and supports Assists multidisciplinary the neonatal in team ofthe assessment risks actual and potential in the workplace selffor and others. with policies be legislation, compliant to a way in such Works and procedures. Monitors and maintains health, safety and security and maintains health, of selfMonitors and others. • • 1. moving and handling infants/equipment 2. alarm systems 3. skills parenting monitoring 4. use and equipment equipment cleaning 5. handling safe of EBM and infant formula 6. health maintenance. personal 7. • • • • • the to manage risks. best how • Identifies • • when this is necessary. immediately assistance • Summons • safety and security. in maintaining health, • Supports others Competences practice for the levels of neonatal
19 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/midwife neonatal
Ensures the working environment complies complies environment the working Ensures and legal professional with organisational, and guidelines. requirements improves that actively a culture Develops safety and security. health, risk strategies management in the Promotes unit. neonatal safety and best practice in health, Ensures training staff. adequate for including security, training appropriate and provides Develops opportunities. Assumes line management responsibility for for responsibility line management Assumes reporting and monitoring. accident/incident and identifies training needsof Acknowledges training facilitates resources, negotiates staff, meet needs. to the and manages the need for Assesses of supportpurchase to neonatal equipment care. • practices. work safe • Monitors • • • • • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Supports others to deal with deal to Supports emergency others situations. Carries to risk out related assessments those risks and manages care neonatal appropriately. in taken are measures all appropriate Ensures infection control. to relation and and maintains equipment Prepares staffensure training and is current up-to-date. Acts as a role model and promotes best model and promotes as a role Acts safety and security. practice in health, • • • • • staff to • Contributes training. Competent neonatal nurse/midwife nurse/midwife neonatal Competent (QIS) Manages emergency situations, summons summons situations, emergency Manages and acts within of own level help, appropriate competence. professional safety and and maintains the health, Monitors security of self in the neonatal and others unit. Actively implements local health and national implements Actively infectionand safety control legislation, and risk governance clinical policies, and integrates these regulations, management practice. into • • • and maintains equipment. • Prepares Novice/advanced beginner: Novice/advanced new entrant Is aware of, and complies with, local and with, and complies of, aware Is national health and safety legislation, and clinical policies, infection control and risk regulations. management governance and workplace potential risks in the Identifies minimise the risk. action to appropriate takes and in the preparation Participates ofmaintenance equipment. neonatal summons situations, emergency Identifies help and acts within of own level expertise. Assists in maintaining a safe and secure and secure in maintaining a safe Assists environment. • • • • •
Return to contents 20 Royal colleGe of nursing
Service development
Including logistics, facilities maintenance and management, partnership, leadership, management of people, and management of physical and/or financial resources.
The neonatal practitioner 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 practitioner will contribute effectively to the planning and organisation of neonatal care services to maximise the provision of a high quality service to infants, parents, families and carers. Elements • Demonstrate ability to co-ordinate, organise and prioritise workload. • Demonstrate leadership skills within the neonatal nursing practice. • Maintain collaborative working relationships with the multidisciplinary team, the general public and external agencies. • Manage resources effectively. • Be receptive to new developments in the provision of neonatal care. • Participate in clinical governance initiatives.
Tools • Setting goals and objectives. • Supervising and facilitating. • Delegating. • Equipment. • Operational planning. • Budgeting. • Controlling and monitoring. • Administration. • Leading, managing and developing staff. • Coaching and mentoring. • Visioning. • Resources. • Time management. • Prioritising. • Project planning. • People management.
21 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/midwife neonatal
Develops strategiesDevelops neonatal and policies for service at local and national development level. activities work with by a team Leads complex and standards. objectives establishing partnership and evaluates sustains Develops, agencies groups, withworking individuals, of in the provision involved and others care. neonatal policies and evaluates implements Develops, deploying, and strategies recruiting, for staff. and retaining developing a criticallyDemonstrates analytical approach strategic to making and judgements decision care. neonatal to related in and management leadership Provides role effective through nursing neonatal offering vision the modelling, for ofadvancement nursing. neonatal in practice and nurses neonatal Empowers and enthusiasm co-operation stimulates within team. nursing the neonatal • staff development. • Monitors • • • • • • Level 4
Shows a willingnessShows of and understanding identify the need to of the effectiveness the service that will and areas improve any own practicetheir within team. the neonatal services on comment provided to parents/families Encourages box/online questionnaire/comments parents through forums and so forth. feedback/parent service to approach and constructive a positive Demonstrates improvement. of members senior to staff neonatal Raises concerns when it is that aspects of affecting the serviceperceived adversely are of members and other carers staff families, parents, patients, and so forth. issues infection control example, – for Works within and of the scope practice their and competence Works upon work improve to team the nursing seeks support from practices and the services. Competence to facilitate a greater understanding of understanding a greater service facilitate to Competence development. • • • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Provides effective professional leadership, leadership, professional effective Provides the service and developing facilitating change needs. changing health care to in response and participates facilitates in Proactively unit management, and neonatal resource the to and contributing maximising resources of and development staff. management Highlights action and instigates plans to resources. in deficits manage and selection in the recruitment involved Is of development professional and personal staff. with working and sustains Develops and others agencies groups, individuals, care. in neonatal involved Actively contributes and participates in the contributes Actively ofdevelopment services. neonatal monitors co-ordinates, delegates, Allocates, ofand assesses work and the team individuals. • • • • the line manager. • Deputises for • • policy/service changes. • Proposes • Level 3
Identifies and evaluates areas for potential service potential for areas and evaluates Identifies the Discusses these with and agrees how others improvement. as a result. service be improved could during members times of team Supports other and change that and tensions problems with overcome work to others present. could policies direction, the vision maintain and sustains to Shares and strategies firmlyembedded. until they are their in linepractice to alter flexibility with sufficient Has tradition and challenge is on which agreed improvements oflonger use. of with the effectiveness service others Evaluates improvements. in making an appraisal ofSupports others draft policies and improvement. for recommendations makes Appraises, interprets and applies suggestions, recommendations recommendations suggestions, and applies interprets Appraises, services. improve to and directives • • • • • • Competent neonatal nurse/midwife nurse/midwife neonatal Competent (QIS) Supervises staff junior within predetermined feedback. and provides parameters within potential leadership the Develops model acting as a role environment, clinical stafffor and peers. with working in partnership, Participates within and others groups the individuals, unit. neonatal of the realm (Within allocated responsibility), in the neonatal resources manages effectively unit. of the realm (Within delegated the to contributes responsibility), ofdevelopment care. neonatal a daily Plans own time and prioritises over time-scale. and weekly infants and Organises the logistics move to equipment. • • • • • • • Novice/advanced beginner: Novice/advanced new entrant Level 2 Discusses the the implications and agrees with team the work practice. current their on policies and strategies have direction, and in making the need for in understanding Supports others agreed changes. so, do to when required work own and others Evaluates of the effectiveness evaluate perhaps to using benchmarking change. to raise an alert in place if systems are the confidence there Has detrimental of the delivery are to which the service. Comments on policies, procedures or or procedures policies, on Comments possible developments. in partnership within working Participates unit. the neonatal organise and prioritise the need to Recognises as partworkload taking cognisance of a team, of activities within unit. the neonatal of and maintains the physical aware Is unit. in the neonatal resources of uses the financial and efficiently aware Is unit. in the neonatal resources Assists in maintenance and development of and development in maintenance Assists service.the neonatal and colleagues junior model for as a role Acts learners and supervises learners as parameters within predetermined appropriate feedback. and provides with Assists the logistics of moving infants withinand equipment the service. Voices ‘bright ideas’ and negotiates the changes that they can the changes and negotiates ‘bright ideas’ Voices service. the neonatal develop to as a team make • • of discuss elements to able good practice• Feels elsewhere. • Contributes to the improvement of services. the improvement to Contributes • • • • • • • • • • Competences practice for the levels of neonatal
Return to contents 22 Royal colleGe of nursing Prepares, develops and monitors financial and and monitors develops Prepares, a range for of complex resource material activities. care neonatal criteria and establishes success Identifies nursing neonatal for systems monitoring practice. service to related projects Plans and manages and safe strategies ensure to development of infants and equipment. movement efficient and resources and financial physical Secures strategiesestablish use. their for • • • • Plans and organises several complex neonatal neonatal complex Plans and organises several activities. care Organises and prioritises conflicting demands. workload ofPrioritises infants and the movement equipment. • • •
23 Return to contents Career, education and competence framework for neonatal nursing in the UK
Quality
Including research and development.
The neonatal practitioner will demonstrate commitment to evidence-based practice, utilising research, quality standards and clinical audit tools. The neonatal practitioner will demonstrate a critical thinking approach to problem solving to enhance neonatal care. Elements • Actively use a problem solving approach to care delivery and the needs of the infant. • Utilise research skills, critically appraise and evaluate neonatal practice. • Contribute to the maintenance of an environment within the neonatal unit where research, quality and clinical audit are valued. • In collaboration with the multi-professional team, audit standards of care delivery. • Use decision-making skills.
Tools • Creative thinking. • Decision making. • Research. • Audit. • Evaluation. • Making recommendations. • Reflective practice.
Return to contents 24 Royal colleGe of nursing Expert nurse/midwife neonatal
Makes decisions and develops solutions to to solutions and develops decisions Makes have risk clear and may that involve problems answer. no clear a direct significant that have decisions Makes long-term impact or the medium on ofperformance unit. the neonatal clinical in research for areas Identifies practice. projects leads research in and/or Participates within collaboration others. review of in the systematic Participates to plans and outcomes treatment protocols, in meeting effectiveness their determine of standards established care. Analyses and develop solutions for complex complex for solutions and develop Analyses managerial or problems. clinical professional, • • • • • • Level 4
Demonstrates an awareness of quality in the health care an awareness Demonstrates during and suggestions recommendations setting and makes the quality of enhance meetingsteam could which care. maintain the need to as to an understanding Demonstrates of own 2 and 3 in their standards and support Level care care. quality sustain family-centred to quests of the workload 2 and 3 staff any Level and refers Monitors of member a senior to team. the neonatal concerns of suggestion any satisfaction and refer parent Monitors of member a senior to the team. complaint bewithin safe to their how that theyDemonstrates know ofsphere ability and competence. a senior to quality promptly issues refer to how Knows ofmember staff. and efficiently of use and maintain resources to how aware Is and sundries. as consumables such effectively, Competencies to facilitate a greater understanding of understanding a greater quality. facilitate to Competencies • • • • • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Makes recommendations that have a positive a positive that have recommendations Makes impact care. neonatal on and proactively and facilitates Instigates, of a culture enquiryfosters and facilitate integrate best evidence to into change using strategies by of research care, neonatal and audit. Assesses and analyses information to solve solve information to and analyses Assesses problems. • • • Level 3
Understands their own role within own role their the multidisciplinary team Understands 3 practitioner The Level withinand works own scope. their time. skill their base over develop seeks to organises and performs own Prioritises own workload, their that maintains and promotes in a manner responsibilities quality. the quality of and raises work own and others Evaluates risksquality with and related issues people. the relevant of and maintenance Supports the introduction quality systems the appropriate and take area in own work and processes quality problems. persistent are action when there Acts consistently with legislation, policies, procedures and procedures with policies, legislation, consistently Acts of the value quality and promotes qualityother approaches others. to approaches and member team and responsible as an effective Works so. do supports to others The Level 3 neonatal practitioner has a role in contribution to to in contribution practitioner 3 neonatal has a role The Level of quality. the improvement • • • • • • Competent neonatal nurse/midwife nurse/midwife neonatal Competent (QIS) Identifies areas for practice development, practice development, for areas Identifies utilising local improvements suggests appropriate and assists where mechanisms with process. the change of skillsDemonstrates and understanding principles and evidence audit methodology, based practice. Adopts a critical approach to clinical practice clinical to a critical approach Adopts in questioning/reflection and encourages of a culture best practice in promote to others care. neonatal • • • Novice/advanced beginner: Novice/advanced new entrant Level 2 Seeks to prioritiseSeeks to and organises own workload their own risks quality care. to reduce to work resources setting’s use and maintain the health care Seeks to do so. to supports and others effectively and efficiently the quality of monitor and Seeks to own in their area work qualityalerts issues. to others Acts consistently with legislation, policies, procedures and procedures with policies, legislation, consistently Acts so. do to others and encourages qualityother approaches within and within the limits of own their competence Works of own level their in the and accountability responsibility multidisciplinary and organisation. team attitude a questioning/reflective Adopts seeking and utilising practice, clinical towards ofbest evidence in the provision /guidelines families. the infants and their to care and development research with Assists audit, projects. Maintains quality in own work and encourage others to do so. do to others quality and encourage in own work Maintains • • • member. team and responsible as an effective Works • • • • • Competences practice for the levels of neonatal
25 Return to contents Career, education and competence framework for neonatal nursing in the UK
Equality, diversity and rights
The neonatal practitioner will practice within a legal, professional and ethical framework that includes employer’s and local guidance, policies and procedures, ensuring that 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 • Midwives’ Rules and Standards • the Children Act 2004, Safeguarding Framework and local procedures • International Convention on Human Rights/The Rights of the Child.
Tools • Creative thinking. • Decision making. • Research. • Audit. • Evaluation. • Making recommendations. • Reflective practice. • Mandatory training and updates.
Return to contents 26 Royal colleGe of nursing Expert nurse/midwife neonatal
Develops anti-discriminatoryDevelops policies/ support appropriate and provides procedures and staff carers parents, services infants, for with professional legislation, that comply and best practice. regulations diversity of effectiveness equality, Monitors and rights policies and procedures unit. the neonatal throughout reviews implementation, Regularly with equality and compliance effectiveness legislation. and diversity Actively develops and promotes an and promotes develops Actively is treated everyone in which environment and withequitably respect. • • • • Level 4
Is able to demonstrate an awareness of relevant standards, of standards, relevant an awareness demonstrate to able Is affect which the key policies and procedures legislation, disability, to: aspects relate of may which the Band 4 role human religious beliefs, capacity, mental dignity at work, resolution. and issue complaints language, rights, privacy and ensure to how that theyDemonstrates know breast expressing or when breastfeeding example, for dignity, cultural beliefs. care, kangaroo milk, that families will have aware that theyDemonstrates are religious as cultural, and behaviour such differing perspectives and ethnic differences. practice an ability treat to day-to-day in their Demonstrates discriminatory identify people and fairly equally and be to able practices. practice an ability identify to day-to-day in their Demonstrates families and carers. parents, neonates, discrimination towards Competences to facilitate a greater understanding of equality, of understanding a greater equality, facilitate to Competences and rights.diversity • • • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Promotes an environment in which everyone everyone in which an environment Promotes and with equitably respect. is treated informed decisions make to parents Enables infant and supports their in them regarding decisions. their to action and take for the potential Identifies discrimination rectify or and prevent of rights.compromise of ways and challenges working Interprets solutions. appropriate and develop Acts as an advocate on behalf on as an advocate of Acts those whose been compromised. rights have • • • • • Level 3
Interprets and transfers the ethos of equality, diversity and diversity and transfers the ethos ofInterprets equality, and procedures with policies, legislation, rights in accordance ethic and support work their the into standards relevant this requirement. to ofdelivery is sensitive which care of patterns identify Seeks to action to discrimination and takes and equality diversity discrimination and promote overcome of opportunity all. for and a equality and diversity promote to others Enables non-discriminatory culture. rights. their Supports in exercising people who need assistance the rights encourage Seeks to of be nourished the infant to milk. breast with own mother’s their caring, the quality of ensure is respectful, to care steps Takes and family-centred. and compassionate Works in such a way that promotes equality diversity. and values that promotes a way in such Works • • • • • • Competent neonatal nurse/midwife nurse/midwife neonatal Competent (QIS) Reflects on and challenges assumptions and challenges assumptions on and Reflects of ofways working others. everyone, in which Supports an environment families and parents/carers, infants, including and with equitably – is treated colleagues respect. with parents the information Provides informed make to them for required infant. their regarding decisions • • • Novice/advanced beginner: Novice/advanced new entrant Level 2 Recognises the importance of the infant and family’s rights the importance ofRecognises the infant and family’s with policies and legislation, and acts in accordance procedures. the rights of promote Seeks to be nourished the infant to with milk. breast own mother’s their is which care the quality of providing enhance Seeks to by care respectfully family-centred. of account own behaviour and communication their Takes on have the effect these may on style be aware and the need to others. a have may which situations identify skills to Develops rights and take family’s impact their an infant or on negative see resolved. the situation action to Recognises and respects the preferences and the preferences and respects Recognises beliefs of the family/carers. challenges personal on and Reflects of and ways assumptions working. of is aware safeguarding) child to relation (In and activate and responsibilities role when necessary, procedures safeguarding seeking support as required. Acts in a way that acknowledges and recognises a person’s a person’s and recognises that acknowledges in a way Acts and choices. preferences beliefs, expressed Assists in maintaining an environment in in maintaining an environment Assists parents/ infants, – including everyone which – is treated families and colleagues carers, and withequitably respect. that support in a manner equality, Acts and rightsdiversity of all individuals • people as individuals. and values diversity • Respects • • • • Works in such a way that supports equality a way diversity. and values in such Works • • • infants rights. for as an advocate Acts • • • • Competences practice for the levels of neonatal
27 Return to contents Career, education and competence framework for neonatal nursing in the UK
Responsibility for patient care Tools • Education and training. Including assessment of addressing individuals, • Health promotion. improvement of protection of health and wellbeing • Guidelines, protocols, policies and standards. needs, biomedical investigation and reporting, and • Biomedical investigations and reporting. measuring, monitoring and treating physiological conditions through the application of specific • Neonatal care assessment tools. technologies. • Quality standards. • Legislation. The neonatal practitioner will, within agreed parameters, • Specific technologies. apply knowledge, clinical judgement, and a range of skills to provide safe, effective care to infants and their families/ carers. Elements • 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, individualised 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/advise parents and families. • Ensure care is taken to safeguard infants 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.
Return to contents 28 Royal colleGe of nursing Level 4
The infant and family’s emotional health and wellbeing needs. emotional The infant and family’s when Spiritual health and wellbeing needs and the need for, care. palliative appropriate, health and wellbeing might safeguarding to Risks arise from issues. Adheres to relevant legislation, policies and procedures may be may policies and procedures legislation, relevant to Adheres local. national or Plans, delivers and evaluates care to address the infant and their the infant and their address to care and evaluates delivers Plans, include These may health and wellbeing needs. complex family’s elaborated in the clinical health and wellbeing needs are which competences. • health and wellbeing needs. physical • The infant and family’s • • risk to of• Exposure incidents/accidents. of• The neglect. prevention rapid deterioration to of situation. or • Responds condition specialist in a neonatal environment. care for A requirement • • Level 3
Helps provide for the spiritual for health and wellbeing needs and provide Helps the needs of appropriate and where the infant and family care. assists with palliative health and wellbeing might safeguarding to Risks arise from issues. the relevant to adherence permit correct to guidance Follows local. be or national may policies and procedures legislation, Assists with the infant and family’s emotional health and emotional with Assists the infant and family’s wellbeing needs. health and physical with Assists the infant and family’s wellbeing needs. specialist in a neonatal care for with Assists the requirement environment. With supervision and support, plan, deliver and evaluate care to to care and evaluate deliver supervision plan, and support, With meet health and wellbeing the infant who needs is in special care and those of family. their • • • • risk to of exposure incidents/accidents. • Reduces of neglect. the prevention Aids • rapid deterioration to of situation. or • Responds condition • • Level 2
Undertakes care to support the infant and family’s emotional emotional support to the infant and family’s care Undertakes health and wellbeing needs. physical support to the infant and family’s care Undertakes health and wellbeing needs. of designed support to the provision care spiritual Undertakes health and wellbeing of appropriate and where the family care. assists with palliative might health and wellbeing which a arise from any Reports issue. safeguarding risk to of designed limit the exposure to care Undertakes incidents/accidents. designed assist with to planned care the neonate’s Undertakes in the specialist environment. care with the relevant designed comply to care Undertakes whether local. national or policies and procedures legislation, • • • • deterioration of situation. or any condition to Alerts colleagues • • • With guidance, supervision and support guidance, the practitioner will With activities meet care the health and wellbeing needs to undertake of family. the infant and their • Competences practice for the levels of neonatal
29 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/midwife neonatal
Develops and maintains knowledge, skills and maintains knowledge, Develops of the level to the expert and competence function in an independent who to is able role. practice in applyingDevelops technology and monitoring measurement, for treatment. practice in biomedical Develops and reporting. investigation a criticallyDemonstrates analytic approach strategicto making and decision care. neonatal to related judgements activities monitors against Continuously that factors anticipates quality standards, effective quality and takes reduce may them. address action to and evaluates implements Develops, the and strategies improve to initiatives quality of care. neonatal quality of through care neonatal Improves practice review. strategies and implements Develops for policies standards, include care, neonatal delivery. care for and guidelines policies and strategiesDevelops improve to the health and wellbeing of infants. care Seeks to opportunities add value to provision. practice by nursing neonatal Empowers nationally and locally, publishing internationally. Acts as a role model for effective leadership leadership effective model for as a role Acts to and contributes nursing in neonatal of a vision the advancement creating for co- so stimulating nursing neonatal in neonatal operation and enthusiasm nursing. • • • • • • • • • culture. care a proactive • Fosters • • • Proficient neonatal nurse/midwife nurse/midwife neonatal Proficient
Manages the implementation of the implementation Manages quality care/service and reports interprets analyses, Plans, within own level investigations biomedical of practice. the and quality assures monitors Plans, ofapplication technology measurement, for and treatment. monitoring partnership and the In with parents/carers use highly team, multi-professional and clinical knowledge developed/specialist a culture create skills unit to in the neonatal and responsive that is proactive and climate needs of meet the health care to infants. junior by Supervises given the care colleagues. Acts as a role model, providing support and providing model, as a role Acts care. in implementing others to guidance and evaluates delivers plans, Assesses, needs that are address to care neonatal changing. and ever complex • • • • • quality improvement. to • Contributes • • Competent neonatal nurse/midwife (QIS) nurse/midwife neonatal Competent
Plans, implements and evaluates nursing care to meet to care nursing and evaluates implements Plans, the health and wellbeing needs of the infant when the is stable. condition infant’s and facilitate to critical and reasoning judgement Uses infants in partnership to with care parents/ deliver team. professional and the multi carers action when the appropriate and takes Recognises is or unstable is becoming condition infant’s and initiation referral of including deteriorating, interventions. emergency and skills base knowledge a comprehensive Maintains nursing. neonatal to related quality and alert to actions others promote Ensures qualityrelevant issues. critical skills reasoning and develops clinical core Uses infants in to care and effective safe provide skills to partnership and the multi with parents/carers team. professional delivery care overall for and accountable responsible Is of a defined for group infants with indirect supervision. quality and alert to actions others promote Ensures qualityrelevant issues. Assists in the care of in the care Assists the infant whose needs are changing. and ever complex and monitoring technology measurement, for Applies the needs of to and respond interpret treatment, families/parents/carers. staff and other assess infant’s to parents/carers Assists needs. wellbeing and related health, plans and participates in the need for, Anticipates programmes ofhealth and support to future care audiology wellbeing including: and ophthalmic planning and discharge vaccination, screening, information/ specificpromotion health delivering teaching. and monitoring technology measurement, for Applies treatment. • • • • • • • colleagues. to as a resource Acts • • Supervises of delivery care colleagues. junior • • practice development. to • Contributes own practice. for accountable • Is • • • • Supervises of delivery care colleagues. junior • Novice/advanced beginner: Novice/advanced new entrant Develops a sound knowledge base a sound knowledge Develops nursing. neonatal to relevant routine essential quality, Provides within defined care neonatal clearly guidelines. the needs of to the infant and Responds using quality care providing the family, information and knowledge. current tasks assessment routine Undertakes the health and wellbeing of to related the infant. and tasks related tests routine Performs and reporting. investigations neonatal to of actions assist the maintenance Ensures high-quality care. neonatal Assists in delivering programmes of in delivering Assists health support to future care neonatal of delivery including and wellbeing, information/ specificpromotion health teaching. and evaluates intervenes, Assesses, ofreports planned the outcomes care. • • • • • • • •
Return to contents 30 Royal colleGe of nursing 3
The neonatal workforce must have the knowledge and ability Core clinical skills to rationalise the strategy chosen in the application of all for the neonatal clinical skills. Nurse consultant, clinical nurse specialist, lead nurse, workforce advanced neonatal nurse practitioner. In addition to the above core clinical skills, nurse consultants, clinical nurse specialists, lead nurses and advanced nurse practitioners will be required to To achieve the competences expected for each of the levels of demonstrate elements from the following (RCN, 2012): neonatal nursing practice from unregistered new entrant to • provide expert professional advice to patients, carers expert and advanced, the neonatal workforce must develop and colleagues specific skills (see Section 4 for example curriculum to • undertake research in a specialist area enable these to be met). The skills required are diverse • provide education and training to other staff, students (DH, 2010, p.53). Some are transferable across several competences and the skills required are likely to change over • ensure the maintenance of clinical excellence. time. Therefore the working group has restricted competence clarification to core clinical skills. Scotland has developed more detailed frameworks for Levels 2-4 reflecting the RCN’s position of the Level 2-4 knowledge and skills frameworks. These are reproduced in the addendum which can be found at the end of this section.
This document focuses on the key competences required for those who have responsibility for infant care and uses the modified categories of skills previously selected by the RCN in its 2009 publication, Integrated core career and competence framework for registered nurses.
Categories are as follows: • fluid, electrolyte, nutrition and elimination management • neurological, developmental care and pain management • respiratory and cardiovascular management • skin, hygiene and infection control management • infant temperature management • palliative care, end-of-life care and bereavement management • investigations and procedures • equipment and monitoring.
31 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/ neonatal ANNP/nurse consultant Investigates, prescribes and manages and manages prescribes Investigates, and GI problems, any for treatments with urinaryproblems tract function and bilirubin elimination. Devises education family can feel programmes so that parents as partners and valued included in ofthe care infants. their unit audits and updates Monitors, of the care to policies relate which GI problems, infants who have with urinaryproblems tract function and bilirubin elimination. audits and reviews Devises, guidelines best practicefor in partnership with medical staff. roles nurse consultant undertake May nutritionin neonatal and as lactation specialists. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Initiates management and follows and follows management Initiates and in the care guidelines ofmanagement infants who have deviation the normal from eliminatory pathways. and supervises mentors Teaches, staffother the infant look after to a range of who care have requirements. ofSupports the development family programmeseducation so that and valued can feel included parents as partners of in the care their infants. ofSupports the development unit breastfeeding. to policies related and supervises mentors Teaches, staffother the importance of natural feeding. in others and involves Participates of and development practice research breastfeeding. promote to Competent neonatal nurse neonatal Competent (QIS) Recognises the more subtle subtle the more Recognises deviations the normal from function and urinarygastrointestinal tract function. high bilirubin levels. Manages sustain to interventions Implements unit to according homeostasis guidelines. and supports so the family Teaches in the care that they can be involved of infants. their of and advises storage Informs on hand and breastfeeding, milk, breast and expression mechanical supplementary methods of feeding. to and assists the mother Encourages evidence- to feed according breast base/unit guidelines. Supports unit staff in the ofmanagement the breastfeeding dyad. ofSupports the development unit breastfeeding. to policies related Novice/advanced beginner: Novice/advanced new entrant Recognises normal and abnormal Recognises urinary function, gastrointestinal tract function and bilirubin reporting deviations. elimination, sustain to interventions Implements unit to according homeostasis guidelines. of in the care the family Involves infants. their and supports lactation.Initiates in manual/ Supports mothers of milk. expression breast mechanical feed breast to the mother Assists evidence-base/unit to according guidelines.
Advises and supports in mothers Advises of expression manual/mechanical milk and the handling and breast ofstorage same. feed breast to the mother Assists evidence-based/unit to according guidelines. Unregistered and support Unregistered workforce neonatal normal characteristics ofRecognises and urine. stool the infant’s of the care in the family their Involves infants. Fluid, electrolyte, nutrition and elimination management nutrition and elimination management Fluid, electrolyte,
Return to contents 32 Royal colleGe of nursing Expert nurse/ neonatal ANNP/nurse consultant Devises, audits and reviews Devises, guidelines best practicefor in partnership with medical staff. staff where identify to how Teaches difficulties are with the infants there and makes feeding (see below) speech and language to referrals specialists. growth trajectory the infant’s Assesses nutritionaland prescribes as required. supplements nutritional the needReviews for supplements. and intravenous Establishes lines, umbilical intra-arterial access, etc. lines. central Inserts and removes treatment. and prescribes Instigates Selects appropriate and prescribes fluid management. audits and reviews Devises, guidelines best practicefor in partnership with medical staff. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Uses evidence-based practice for Uses feeding.enteral for Devises procedures/guidelines feeding.enteral audits and and evaluates, Monitors reviews implementation. nutritional the need for Monitors compliance. and ensures supplements inserts specific situations, In lines. peripheral intravenous Supervises insertion of intravenous others. lines by for treatment appropriate Manages deviations/complications. partnershipIn with the family a plan ofdesigns and institutes meet to in order individualised care needs. the infant’s and supervises mentors Educates, care. staff safe ensure to Competent neonatal nurse neonatal Competent (QIS) Informs and advises allInforms on aspects of feeding methods. enteral other feeding needs, enteral Assesses devises plan in partnership with the and reviews appropriately. parents nutritional the required Ensures prescribed. are supplements maintains and discontinues Sets up, intravenous/intra-arterial therapy, unit guidelines. to according lines and infusions central Maintains nutrition as transparental such (TPN). reduce/ to appropriately Intervenes deviations/complications. avoid feeding difficulties according Manage and support reassure plan to care to the family. Novice/advanced beginner: Novice/advanced new entrant Advises and demonstrates and demonstrates Advises of feeding procedures sterilisation of storage sterilised equipment, equipment. the to and demonstrates Educates staff and junior parents the on of feedsreconstitution and the ofmanagement these feeds. in enteral parents/carers Assists feeding techniques. carriesSafely all out forms of tube to and bottle feeding according evidence-base/unit guidelines. nutritional supplements Administers and in prescription to according guidelines. to accordance intravenous administers Safely unit guidelines, to according therapy and reporting deviationsrecognising and complications. typicalIdentifies and atypicaloral and feeding behaviour; records reports findings.
Performs safe bottle safe feeding Performs techniques. nutritional supplements Administers and under prescription to according ofthe direction team. the nursing typicalRecognises and atypical oral and feeding behaviour; records reports findings. Unregistered and support Unregistered workforce neonatal and demonstrates Advises of feeding procedures sterilisation and storage. equipment safety on around issues Advises milk. formula prepared in bottle parents/carers Assists feeding techniques.
33 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/ neonatal ANNP/nurse consultant Calculates and prescribes fluid intake fluid intake and prescribes Calculates and condition clinical to according environment. and manages prescribes Investigates, with weight problems for treatments length. or appropriate and instigates Interprets and furthermanagement investigation. audits and reviewsDevises, unit best practice for in guidelines partnership with medical staff. to according phototherapy Prescribes need. clinical cause of pathological Investigates hyperbilirubinaemia. audits and reviews Devises, guidelines best practicefor in partnership with medical staff. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Calculates intake and output and output intake Calculates and condition clinical to according within set guidelines. environment and supervises mentors Educates, care. staff safe ensure to deviations normal on from Acts and refers growth and development appropriately. of implementation Ensures evidence-based guidelines. and supervises mentors Educates, sampling staff safe ensure to techniques. and supervises mentors Educates, care. staff safe ensure to of Supports the development parent information so that parents materials written information can have and the treatment regarding ofmanagement infant. their Competent neonatal nurse neonatal Competent (QIS) Calculates intake requirements requirements intake Calculates Measures guidelines. to according output. growth and development Monitors of measurement through weight and reporting oflength, deviations. according interventions Implements blood glucose for unit guidelines to regulation. to according phototherapy Initiates criteria and supportspredetermined and supervises staff caring who are these infants. for an received have the family Ensures and the treatment for explanation ofmanagement infant. their Novice/advanced beginner: Novice/advanced new entrant Monitors input and output. input Monitors weight and length. Measures Obtains capillary blood sample to blood glucose and monitors measure Follows reporting deviations. levels, unit guidelines. the infant who requires for Cares local to according phototherapy guidance. and supportsEncourages the family care. infant’s engage in their to
Measures and weighs infants, records records and weighs infants, Measures and reports findings. Supports the infant and family unit Follows during blood sampling. guidelines. an otherwise to care well Provides phototherapy infant who is receiving local guidance. to according engage in their to Supports the family infants care. Unregistered and support Unregistered workforce neonatal records and output, input Monitors and reports findings. Fluid, electrolyte, nutrition and elimination management (continued) nutrition and elimination management Fluid, electrolyte,
Return to contents 34 Royal colleGe of nursing Expert nurse/ neonatal ANNP/nurse consultant Initiates referrals based on need. based referrals on Initiates audits and reviews Devises, guidelines best practicefor in partnership with medical staff. treatment. appropriate Initiates audits and reviews Devises, guidelines best practicefor in partnership with medical staff. partnership(In with the medical staff) informs and provides where the family to explanation occurred. have events adverse relief stress and pain reduction Audits protocols. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Provides education, guidance and guidance education, Provides support staff for to them enable to physiological the infant’s recognise and behavioural differences. staffEducates the use of on relevant tools. assessment and supervises staffMonitors who consistency ensure to use these tools in the use of instruments. such and management care Reviews the strategies avoid/minimise to impact of events. adverse the family to explanation Provides occurred. have events ‘minor’ where stress reduce to Devises protocols pain. and relieve Competent neonatal nurse neonatal Competent (QIS) Recognises physiological and physiological Recognises between behavioural differences pain, discomfort, distress, stress, and drug withdrawal. convulsions discomfort/pain Alleviates infant’s strategies. nursing using standard partnership(In with the family) devises plan taking into a care need for the infant’s account and sleep periods.stimulation of assessment outcomes Interprets strategiesand implements according local guidelines. to on the family to explanation Provide the use of tools. assessment care and evaluates implements Plans, the impact of avoid/minimise to events. adverse identified Documents and refers events. adverse and reports signs subtle ofRecognises pain. strategiesImplements that minimise painful experiences. agents that pharmaceutical Ensures are minimise pain and discomfort to prescribed when required. Supports and supervises staff to provided that infants are ensure when necessary. comfort Novice/advanced beginner: Novice/advanced new entrant Recognises normal behaviour in Recognises infants of gestations, different states. sleep/awake including and posture normal tone, Recognises movement. deviations normal Reports from the follow to Supports the family and stimulation need for infant’s sleep periods. available/appropriate Completes and report findings. tools assessment events adverse potentially Anticipates minimise their to on and refers impact should they occur. and reports signs ofRecognises pain. to care nursing routine Provides alleviate the infant to pain and stress unit guidelines. to according to agents pharmaceutical Provides as minimise pain and discomfort prescribed. and supportsEncourages the family non-pharmaceutical provide to of comfort. measures promoting
Maintains ongoing use of ongoing Maintains relevant and report findings. tools assessment events adverse potentially Identifies impact minimise any to on and refers should they occur. signs and recognises ofAnticipates in the newborndistress/pain and follows comfort provide to steps takes unit guidelines. provide to Supports the family of measures non-pharmaceutical comfort. promoting Unregistered and support Unregistered workforce neonatal Caring infant. the well for typical states, Recognises sleep/wake in the and movement posture usual newborn. deviations normal. Reports from the follow to Supports the family and stimulation need for infant’s sleep periods. Neurological, developmental care and pain management care developmental Neurological,
35 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/ neonatal ANNP/nurse consultant Expert nurse/ neonatal ANNP/nurse consultant Develops strategiesDevelops staff for regarding and NAS drugmaternal dependency multi-disciplinary/agency involving groups. need. based referrals on Initiates need. based referrals on Initiates deviations normal from Recognises respiratory and cardiovascular function. in trends to and responds Interprets ofthe results blood gas analysis. Diagnoses respiratory pathology ofinterpretation radiography. chest supportive and instigates Prescribes and therapies following interventions infant assessment. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse nurse/ neonatal Proficient neonatal enhanced practice nurse Provides support and guidance for for support and guidance Provides associated in the care staff involved with and drug maternal dependency NAS. and supports staffEducates in the strategies.use of care developmental the family to explanations Provides are when additional measures required. and evaluates trends Interprets blood gas including management, analysis. and supervises mentors Educates, staff of assessment in the accurate the vital signs. infant’s Competent neonatal nurse neonatal Competent (QIS) nurse neonatal Competent (QIS) Implements strategiesImplements that minimise the effects of NAS. partnership(In with the family) and adapts care plans the infant’s strategiesnursing meet the needs to of specific infants. of the families in care Involves infants. their restore/maintain to Intervenes local to according homeostasis guidelines. supervises and supports Mentors, vital staff in assessing the infant’s signs. Novice/advanced beginner: Novice/advanced new entrant beginner: Novice/advanced new entrant Recognises behaviour associated with associated behaviour Recognises NAS. to care nursing routine Provides alleviate effects of NAS; administration of medications to these infants. manage strategies care developmental Uses aspects, environmental including positioning and handling according unit to plan and according the care to policies. of the involvement Encourages families. normal and abnormal Recognises function. respiratory/cardiovascular deviations normal. Reports from
Follows individualised developmental individualised developmental Follows be plans support to the family care care. infant’s in their involved Unregistered and support Unregistered workforce neonatal with associated behaviour Recognises syndrome abstinence neonatal (NAS). provide to Supports the family of measures non-pharmaceutical and consolation comfort promoting infant who their has NAS. to and support Unregistered workforce neonatal wellbeing. an infant’s Assesses deviations normal Reports from and deviations the breathing from normal pulse. Neurological, developmental care and pain management (continued) and pain management care developmental Neurological, Respiratory management and cardiovascular
Return to contents 36 Royal colleGe of nursing Performs and leads advanced and leads advanced Performs and stabilisation. resuscitation staff skills the assessment and Teaches lung supportthe basic life chronic to disease (CLD) actions required deviations. to respond life advanced neonatal to Performs standards. support (NALS) partnership(In with the medical informs families ofteam) the of resuscitation. outcomes long-term and manages Initiates respiratory support infants with for disease (CLD), lung chronic manage medicationprescribes to CLD. discharge and co-ordinates Instigates families ofplanning for infants with CLD. audits and reviews Devises, guidelines best practicefor in partnership with medical staff. physiotherapy. chest Prescribes need. based referrals on Initiates audits and reviews Devises, guidelines best practicefor in partnership with medical staff. Leads in basic life support in basic life Leads situation and stabilisation. performs situations) some the (In of resuscitator. role an advanced debriefs when team Provides required. respiratory support Adjusts need within to the local according guidelines. and supervises, mentors Educates, supports staff caring who for are infants with respiratory a need for support. the and evaluates Reviews and ofeffectiveness physiotherapy suction interventions. supervises and mentors Educates, staff assess an infant for who need to to suctioning and in how the need for performsafely the procedure. Performs basic life support. basic life Performs and requests need for Recognises assistance. with resuscitation Assists advanced and stabilisation. parents to explanation Provides if event the during the resuscitative wish be present. parents to the infant requiring for cares Safely ventilation/continuous mechanical pressure. airways positive and reassurance explanation Provides an infant who the family have for Where with requirement. this care in planning them involve possible, and participating infants care. in their suction of the need for Assesses respiratory secretions. endotracheal and effective safe Uses suction tube/tracheostomy techniques. physiotherapy chest Performs as prescribed. techniques Recognises the need for, and requests, and requests, the need for, Recognises assistance. Observes and participates in the ofresuscitation the infant. support basic life measures Initiates in an emergency. parents. Supports and comforts via therapy oxygen administers Safely nasal head box, the incubator, including and facially, cannulae as humidification adequate prescribed. become families to Encourages of in the care infant their involved requirement. who has an oxygen oral and nasal and effective safe Uses suction techniques. Provides ongoing care of care ongoing infants who Provides and who are dependent oxygen are otherwise stable. participateSupports families to in the ofcare infant. their a build when infants have Recognises up of action to and takes secretions airway. a clear ensure Anticipates and recognises and recognises Anticipates deterioration in the newborn and and assistance request to steps takes support basic life initiates measures in an emergency. parents. Supports and comforts
37 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/ neonatal ANNP/nurse consultant Assesses the need for and prescribes and prescribes the need for Assesses support. inotropic Detects anomaly underlying cardiac patient example, for disease; or pulmonary persistent arterial duct, hypertension of the newborn, heart disease. congenital Performs intubation. Performs a range and prescribes ofAssesses example, for modalities; ventilation mandatory intermittent synchronised tidal volume (SIMV), ventilation (TV), patient-triggered ventilation support pressure (PTV), ventilation high frequency (PSV), ventilation (HFOV). oscillation ventilation and sedation/analgesia Prescribes maintain infant to relaxation muscle with and complies comfort ventilation. supportive respiratory adjunctive Prescribes nitric oxide example, support; for systemic (iNO), inhalation pulmonary vasodilators. chest and removes secures Inserts, drainage. audits and reviews Devises, guidelines best practicefor in partnership with medical staff. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Cares for infants who are unstable unstable infants who are for Cares inotropic complex requiring and are support. support such according down Weans protocols. inotropic to Recognises the need for intubation/ the need for Recognises extubation. a range infants requiring of for Cares strategiesventilation and adjunctive in support provided (see examples the ANNP column). extubation. Performs and supports staff mentors Educates, infants who require for care to support. ventilatory supervises and mentors Educates, staff caring infants who who for are drain. a chest for a requirement have Competent neonatal nurse neonatal Competent (QIS) Cares for infants who are requiring requiring infants who are for Cares support maintain to inotropic stability. Assists with elective/emergency withAssists elective/emergency intubation. infants who require for Cares ventilation. Supports extubation. with ofAssists the insertion/removal drainage. chest infant with for chest care Provides drain in situ. Novice/advanced beginner: Novice/advanced new entrant Observes the healing of the chest concerns. reports any drain wound,
Monitors skin integrity infants where Monitors drains. had chest have Observes the skin integrity of the site. Unregistered and support Unregistered workforce neonatal Respiratory (continued) management and cardiovascular
Return to contents 38 Royal colleGe of nursing Expert nurse/ neonatal ANNP/nurse consultant Audits compliance with best practice compliance Audits infection control to in relation measures. evidence-based practice to Researches support infection for guidelines control. therapies and manages to Prescribes skin integrity. promote audits and reviews Devises, guidelines best practicefor in partnership with medical staff. audits and reviews Devises, guidelines best practicefor in partnership with medical staff. and appliances. treatments Prescribes as appropriate. Refers Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Devises, audits and reviewsDevises, best practice for in guidelines partnership with medical staff. staffEducates use of in the correct assess skin. to tools and supervises mentors Educates, staff of in the care a variety of stoma and what output the usual characteristic are. staff other to any Refers with as the stoma complications appropriate. Competent neonatal nurse neonatal Competent (QIS) Implements correct hand washing correct Implements measures infectionand other control as per local guidelines. in the the parents Educates with infection control compliance guidelines. a range of aseptic and Performs techniques. non-touch and supervise staffMentors in performing required the assessments the wellbeing of ensure to the infant. partnership(In with the parents) devises a plan of meet their to care needs. infant’s strategies prevent Implements to and potential damage iatrogenic injury. healing processes. wound Assesses and characteristics of nature Assesses output. stoma therapeutic wound Performs techniques. cleansing therapeutic dressings. Applies in designing a plan parents Involves participate to of them enable to care care. infant’s in their Novice/advanced beginner: Novice/advanced new entrant Implements correct hand washing correct Implements measures infectionand other control as per local guidelines. with infection compliance Polices guidelines. control basic aseptic and Performs techniques. non-touch skin and mucous Examines base for and cord eyes membranes, deviations normal and report. from the infants to according care Provides plan. care deviations for treatment Implements as prescribed. participate to in parents Encourages care. infant’s their to measures appropriate Uses and skin integrity. maintain hygiene care. stoma Provides and characteristics of nature Assesses deviations recognise output stoma the norm. from participate to in parents Encourages care. infant’s their
Performs care according to the to according care Performs plan. care infant’s using and eyes cord skin, Examines if to tool(s) assessment appropriate and reports records local practice, findings. participate to in Supports parents care. infant’s their of management ongoing Provides a QIS if to refers stoma; established output. as to is concern there participate to in Supports parents care. infant’s their Unregistered and support Unregistered workforce neonatal with hand hygiene Complies correct other implements procedure, and control infection prevention as per local policies. measures with comply Supports families to policy and infection hand hygiene strategies. control Skin, hygiene and infection control management hygiene and infection control Skin,
39 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/ neonatal ANNP/nurse consultant Devises audit and reviews nursing temperature for guidelines monitoring. cooling. passive Commences and supervises of the care Monitors therapeutic receiving infants who are hypothermia. function the cerebral Manages in use. these are where monitors partnership(In with the medical rationale the use for provides team) of hypothermia and ongoing the families who have to explanation receiving infants who are hypothermia. Devises, audits and reviews Devises, guidelines best practicefor in partnership with medical staff. temperature and treats Investigates deviations. Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse Supports the development ofSupports the development audit for guidelines and reviews nursing monitoring. temperature therapeutic the need for Recognises hypothermia in following the ofresuscitation infants at risk of (HIE). event ischemic hypoxic receiving infants who are for Cares therapeutic hypothermia. supervises and mentors Educates, staff infants who need for to care to who or require cooled be passively therapeutic hypothermia. provided the explanation Reinforces the families as to the medical team by hypothermia. the need for to audits and reviewsDevises, nursing regulation temperature for guidelines strategies. Competent neonatal nurse neonatal Competent (QIS) Assesses neonatal body temperature temperature body neonatal Assesses method and site using appropriate high infants who require for and care, and intensive dependency reports deviations normal. from and peripheral central Monitors and reports gap, temperature deviations normal. from receiving infants who are for Cares therapeutic hypothermia. risk of the infant’s Anticipates deviations.temperature strategies prevent to Uses deviations infants temperature for high and dependency who require care. intensive to interventions appropriate Uses deviations temperature for correct high dependency infants who require care. and intensive Novice/advanced beginner: Novice/advanced new entrant Assesses neonatal body temperature temperature body neonatal Assesses method and site using appropriate special care infants who require for and report deviations normal. from be involved to the family Encourages care. in the infant’s the need as to explanation Provides in a for be cared the infant to for needs. their to suited temperature strategies to appropriate Uses within temperature maintain body including normal limits, and clothing aspects, environmental infants who require for equipment special care. to interventions appropriate Uses deviations temperature for correct special care. infants who require
Monitors the temperature in infants the temperature Monitors care, skin-to-skin having who are and bathing, swaddled comfort, for so forth. safety and in the home Promotes literature infant death sudden applies of care to the infant. Unregistered and support Unregistered workforce neonatal an infant’s manages Routinely safety in and promotes temperature the home. in the infant’s the family Involves care. Temperature management Temperature
Return to contents 40 Royal colleGe of nursing Expert nurse/ neonatal ANNP/nurse consultant Expert nurse/ neonatal ANNP/nurse consultant Initiates and facilitates sensitive sensitive and facilitates Initiates with and senior discussion parents medical staff. and the failed resuscitations Manages of and discontinuation aggressive futile supporting strategies. as the infant and families Acts and and lead the palliative advocate an infant who for care end-of-life plan. a care such requires with discussions sensitive Facilitates staff maintain a and proactively of supportsculture which all care individuals. specimens and samples. Requests management appropriate Prescribes results. to according audits and reviews Devises, guidelines best practicefor in partnership with medical staff. Performs non-invasive and invasive and invasive non-invasive Performs congenital example for procedures hip anomalies. central percutaneous Inserts arterial, lines. and central catheter venous Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse nurse/ neonatal Proficient neonatal enhanced practice nurse Supports and guides staffSupports and guides caring for the dying infant. staffSupports and guides caring for wider family the infant and parents, death. the infant’s and friends after protocol. Devises bereavement identifies staff, Supports and guides staff and who stressed need who are additional support. management. appropriate Instigates Performs venepuncture according to to according venepuncture Performs local guidelines. arterial line and central Performs sampling. Competent neonatal nurse neonatal Competent (QIS) nurse neonatal Competent (QIS) Sensitively and empathetically cares and empathetically cares Sensitively the dying for infant and his/her withparents support and guidance staff. senior from and empathetically cares Sensitively the infant who has diedfor and the with in accordance parents bereaved with support protocol bereavement staff. senior from and guidance and self-awareness Develops in others. distress stress/ recognises in support network; Participates and guidance seeks appropriate support some and guidance provides staff. for of the significance results Recognises management. and seeks appropriate of in the care Assists infants requiring care high and intensive dependency and invasive non-invasive undergoing and procedures. investigations Assists in the care of in the care Assists infants requiring care high and intensive dependency blood sampling.undergoing Novice/advanced beginner: Novice/advanced new entrant beginner: Novice/advanced new entrant (With the support of(With the mentor) ofparticipates in the care the dying infant and the who is receiving care. palliative the support of(With the mentor) the for care appropriate provides infant who has died. and the need self-awareness Develops distress. relieve to of network the unit’s Accesses death support following an infant’s diagnostic and routine Performs to according therapeutic procedures and guidelines. protocols prescribed management. Implements of in the care Assist infants requiring non-invasive undergoing special care and procedures investigations Assists in the care of in the care Assists infants requiring blood undergoing special care sampling. capillary blood sampling.Performs
Follows plan of care to ensure plan of ensure to care Follows and effective sensitive with families ofcommunication died. infants who have family. for Cares own needs ofRecognises and stress discomfort. support network unit’s Uses of in the care Assists infants requiring a defined undergoing special care investigations range of non-invasive and procedures. Unregistered and support Unregistered workforce neonatal plan of the comfort for care Follows of where an infant and family is agreed. care palliative and support Unregistered workforce neonatal a defined of range Undertakes which and procedures investigations the infant. by required are Assists the ANP/medical team in ANP/medical team the Assists support of infants who are and investigations undergoing example, for procedures; cannulation. or venepuncture Palliative care, end-of-life care and bereavement management management and bereavement care end-of-life Palliative care, Investigations, tests and procedures
41 Return to contents Career, education and competence framework for neonatal nursing in the UK Expert nurse/ neonatal ANNP/nurse consultant Expert nurse/ neonatal ANNP/nurse consultant Prescribes blood and blood products blood and blood products Prescribes and local national to according policies. and partial exchange Performs exchange. drugs and administers viaPrescribes and national to according all routes, local policies. drug and evaluates implements Plans, therapies. therapeutic response/side Evaluates effects and acts accordingly. Prescribes appropriate therapy to to therapy appropriate Prescribes maintain homeostasis. of new awareness ongoing Has the applicability their to innovations, practitioners own unit and ofconsideration the need for equipment. new adopting new case for the business Makes in the role has a central technology, of and development education the staff in the use of technology. new Proficient neonatal nurse/ neonatal Proficient neonatal enhanced practice nurse nurse/ neonatal Proficient neonatal enhanced practice nurse Review therapeutic response to to therapeuticReview response exchange exchange/partial care transfusion and provides local guidelines. to according Interprets blood pressure recordings. blood pressure Interprets for is ready that equipment Ensures use if and when required. the functionalityEnsures of equipment. supportive Devises the setting up for guidelines ofand testing equipment. Competent neonatal nurse neonatal Competent (QIS) nurse neonatal Competent (QIS) Cares for infant receiving exchange exchange infant receiving for Cares transfusion. and partial exchange drugs via IV route Administers and local professional to according policies. the therapeutic response. Assesses effects and side acts Identifies within local guidelines. appropriately Sets up arterial blood pressure Sets up arterial blood pressure transducer. arterial blood pressure. Measures equipment and stores Cleans ofnecessary the care for infants highrequiring and dependency with in accordance care intensive instruction. local and manufacturer’s equipment Sets up and tests ofnecessary the care for infants highrequiring and dependency with in accordance care intensive instruction local and manufacturer’s Novice/advanced beginner: Novice/advanced new entrant beginner: Novice/advanced new entrant Cares for infant receiving blood infant receiving for Cares transfusion. drugs topical, via oral, Administers and intramuscularrectal routes, and local professional to according policies. the therapeutic response. Assesses reporteffects and side Identifies appropriately. Measures blood pressure using blood pressure Measures reporting techniques, non-invasive deviations normal. from equipment and stores Cleans ofnecessary the care for infants in accordance specialrequiring care with local and manufacturer’s instruction. equipment Sets up and tests ofnecessary the care for infants in accordance specialrequiring care with local and manufacturer’s instruction.
Sets up and checks equipment equipment Sets up and checks necessary the support for of infants with unit accordance in the neonatal instruction. local and manufacturer’s Unregistered and support Unregistered workforce neonatal of measurements vital Undertakes heart rate, signs (temperature, respiratory and oxygen rate and reports. records saturation), and records colour, Observes infant’s reports. and support Unregistered workforce neonatal a range of and stores Cleans is necessary which equipment the for ofcare unit infants in the neonatal with local and accordance instruction. manufacturer’s Investigations, tests (continued) and procedures Equipment and monitoring
Return to contents 42 Royal colleGe of nursing Assesses the need for equipment used equipment the need for Assesses and advise care in neonatal appropriately. Devises, audits and reviews Devises, guidelines best practicefor in partnership with medical staff alarm for parameters. Level 4 Nursery nurse/assistant practitioner (in the infant receiving special care) Understands and recognises normal and abnormal and recognises Understands urinary function, gastrointestinal tract function and bilirubin elimination. a QIS and reports deviations normal to from Records practitioner. the maturationExplains of feeding skills in the newborn. devise plan and reviews feeding needs, enteral Assesses appropriately. naso/oral gastric feeding tubes. Passes as appropriate. nutritional the need on for supplements Advises infants at risk of and monitors Anticipates and hypoglycaemia corrective necessary, where and, preventive implements local guidance. to strategiesmanagement according and initiates serum bilirubin levels and measures Monitors local guidance. to according phototherapy and reports recognises site, cannula intravenous monitors Safely deviations/complications. Devises use of the safe for guidelines equipment. Efficiently and safely uses equipment uses equipment and safely Efficiently ofnecessary the care for infants highrequiring and dependency with in accordance care intensive instruction. local and manufacturer’s of significance Interprets equipment alarms high in infants requiring and care and intensive dependency appropriately. respond problems. equipment Troubleshoots Level 3 Nursery nurse/HCA/SHCSW (in the infant receiving special care) Recognises normal and abnormal gastrointestinal and urinary normal and abnormal gastrointestinal Recognises tract function. the assistant and reports deviations normal to from Records practitioner/QIS practitioner. to feeding according enteral for requirements intake Verifies guidelines. cup, forms of other example, for feeding; enteral Provides local guidance. to according gastric and gastrostomy measurements. feeding pumps and records Sets up enteral been have oral which nutritional supplements Administers local policy. to practitioner according a registered by checked practitioner. a registered by as directed phototherapy Initiates Efficiently and safely uses equipment uses equipment and safely Efficiently ofnecessary the care for infants in accordance specialrequiring care with local and manufacturer’s instruction. of significance Interprets equipment alarms special in infants requiring appropriately. and responds care Level 2 HCA/MSW/HCSW (in the well infant) Interprets and responds to the alarms to and responds Interprets of in use special the equipment care. Safely uses a designated rangeSafely of necessaryequipment the for observation of and monitoring in specialinfants requiring care with local and accordance instruction. manufacturer’s of the initiation and maintenance on lactation. Advises expression and supports in manual/mechanical mothers Advises of milk and its handling and storage. breast evidence based/ to feed according breast to the mother Assists unit guidelines. of feeding procedures sterilisation and demonstrates Advises of and storage equipment same. in bottle feeding techniques. parents/carers Assists typicalRecognises and atypical oral feeding behaviour; records and reports findings. and reports findings. records and weighs infants, Measures and reports findings. records and output, input Monitors phototherapy a infant receiving to care nursing Applies local guidance. to according Addendum: Frameworks for levels 2–4 Addendum: Frameworks nutrition and elimination management Fluid, electrolyte,
43 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 Nursery nurse/assistant practitioner (in the infant receiving special care) Examines and assesses skin, cord, eyes and mucous membranes and mucous eyes cord, and assesses skin, Examines records local practice, if to tool(s) using assessment appropriate and reports findings. the infant at risk ofAnticipates for skin damage; iatrogenic and assesses the infant with NAS infant, the immature example, skin integrity local if to tool(s) using assessment appropriate practice. strategies/treatment skin manage Implements as prescribed to and mucous eyes injury and infection(s) cord, of skin, evaluating inform subsequent and reporting to membranes, care/management. with infection comply and supportsDemonstrates to others policies. and control prevention in audit activities observing through Participates practice and compliance. monitoring Level 3 Nursery nurse/HCA/SHCSW (in the infant receiving special care) Applies strategies skin integrity maintain and manages to Applies in the care, stoma example, for and vulnerable infant; immature of applications. and removal tapesapplication and topical Describes and signs of records skin infection in the newborn, reports observations. appropriate screening infection/colonisation routine Undertakes local practice. to in audit activities. Participates infection and susceptibility to infant’s their parents to Explains measures and control behind infection prevention the reasons in the unit. Level 2 HCA/MSW/HCSW (in the well infant) Examines skin, cord and eyes using assessment tool(s) if tool(s) using assessment and eyes cord skin, Examines and reports findings. records local practice, to appropriate can be involved parents in which and supports ways Recognises of the normal process explains example, for care; infant’s in their healthy promoting to describes approaches separation, cord describes typesskin, ofsafety. around issues bathing including and control with infection prevention Complies standard and local policies. precautions infection and other procedure hand hygiene correct Performs as per local policies. measures and control prevention visitors and staff their about and advisesDemonstrates parents, and visitinghygiene guidelines. Skin, hygiene and infection control management management hygiene and infection control Skin,
Return to contents 44 Royal colleGe of nursing Level 4 Nursery nurse/assistant practitioner (in the infant receiving special care) Recognises physiological and behavioural differences between between and behavioural differences physiological Recognises and drug convulsions pain, distress, stress, states, sleep/awake withdrawal behaviour in infants of gestations. different applies events, distressing/painful potentially Anticipates strategies implements support to assessment, appropriate care inform subsequent to evaluates stability and comfort, planning. Level 3 Nursery nurse/HCA/SHCSW (in the infant receiving special care) Recognises and reports overt signs and reports of overt Recognises pain. stability and strategies promote care to developmental Uses aspects, environmental including pain/distress, reduce non- positioning and handling, swaddling, containment, sucking. nutritive and report typical/atypicalRecords observations of physiology and behaviour. in applying cues and support parents infant’s to Responds care. sensitive developmentally Level 2 HCA/MSW/HCSW (in the well infant) Recognises typical sleep/wake states, posture and movement in and movement posture typical states, Recognises sleep/wake the newborn. in the newborn distress/pain and recognises and Anticipates comfort. provide to steps takes with associated behaviour abstinence neonatal Recognises (NAS). syndrome alleviate to effects of care nursing routine NAS. Provides local practice. to according tools assessment Completes and reports typical/atypicalRecords observations of behaviour. with of parents an explanation tool(s) the assessment Provides infant. their being to applied infant’s their and interpreting in recognising parents Assists behavioural cues. Neurological, developmental care and pain management and pain management care developmental Neurological,
45 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 Nursery nurse/assistant practitioner (in the infant receiving special care) Recognises the need for and/or modifies and/or the need for vital sign Recognises monitoring and local guidelines. condition infant’s to according techniques, using non-invasive blood pressure Measures reporting deviations normal. from strategies maintain and normalise vitalImplements to signs parameters. within accepted naso-pharyngeal and effective suction safe as clinically Initiates indicated. with of parents an explanation to the specific the care Provides highlighting risks and therapy, ofdelivery oxygen supplemental safetyprocedures. and monitoring benefits, Level 3 Nursery nurse/HCA/SHCSW (in the infant receiving special care) Measures and records temperature, heart rate, respiratory rate heart rate, temperature, and records Measures methods, and continuous intermittent saturation by and oxygen reporting deviations normal. from including therapy oxygen supplemental administers Safely via non-mechanical appropriate where humidification adequate in reporting changes local guidelines, to means according requirements. oxygen and performs and effective safe patency for the airway Assesses oral suction as directed. with of parents an explanation to the specific the care Provides therapy. ofdelivery oxygen supplemental Level 2 HCA/MSW/HCSW (in the well infant) Recognises normal colour and tone in the newborn, reporting in the newborn, and tone normal colour Recognises deviations normal. from vital respiratory signs and oxygen rate (heart rate, Measures and reports results. records saturation), reports deterioration in the newborn, and recognises Anticipates results. newborn resuscitation an approved in a local and or Participates programme. support basic life infant and initiate collapsed Alerts to others measures. and resuscitation. with stabilisation Assists advanced vital signs with of parents an explanation infant’s Provides of and implications giving rationale(s) measurements for findings. Respiratory management and cardiovascular
Return to contents 46 Royal colleGe of nursing Level 4 Nursery nurse/assistant practitioner (in the infant receiving special care) Recognises the need for and/or modifies temperature temperature modifies and/or the need for Recognises infant’s to according continuously including monitoring and reports results. records and local guidelines, condition normothermia strategies achieve/maintain Implements to parameters). (within accepted temperature correct to interventions appropriate Uses deviations. Level 3 Nursery nurse/HCA/SHCSW (in the infant receiving special care) Anticipates infants at risk ofAnticipates thermal instability and proactively occurring; for from stress cold/heat prevent to steps take instigating cot, to incubator when transitioning from example, phototherapy. incubator activities achieve/ and nursing clothing to environment, Adjusts withinmaintain normothermia plan. as directed management radiant incubator, example, for specialist equipment; Uses as maintain thermoneutral environment to cot heated warmer, within plan. directed management Level 2 HCA/MSW/HCSW (in the well infant) Anticipates infants at risk ofAnticipates hypo/hyperthermia and proactively occurring. from stress cold/heat prevent to steps takes bathing – in the example, – for procedures nursing Performs with local thermal stability in accordance newborn promote to guidelines. local and using guidelines to according temperature Measures and reports results. records equipment, available can be temperature in which the ways with parents Identifies and the risks oftaken cold. too hot or infant being too incorporating needs/ their and assists parents, Advises the care to infant according their dress to how on preferences, of the temperature the bathing, example, for giving undertaken; strategies adjust and to as the v outdoors) (indoors environment changes. temperature Infant temperature management management Infant temperature
47 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 Nursery nurse/assistant practitioner Level 4 Nursery nurse/assistant practitioner (in the infant receiving special care) Undertakes heal prick procedure for blood glucose management. blood glucose for heal prick procedure Undertakes explaining bornscreening, new for screen bloodspot Undertakes rationale test. for Collects specimen urine specimens using the correct and stool medium. specimen Collects using the correct oral and nasal secretions medium. different swab for Collects skin swabs using the correct investigations. of necessary equipment the care for infants and stores Cleans with local minimal highrequiring in accordance dependency instruction. and manufacturer’s guidelines of necessary uses equipment and safely the care for Efficiently in specialinfants requiring and minimal high care dependency instruction. with local and manufacturer’s guidelines accordance of significance and interprets alarms checks equipment Sets up, specialin infants requiring and minimal high care dependency with local and manufacturer’s guidelines in accordance instruction. resuscitation for required equipment Sets up and checks purposes. Level 3 Level 3 Nursery nurse/HCA/SHCSW (in the infant receiving special care) Under supervision may be required to undertake heal prick undertake to supervision be required may Under bloodmanagement. glucose for procedure Collects specimen urine specimens using the correct and stool medium. oral collect and nasal to supervision be required may Under specimen medium. using the correct secretions different swab for Collects skin swabs using the correct investigations. of necessary equipment the care for infants and stores Cleans with local and guidelines in accordance specialrequiring care instruction. manufacturer’s of necessary uses equipment and safely the care for Efficiently with local guidelines in accordance specialinfants requiring care instruction. and manufacturer’s alarms in infants requiring equipment Sets up and checks special care. Level 2 Level 2 HCA/MSW/HCSW (in the well infant) Supports infants and families while the infant has a requirement Supports infants and families while the infant has a requirement management. blood glucose for heal prick procedures for Collects specimen urine specimens using the correct and stool medium. oral collect is a need to Supports infants and families when there and nasal secretions. of necessary equipment the care for infants in and stores Cleans instruction. with local and manufacturer’s guidelines accordance of necessary uses equipment and safely the care for Efficiently with local and guidelines well infants in accordance instruction. manufacturer’s and should be checked that equipment the frequency States equipment. replacement find and be to able changed expiry/service and consumables/equipment for date Verifies of same. replacement/repair for processes resuscitation for required equipment and checks Locates purposes. with of parents an explanation the equipment/ Provides infant is receiving. monitoring Investigations, tests and procedures Equipment and monitoring
Return to contents 48 Royal colleGe of nursing 4
Since 2010, the newly registered entrant to neonatal nursing Curricula/ will have been prepared according to the NMC’s criteria for entering the register and will have grounding of competency programme within the four domains of nursing: 1. professional values 2. communication and interpersonal skills preparation and 3. nursing practice and decision-making 4. leadership, management and team working. maintaining These skills are transferable, but vary depending on the field of practice the registrant has specialised in. It is proficiency recommended, therefore, that a comprehensive programme equipping the neonatal workforce is provided, commensurate with the level in which the practitioner is expected to function. The new registrant as a novice in It is a matter of some concern that there are no nationally neonatal care could undertake a foundation neonatal UK-wide agreed curriculums or programmes of preparation nursing course, in addition to a suitable induction and close for the neonatal workforce. For the maternity support mentoring. However, registration and regulation are no worker (MSW) or the health care assistant (HCA) there may barriers to other members of the neonatal workforce have been no programme of preparation prior to undertaking such certification and flexibility in the entry appointment, so a period of preparation to equip these requirements in HEIs could be considered to accommodate workers with the knowledge and skills to perform the access. fundamentals of care will be required as part of an induction, as a minimum. Further training and supervision Becoming qualified in speciality will be required as the MSW or HCA consolidates this When considering progression within the neonatal induction and to prepare them to expand their repertoire of speciality, the RCN’s Competence, education and careers skills for use in the service. in neonatal nursing (2012) and the BAPM’s Matching knowledge and skills for qualified in speciality (QIS) Nursery nurse education and training has evolved over a neonatal nurses (2012) went some way in setting period of years and is currently offered at several levels, benchmarks for HEIs to follow. However, there continues from certification to diploma. The focus of nursery nurse to be a considerable variation in the educational provision education is on the normal development from birth to school and level of training towards QIS provision. The learning years, and will usually not include the sick or premature outcomes of such programmes of preparation should be fully neonate. When appointed to work in neonatal units these integrated into the competency framework so there is no practitioners will also require a period of induction and theory/practice gap. training, depending on their level of experience. It is one thing to prepare a registrant to the QIS level, Associate and assistant practitioners may be educated to whether this is for the child field of practice, or as a midwife foundation degree level but may not have a neonatal specific or ANNP, but it is quite another to determine how they set of skills, so a period of preparation to equip them with should sustain their level of practice. A rolling programme the skills to perform within this specialist area will be of revalidation that is built into a system of mentoring and required. This could be offered as an in-house induction support which complements the annual performance review apprentice-style development programme or provided as a is to be welcomed and at the time of writing the NMC was in combination of supervised practice and theory, which could the process of developing this. However, the central ethos of be delivered by a local educational establishment; the both the individual performance review (IPR) and the combination in partnership could provide a neonatal revalidation process should be to sustain the learning and foundation certificate which attracts credits. development of the practitioner, rather than just monitor a baseline of acceptable performance.
49 Return to contents Career, education and competence framework for neonatal nursing in the UK
Enhanced practice neonatal nurses/specialist neonatal nurses
The enhanced/specialist neonatal nurse/midwife is a practitioner who has completed a QIS programme and has undertaken further education and training within the field such as cannulation, insertion of lines, and airway and respiratory management. They may be mid-way to considering the full ANNP role, or they may have followed a more holistic path and developed specialist breastfeeding advisor roles, neonatal outreach nursing, or roles to support families – such as family co-ordinators. These roles are flexible and adaptable and reflect the requirements of the neonatal units within which individuals work.
The ANNP is an established and highly valued member of the neonatal workforce and should be funded from whichever budget their roles support and counted within the staffing accordingly. They should not be funded from the nursing budget if their roles are predominately medical. The importance of the family Neonatal nurses work in partnership with parents and families. The family should be integrated into everything we do, consequently there is no one section which focuses solely on families. The family has inestimable value in participating in the care which has been planned to ensure the wellbeing of infants who are resident in neonatal care. Therefore, the family’s participation is included throughout; to do otherwise would run the risk of isolating the needs of families from the curriculum. Page 51 shows an example curriculum.
As with the previous section where the skills are progressively gained the curricula can be regarded as a spiral with each phase building on a previous stage. This section has focused on the QIS functioning mainly in high dependency and intensive care. Where skill mix permits they would naturally complement and enhance the special care workforce.
Return to contents 50 Royal colleGe of nursing Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant of 2 a Level the ability perform the skills to from expected Inclusive 4 the Level is acknowledged and 3 practitioner overlap and some practitioner a programme of should undergo and training education normal and and recognise the practitioner understand enable to to urinary function, abnormal gastrointestinal tract function and bilirubin elimination. deviations minor for and record to respond to how Understand normal functioning and report these deviations a QIS practitioner. to Be equipped with the maturation the abilityof explain to feeding skills in the newborn. devise plan and feeding needs, enteral assess the infant’s Be to able review appropriately. ability pass naso/oral their and assessed on to prepared Be educated, gastric positioning. their and monitor feeding tubes safely and possess the need the ability advise for the as to on to Be educated as appropriate nutritionalneed for supplements at risk of infants are some why anticipate hypoglycaemia Understand at risk Be infants who ofrisks are and monitor hypoglycaemia. necessary and where corrective preventive implement to educated local guidance. to strategiesmanagement according Level 3 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery of the ability perform the skills to Inclusive 2 practitioner and the Level from expected 3 The Level is acknowledged. overlap some practitioner a programme of should undergo recognise the learner to enable to preparation and normal and abnormal gastrointestinal urinary tract function. observations related record to how Understand make of status the gastrointestinal to the infant, these and report on deviationsan assessment the assistant practitioner/QIS normal to from practitioner. the rationale fluid management for Understand the ability calculate to the NNU and develop on for requirements nutritional intake the infant’s guidelines. to feeding according enteral A programme of to and mentoring preparation the practitioner adviseequip and support to expression in the manual/mechanical mothers of of milk and the handling and storage breast this. forms of other provide the skills to Develop gastric and cup, example, feeding – for enteral local guidance. to – according gastrostomy Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health A programme of and period preparation of supervision the practitioner provide equip to to of the initiation and maintenance on advice lactation. A programme of to and mentoring preparation the practitioner adviseequip and support to expression in the manual/mechanical mothers of of milk and the handling and storage breast this. A programme of to and guidance preparation to the practitioner assist the mother equip to evidence-based/unit to according breastfeed guidelines. A programme of to and assessment preparation the practitioner adviseequip and to of feeding procedures sterilisation demonstrate and storage. equipment a practical can be assessed by The above and a seriesassessment of workbooks. observationA programme of and preparation, the practitioner provide equip to to assessment formula prepared safety on advice around issues in bottle-feeding assist parents/carers milk, techniques. Levels 2-4
The learner will be able the for provide to nutritional needs of the neonate/well stable infant. Suggested curriculum to support development of competence/retention of competencesSuggested curriculum to support development of competence/retention – learning outcomes nutrition and elimination management Fluid, electrolyte,
51 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Understands the basics of the bilirubin pathway. In some area may be may area some In the basics of the bilirubin pathway. Understands serum bilirubin and measure monitor to and prepared educated local guidance. to according phototherapy and initiate levels IV having infants who are for care 4 to Level require units may Some and skills education training require may 4 students so Level therapy, the safetyon of these and the importance of observing an and reporting deviations/ recognising site, cannula intravenous the functioning of Monitoring the pumps complications. of the fluids infused. and recording pressures documenting support mentor, to remit some 4 practitioner they a Level have As of in the maintenance and supervise 3 colleagues 2 and Level Level care. and safe high standards a be assessed by and skill integrated set could knowledge The above portfolio of a vocational be assessed formally by practice could or skill level The practitioner’s degree. a foundation 4 or module at Level be during reviewed annually the individual performance could review. Level 3 unregistered Sets up enteral feeding pumps and records feeding pumps and records Sets up enteral measurements. oral adminsters designated areas some In been have which nutritional supplements practitioner according a registered by checked local policy. to to remit some 3 practitioner willThe Level have support and supervise 2 Level mentor, of in the maintenance highcolleagues standards care. and safe and skills integrated knowledge The above a portfolio be assessed by ofcould practice or a vocational be assessed formally by could skill level The practitioner’s 3. module at Level be during reviewed annually the could review. individual performance Level 2 unregistered A programme of and development preparation typical the practitioner recognise equip to to and atypical and oral feeding behaviour; record and reportto measure findings and be able and report findings. record weigh infants, A programme of the equip to preparation and output, input practitioner monitor to and report findings record supportA programme and of preparation, the practitioner provide equip to to guidance in phototherapy an infant receiving to care with the local policy. accordance a be assessed formally by could The above a portfolio By of 2. module at Level vocational skill level the practitioner’s practice and have duringreviewed annually the individual review. performance Levels 2-4
The learner will be able the for provide to nutritional needs of the neonate/well stable infant. Fluid, electrolyte, nutrition and elimination management – learning outcomes nutrition and elimination management (c0ntinued) Fluid, electrolyte,
Return to contents 52 Royal colleGe of nursing Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant in special care. who are Infants of 2-3 Level the ability perform the skills to from expected Inclusive 4 practitioners Level is acknowledged. practitioners overlap and some a programme of the should undergo enable to preparation Appropriate signs and report of overt practitioner recognise to pain. in the use of supportinterpretation to this. tools A programme of the practitioner recognise equip to to preparation states, sleep/awake between and behavioural differences physiological and drug withdrawal behaviour in convulsions pain, distress, stress, infants of gestations. different anticipate to them enable of to the skills required Acquisition assessment appropriate apply events, distressing/painful potentially The strategiesand implement support to stability and comfort. of the success the strategiespractitioner evaluate should be to able planning. care inform subsequent used to module at Level a vocational be assessed formally by could The above of be as part these skills could Retention of4, degree. a foundation maintaining a portfolio by demonstrated of practice and the be during reviewed annually the could skill level practitioner’s review. individual performance Level 3 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery of the ability perform the skills to Inclusive 2 practitioner and some a Level from expected 3 practitioners Level is acknowledged. overlap a programme ofshould undergo to preparation and report the practitioner recognise enable to signs ofovert pain. use developmental be to able Be equipped to stability and reduce strategies promote care to aspects, environmental including pain/distress distraction swaddling, and so containment, forth. the importance of positioning and Understand opportunities handling for and providing to consent if sucking non-nutritive the parents’ soothers. of delayed understanding some normal, Have transfer and be to able development and altered and report typical/atypical record this to observations of and behaviour. physiology actions in nursing to this understanding Apply basic Assimilate cues. infant’s to response and teach be to able to skills in order teaching in applyingsupport developmentally parents care. sensitive to 3 practitioner remit has some The Level support and supervise 2 Level mentor, of in the maintenance highcolleagues standards mentoring to introduction An care. and safe supportto bepractitioners beneficial to may function in this role. a be assessed formally by could The above a portfolio 3 by of module at Level vocational could skill level practice and the practitioner’s be during reviewed annually the individual review. performance Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health A programme of the enable to preparation typicalpractitioner recognise to sleep/wake and movement normal posture states, in the newborn.behaviours A programme of the enable to preparation distress/ and recognise practitioner anticipate to provide to pain in the newborn steps and take comfort. supportA programme and of preparation, the practitioner recognise enable to to guidance with behaviour associated abstinence neonatal to care routine and provide (NAS) syndrome the infant who has mild NAS. comfort the practitioner enable to may The preparation local to according tools assessment complete of an explanation practice and provide the assess the being used to tool(s) assessment the parents. infant to A programme of to and mentorship preparation the practitioner assist and supportenable to their and interpreting in recognising parents behavioural cues. infant’s of skills and retention The attainment the above module vocational a suitable can be assessed by maintaining a portfolio By of at this level. practice reviewed and the skill annually level during review. the individual performance Levels 2-4
The learner would be The learner would the enhance to able wellbeing of the infant normal and promote development. Neurological, developmental care and infant pain management – learning outcomes and infant pain management care developmental Neurological,
53 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant of 2 and Level the ability perform the skills to from expected Inclusive a programme of 4 will the Level require 3 practitioners, Level a facilitate of to the acquisition enable competencies to preparation to of understanding and skillsgreater required the knowledge and respiratory of care/support the cardiovascular facilitate the neonate. that the ensure programme would in-house resuscitation An the location of state practitioner procedure could and the checking trolley. and the resuscitation equipment the emergency for should be equipment the rationale when the resuscitation for Provide should be in the nursery what equipment explain be to able checked, use for commission purposes find and and be to resuscitation able for when required. equipment replacement on explanation provide to them enable to will be required Training and they should be changed should be equipment frequently how use of: correct demonstrate to able bag and mask 1. neopuff 2. and air supply oxygen 3. suction 4. alarm limits. 5. and they can commence where a level to They should be prepared supportassist in the basic life of gain formal and may a neonate certification in these skills. request the need to recognise be to able to They should be prepared of in the event a resuscitation assistance deterioration and recognise to knowledge background sufficient and should have situation the rationale the actionsexplain for during this. Level 3 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery of the ability perform the skills to Inclusive 2 practitioners (some Level from expected of the end At a is acknowledged). overlap role programme to of learning and according will students be to able and responsibilities, heart rate, temperature, and record measure saturation by respiratory and oxygen rate methods, and continuous intermittent reporting deviations normal. from supplemental administer safely to Be prepared the the basics on understanding oxygen, of and disadvantages advantages therapy. such of the understanding This should include the importance of where humidification adequate The local guidelines. to according appropriate in confidence acquire needs to student and requirements in oxygen reporting changes of interpretation more saturation to readings staff. experienced skills in The practitioner develop needs to and patency for airway assessing the infant’s permit to them base to a knowledge develop of elements incorporate the evidence base skills in performing developing to leading on oral suction as directed. and effective safe as part of skills acquired teaching this Using should the student programme of preparation, of an explanation parents to provide be to able ofdelivery to the specific the care supplemental in support parents to Provide therapy. oxygen deterioration and ofthe event infant’s their intervention. for requirement Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health a programme of willAll levels require enable to and practice simulation preparation the practitioner assess the respiratory to and wellbeing ofcardiovascular an infant. A programme of the enable to preparation an to appropriately practitioner respond to and requires infant who has collapsed resuscitation. A programme of the enable to preparation practitioner assess the normal pulse and to respiratory of patterns and alert the neonate the is deviation there where appropriately team these. from the periodFollowing of the student preparation with parents an provide should be to able vital signs giving ofexplanation infant’s their and implications rationale(s) measurements for initialsupport Provide and of findings. of in the event their parents to reassurance deterioration. infant’s of these skills beingEvidence maintained during mandatoryBLS annual The testimony training. and play role observation, direct of others, reviewed during the individual performance review. Levels 2-4
Learners willLearners be to able essential make ofassessments vital signs. and recognise to Able an infant to respond who and deteriorates appropriately. respond those who may Identify need resuscitation. Respiratory – learning outcomes management and cardiovascular
Return to contents 54 Royal colleGe of nursing demonstrate recording the apex of the apex and correct a neonate recording demonstrate documentation setting including monitor settingdemonstrate up a cardiac alarm limits appropriate of and monitoring techniques cleaning demonstrate stethoscope equipment They should be prepared to interact appropriately with the family interact appropriately to They should be prepared local Depending policy, on incident. a resuscitation during and after prior the family to resuscitation neonatal demonstrate be equipped to home. discharge to deviation they can recognise where a level They to should be educated some normal respiratory why functionfrom and understand respirations. infant’s preterm an effect on activities can have the respiratory of rate skills a in assessing and recording Develop and the importance of and neonate interpretation correct documentation. with the student equip the ability set to up a Practical to preparation The alarm limits. setting appropriate including respiratory monitor, deviations and common understand to them equip to knowledge The student these deviations to accordingly. respond to them enable and alerting processes the appropriate demonstrate should be to able more an infant requires where report mechanisms the escalation care. supportive Equipped with of a basic understanding apnoea of prematurity to in the stimulation appropriate and provide intervene to them enable and desaturating. of bradycardic event becoming a neonate oxygen administer the skills be to able have Equipped to within that saturations remain the ensure to appropriately set limits. appropriate the treatment Initiate an infant who identify is apnoeic. Equipped to of an understanding Demonstrate and care an infant who is apnoeic. apnoea. following frequent of possible investigations The programme of essential should include preparation strategies assessment and the practitionercardiovascular should be and term the normal in a preterm rate apex range state for to able neonate. deviations that they can recognise from a way in such Educated function: normal cardiovascular • • • activities• state that can affect beat the apex of infant a preterm Evidence of these skills beingEvidence attained and during be a BLS undertaken maintained could assessed by mandatoryannual training session, observationdirect and reviewed during the review. individual performance
55 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered state the blood pressure values of a neonate taking into account of values account taking into a neonate the blood pressure state gestation their a preterm on a blood pressure taking a recording demonstrate infant activitiesstate that will affect the reading reporting of deviation mechanism state in the cardiovascular any of infant. reading the preterm due show neonatal, dependent of care demonstrates an oxygen maintaining and weaning for regard via additional oxygen the ability provide demonstrate to be to able mask when required face and high flow low on a neonate for the ability care demonstrates to therapy. flow • of cuff size choice • demonstrate correct and application • • should be monitored blood pressure why reasons • discuss and state • Suctioning and apply understand The practitioner be to able to will be required assess the this skill and be to able to related evidence-based practice, the infants airways. suctioning to apply need to the reasons understand The practitioner to will be prepared need to various types are there ofwhy and sizes select suction the catheter the importance of and understand one using a sterile appropriate suctioning. for technique and be able neonates used for suction pressure Select the appropriate the risks skilled identify Be with sufficiently associated to suctioning. oral aspirate and naso pharyngeal safely safetyto and mucous when the need arises. microscopy for and send effectively the importance of the characteristics, documenting Understand and ease ofvolume aspiration obtained. the secretions saturation: to and skillsEducation related and neonate the preterm • describe for saturation levels the correct of saturation wrap. size choice • demonstrate correct Oxygen • meters flow and low meters flow use oxygen to how • knows • • including therapy of effects of some the adverse oxygen Understands of ofa basic understanding prematurity. retinopathy Level 3 unregistered Level 2 unregistered Levels 2-4
Respiratory – learning outcomes management and cardiovascular (continued)
Return to contents 56 Royal colleGe of nursing Provides a more detailed explanation to parents ofto specific parents to the care detailed explanation a more Provides therapy. ofthe delivery oxygen supplemental deterioration of in the event support infant’s their parents to Provides intervention. for and requirement can be formally assessed as part the above of from Elements a an organised or simulated in-house simulation degree, foundation of the skills can be Retention assessed (OSCE). examination clinical IPR. the individual’s doing
57 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant of 3 a Level the ability perform the skills to from expected Inclusive 4 practitioner a programme will of a Level required practitioner, of understanding and a greater knowledge facilitate to preparation and skin integrity the hygiene needs of ensure to the skills required met. are neonate the practitioner discuss the equip to to knowledge background Have to Prepared ofappearance age. gestational on skin depending the importance requirements. ofunderstand and hygiene skin care discuss the importance ofBe to able participation family in the needs of and care hygiene the infant. the importance ofStates for the timing of reasons including care minimal handling. Discusses perform the importance of this and tail bathing, top to others. the skills teach and safety, with confidence ofLists the areas particular be washed importance and observed to oral care. and eye including care, to whilst attending with symptoms associated States infection in the infant and discuss of and treatment infections. common prevention the importance ofStates during equipment monitoring repositioning associated and the documentation SaO2 probe example, for cares, with the changes. during the neonatal offered schedule Discusses the immunisation period and the importance of consent. parental controlInfection discuss the importance ofBe to able participation family in infection these in practice. promote can safely measures, control Level 3 unregistered a programme of designed preparation to the practitioner of supportequip to the care special care an infant receiving a programme of the enable to preparation strategiespractitioner apply maintain to to skin integrityand manage in the immature and vulnerable infant. Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery of the ability perform the skills to Inclusive 3 a Level 2 practitioner, a Level from expected practitioner will require: • • and application care, stoma example, For of applications. removal tapes and topical 3 practitioners willLevel describe beto enabled the signs of skin infection in the newborn, and report observations. record infection/colonisation routine Undertake local practice. to appropriate screening in audit activities. Participate susceptibility to infant’s their parents to Explain behind infection infection and the reasons in the unit. measures and control prevention 3 practitioner some they a Level willAs have the support for responsibility of 2 Level and the high standards ensure to colleagues ofmaintenance practice. safe be ofThe skills assessment could the above performed formally as part of a vocational of the above Retention 3. module set at Level a portfolio be assessed by ofcould practice and be reviewed could skill level the practitioner’s duringannually the individual performance review. Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health A programme of designed equip preparation to a infant; the well for the practitioner care to and mentorship programme of preparation, the practitioner examine support enable to to if tool(s) using assessment and eyes cord skin, and report record local practice, to appropriate findings. A programme of the equip to preparation in and supportpractitioner recognise ways to infant’s in their can be involved parents which care. of the normal process understand Enabled to to describe approaches separation, cord describe types skin, of healthy promoting safety. around issues bathing including assist the to updates relevant Require with infection standard practitioner comply to and local precautions and control prevention in practitioner’s Assessment policies. hand hygiene perform correct to compliance infection other and implement procedure as per local measures and control prevention policies. The practitioner demonstrate should be to able visitors and staff about and advise parents, and visitinghygiene guidelines. be ofThe skills assessment could the above performed formally as part of a vocational of the above Retention module set at this level. maintaining a portfolioskills can be assessed by of practice reviewed and the skill annually level during review. the individual performance Levels 2-4
The learner will be able essential provide to infant care. The learner will comply with infection standard and control prevention precautions. Skin, hygiene and infection control management – learning outcomes management hygiene and infection control Skin,
Return to contents 58 Royal colleGe of nursing Discusses the importance of with and complying implementing including: as per local guidelines, measures infection control • hand hygiene • aseptic technique precautions • universal segregation. waste • clinical the practitioner discuss equip to to preparation the background Has Safely techniques. isolation and require infants would which perform these skills in practice. undertaking for swabs for procedure the correct Demonstrates purposes as MRSA. – such infection control and storage the cleaning for procedure the correct demonstrate Can of policy. as per infection control equipment of disinfection (feeding and sterilisation an awareness Demonstrates bottles/milk tanks and so on). a provide 4 practitioner be to able should beThe Level equipped to to susceptibility infant’s their parents to detailed explanation more and control behind infection prevention infection and the reasons in the unit. measures the 4 practitioner for responsibility some they a Level willAs have high standards ensure support to 2 colleagues of 3 and Level Level ofand the maintenance practice. safe be part could ofAssessment a degree or a formal foundation the include OSCE could An 4. module set at Level vocational undertake opportunity that the learner can correctly demonstrate to perform and can safely the care hand washing procedure the infant, and tail’ ‘top of – care in their a neonate requirements infant bath demonstration a simple aseptic or technique. provide could of of infectionAssessment control to the retention skills related during updates. be the annual undertaken
59 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant 3 practitioner 4 the level 2 and Level of in a Level the skills required Inclusive practitioner will need a programme of an facilitate to preparation of infant. ofunderstanding a preterm requirements the thermoregulation infant the preterm/term for values the normal temperature state Be to able temperature. affect the infant’s that may factors and the environmental method using appropriate temperature body assess the neonatal Be to able and site. cause temperature that may than environmental possible causes other States instability. that can be interventions State deviations. temperature prevent to Intervenes used. Document high. is too temperature if possible interventions States an infant’s observation on correctly chart. temperature an infant being for maintain a thermo-neutral environment to Discusses how safely. these infants require and perform the care in an incubator nursed and in consultation an infant in a cot nurse to when it is appropriate Knows an incubator an infant from move plan to a care with can produce the family a cot. to the learner with providing strategies an assessment include Formal could using a temperature assess an infant’s to opportunity how demonstrate to the document correctly to how Demonstrate range of methods. appropriate reading. temperature infant’s A review of use of the safe designed maintain infant’s equipment to in a portfolio be included of could temperature practice. be part could the skill of level Maintaining review. the individual performance Level 3 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery 2 of in a Level the skills required Inclusive 3 practitioner at the the Level practitioner, ofend a programme of learning and will and responsibilities, role to according the infants at risk anticipate ofbe to able take thermal instability and proactively from stress cold/heat prevent to steps when occurring example, – for cot, to incubator transitioning from phototherapy. instigating incubator some make should be to able Students environment, the infant’s adjustments to activities achieve/ and nursing clothing to within as directed maintain normothermia, plan. management example, – for specialist equipment Use – to cot heated radiant warmer, incubator, as maintain thermoneutral environment within plan. directed management of and retention the above The acquisition a be assessed formally by skills could and reviewed module vocational relevant duringannually the individual review. performance Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health a programme of and Follows preparation supervision that the designed ensure to which the means by learner understands maintained at the are infant temperatures the on depending optimal level, temperature. environmental the to parents and refers Advises infant sleep and safe on recommendations of overheating. prevention of and retention the above The acquisition maintaining a skills can be assessed by portfolio of practice and the skill level duringreviewed annually the individual review. performance Levels 2-4
All learners need to beAll learners need to support to the able maintain infant to optimal temperature management. Infant temperature management – learning outcomes management Infant temperature
Return to contents 60 Royal colleGe of nursing Level 4 unregistered Health care assistant (HCA) care Health Maternity (MSW) support worker (HCSW) support care worker Health (NN) diploma nurse Nursery practitionerAssociate/assistant foundation degree (AP) of 4 practitioners at Level of the abilities expected 2 and 3, Inclusive Level of a programme of an understanding facilitate to the require preparation sufficiently of management the family, basis oftheoretical bereavement can be met. that the following outcomes ensure detailed to Discusses the importance of and interacting in a professional communicating of with and members manner parents the multi-disciplinary team. on it is implemented and how the importance ofStates care family-centred the unit. feelings of grief assess the individual Can the family’s Recognises and loss. needs of the family. duringSupports the family bereavement. families information of give to able support and agencies mechanisms Is within the hospital environment. and outside the importance ofStates bereavement information with to parent regarding and support. and attitudes of to relating cultural diversity an awareness Demonstrates death. surrounding behaviours members. family memories for Creates during reviewed annually review. the individual performance Sensitively Level 3 unregistered Health care assistant (HCA) care Health Maternity (MSW) support worker (HCSW) support care worker Health certificate nurse Nursery (NN) the A programme of provide to preparation ofpractitioner with the an awareness theories of loss and grief and an ofunderstanding the importance of with communication and effective sensitive families. the importance of effective Understand with professionals. other communication and understanding awareness Demonstrate of of philosophy and the definition and care perinatal/neonatal palliative Knowledge local guidelines. care end-of-life of local and national and awareness care and end-of-life care palliative neonatal and frameworks. guidelines Planning of care the importance and Understand of significance memory Ensure making. are equipment and relevant that resources memory Understand for making. available the importance of relevant having Consider and ready. available equipment and step-family siblings, involving ofgrandparents in the care the infant in wishes. line with the parents’ of the role a children’s Understanding and what services be available. may hospice, available, If is a designated room there appropriately. that it is prepared ensure contact to how knowledge Demonstrate and other team faith chaplaincy multi support services. Level 2 unregistered Health care assistant (HCA) care Health Maternity (MSW) support worker (HCSW) support care worker Health A programme of designed preparation to the theories to of an introduction provide loss and grief affect these may and how an infant who has families who have needs. care end-of-life or palliative and the the definition to Introduction of perinatal/neonatalphilosophy palliative care. and end-of-life care of local neonatal and national Awareness care and end-of-life care palliative and frameworks. guidelines willLearners follow be equipped to need to the importance understand a plan of care, of memory and facilitate making. ofProgramme and mentoring preparation the the practitioner understand enable to to importance for of required equipment supporting care an infant with palliative needs. and relevant that resources Ensures memory for available are equipment equipment the appropriate Ensure making. If is a there use. for and available is ready that it is ensure available, designated room appropriately. prepared and peer support to mentorship Ongoing that the optimal means ofensure used with are families. communication and effective skills in sensitive Develop with families ofcommunication infants care and end-of-life palliative who have when an infant has died. or needs, Levels 2-4
Learners willLearners be need to palliative provide to able and care care/end-of-life bereavement withmanagement skills with commensurate of level their seniority. Palliative care, end-of-life and bereavement management – learning outcomes management and bereavement end-of-life Palliative care,
61 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Level 3 unregistered Identifies which infants are appropriate for for appropriate infants are which Identifies care. continuing for referral Communication abilityDemonstrates provide to practical support the appropriate for family. the abilityDemonstrates communicate to and with sensitively the family empathetically. planning care Parallel care to skills required clinical Demonstrates and/or the infant withfor palliative with needs family and their end-of-life supportsenior if appropriate. of suppression regarding mother Advises of option or milk supply EBM. donating care Postnatal own health her regarding mother Advises to appropriately needs and refers midwiferycontinuing care. will that parents be exhausted Awareness worrywith and travelling. of lack sleep, planning care End-of-life in caring their for Supports the parents ofinfant at the end life. the infant’s focuses on which care Delivers and practical and emotional comfort support the family. for for comfort provide to how parents Advises suckling, containment, cuddling, the infant, music. cues, to responding of in transferringKnowledge the process a of Knowledge the the mortuary. infant to the accompany to paperwork required the mortuary. infant to Level 2 unregistered Awareness of a postnatal the need for care Awareness plan and a midwifery practitioner and care should support to the mother and facilitate this. access of contact knowledge Demonstrates to how and other team chaplaincy multi-faith support services. plan care End-of-life of and awareness knowledge Demonstrates ofthe process transferring an infant who the mortuary. has died to care Post-death of what paperwork is required Awareness or a cremation when an infant is having post mortem examination. involved of professionals other Awareness ofin the care – death the infant after coroner. pathologist, mortuary technician, and recognises self-awareness Develops Seeks own needs of and discomfort. stress support or colleagues support from organisations. Awareness further learning needs. Identifies of get own support to needs and where support from. can of level skillsThe above and awareness ability to the practitioner’s by be provided of confirmation verbal their give of understanding palliative neonatal their this where and identify pathway care information can be found. methodDemonstrate of of maintenance of and supply cleanliness equipment. Levels 2-4
Palliative care, end-of-life and bereavement management – learning outcomes management and bereavement (continued) end-of-life Palliative care,
Return to contents 62 Royal colleGe of nursing Post-death care Post-death families for process correct the Identifies Awareness viewing death. an infant after visit the unit or families may that bereaved up appointment. follow for return in stressful self-awareness Develops own needs Recognise circumstances. in caring and discomfort stress regarding and end-of-life an infant withfor palliative colleagues Seek support from needs. care supportand other organisations. further learning needs.Identifies a portfolio be assessed by could The above skill level of practice and the practitioner’s be with reviewed annually could sensitivity during review. the individual performance Describes with responsibilities their regards with and the colleagues communication to an infant receiving wider around team care. palliative/end-of-life Describes and behaviours the attitudes necessary with when dealing whose a family palliative/end-of-life infant is receiving care. during reviewed annually the Sensitively review. individual performance
63 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant of 4 practitioner a will the Level the skills of require 2 and 3, Inclusive Level who special care the infant receiving for care to them equip programme to to be required they may diagnostic procedures; routine undergone have may instruction/local to guidelines. strategies treatment implement according as such procedures complex specific undertakes and as directed with, Assists urinalysis. care, tracheostomy long-term care, wound the evaluate techniques, using non-invasive blood pressure measure Be to able and report deviations normal as appropriate. results from modify and/or vital the need for blood sign including Recognises monitoring and local guidelines. condition infant’s to according pressure strategies maintain and normalise vitalImplements to signs within accepted parameters. oral and nasal/pharyngeal and effective safe suction as clinically Initiates indicated. local policies. to according drugs via routes oral and topical Administers as part be undertaken Peer of could assessment Formal degree. a foundation review maths and safe an annual and evidence of by examined skill retention is also There medication administration this is appropriate. where assessment during the IPR. the opportunity review competence to Level 3 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery of 3 the Level the skills of 2, Inclusive Level practitioner a programme of will require the practitioner equip to to preparation vital signs by and record measure methods, continuous and/or intermittent reporting deviations. and equipped withEducated the ability to to according oxygen supplemental adjust in reporting changes local guidelines, delivery. concentration oxygen and equipped withEducated the ability and perform oral to suction as skills required directed. with Assists performs and/or routine obtaining consent, including screening example, description; for role to according hearing screening. as such with investigations, Assists routine local guidelines. to according X-ray, plans prescribed management Implements blood example, for findings; to in response estimation. glucose non-invasive Escorts infants undergoing for unit, the neonatal outside procedures ultrasound. example, peer review by ofAssessed performance, ofthe maintenance a portfolio of practice can be retention skills level and ongoing duringreviewed annually the individual review. performance Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health a programme of in Follows preparation the practitioner assist the equip to to order in supportANP/medical team of infants and investigations undergoing who are venepuncture, example, for procedures, cannulation. normal and abnormal vital Recognises to referenced – cross signs and colour and respiratory skills set. cardiovascular with of parents an explanation the Provides the infant is and procedures investigations receiving. of measurements vital signs Undertakes respiratory rate heart rate, (temperature, and reports records saturation), and oxygen results. deterioration in and recognises Anticipates request to the newborn steps and takes support basic life and initiate assistance measures. with diagnostic routine Performs/assists to according and therapeutic procedures newborn example, for local guidelines; MRSA screening, blood spot screening, serum/ monitoring, blood glucose swabs, transcutaneous bilirubin estimation, Records administration of phototherapy. and reports findingsof procedures. to reactions of adverse potential Be aware implement and procedures; investigations provide to steps and take safety procedures comfort. Levels 2-4
The learner will be supportequipped to infants who need to or investigations a defined undertake range of investigations which and procedures the by required are infant. Investigations, tests – learning outcomes and procedures
Return to contents 64 Royal colleGe of nursing Records and reports physiology and and reports physiology Records and investigations to behaviour responses procedures. in which and supports ways Recognises of in the care their can be involved parents infant during an investigation/procedure; offering infant, their talking to example, for breastfeeding/bottle care, skin-to-skin feeding. maintaining a portfolio by ofAssessed can be skills level practice and ongoing duringreviewed annually the individual review. performance
65 Return to contents Career, education and competence framework for neonatal nursing in the UK Level 4 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) diploma nurse Nursery practitioner degree (AP) foundation Associate/assistant of a programme acquisition of allow competences to Follows preparation of an understanding designed facilitate the neonatal used on to the equipment 2 and practice at Level for willunit which the skills required incorporate 3. Level of and storage the cleaning for equipment procedure the correct Demonstrates policy. as per infection control of disinfection techniques. and sterilisation an awareness Demonstrates and procedure resuscitation for location ofStates procedure and the checking equipment. air and suction equipment. oxygen, check to how States use. clinical for in readiness equipment prepare to how Demonstrates needs servicing whenDemonstrates equipment repairing. or use ofSafe a range of equipment. monitoring of with detailed explanation parents a more the equipment/ Provides infant is receiving. their monitoring as part be formally skill undertaken set of could 4 The above a Level of programme be assessed or as a component degree. a foundation vocational demonstration a ofcould involve The assessments learning and proficiencies can check correctly, equipment that the practitioner and store can clean for use equipment to how use and can demonstrate prior to equipment best use of make designed maintain an to the equipment to how example temperature. infant’s Level 3 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health (NN) certificate nurse Nursery of the end At a programme of learning and and responsibilities, role to according willstudents perform the skill be to able set ofexpected 2 practitioner and also a Level act in a supervisory safe capacity ensure to of and the cleaning storage the use, of necessaryequipment the care for infants with in accordance specialrequiring care, local and manufacturer’s guidelines instruction. uses equipment and safely Efficiently ofnecessary the care for infants requiring with local in accordance special care instruction. and manufacturer’s guidelines alarms for equipment Sets up and checks specialinfants requiring care. of parents to the an explanation Provides infant is their equipment/monitoring receiving. be formally skill set could The above as partundertaken of 3 vocational a Level skill set can be The above programme. reviewed during mandatory training and during review. the individual performance Level 2 unregistered Health care assistant (HCA) care Health (MSW) supportMaternity worker (HCSW) support worker care Health a programme of to Follows preparation of risks the potential raise to awareness safety. infant and family health to of hazardous Control substances handling and reporting manual (COSHH), incidents. clinical The practitioner locate should be to able equipment. emergency and check use of side appropriate Demonstrates cot typeinfant baths and other of changing equipment. trigger to alarms in the clinical how Knows alarms. emergency alarms, fire area; familiarityDemonstrates with evacuation policy. necessary equipment for and stores Cleans with ofthe care an infant in accordance local and manufacturer’s guidelines instruction. uses equipment and safely Efficiently ofnecessary the care for well infants in with local and guidelines accordance instruction. manufacturer’s should that equipment the frequency States find and be to able and changed be checked equipment. replacement for date ‘expiry’/’service’ Verifies for and processes consumables/equipment of same. replacement/repair Levels 2-4
All learners will be use the to required the infant equipment preserve safely, requires infant safety and the stability ofmonitor the infant. Equipment and monitoring – learning outcomes
Return to contents 66 Royal colleGe of nursing Locates and checks equipment required for for required equipment and checks Locates purposes. resuscitation with parents a basic explanation Provides of that their the equipment/monitoring infant is receiving. be formally skill set could The above as partundertaken of 2 vocational a Level These skills can be reviewed programme. during mandatory training and during the reviewindividual performance .
67 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Follows a programme of and practicalFollows theoretical nurse care intensive the neonatal enable to preparation for the management following assessment initiate to This homoeostatic requirements. the infant’s sustaining anatomy, detailed embryology, should include and pathologyphysiology of tract, the gastrointestinal tractrenal and a range and of mechanisms excretory and understanding This should include pathways. ofinterpretation normal and their and abnormal values of the normal maturational development management, and infant trajectories.growth infant reflexes a programme of review the to Follows preparation ofcomplexities transepidermal loss and the water should also be There these. strategiesnursing reduce to restriction fluid for the requirements on preparation The fluid and electrolyte calculations. and complex administration to include of these fluids is likely these lines need manage to lines and skillsmultiple to accordingly. be acquired should be equipped nurse care The intensive neonatal stability priming, gut for assess infant’s to and prepared TPN as a means of administer skilled and informed to tolerate to nutrition stable until the infant is sufficiently a practice to They should be committed feeds. enteral breastfeeding. designed promote to and culture periods, prolonged for mouth nil by infants are Where with nurse the neonatal working collegiately others a plan of oral for provide should be equipped to care stimulation. enteral tolerate to stable sufficiently infants are Where with a suitable should be prepares feeds the nurse of a background skilfully administer to preparation Berange well informed of of nutritional supplements. and the the preterm for the specialist suitable formulas malabsorption a or infant who has intolerance, metabolic management. for requirement High dependency neonatal nurse dependency neonatal High Follows a programme to provide the theoretical and the theoretical provide a programme to Follows and skills knowledge develop practical to preparation fluid neonatal complex the more in understanding provide literature, the relevant Citing regimes. knowledge, ofevidence-based devices, care IV access the requirement others and ability teach to awareness vigilance offor in the care these. a holistic and the ability undertake to Develops nutritional and dietary of assessment comprehensive the infant in high care. dependency the fluid and and prepares calculates Accurately and preterm term for electrolyte requirements in the high area. neonates dependency of a range of awareness and Theoretical congenital gut in altered result which conditions acquired informed administration of Skilled, physiology. nutrition. transparental reviewTheoretically priming the evidence gut on and infants in the high area. this to dependency apply evidence, Using the use of charts. centile Understands the use the principlesbased on of promotes nutrition, the development own milk and monitor of mother’s of as an indication emerging the reflexes of the infant’s and swallow. suck ability co-ordinate to with positioning and Supports breastfeeding correct skills in supporting mothers consolidate attachment, and withwith the use of hand expression breast and ofAnalysis problems breastfeeding pumps. of with the formulation working the families develop these. resolve to solutions microbiology safe to reference appropriate With milk. of and usage breast storage expressed the the evidence evaluate to reference With feeds such enteral to additives enteral for requirement milk fortifier. as sodium and breast Novice/advanced beginner: new entrant Novice/advanced Theoretical and practical preparation in order to to and practicalTheoretical in order preparation the and skills in understanding knowledge develop fluid daily calculate Accurately regimes. fluid neonatal used in neonates and preterm term for requirements area. clinical the registrant’s of volume daily Assessment total the ability calculate to why Understand and individual feed requirements. using unit increased, are feeding volumes daily guidelines. infants, abilityDemonstrates weigh and measure to chart. in weight using centile changes document with positioning and Supports breastfeeding correct attachment. skills in supportingDevelops with mothers hand and with the use ofexpression pumps. breast milk. breast expressed store to able Safely fortifier. milk breast using for reasons the Identifies of artificialfeedsKnowledge and the different use. for indications identifies and demonstrates up feeds when required makes Safely up artificialto families in line feeds make with to how local policies. and national Assess and uses a feeding tube. tests inserts, Safely Insert oflength tube safely. be inserted. tube to tube and document Secure pH of aspirate. Tests use a feeding tube. when not to Identify insertion. infant viaFeeds tube in line with and unit guidelines Support families in tube feeding their document. infants. using a variety feeds infants enterally Safely of oral signs identify and symptoms to ofAbility strategies. plan. reflux management prepared a follow and reflux Levels 5 +
The learner will be provide equipped to the infant to skilled care complex who has more electrolyte, fluid, nutritional and elimination support needs. All learners will the understand importance of including in the infant’s the family plan. care Fluid, electrolyte, nutrition and elimination management – learning outcomes nutrition and elimination management Fluid, electrolyte,
Return to contents 68 Royal colleGe of nursing Where infants are sufficiently stable to tolerate enteral enteral tolerate to stable sufficiently infants are Where a manage to prepared should be suitably feeds the nurse gastrostomy. nasal or range oral, of feeding tubes, ‘feeding/ replacement or re-feeding are there Where needsnurse the neonatal strategies, management fluid’ and the process the calculations manage be to able to effectively. with will nurses the be care prepared intensive Neonatal infants with identify to background theoretical functioningabnormal gut and set of equip skills to some In infant with the unstable for NEC. care to them surgical acute for units this will a requirement include skills. nursing a will nurse require care The intensive neonatal and output assessing renal on background theoretical Be poly/oliguria. strategiesmanagement address to pass urinaryskilled to when and manage catheters may units there some In catheters. supra-pubic required skills in managing peritoneal have to be a requirement support strategies renal extracorporeal or to dialysis failure. deranged electrolytemanage renal or values an these skills will have who need require to Units in-service training strategy. and assessment in-service provide training units may Some and molecular adsorbent on assessment recirculating (MARS). systems needs to care intensive in neonatal working The nurse and skilled in assessing bilirubin levels, be prepared a range ofproviding and in light therapies as required transfusion. participating in exchange should be prepared nurse care The intensive neonatal critically nurse unstable be to able and equipped to infants and support expert neonatal in nurses of and currency unit the effectiveness monitoring nutritional and electrolyte, fluid, to related guidelines elimination management. Comprehensive knowledge of knowledge proprietary brands ofComprehensive artificialof feeds and the ofacquisition knowledge use. for indications Identify specialist formula. and up feeds when required make The ability safely to up artificialto families feeds make to how demonstrate in line with local policies. and national and use a feeding test insert, safely guidelines Using the and support nurse neonatal the novice Teach tube. importance of the pH test and to assessing tube length of the ability recognise to Acquisition of aspirate. in abnormal characteristics and volume in character gastric calculate Safely gastric loss aspirates. ifreplacement required. designreflux and a suffering infants from Identifies the and staged individual plan for stepped the infant’s Evaluate ofmanagement these infants. to of taken the effectiveness the steps to response alleviate. ofBased the understanding on homeostasis blood glucose for the requirements understand pain management and promote justify analysis, and importance of the requirement Teach strategies. sampling device and accessing using the appropriate of area the correct heel. of understanding and physiological the Anatomical urine neonatal output tract assess the infant’s renal to the range of states altered Understand in mls/kg/hour. urinary impact urinary on Pass may which output. Support and teach weigh nappies. accurately catheters, perform urinalysis to abnormal and identify others obtain urine to others Support and teach values. samples. of understanding and physiological the Anatomical normal newborn tract to intestinal gastro apply to Develop ofweek in the first output bowel life. ofunderstanding a range of may which conditions in deviations this. result from Undertakes a blood glucose analysis. a blood glucose Undertakes strategies. pain management Demonstrates Sample from sampling device. Selects appropriate of area correct heel. Disposes of material sharps and contaminated appropriately. discuss abnormal values. to unit guidelines Uses of understanding and physiological the Anatomical tract normal urine identify neonatal renal in to output urinary and document Assess output. mls/kg/hour. urinalysis abnormal values. and identify Perform of the principles ofUnderstanding laboratory obtain urine to bag. sample using sterile processes of understanding and physiological the Anatomical normal newborn tract to apply gastrointestinal to ofweek in the first output bowel life. of understanding Physiological the elimination informed care provide of to bilirubin in order pathway in special care. of phototherapy receiving a neonate be to and practicalTheoretical in order preparation phototherapy. neonatal commence to able the and justifies phototherapy for equipment Prepares of used.choice equipment to minimise side interventions nursing Identifies effects of phototherapy. of the importance ofAppreciation using charts and of serum bilirubin in the recording documentation levels. learning other agree to may The learner and mentor such of the level enhance which competence outcomes learning outcomes all feedingcore but as gastrostomy be signedmust off nurse. a QIS neonatal by
69 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal The nurse working in neonatal intensive care units care intensive in neonatal working The nurse of supportive the parents be compassionately needs to and families of and seek to care the infants in their them. and involve opportunities consult to provide and administrationAssessment of drugs and specialist feeds diary – reviewing the use of and diuretics specialist formulas. MARS or Specialist strategies assessment dialysis, for strategies. re-feeding complex The QIS should be neonatal sign off so that mentors professional support and take they can develop, the as to judgements in making value responsibility and endorse of colleagues junior more their competence progression. their ofAssessment considered the skills and knowledge of the auspices be formal under could an HEI above The MCQs. OSCE, case studies, include and could ofby the acquisition skills can be clinical confirmed ofcompletion or practice documents assessment of assessment The ongoing skills clusters. enhanced practice being and the evidence that the QIS skills are the line manager be ascertained by maintained could during review. the individual performance High dependency neonatal nurse dependency neonatal High Identify characteristics of abnormal neonatal faeces, characteristics ofIdentify faeces, abnormal neonatal ability assess an infant at risk to of necrotising of basis the theoretical Acquisition enterocolitis. an infant being for care competently to required mild necrotising for conservatively managed in the high area. dependency enterocolitis and the ability for to the requirement Understanding perform washouts. rectal of understanding Physiological the elimination evidence- provide of to bilirubin in order pathway in the of phototherapy based care receiving a neonate and practical Theoretical high area. dependency neonatal commence be to able to in order preparation the use of nursing promote phototherapy, effects of side minimise potential to interventions phototherapy. of and practicalTheoretic skills in the process transfusion. exchange The high should be nurse neonatal dependancy completed and undertaken to have skilled sufficiently a programme of so that they can support mentorship colleagues. junior more their of could skill set and knowledge Assessment the above assignmentbe a formal basedtheoretical or on as part of and so forth, essay/MCQ a by examination based within of an institution higherpathway learning. of observation – direct Assessment of competency critiques and a literature diary reflections, infants care, that the skill set is being Evidence case study. maintained can be reviewed during the annual review. individual performance Novice/advanced beginner: new entrant Novice/advanced Assessment of the above skills could be a based on of skills could Assessment the above formal structured assignment/examination/multiple presentation poster (MCQs), questions choice or establishments educational recognised by provided observation in-house using direct from provided A a skills log. and performance complete to mentor be used. of could blend the above during reviewedSkill annually the individual levels review. performance support to be gathered families could from Evidence expertise of elements in some continued to the claim these skills. Levels 5 +
Fluid, electrolyte, nutrition and elimination management – learning outcomes nutrition and elimination management (continued) Fluid, electrolyte,
Return to contents 70 Royal colleGe of nursing Neonatal intensive care nurse care intensive Neonatal Follows a programme of and practicalFollows theoretical nurse care intensive the neonatal enable to preparation neurological of an assessment provide the infant’s to detailed This should include and stability. status of and physiology the nervous anatomy embryology, of and an understanding for system the potential pathology. the antenatal/ things: other among This shouldinclude, to perinatal/postnatal contribute risk may which factors terminal infection, brain maternal injury; example, for natal hypoxia, intranatal asphyxia/post apnoea, deranged blood instability. gasses and haemodynamic manage to should be prepared The QIS nurse neonatal the understand brainrestriction, sparing fluid riskstheoretical of poor perfusion and reperfusion the risk ameliorate of to steps injuries and take This instability brain. the neonatal on physiological strategies care things: other to among include, would by careful fluctuationsof blood flow cerebral prevent of tight fixation avoidance midline head positioning, of the Setting suction to and strapping. the pressures functional efficacy. for lowest monitoring to skills related units willSome require and blood flow cerebral functioning, cerebral in-house This willtherapeutic require hypothermia. nurses units will Some training require and assessment. intracranial manage and skills to knowledge have to This will management. and shut monitoring pressure in-house training and assessment. require will care be in intensive working nurses Neonatal signs identify of ischaemic to hypoxic prepared haemorrhage intraventricular and encephalopathy, They will be knowledgeable need to activity. seizure management. about anticonvulsant High dependency neonatal nurse dependency neonatal High Theoretical and practical preparation in the anatomy and practicalTheoretical in the anatomy preparation ofand physiology in order nervous the central system and and skills in understanding knowledge develop to neurological caring infants with complex for more a holistic the ability undertake to Develop conditions. of assessment neurological the and comprehensive infant in high care. dependency a range of recognise to Ability convulsions neonatal Theoretical appropriately. and respond anti-convulsing ofunderstandings the common how Monitor and what effects are. therapies side their work at riskinfants who of are and support their seizure families. skills demonstrate in the literature, to reference With ofthe assessment pain in high neonatal dependency have Critique a range of tools, a pain assessment area. familiarity with used in their the one comprehensive and the ability support team to other area own clinical use of tools. such in the consistent members the use of and demonstrate Understand pharmacological and non-pharmacological methods of pain and distraction in the high management area. dependency the recognise to them teach with parents, Working and distress stress, between behavioural differences these to respond to infant and how in their discomfort cues. the effects of to and respond NAS. Recognise the basis of on evidenceFormulate an individualised the account infants taking into plan of such for care for social requirement unique infant and family’s the across inter-collegially work to Ability support. of care the ongoing these disciplines for professional infants. Novice/advanced beginner: new entrant Novice/advanced Follows a programme of and practicalFollows theoretical skills assess an infant’s be to able to the student equip to the of Identify state and wellbeing. comfort pharmacological and non-pharmacological methods of pain management. of understanding and physiological the Anatomical aid the to system skeletal infants muscular the importance ofunderstanding supportive lying, infants – side and premature sick positioning for supine. prone, of aid the teaching epistemologyTheoretical to parents position infants and to their care, skin-to-skin give to of the a level to provide sensory appropriate stimulus stability of infant. their effects on of the adverse on the literature Awareness and the infant because of environment the neonatal this. ameliorate to what can be done stimulation, for psychology and the requirement Infant and psychological physical the use of promote to play development. of acquisition Theoretical and relationship family of the neonatal and the transference studies these to unit. of the consequences understand Be equipped to and the rationale (NAS) syndrome abstinence neonatal the pharmacological and non-pharmacologicalfor The use of strategies. assess and management to tools support the infant. by be formally completed may Assessment an HEI, participation by in a programme offered of assignmentan perhapscare the based on including a case. Levels 5 +
The learner will be able to care provide to support an infant’s wellbeing.neurological provide All learners to is which care developmentally and can appropriate infant pain provide management. All learners will the understand importance of including in the infant’s the family plan. care Neurological, developmental care and pain management – learning outcomes and pain management care developmental Neurological,
71 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Nurses working with the preterm will require will with working the preterm require Nurses of retinopathy and prevent understand to preparation causes and risk factors, prematurity – vascularisation, of and corrective retina to damage consequences management. be the impact informed on need of to nurses Neonatal immature on short pain and stress term and long They will need skills of in the assessment systems. pain relaxant muscle and have sedated in infants who are They will and need preparation in progress. infusions infant. NAS affected severely the more for care skill to Their programme of should include preparation and of the development infant reflexes understanding well should be sufficiently nurses Neonatal deviations. the use of care developmental promote informed to strategies. be need to may the student localDepending on policies, a range prescribe of to and other analgesics prepared in-house training This will require therapeutic agents. and assessment. be part could ofAssessment a formal module on HEI. a recognised by as offered care intensive neonatal a practice complete to be required could The student these themes. to related document assessment of a student’s include PREP could Evidence drugs diary and have anticonvulsant a case study evidence of observed performing being directly care. be being maintained could that the skills are Evidence ascertained during review. the individual performance co-ordinate the transfer or discharge of the transfer discharge or a neonate co-ordinate clinical another or home needs to with complex setting. identifies family support family identifies services in available parents for resources and on-line area clinical High dependency neonatal nurse dependency neonatal High receiving continual positive airways pressure pressure airways positive continual receiving (CPAP) b. b. be could ofAssessment and competency knowledge of using a blend undertaken assessment theoretical observation diaryand direct of infants care, critiques and case study. literature reflections, Have the theoretical background required to justify justify to required background the theoretical Have in the neonates positioning for and select supportive high-dependency area: lying side 1. prone 2. supine 3. supplementary oxygen receiving 4. 5. of assessment sit in infant chair. suitability6. to to and benefits be able the theoretical Understands in infant and parent between care skin-to-skin initiate Support families during this. high-dependency area. reduce to interventions nursing other Demonstrates in the high stress and neonatal dependency parental the use of and demonstrate to play Promote area. in development and psychological physical enhance the high area. dependency the importance of supporting the Understands of withoptimal development a neonate complex needs by: for: area clinical • identifying details in your contact specialist play a. physiotherapist b. therapist occupational c. therapist. speech and language d. • Supports growth of skills: parenting a. Novice/advanced beginner: new entrant Novice/advanced Clinical assignment could be the use of through assignmentClinical could direct observation mentor. the students of by care clinical Skill levels ofCompletion workbook. neurological duringreviewed annually the individual performance review. Levels 5 +
Neurological, developmental care and pain management – learning outcomes and pain management care (continued) developmental Neurological,
Return to contents 72 Royal colleGe of nursing Neonatal intensive care nurse care intensive Neonatal Follows a programme of and practicalFollows theoretical nurse care intensive the neonatal enable to preparation respiratory of an assessment provide the infant’s to This should stability. function and cardiovascular and physiology anatomy detailed embryology, include of and lungs and an circulation the heart, and cardiovascular ofunderstanding common the more respiratory pathologies. the be equipped and have need to QIS nurses Neonatal on decisions effective and quick to make confidence stabilityairway and respiratory as as well management the effectiveness and evaluate trends interpret be to able Theyof will be need to the selected management. with infants who have appropriately deal to prepared and desaturations. bradycardia apnoea, ofThey understanding will the principles require of support life and the prioritiesbasic and advanced of ofaction in the management collapse. sudden to should be designed enable The preparation to an infant who is nurse safely to nurse neonatal ET for indications the clinical Review intubated. and oxygenation review ventilation, intubation, respiratory support strategies. to Be equipped with and skills required the knowledge intubation drugs intubation and prepare prepare surfactant in line with local Prepare equipment. effects of the side identify Be to able intubation policies. medication and surfactant. of size the correct identify ET tube Be and to able use of correct laryngoscope and be to able introducer, sounds with stethoscope. breath/ventilator auscultate High dependency neonatal nurse dependency neonatal High Theoretical and practical preparation in order to to and practicalTheoretical in order preparation and skills in assessing and the knowledge develop the highly (HD) infant’s monitoring dependent a Have and circulatory status. cardiorespiratory of knowledge parameters physiological the expected Theoretical deviations these. and detect from and ofunderstanding developmental embryological, impact the on may which maturational circumstances of understanding Theoretical a in HD care. neonate range of may which conditions respiratory and cardiac affect the neonate. restore/maintain to interventions nursing Justify local to stabilitycardiorespiratory according and sampling ofAnalysis blood and use of guidelines. deviations skilfully detect knowledge theoretical from normal values. of levels and observation monitoring Justify and Educate status. with the infant’s commensurate these. for the requirement as to inform the family skilful and perform support, basic life Initiate and resuscitation advanced withassistance intubation, stabilisation. of understanding basis ofTheoretical the physiological formsof or other positive biPAP ofthe benefits CPAP, set Safe of up and usage these (see equipment pressure. lead infant led weaning to Ability and monitoring). respiratory support.from airways of of the infant’s the anatomy Understanding positioning can be used to prone and thorax and how oxygenation. enhance for of understanding Theoretical the requirement and familiarity therapy and humidification oxygen with the variety of this supply methods used to support. Novice/advanced beginner: new entrant Novice/advanced Using knowledge developed from understanding the understanding from developed knowledge Using identify ofphysiology respiratory system, the preterm signsthe clinical of respiratory and work distress of the ability distinguish cyanosis between to towards origins. respiratory and cardiac disassociation curve and Instruction the oxygen on indicate would which saturation levels oxygen identify as oxygen supplemental administer the need to infants. infants/term premature prescribed for and practicalTheoretical of understanding and safe of management nursing receiving a neonate competent supplementary oxygen. for the therapy oxygen risks and benefits Identifies of infants and term premature minimise the risk to of interventions nursing Identify effects of therapy. adverse supplementary oxygen and evidence-based airways care altered Understands in the Support parents of the tracheostomy. ofmanagement infant with their a tracheostomy. understanding, physiological some Demonstrates review the normal of parameters heart the neonatal and preterm the term for and bloodrate pressure neonate. term and in the and tachycardia bradycardia Defines accurate and demonstrates neonate preterm documentation. and assesses perfusion. blood pressure Performs and practicalTheoretical of application skills and ofknowledge resuscitation. neonatal Levels 5 +
The learner will be able support and assess, to infants whomanage respiratory and have function cardiovascular needs. care All learners will the understand importance of including in the infant’s the family plan. care Respiratory – learning outcomes management and cardiovascular
73 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Demonstrates nursing interventions to optimise to interventions nursing Demonstrates OP suction as required, supplies procedure, intubation and informs team observes vital signs during procedure of placement has ability check of to abnormal values, of stomach. decompression tube, secure to Able tube. in patency airway strategiesDemonstrate promote to positioning of optimum line with local policies, intervalof appropriate justifies tube ET neonate, of technique ET tube suctioning reviewsuctioning, the evidence ET tube lavage. base on whose informs and supports infants parents Involves, criticallyare unwell. most and humidifiers set up the ventilators Be to able standard to area used clinical in their frequently is in use and there nitric areas some oxide In settings. should be and training an in-house education provision use. safe for nurse the neonatal equip to management nursing and competent safe Demonstrates the difference Explain of neonate. the ventilated in their the modes ofbetween available ventilation the use for indications clinical and identify area clinical of these. and type the frequency of Justifies observations nursing of the results Review a neonate. a ventilated for required medical and explain to blood and use them gas analysis Identify of neonate. management nursing the ventilated the Identify the blood as normal/abnormal. gas analysis blood as compensated/uncompensated. gas analysis respiratoryblood the as gas analysis or Identifies acidosis/alkalosis metabolic mixed or nursing medical and/or the most likely Identifies intervention. infants who are for care need to may nurses Neonatal education so will via require a tracheostomy ventilated this form ofand skills with to regards management. High dependency neonatal nurse dependency neonatal High Understands the anatomy of the infant’s airways and airways of the infant’s the anatomy Understands positioning can be used to prone thorax and how oxygenation. enhance for of understanding Theoretical the requirement and familiarity therapy and humidification oxygen with the variety of this supply methods used to support. of of understanding Theoretical the the anatomy suction of for and the requirement airways upper review the safe literature Citing respiratory secretions. suction endotracheal tube/tracheostomy and effective techniques. of knowledge to theoretical physiology chest Applies chest ofthe development a pneumothorax, and skilfullyauscultation perform physiotherapy. chest of understanding Theoretical and pulmonary airway the Citing and the use ofmechanics tracheostomy. the infant to care skilfully provide literature relevant who and support parents Teach with a tracheostomy. their for care to an infant with a tracheostomy have child. of of OSCE Assessment maintenance or competency of simulation other or collapse. resuscitation/infant that the skill set is being maintained and can Evidence be reviewed during mandatory training and during review. the individual performance Novice/advanced beginner: new entrant Novice/advanced demonstrate five inflation breaths (lasting two breaths (lasting inflation five demonstrate each) seconds (HR<60 massage cardiac appropriate commence position and correct 120bpm, rate ratio 3:1, bpm, ofdepth compressions). Resuscitation practice using infant mannequin: Resuscitation the initial assessment • demonstrate help• call for breathing heart rate, colour, • assess tone, • initial stimulation inflation chest • competent • head in neutral position mask sized correct • apply • and HR. movement chest for • check jaw competent poor/non-inflation Troubleshoots thrust thrust jaw head position/apply • recheck breaths inflation • repeat movement HR and chest • check manoeuvre. airway after inflation chest • competent correct thrust insert. or jaw two-person Demonstrates Repeat using laryngoscope. airway Guedel size chest movement. HR and Check breaths. inflation massage: cardiac Performs • head in neutral position • and vascular access and the needDiscusses options for drugs. controversy. review the oxygen to Able of the management to the infant of contribute to Able viability. borderline critical anonymous reflections OSCE, Skills assessed by witnessed resuscitations on and evidence that these are mandatory annual training by being retained and during review. the individual performance Levels 5 +
Respiratory – learning outcomes management and cardiovascular (continued)
Return to contents 74 Royal colleGe of nursing describe frequency and typedescribe frequency of observations nursing with drain a neonate for a chest in situ. required identify equipment for management of management for equipment identify pneumothorax identify emergency equipment kept at the cot side of side at the cot kept equipment emergency identify with draina neonate a chest in situ In some units extracorporeal circuits are used to used to are circuits units extracorporeal some In or conventional to support not respond infants who do in-house trainingAn and therapies. enhanced programmeassessment will be provided. need to to should be prepared nurse care The intensive neonatal Be skilled in identifying care. chest optimum provide abnormal air entry nursing and review the most likely and make this, manage to and medical intervention physiotherapist. to referral characteristicsDescribes of common chest neonatal conditions: the following clinical for x-rays respiratory syndrome distress a. transient of tachypnoea the newborn b. pneumothorax c. pulmonary emphysema interstitial d. infection. e. can which interventions nursing identify to Ability minimise the risk of of complications long common ventilation: term disease lung chronic a. palate arched b. oral aversion c. dependency opiate d. infection. e. of management nursing Describes and competent safe in line withpneumothorax local policies: signs clinical identify ofa. pneumothorax risks identify of pneumothorax neonatal b. light source cold locate c. d. drain chest circuit assemble e. describeof fixation f. chest drain g. h.
75 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal describe nursing observations required for the for describe observations nursing required neonate. extubated recently Demonstrates safe and competent nursing management management nursing and competent safe Demonstrates of ET extubation: procedure for and equipment neonate prepare a. b. and care assessment, demonstrate Be to able ofmanagement infants with lines including multiple and peripheral This should arterial lines. UAC UVC, the for indications the ability identify to include insertion of of knowledge arterial the risks lines, withassociated and peripheral central indwelling the arterial secure lines ability correctly to arterial lines, of placement the correct ability recognise to in use, lines. Calibrates use. for circuit transducer Prepares neonate Positions and sets alarmtransducer limits. and connection. transducer to in relation correctly needreads identifies a satisfactory and trace, Identifies with in accordance circuit and changes recalibration for unit policy. shortterm and long risks associated Identifies with hypotension. neonatal risks associated Identifies with the medical management of using the following examples: hypotension neonatal • normal saline bolus • blood transfusion • dopamine • dobutamine. management of nursing Assessment and competent safe neonate. of the hypotensive High dependency neonatal nurse dependency neonatal High Novice/advanced beginner: new entrant Novice/advanced Levels 5 +
Respiratory – learning outcomes management and cardiovascular (continued)
Return to contents 76 Royal colleGe of nursing Demonstrates safe and competent nursing management management nursing and competent safe Demonstrates of the insertion of line in with venous a central insertionfor indications of Identifies a local policy. use. for equipment Prepares line. venous central Optimal procedure. for and family neonate Prepares risks associated Identifies with an positioning. correct Identifies line. venous central indwelling Identifies of method fixation for line. venous central of patency line while promote actions to nursing and Describes frequency by X-ray. position is confirmed type of observations with nursing a neonate for a line in situ. venous central infants for care to be required may nurse A neonatal and should be to defects able cardiac with congenital ductus Patent anomalies. common review the more ventricular atrial (ASD), septal defect arteriosis (PDA), transposition ofseptal (VSD), defect arteries the great for care to They preparation willand so forth. require they compromise, cardiac in acute infants who are review use of for the indications should be to able the potential understand prostaglandin, intravenous risks associated and benefits ofwith the use this medication. ofAssessment theory be undertaken and practice could a MCQs, OSCE, drugs maintaining a relevant diary, by that observation Evidence and direct case study of care. be ascertained being maintained could the skills are during review. the individual performance
77 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Nurses who care for infants in intensive care will require will care require infants in intensive for who care Nurses and practical in the a theoretical preparation and maturation of physiology the anatomy, embryology, They will in healing. grounding skin. need a theoretical of understanding some They will have need to microbiology and be skilled in harvesting a range of They will the body understand specimens. need to the response, the immune mechanisms, defence of care competent the inflammatoryenable to cascade and neonates infected infants, preterm extremely of the spread the strategiesunderstand prevent used to infection. to will care be required in intensive working Nurses of unit’s withtheir the compliance and monitor comply guidelines. infection control will care be caring for in intensive working Nurses relaxed muscles their and have sedated infants who are at risk ofand are and will skin damage iatrogenic need be skilled to in assessing the skin and performing They will critically be to able reviewessential skin care. a range of and be particularly tools skin assessment used unit. in their familiar with that are the tools in partnership with agreeing the the parents Working with care the need the requirement between for balance to parents Support the infant’s minimal handling. for in line skin care about neonatal informed choices make with discussing the use of local policies by wipes, nappy and skin lotions/oils. infant skin cleansing swallow lose their may relaxed muscle who are Infants skilled for mouth special requirement and gag and have care. and skills in all aspects knowledge Integrated of associated ventilator including infection prevention review the signs to Ability and symptoms pneumonia. of sepsis. local infection and systemic High dependency neonatal nurse dependency neonatal High A theoretical and practical in body A theoretical preparation and response the immune mechanisms, defence of care competent the enable to inflammatory cascade, Integrated spread. and prevent neonates infected and skills in all aspectsknowledge of infection signs identify and symptoms to ofAbility prevention. sepsis. and mentor teach, to the skills required have Will supervise new nursing, entrants neonatal new to the NMT in ensuring from families and colleagues and control that they the infection uphold prevention strategies. of barrier in the care Competent infants who require nursing. underpinning microbiology, to reference With in a range of competence asepticdemonstrate of and management techniques lines. sterile and of understanding A theoretical the anatomy ofphysiology skin with the newborn premature of need understanding and reducing the keratinisation as skin maturity humidification for progresses. of understanding Theoretical healing the wound cleansing therapeutic wound Perform processes. and ability select as appropriate to techniques, skin therapeutic and prophylactic apply correctly dressings. critique to a range ofAbility and tools skin assessment familiarity with the units own selected tool. in the use of Competent and ability teach this tool to strategies assess skin and implement to to others Teach injury. and potential damage iatrogenic prevent of the stages observe and understand to others wound healing. lead to a range of may which conditions Understand requirements. skin care altered Novice/advanced beginner: new entrant Novice/advanced Anatomical, theoretical and practical in theoretical preparation Anatomical, and skills in assessing an knowledge develop to order skin and providing: infant’s care • mouth care area • nappy of• care stoma bath • immersion swab. and taking an eye care • eye of in the acquisition Supports parenting the parents of care the essential undertake skills infant. their to of and the application care wound physiology, Healing of the choice dressings. to research review the appropriate selected literature Using fixation and devices, vascular access for dressings and the use of, assess the need Risk for, insertion site. splint and limb restraints as the use of these are controversial. and practicalTheoretical demonstration of the importance of and clothing protection using personal and practical Theoretical the use of gloves. ofconsiderations the risks of infection and containing infection in neonates. the components justify Rationale and evidence used to of the infection screen. antibiotic local policy for and apply locate to Ability and usage. storage safe review of the management to Ability a neonate antibiotics. receiving of understanding Demonstrates the common effects. side antibiotics used common and their ofAssessments these skills during the programme of an observation be by of could preparation in the nurse area. practice in the clinical Levels 5 +
All learners will be able maintain skin, to an manage integrity, and hygiene infant’s effective promote infection control. All learners will the understand importance of involving in the infant’s the family planning. care Skin, hygiene and infection control management – learning outcomes management hygiene and infection control Skin,
Return to contents 78 Royal colleGe of nursing Assessment of be viaAssessment could MCQs skills and knowledge of in assessment the provision and ongoing a case study nurses who function neonatal qualified, Once practice. of at this level willsupport proficiency the MDT wider bestin evaluating practice. for the unit guidelines be that the skill set is being maintained could Evidence review. during performance examined the annual Competent in the care of in the care and in Competent newly formed stoma the observation of and early detection stoma complications. and supports entrant neonatal new into Mentors perform essential infant safe to and parents nursing when behind wearing the ears mouth, ofcare the eyes, umbilical skin, area, nappy skin creases, cap, CPAP fungal infection Identify areas. pressure other stump of tract. the gastro-intestinal critiques and literature ofAssessment competency, observation of opportunities. teaching clinical that the skill set is being maintained can be Evidence during mandatory annual provided training and reviewed as part of review. the individual performance Safe care assessment for a neonate with a neonate for a vascular assessment care Safe the nurse review theoretically how device in situ, access signs clinical identify of clinical would local infection, signs of infection. systemic the use of of Storage EBM, exercise. assessment Risk of Use skin. preterm extremely on water non-sterile feeds. in preterm additives non-sterile the principles apply of and to infectionAble control the rationale Understand area. the neonatal to asepsis barrierfor nursing. policies. and critiqueReview local infection control diary. reflective pack, teaching parental Assessment parents. by Assessment be during reviewedSkill annually the base could review. individual performance
79 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Nurses who care for infants in intensive care will require will care require infants in intensive for who care Nurses and practical in supportinga theoretical preparation temperature. maintain an optimum to the neonate They will of the mechanisms understand need to heat loss and the energy triangle. to a rangeReviews of available interventions nursing minimise heat loss during handling/medical procedures and insertion as intubation such Be of drain. a chest using incubator for the indications identify to able humidity and familiar with weaning the unit policy for humidity and temperature. incubator and safe demonstrate They to will be required of management nursing thermal instabilitycompetent appropriate Take care. intensive receiving a neonate for the Review heat loss. prevent to at delivery steps their the use of for indications Justify the plastic bag. and of probes assessment choice temperature and the meritsequipment of versus continual monitoring. intermittent review for the options with conjunction the family, In how the parents to and explain bedding and clothing maintain neonatal humidity helps to incubator temperature. infants who need transportationFor investigations, for unit the another to removal or surgical interventions review the strategies should be to able nurse neonatal in temperature the infant’s and monitor sustain used to the transport and minimise the risk of incubator heat loss during handling and transport. should be to able at this level working nurses Neonatal of ofsupport the development auditing the success temperatures strategiesnursing in maintaining infant’s temperature for guidelines and review nursing monitoring. an therapeutic hypothermia is practiced, units where In in-house programme of and assessment preparation will be required. High dependency neonatal nurse dependency neonatal High provide reasons for choice of choice for temperature reasons provide equipment assessment available interventions discuss with nursing parents minimise heat loss during handling.to A theoretical and practical preparation in the infant’s and practical in the infant’s A theoretical preparation of appreciation the difference thermoregulation, This preparation and the IUGR. the preterm between of the risks the neonate should focus on to heat loss, of and lack fat production heat inefficient brown gap. behind the temperature and reasons reserves using temperature body assess neonatal to Ability infants who require for methods and sites appropriate to Detect and respond high care. dependency deviations normal. from and supervises entrant manage the new to Mentors the signs, teaches temperature, the infant’s effectively the symptoms and risks of Identifies hypothermia. infants most at risk of use deviations, temperature deviations temperature for strategies prevent to high care: dependency infants who require (OHH) heater • incubator/overhead use for equipment • prepare of assessment • discuss frequency temperature • bedding and clothing for • discuss options • a suitability transfer for into assess infant’s to Ability of assessment. Discuss frequency temperature cot. of assessment choice for temperature reasons Provide bedding and clothing. Discussfor options equipment. temperature. assess neonatal to parent Teach be transferred to caring HIE infants who are for When passive commence safely cooling, for centres to protocol. to strategiescooling according from of and management Care infants recovering of therapeutic the requirements lead to which events of thermal monitoring Ongoing these hypothermia. down during step local protocols to infants according care. Novice/advanced beginner: new entrant Novice/advanced Anatomical and physiological differences impact on differences and physiological Anatomical thermoneutrality. ability sustain to the infant’s ofThe mechanisms heat loss. identify values The normal temperature neonatal the and relate hypothermianeonatal and pyrexia of significance to a of range these conditions. neonatal to the threats on assessment Risks birth discharge. to from thermoneutrality, warmer, cot of at birth, plastic containment Use incubator. heater, overhead procedures. phototherapy/other for Exposure care. Kangaroo energyRecap the triangle. Humidification. taking on assessment and clinical Practical application temperature. the neonate’s of skills can be and retention the above The acquisition Skill base the use ofassessed by scenarios. clinical be during reviewed annually the individual could reviewperformance Levels 5 +
All learners will be able maintain the optimal to for required temperature the infant. All learners will the understand importance of including in the infant’s the family plan. care Infant temperature management – learning outcomes management Infant temperature
Return to contents 80 Royal colleGe of nursing There should be continual assessment of assessment should be continual clinical There successful include could which competences, other or simulation ofcompletion scenarios, clinical evidence that the skill set is being retained/maintained and this can be reviewed during the individual review. performance
81 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Follows a programme of the equip to Follows preparation support staff to and guide nurse neonatal who are caring the dying for infant. staffSupports and guides caring the infant and for Devises bereavement death. the infant’s after parents staff. Support and guide protocol. of and understanding knowledge Demonstrates the key theories of loss and grief. with local and in accordance pathways care Initiating national guidance. the needs of to infants. according care clinical Leads with choice, discussions families regarding Initiates with discussions Leading and decision-making. options and families. the team and contentious sensitive complex, and process Receives initiating actions required. information, in providers with care closely specialist palliative Works of high standards delivering care. of and knowledge symptom control Comprehensive appropriate prescribing include may management; medication. a and influence wide presentations give meetings, Leads range of at strategic individuals take and groups to level changes. action and make and audit. research and facilitates Instigates of a culture enquiry fosters and facilitate Proactively integrate care. neonatal best evidence to into change between communication is effective there Ensures professionals. communication and sensitive is effective there Ensures staffbetween and families. High dependency neonatal nurse dependency neonatal High Follows a programme to provide theoretical theoretical provide a programme to Follows of maturational understanding developmental, viability viability. and borderline and the of and pressure stress parental Understanding theories of grief and mourning. cultural and respects ritual and religious Appreciates of the death practices surrounding the infant. naming and baptism perform if emergency to Ability this. like would the parents of perinatal/neonatal the philosophy Translating practice. clinical into care palliative the theories abilityDemonstrates apply of to loss and grief when caring and supporting for families of needs. care and end-of-life infants with palliative use of appropriate Demonstrates local and national and frameworks. guidelines care palliative neonatal the importance of relevant having Understands and resources Ensure and ready. available equipment memory for making. available are equipment relevant opportunities memory time for Initiate making from of admission. opportunities memory for Facilitates making as a a walk with for going a pram. – privacy, family and local clinical and develops, to, Contributes practical guidelines. effectively the abilityDemonstrates communicate to colleagues. and efficiently with sensitively the abilityDemonstrates communicate to and empathetically with families. care eligible palliative for infants are which Identifies round. the ward on discussions and initiate Novice/advanced beginner: new entrant Novice/advanced Follows a programme of the equip to Follows preparation the theories of how understand to loss and griefnovice practice. can inform their a working demonstrate should be to able Learners of ofunderstanding philosophy and the definition and local guideline care perinatal/neonatal palliative practice. clinical and translate into the a programme of prepare to Follows preparation guidelines care withinpractitioner work palliative to and frameworks. this the practitioner plan should beFollowing to able and the preferences and respects recognises which care beliefs of families. opportunities initiate for should be to able Learners memory the time of making from admission. that it is ensure available, If is a designated room there if facilities use, for and ready appropriately prepared within space a unit identified private limited more are and used when needed. Communication effectively the abilityDemonstrates communicate to colleagues. and efficiently with strategies to communication effective Demonstrates all them in partnership give work with families, to information necessary assist informed choice, to meet the needs of and the infant with palliative needs. care end-of-life and communicate you in ways/styles which Identifies families and on the impact of communication your professionals. other with discussions regarding the family Initiates and other team faith chaplaincy the multi accessing support services. Levels 5 +
All learners will be provide to required care/ optimal palliative and care end-of-life bereavement management. All learners will the understand importance of including in family the extended plan and care the infant’s of agencies other support provide to care. ongoing Palliative care, end-of-life care and bereavement management – learning outcomes management and bereavement care end-of-life Palliative care,
Return to contents 82 Royal colleGe of nursing Provides effective professional leadership, facilitating leadership, professional effective Provides change. and assesses monitors co-ordinates, delegates, Allocates, ofthe work and individuals. the team to abilityDemonstrates support to and contribute educating staff caring on care infants with for palliative an infant once continuing needs, care and end-of-life has died. high provide to required The skills and knowledge of family. the infant and their standards for care participate withDevises local and guidance, guidelines national guidance. with and maintain communication Establishes and difficult about complex individuals and groups problems. any overcoming matters, with closely national and work relevant Collaborates organisations. Critically reviews legal that arise and ethical issues in the practice of care. palliative neonatal strategic policy making at localInfluences and national level. the facilitate organisationalDemonstrates skills to smooth transfer of post mortem an infant for examination. the of for knowledge Demonstrates legal requirements death. after family of knowledge Demonstrates when registering a death the organisation. local to the area outside live the family support for maintain continuing skillsDemonstrates to infant has died. their after the family of places alternative regarding knowledge Demonstrates facilitate to and how death the infant after for rest transfer of the body. Identifies eligible infants for referral to palliative care/ referralto palliative eligible for infants Identifies the referral services care and commence continuing process. care/ of palliative Knowledge the most appropriate service care the infant with for continuing palliative family. and their care care/end-of-life with relationships working robust Maintains in the community. care continuing for professionals and care the infant with for palliative cares Sensitively Initiates needs family. and their care end-of-life siblings, involving to with related discussions parents the planning for in care family grandparents and step infant. the needs of grandparents and Recognises siblings, needsof specific ongoing Identify the family. step plan. and be flexible family with the care plan as part care ofDiscusses end-of-life advanced Provides plan with and family. care parents practical support with the family appropriate for a needs. care infant with palliative grandparents and step siblings, involves Actively of in the care family the infant with the parents’ wishes. parallel planning withinFacilitate infant’s care advanced Consider multidisciplinary plan. care plan. care end-of-life planning with to regards and what hospice, of the role a children’s Understands services available. are and with sensitively the family communicate to Ability communication advanced use more emphatically strategies. of and understanding appropriate Knowledge and (buccal/subcut) routes symptom control-different appropriately. administer to how principlesDefines the working.of MDT collaborative Parallel care planning care Parallel or the infant who limited is life for cares Sensitively dying family. and their practical skills and support appropriate for Provides needs family. and their care the infant with palliative family, grandparents and step siblings, involves Actively wider of and friends family in the care the infant in wishes. with the parents’ accordance care Antenatal of the infant who is plan for the antenatal Awareness limited. life planning with to care regards advanced Considers plan. care end-of-life and with sensitively the family Communicates the principles of the law Understand empathetically. withholding to and withdrawingand ethics in relation treatment. sustaining life care Postnatal in care eligible palliative for infants are which Identifies the ward on discussions and initiates a timely manner withround colleagues. care of care/continuing palliative Knowledge which specific the infant’s for service is most appropriate needs family. and their and what hospice, of the role a children’s Understands with discussions Following the services available. are process. the referral commence multidisciplinary team, withSupports the family difficult discussions, and choice. decision-making of and understanding appropriate Knowledge and (buccal/subcut) routes symptom control-different appropriately. administer to how
83 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Ensures that families receive appropriate information, information, appropriate that families receive Ensures support and writtenboth verbal regarding and what will now. happen organisations, of knowledge Demonstrates organisational funeral procedures. of and appointments parents Informs follow-up days. remembrance of own feelings and develop about death Awareness self-awareness. skills and practice and own knowledge, Develops of the development others. to contribute of and clinical specialist knowledge as a resource Acts caringpractice infants with for for palliative/end-of-life needs when an infant has died. or care review be of via would sensitive Assessment skill base review. during performance annual High dependency neonatal nurse dependency neonatal High Supports parental choice. Supports parental the principles of and ethics in the law Understands withholding to and withdrawingrelation life treatment. sustaining withSupports the family and difficult discussions decision-making. of understanding Demonstrates post mortem process and support families with decision. their for of and the process Knowledge paperwork required post mortems. within potential leadership the clinical Develops staff model for acting as a role and environment, peers. with working individuals, in partnership, Participates within and others groups unit and across the neonatal organisations. practice development. for areas Identifies of skillsDemonstrates and understanding audit principles and evidence-based practice. methodology, within effectively rapportDevelops and communicates HCP. and other team the neonatal communication effective and promotes Demonstrates with families and colleagues. of the realm influences allocated responsibility Within others. and teaches and with sensitively the family communicate to Ability skills. advanced empathetically – uses more of and understanding appropriate Knowledge (buccal/sub- routes symptom control-different administer to and how cutaneous/rectal) appropriately.
Novice/advanced beginner: new entrant Novice/advanced Defines the principles of effective collaborative MDT principlesDefines the collaborative of effective working. planning care End-of-life of the benefits Demonstrates an individualised of plan and limitations care advanced resuscitation guidance/document. transferring of for Knowledge an infant for the process and the paperworka post mortem examination required. death care Post to parents enabling measures supportive Demonstrates infant post their death. for care of understanding Demonstrates post mortem consent and supports families with decision. their of for knowledge Demonstrates legal requirements as registering the such a infant has died, once parents birth and death infant’s ofof of limitations scope and identifies aware Is skills, practice. professional and support and seeks advice accountability Exercises accordingly. Supports and supervises staff junior in caring for supervision clinical needs, care infants with palliative practice. and reflective a own feelings and develops about death Recognises self-awareness. greater continuous to a commitment Demonstrates development. professional programmes participates and in teaching Actively learning offacilitate staff. junior signs of and seeks Recognises stress own negative appropriate support. Levels 5 +
Palliative care, end-of-life care and bereavement management – learning outcomes management and bereavement (continued) care end-of-life Palliative care,
Return to contents 84 Royal colleGe of nursing Defines the principlesDefines the working.of MDT collaborative the principles of and ethics in the law Understands withholding to and withdrawingrelation life treatment. sustaining withSupports the family and difficult discussions decision-making. of aware and is mechanisms self-coping Identifies support available. of understanding Demonstrates what services are seek and must hospice a children’s by provided opportunities visit to the service. of Knowledge all interdisciplinary other professionals transition to and and how care in the infant’s involved transfer care. Be part of facilitating compassionate team the care in a varietyextubation of settings home (including as per local guidelines. and hospice) and the ability offer to the knowledge have Must as location of (such options care care). palliative families and making for and decision Supports choices options. realistic offer staff junior to and explain and recognise to Able when an infant changes physical the expected parents dies. Liaises with mortuary staff and perinatal pathologist transfer ofregarding post mortem the infant for examination. the of for knowledge Demonstrates legal requirements a infant has died. once family own and skill knowledge and/or limitations Identifies of a plan formulates actionorganises and deficits, continuous opportunities enhance to development development. professional Identifies further learning needsIdentifies and seeks opportunities. and learners; colleagues junior model for as a role Acts learning a supportive provides you ensures environment. during reviewed annually the individual Sensitively review. performance
85 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal High dependency neonatal nurse dependency neonatal High Demonstrates increased confidence in own in skillsfor confidence increased Demonstrates interdisciplinary robust and sustaining developing relationships. working offer signs of in others, Recognises stress negative alleviation ofsupport towards and works tension. 1:1 providing Supports by and supervises staff, junior practice. supervision, reflective clinical support, own feelings of a Recognises and develops death self-awareness. greater needs own emotional and seeks support. Recognises and seeks further learningopportunities. Identifies reviewed during the skills base is sensitively Ensures meeting. individual performance annual Novice/advanced beginner: new entrant Novice/advanced Levels 5 +
Palliative care, end-of-life care and bereavement management – learning outcomes management and bereavement (continued) care end-of-life Palliative care,
Return to contents 86 Royal colleGe of nursing Neonatal intensive care nurse care intensive Neonatal Follows a programme of preparation to prepare the QIS a programme of prepare to Follows preparation for requirements infant’s to respond to nurse investigation. Interpret arterial line sampling. and central Performs of Education staff equip to recordings. blood pressure blood infant receiving for care safely to them transfusion. and partial exchange exchange transfusion, audit and perform, to the skills required Develops of the management for guidelines review nursing transfusions. such infants requiring and acts accordingly therapeuticReviews response within local guidelines. the for guidelines audits and reviewsDevises, nursing medication administration Manage of medicines. incidents. of ofAssessment the retention the practitioners skills meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s High dependency neonatal nurse dependency neonatal High Follows a programme of preparation to acquire the a programme of acquire to Follows preparation diagnostic and performability safely routine, to and protocols to according therapeutic procedures the in preparing competence and develop guidelines as supra pubic such assisting with procedures infant, examination. and retinal puncture lumber aspiration, and procedures infants undergoing Monitors be a pause in needs to when there recognises to Ability recover. the infant to allow to proceedings as such of investigations the results read common of the significance and recognise x-ray deviations from management. and seek appropriate normal results of in the care highCompetent infants requiring blood undergoing care, and intensive dependency Set of up sampling cannulation and arteries. veins arterial measure transducer arterial blood pressure blood pressure. in calculating and the administrationCompetent of and local professional to drugs according via IV route and assess the therapeutic response to Ability policies. effects and act side the ability identify appropriately to and support the more Mentor within local guidelines. entrantexperienced administration in the safe of IV medications. of exchange in the care Competent infants receiving transfusion. and partial exchange and supports entrant new mentors in the safe Teaches, harvesting of capillary blood samples. providing be mentors performed by could Assessment ofsupervised The completion a skills log. practice. being maintained could that the skills set are Evidence of the maintenance a diary by be provided of and during the annual and procedures investigations review. individual performance Novice/advanced beginner: new entrant Novice/advanced Follows a programme of preparation to provide an a programme of provide to Follows preparation review and theoretical ofanatomical a range of investigations. common section vital for cardiovascular/respiratory to Refers signs skill preparation. nutrition and electrolytes section hydration, to Refers value Considers blood sampling skillfor preparation. appropriately. and responds obtained glucose/bilirubin reviewTheoretical of when be taken the actions to obtained. are values altered the principles of and interpretation x-ray Understands of films. standard and abdomen. chest of assessment Clinical the infant’s of oral be nasal. either or tube may an enteral Passage and correctly nasopharyngeal aspirates, Performs the laboratory these so they to go in processes condition. optimum observes for withAssists punctures, lumbar appropriately. and responds afterwards complications OSCE. be assessed by base could Skills and knowledge of of be by the maintenance the skillsEvidence could ofthe development a skills log and reviewed annually during review. the individual performance Levels 5 +
All learners will be support to the required infant undergoing and investigations and safely procedures their to with regard due dignity and comfort. All learners will the understand importance of including in the infant’s the family plan. care Investigations, tests – learning outcomes and procedures
87 Return to contents Career, education and competence framework for neonatal nursing in the UK Neonatal intensive care nurse care intensive Neonatal Follows a programme of preparation to prepare the QIS a programme of prepare to Follows preparation infants requirements to respond or anticipate, to nurse monitoring. and for equipment supportive for requirements assess the infant’s the skills to Develops that the infant and selects equipment the monitoring use of and competent safe demonstrates the requires, needs and infant’s monitors Continually equipment. of the components and removes requirements required. when no longer monitoring with unit guidelines compliance and monitors Audits of use and cleaning in the safe and protocols equipment. arranges is being introduced, equipment new When and training education ofdemonstrations, staff. Devises of the setting up and testing for guidelines equipment. Devises use of the safe for guidelines equipment. entrants new use of in the safe Educates equipment. with unit policies. compliance Monitor ofcould The assessments learning and proficiencies of detail passport an equipment provides which include the unit and practitioner on the equipment could use each safely to educated that theylog were the dates of was used. piece equipment and dates equipment The evidence being maintained that the skill sets are be reviewed during individual could the annual review. performance High dependency neonatal nurse dependency neonatal High Competent in cleaning and ensuring safe storage of and ensuring storage in cleaning safe Competent requiring of necessaryequipment the care for infant’s with local and manufacturer’s in accordance high care instruction. Supports and supervises entrant the new in developing use of the safe for equipment. skills required necessary equipment set up and test for to Competent ofthe care high infants requiring and dependency with local and in accordance care intensive instruction. manufacturer’s use equipment and safely efficiently to Competent ofnecessary the care for high infants requiring with in accordance care and intensive dependency instruction. local and manufacturer’s of in the interpretation of the significance Competent alarms high in infants requiring equipment and respond care and intensive dependency appropriately. problems. equipment Troubleshoot observation clinical the direct be by could Assessment The of set the safe up of the mentor. by equipment new for package design a teaching learner could entrants setting in the safe up of equipment. log. an equipment Maintaining The evidence being maintained that the skill sets are be reviewed during individual could the annual review. performance Novice/advanced beginner: new entrant Novice/advanced Follows a programme of the enable to Follows preparation and be vigilantregistrant monitor to risk. about equipment. emergency and checks Locates equipment and other incubators use ofSafe OHH, area. used in the clinical emergency alarms, fire area: Alarms in the clinical alarms. equipment alarms, familiarity handling manual with COSHH, Working of reporting policies and the requirements clinical incidents. clinical undertake systems the relevant links to Makes ofassessment vital signs observation. in the demonstrates infection control, links to Makes equipment and store the ability clean to area clinical ofnecessary the care for special infants requiring and with local and in accordance high care dependency instructions. manufacturer’s and support education demonstration, Following use and safely efficiently to assessment undertakes of necessaryequipment the care for infants requiring with local and in accordance special care instruction. manufacturer’s links with the normal of parameters Makes the in demonstrates system respiratory and cardiovascular and the abilityparameters set safe to area the clinical of the significance interpret alarms in equipment a theoretical and provide specialinfants requiring care of responses. account the appropriate calibration. monitors Observes blood glucose, of faulty consideration Theoretical decommissioning and elementaryequipment shooting common trouble equipment. OSCE during be the assessed by skills could The above programme and evidence that the skill set is being maintained can be reviewed during mandatory training and during the individual performance review. Levels 5 +
All learners are required required All learners are and use equipment to devicesmonitoring and in accordance safely with the manufacturer’s instructions. All learners will the understand importance of including in the infant’s the family plan. care Equipment and monitoring – learning outcomes
Return to contents 88 Royal colleGe of nursing Consultant nurse Consultant
Post holders should be educated to PhD level. to should be educated holders Post within of would The role this area consultant the nurse infants. plan and manage ability assess, their to include of the importance of awareness increasing With of neonatal the role consultant nutrition, neonatal be developed. nutritionist could nurse and the role be a bespoke to be likely This would elements programme of include would preparation included the role Where dietetic programmes. from some TPN, prescribing for responsibility the quality enhance would preparation pharmaceutical the infant. to of offered care of vulnerable in a uniquely infants are neonatal Mothers lactation establishing and position with to regards the developed units have Many breastfeeding. successful and support develop oversee, to of nurse role consultant agenda. breastfeeding ofthe success the unit’s skills of ofAssessment the retention the practitioner’s meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements In review. performance annual during the individual’s be updated to is likely the case of there infant feeding, ESPGHAN (European UNICEF and/or evidence from and Hepatology Society Gastroenterology, Paediatric for keep need to would the clinician which Nutrition) cite be to able need to would and as such with, updated this as evidence. Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) Requirements include a programme of include preparation Requirements an undertake ANNP to the designed equip to and assessment, examination, history, appropriate of support to the development perform investigation so allowing of the delivery diagnosis, differential conservative, continuing line and first appropriate for and treatment management active or supportive with urinary problem or suspected GI problem, any tract function and bilirubin elimination. The programme basis for will the theoretical provide of to the development in order practical skills required nutrition electrolyte, fluid, infant’s support effective This will include and elimination function. of and physiology the renal, anatomy embryology, and common and hepatic systems gastrointestinal, anomalies. congenital experienced or The expectation is that the developing ANNP will utilise local as guidelines unit and national practice expected in this area. for a benchmark The programme on of will study content include and collaboration multidisciplinary working, infants for outcomes positive promote to leadership urinary with families whenand their faced a GI, or condition. fluid-related for This programme willcontent the specific include professional the accepted to prescribing non-medical support of to prescribing intravenous/ standard, nutrition and total parenteral intra-arterial fluids, fluid/nutritionsupplementation. The operation ofANNP programme will the ensure towards a continuum along progresses that the student nutrition and electrolyte, in fluid, competence support direct clinical through by elimination, and practice ANNP/consultant) (fellow mentoring supervision to ANNP/registrar consultant) or (senior within safetymaintain patient confidence and enable the changing paradigm of practice. Enhanced practice nurse/ Enhanced practice specialist nurse May be clinically supported and prepared to develop develop to supported be clinically and prepared May set ofan enhanced those of skills on building clinical those ofANNP. the towards the QIS and working example for be in or QIS with a specialist interest May aspects of researching nutrition neonatal and actively growth. would the professional but role be a bespoke to Likely the ethical on and theoretical preparation require aspects of this cohort of on performing research subjects. with level additional a master’s to be educated to Likely and qualitative insight into provide to qualifications methodologies. quantitative as part as or team of perform research a research May perhaps in partof fulfilment an individual, doctorial and been screened will proposal have but research ethics research by will work ongoing be monitored and others. committees of ofAssessment the retention the practitioners skills meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s
Qualified in speciality Bands 6-8+ and skills Knowledge outcomes. All practitioners are skilfully to required fluid, an infant’s manage nutritional electrolyte, and elimination needs. All practitioners will and promote understand the importance of in the family including plan care the infant’s Fluid, electrolyte, nutrition and elimination management – learning outcomes nutrition and elimination management Fluid, electrolyte,
89 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) assess nutritional deviations status in growth trajectory and review supplementation the need for these and prescribe assess the stability of tropic prescribe the infant to tailoring the lead on the feeding and take feeds increase of to progression this process diagnosisassess the function of of the gut, NEC, of management prescribe NEC TPN and electrolyteprescribe supplementation needs unique the infant’s to according diagnose hyperbilirubinaemia perform of measurement as appropriate this and prescribe the to strategythe correct this according manage to needs ofunique the infant initially under transfusions, perform exchange autonomous supervision towards progressing practice plan a strategy to ability, sucking assess the infant’s when infants cannot be orally fed be followed of replacements and routine perform emergency tubes. gastrostomy The development of competence in practical of skills The development competence lines umbilical and intra-arterial(intravenous access, and so forth) will rationale a clear be supported by underpinning, the theoretical identifies which supervised possible), practice (where simulated ofsupervised development practical and practice, self- and subsequently competence, theoretical This of assessment ongoing competence. reflective will as element updates latter annual be supported by and defined will include organisation, within the supervised to reverting of practice in the event skill expectations. deterioration in line with professional programme ANNP will the provide Specifically, to: the student opportunities and prepare • • • • • • • • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing advances. technological Enhanced practice nurse/ Enhanced practice specialist nurse
Qualified in speciality Bands 6-8+ Fluid, electrolyte, nutrition and elimination management – learning outcomes nutrition and elimination management (continued) Fluid, electrolyte,
Return to contents 90 Royal colleGe of nursing Experienced ANNPs will take the lead in the teaching will the lead in the teaching take ANNPs Experienced and supervision of medical staff limited who have of gradesexperience nursing and other care neonatal progression. help role to to required staff educators Neonatal development of and development the education the co-ordinate be skilled and equipped Must team. nursing neonatal lead expertto in HEIs. sessions educational the acuity to than not all units have is recognised It level. at an advanced retained that skills are ensure rotation or simulation Strategies as peer review, such of units will retention acute ensure more other to competences. can be assessed of by competences Retention maintaining a skills log and reviewing it annually during review. the individual performance
91 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
Nurse consultants working within working of the specialist area consultants Nurse training undergone such have may care developmental Developmental as NIDCAP Individualized (Newborn training Programme) or/and Assessment and Care training NBAS behavioural (neonatal Brazelton similar. scale) or assessment this up to keep to be a requirement willThere therefore within individual each and retrain as required date example, NIDCAP for training, training programme. supervision clinical has encompassed within it and this helps management. support performance subsequent as such to neurology relationSpecific skills in ultrasound scanning will be taught as and when the specialise within to is going that area consultant nurse the future, and is not a skill In that all will possess. scan may ‘functional’ a the ability undertake to however, be part This would of in this particular the role area. pairing be by may but be then assessed as appropriate, scans with practitioner another results. and comparing Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) Follows a programme of designed Follows preparation to history, an appropriate undertake ANNP to the equip to and perform investigation assessment, examination, so of diagnosis, support the development differential allowing line and of first the delivery appropriate active or supportive conservative, continuing suspected any for and treatment management and sensory developmental neurological, common condition. The programme basis for will the theoretical provide of to the development in order practical skills required This will function. neurological support appropriate of and physiology the anatomy embryology, include and nervous systems muscular-skeletal, neurological, anomalies. congenital and common experienced or The expectation is that the developing ANNP will utilise local as guidelines unit and national practice expected in this area. for a benchmark for This programme willcontent the specific include professional the accepted to prescribing non-medical support of to prescribing medication to standard, manage/alleviate comfort. symptoms and provide The programme on of will study content include and collaboration multidisciplinary working, infants for outcomes positive promote to leadership with families whenand their faced an infant with sensory or and anomalies developmental neurological, will supportive use the same operational support, and ongoing strategy, development competence as previously stated. ofmaintenance competence Enhanced practice nurse/ Enhanced practice specialist nurse Enhanced practice roles may involve training and involve may practice roles Enhanced the QIS skill on set designed build and to development the skills identified within the towards be working ANNP section. to roles specialist nursing develop may nurses Neonatal of the holisticmanage care infants who have ongoing a need for requirements, care neurological who specialise and nurses in infant care developmental bespoke have to likely These are pain management. of requirements the units in which the reflecting roles they work. care who development manage nurses example For in psychology, hold qualifications may follow-ups physiotherapy. or therapy hospital play skills of ofAssessment the retention the practitioner’s meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s
Qualified in speciality Bands 6-8+ All practitioners are skilfully to required the assess and promote meet to required care optimal neurological wellbeing. All practitioners will and promote understand the importance of in the family including plan. care the infant’s Neurological, developmental care and pain management – learning outcomes and pain management care developmental Neurological,
Return to contents 92 Royal colleGe of nursing take the lead on assessing the infant’s pain and the assessing the infant’s the lead on take pharmacological and non-pharmacological methods of pain management a range of infants whoassess and manage have for pathology neurological deficits; and potential has the infant who is convulsing, example, haemorrhage experienced and infants who are hydrocephalus. developing The development of competence in practical of skills The development competence functioning monitoring, cerebral puncture, (lumbar devices, pressure inter-cranial taps, inter-cranial willtherapeutic cooling) a clear be supported by rationale the theoretical identifies which supervised practiceunderpinning), (where simulated of supervised development practicalpossible, practice, and subsequently competence, and theoretical This of assessment ongoing competence. self-reflective will as element updates latter annual be supported by and defined will include organisation, within the supervised to reverting of practice in the event skill expectations. deterioration in line with professional programme ANNP Specificallywill the provide to: the student opportunities and prepare • the infant with• assess and manage NAS • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing within neurological, advances technological and sensorydevelopmental conditions. will the lead in the teaching take ANNPs Experienced and supervision of medical staff limited who have of gradesexperience nursing and other care neonatal in this area. progression help role to the acuity to than not all units have is recognised It at an retained attained or that skills are ensure Strategies as peer review, such level. advanced units will acute more other to rotation or simulation of and retention competences. development ensure the can be assessed of by competences Retention maintaining of a skills log and reviewed annually during review. the individual performance
93 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
Nurse consultants may lead a team of lead a team may people in consultants Nurse in the neonatal performing within required the roles transport a career follow usually They services. would consultant nurse ANNP and specialist to from pathway paramedical included have which careers have could but qualifications. and neonatal pathways is no specific recognised for trainingThere is which some are in transport, though there consultants nurse be These may support needs. their would which courses as staff been undertaken nurses/sister have to likely and Neonatal (Paediatric PaNSTaR This includes roles. and the STABLE and Retrieval Course) Transfer Safe prior stabilisation to on concentrating programme, help may which beothers some may transport. There assist practitioners withto the difficult and serious ARNI of as the nature cases such undertaking complex of resuscitation the newborn (advanced course infant) may to not specificOthers transport. they but are in-house trainingundertake with medical their training also get some from counterparts may or overseas. of be need and retention to skills would Assessment reviewreviewed again at annual or via peer OSCEs or review. need skills of would consultant x-ray The nurse basic skills as well some ofinterpretation ultrasound function. scan for of ofAssessment the retention the practitioners skills meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements during review. performance the individuals annual of could example Assessment for abilities scan reading the and comparing pairingbe by scans and X-rays diagnosis and findingsof practitioner the with another clinician. Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) perform and lead advanced resuscitation and ongoing and ongoing resuscitation perform and lead advanced stabilisation deviations normal respiratoryrecognise and from function cardiovascular Follows a programme of the designed equip Follows preparation to examine, history, an appropriate undertake ANNP to support to the and perform investigation assess, so allowing the of diagnosis, development differential instigation and of first-line and delivery appropriate management active or supportive conservative, continuing suspected respiratory or common for and treatment problems. cardiovascular the The programme basis for will the theoretical provide of supportdevelopment to effective practical skills required This will include function. respiratory and cardiovascular and maturational physiology anatomy, embryology, of systems, development the respiratory and cardiovascular anomalies. congenital and common experienced or The expectation is that the developing ANNP will utilise local as a guidelines unit and national practice expected in this area. for benchmark for This programme willcontent the specific include professional the accepted to prescribing non-medical support of to prescribing medications for standard, as function such respiratory and cardiovascular effective maintain to relaxation and muscle sedation/analgesia with ventilation. supportive and compliance infant comfort multidisciplinary on The programme will content include positive promote to and leadership collaboration working, with families when infants and their faced for an outcomes infant with and will respiratory of problems cardiovascular competence supportive use the same operational support, of maintenance and ongoing strategy, development as previously stated. competence, programme ANNP Specificallywill the provide to: the student opportunities and prepare • • Enhanced practice nurse/ Enhanced practice specialist nurse Enhanced clinical practice. practice. clinical Enhanced of the example follow some The UK may of the role American units and consider neonatal of the care the respiratory enhance therapist to have or dependent oxygen infants who are a fall under would which requirements ventilation withindesignated scope practice. master’s to be educated individuals would Such reflecting and hold additional qualification level expertise physiology. their in advanced in areas perform research may nurses Neonatal systems respiratory to and cardiovascular related be as part either This of may a management. perhaps in part as an individual, or team research the of under fulfilment research doctorial ofguidance a supervisory research Such team. will work and ongoing be been screened will have and so ethics committees research by monitored forth. of ofAssessment the retention the practitioner’s as to a way in such be negotiated to likely skills are of and can be revalidation meet the requirements annual during the individual’s monitored review. performance
Qualified in speciality Bands 6-8+ All practitioners are maintain the to required optimal respiratory and cardiovascular functioning of the infant. All practitioners will and promote understand the importance of in the family including plan. care the infant’s Respiratory – learning outcomes management and cardiovascular
Return to contents 94 Royal colleGe of nursing initiate, interpret and respond to trends in the results of in the results trends to and respond interpret initiate, blood gas analysis diagnose respiratory pathology of interpretation chest radiography supportive and instigate and prescribe and therapies following infant assessment interventions respiratory individual and ongoing assess the infant’s and a range of and initiate non-invasive requirements HFOV), PSV, PTV, modalities (TVV, ventilation invasive of lung management the subsequent including chronic disease of and application understanding demonstrate nitric example for oxide respiratory support, adjunctive pulmonary systemic vasodilators (iNO), inhalation of management emergency and insertion, pneumothorax drains chest securing and remove the and examine sounds, assess respiratory and cardiac supportinfant to diagnosis of underlying defect disease or cardiorespiratory of case discharge lead in the management complex planning. • • surfactant administer • perform intubation, • • • support inotropic and prescribe • assess the need for • • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing advances. technological and will the lead in the teaching take ANNPs Experienced supervision of experience medical staff limited who have of grades help nursing role and other to care neonatal progression. the acuity ensure to than not all units have is recognised It Strategies such level. at an advanced retained that skills are acute more other to rotation or simulation as peer review, ofunits will retention competences. ensure of specialist that some areas is also recognised It will in additional competence employment result ECMO (including as pace-making, such requirements Appropriate assist devices. ventricular ECMO) or rescue specialist in-house or training outside be undertaken must of supportANNP programme to this. the the can be assessed of by competences Retention maintaining of a skills log during and reviewed annually review. the individual performance
95 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
Tissue viability consultants and infection control viability and infection control Tissue consultants However, centrally held roles. invariably are consultants with units of and neonatal centralisation increasing be bespoke merit in considering could there 50-60 cots requirements. meet individual unit’s to in order roles of ofAssessment the retention the practitioners skills meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) The programme of is designed equip preparation to history, an appropriate undertake ANNP to the support to and perform investigation assess, examine, so allowing of diagnosis, the development differential the instigation line of first and delivery appropriate active or supportive conservative, and continuing suspected common for and treatment management problems. and infection related hygiene skin, The programme basis for will the theoretical provide of supportthe development to practical skills required This will embryology, include infection control. and maturational development physiology anatomy, of and integumentary system systems, the immune anomalies. congenital and common experienced or The expectation is that the developing ANNP will utilise local as guidelines unit and national practice expected in this area. for a benchmark for This programme willcontent the specific include professional the accepted to prescribing non-medical support of to prescribing medications for standard, of and support management for infections, effective maintaining skin integrity. The programme on of will study content include and collaboration multidisciplinary working, infants for outcomes positive promote to leadership with families whenand their faced an infant with and willinfection skin anomaly or use the same competence supportive operational support, of maintenance and ongoing strategy, development as previously stated. competence Enhanced practice nurse/ Enhanced practice specialist nurse There would be scope when developing a when developing be scope would There nurses neonatal for framework career comprehensive viability in tissue specialist roles and in consider to and management. infection control be to The programme of be likely would preparation be ordinarily would the post holder but bespoke or in physiology level master’s to educated microbiology. of ofAssessment the retention the practitioners skills meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s
Qualified in speciality Bands 6-8+ and skills Knowledge outcomes. and hygiene Skin, infection control management. All practitioners will and promote understand the importance of in the family including plan. care the infant’s Skin, hygiene and infection control management – learning outcomes management hygiene and infection control Skin,
Return to contents 96 Royal colleGe of nursing lead in managing infusion injuries, surgical wounds surgical wounds lead in managing injuries, infusion care wound iatrogenic other and potential the effect of and monitor prescribe the therapeutic infections. neonatal manage to required agents Specifically, the ANNP programme ANNP will the provide Specifically, to: the student opportunities and prepare • • perform infection screening • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing advances. technological will the lead in the teaching take ANNPs Experienced and supervision of medical staff who have in this area of experience nursing and other limited care neonatal progression. grades help role to the acuity to than not all units have is recognised It level. at an advanced retained that skills are ensure rotation or simulation Strategies as peer review, such of units will retention acute ensure more other to competences. the can be assessed of by competences Retention maintaining of a skills log and reviewed annually review. performance during the individual’s
97 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
All nurse consultants have an element of research in of an element research have consultants All nurse it is part of However, role; their descriptions. job their an this they for should have be prepared to in order The programmeacademic of route. preparation as an trial of be cited could coordination the TOBY example. Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) act in a supportive capacity to guide effective capacity effective act guide in a supportive to strategies of optimal attaining and sustaining the infant for thermal control therapeutic hypothermia is usedin units where the process the lead in the re-warming take ANNP could of temperature maintain the optimal an infant who is in transit. Follows a programme of the enable to Follows preparation ofunderstanding the effects that deviations the from the infant’s on can have normal temperature metabolism. experienced or The expectation is that the developing ANNP will utilise local as guidelines unit and national practice expected in this area. for a benchmark The programme on of will study content include and collaboration multidisciplinary working, infants for outcomes positive promote to leadership with families whenand their faced an infant with poor and willthermal use the same operational control strategy, development competence supportive support, as previously of maintenance competence and ongoing stated. ANNP will the nurse, neonatal an experienced As basis and practical the theoretical skills to have already the will these to but extend support thermal control, ANNP will: The of areas new work. • • • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing advances. technological will the lead in the teaching take ANNPs Experienced and supervision of medical staff limited who have of gradesexperience nursing and other care neonatal progression. help role to Enhanced practice nurse/ Enhanced practice specialist nurse Some specialist units use procedural hypothermia as specialistSome units use procedural of the benefits part of and in NNUs a surgical process therapeutic hypothermia as part of the management a who have Infants strategies be clear. to HIE seem for the benefit from could this therapy for requirement expertise of with a specialist nurse expertise in this of infants is The role and re-warming cooling area. required and the preparation be bespoke to likely be to likely function in this area to a nurse equipping an in house programme. the use of into nurses therapeutic Research be ordinarily would nurses Such hypothermia. degree, of level the educational to a master’s prepared insight with into provide to additional qualifications methodologies. and quantitative qualitative as part as or team of perform research a research May an individual perhaps in partof fulfilment doctorial and been screened will proposal have but research ethics research by will work ongoing be monitored committees. of ofAssessment the retention the practitioners skills meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s
Qualified in speciality Bands 6-8+ All practitioners will and promote understand the importance of in the family including plan care the infant’s Infant temperature management – learning outcomes management Infant temperature
Return to contents 98 Royal colleGe of nursing
It is recognised than not all units have the acuity to than not all units have is recognised It level. at an advanced retained that skills are ensure rotation or simulation Strategies as peer review, such of units will retention acute ensure more other to competences. the can be assessed of by competences Retention maintaining of a skills log and reviewed annually during review. the individual performance
99 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
A consultant specialist in end-of-life care is likely to to is likely care specialist in end-of-life A consultant meet individual unit’s to in order role a bespoke have engaged in a development and will have requirements function in this role. to them equip plan to skills of ofAssessment the retention the practitioner’s meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) develop advanced communication skills and the communication advanced develop sensitive and facilitate to initiate confidence medical staff with and senior discussion parents the needs of to the according care lead the clinical infant and family; initiating these situations options with choices, discussions families regarding and support making decision their a and influence presentations give lead meetings, wide range of at strategic individuals and groups the enhance to changes action and make take to level ofcare the infant and family with discussions lead poly pharmaceutical the MD medications prescribing and families, team death prior aid comfort to to appropriately and sensitive complex, and process receive initiating actions required information, contentious arrange and lead debriefs staff after for as required ofthe death an infant participate in parallel care planning and advanced post mortem for requests planning (including organ donation) for and the potential examination Follows a programme of the enable to Follows preparation of acquisition understanding and in-depth knowledge of theories the key of This will loss and grief. include ofdevelopment the ability critically to how analyse the above. to in relation be present families may experienced or The expectation is that the developing ANNP will utilise local as guidelines unit and national practice expected in this area. for a benchmark The programme on of will study content include and collaboration multidisciplinary working, infants for outcomes positive promote to leadership with families whenand their faced an infant who and will care use the end-of-life or palliative requires competence supportive same operational support, of maintenance and ongoing strategy, development as previously stated. competence, The ANNP will: • • • • • • • Enhanced practice nurse/ Enhanced practice specialist nurse Infants and families who have requirements for for requirements and families who have Infants benefit would care end-of-life or care palliative or if was co-ordinated considerably care their practice in this area. equipped to nurses performed by a master’s to be educated to likely specialists are Such postgraduate and hold recognised degree level programme Their specialist in this field. qualifications bereavement of include would preparation and counselling. management skills of ofAssessment the retention the practitioner’s and skills the learning reflect outcomes to likely are during the postgraduate programmeacquired of meet as to a way in such be or negotiated preparation The of revalidation. professional the requirements ofmaintenance the skills and expertise can be with sensitivity peers and considered by monitored review. performance annual during the individual’s research neonatal research, to area Although a sensitive greatly would bereavement a focus on who have nurses to of the body add to is required which knowledge support this aspect of care. a programme of require would nurses Research neonatal advance to them equip to preparation on modules include This programme would evidence. to methods and data management research ethics, lead nursing researchers, as lone work to them equip function or as part teams ofresearch a multidisciplinary team.
Qualified in speciality Bands 6-8+ All practitioners will and promote understand the importance of in the family including plan. care the infant’s Palliative care, end-of-life care and bereavement management – learning outcomes management and bereavement care end-of-life Palliative care,
Return to contents 100 Royal colleGe of nursing develop, sustain and evaluate partnership and evaluate sustain working develop, and others agencies groups, with individuals, of in the provision care neonatal involved ofsupport in which the development a culture and inter-professional valued individuals are learning is encouraged the provision strategies ensure to and deliver identify meetof programmes to and development education the needs of service the neonatal own feelingsidentify and develop death about own and triggers stress recognise for self-awareness, in seeking support self. for be proactive • • • • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing advances. technological will the lead in the teaching take ANNPs Experienced and supervision of medical staff limited who have of gradesexperience nursing and other care neonatal progression. help role to the acuity to than not all units have is recognised It level. at an advanced retained that skills are ensure rotation or simulation Strategies as peer review, such of units will retention acute ensure more other to competences. during reviewed annually the individual Sensitively review. performance
101 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
The role of the neonatal nurse consultant in relation to to in relation ofThe role consultant nurse the neonatal be generally to is likely and procedures investigations that ofANNP and the programmesimilar to of the be similar. could preparation a bespoke requirements, role specific are there Where be designed. need to programme would if part ultrasound example, of scanning were For the be to training have then in that would role consultant’s these remain ensure and these skills assessed to included at a satisfactory level. in involved also become may consultants Nurse is no precedent; arranging there which for innovation to ANNPs for the pathways developing example for arrange or of the MDT management blood, prescribe a respiratory or airway requirement. complex of ofAssessment the retention the practitioner skills are meet the as to a way in such be negotiated to likely of and can be monitored revalidation requirements review. performance annual during the individual’s Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) develop advanced communication skills and the communication advanced develop sensitive and facilitate to initiate confidence medical staff with and senior discussion parents the needs of to the according care lead the clinical initiating these situations infant and family options with choices, discussions families regarding and support decision-making their a and influence presentations give lead meetings, wide range of at strategic individuals and groups the enhance to changes action and make take to level ofcare the infant and family with discussions lead poly pharmaceutical the MD medications and families prescribing team death prior aid comfort to to appropriately and sensitive complex, and process receive initiating actions required information, contentious arrange and lead debriefs staff after for as required ofthe death an infant participate in parallel care planning and advanced post mortem for requests planning (including organ donation) for and the potential examination Follows a programme of the enable to Follows preparation of acquisition understanding and in-depth knowledge of theories the key of This will loss and grief. include ofdevelopment the ability critically to how analyse the above. to in relation be present families may experienced or The expectation is that the developing ANNP will utilise local as guidelines unit and national practice expected in this area. for a benchmark The programme on of will study content include and collaboration multidisciplinary working, infants for outcomes positive promote to leadership with families whenand their faced an infant who and will care use the end-of-life or palliative requires competence supportive same operational support, of maintenance and ongoing strategy, development as previously stated. competence The ANNP will: • • • • • • • Enhanced practice nurse/ Enhanced practice specialist nurse In many units, audiometry examinations units, and retinal many In of The care retinal carried infants undergoing are out. specialist if beimaging enhanced were could there support to the ophthalmic/ developed roles nurse be to likely are nurses ophthalmic Such medical team. some and undertake level master’s to educated education. inter-professional skills of ofAssessments the retention the practitioner’s as to a way in such be negotiated to likely are levels of revalidation. professional meet the requirements ofThe maintenance the skills and expertise can be during the peers and considered by monitored review. performance annual individual’s specialist programmes of are There to preparation perform practitionersequip a range to of audiometry assessments. skill of and retention the practitioner’s Assessment the learning reflect outcomes to be likely would level during the specialist programmeand skills of acquired meet as to a way in such negotiated are or preparation of revalidation. professional the requirements
Qualified in speciality Bands 6-8+ All practitioners will that the infant ensure investigations requiring receives and procedures and attention the care, supervision with commensurate needs.their All practitioners will and promote understand the importance of in the family including plan. care the infant’s Investigations, tests – learning outcomes and procedures
Return to contents 102 Royal colleGe of nursing develop, sustain and evaluate partnership and evaluate sustain working develop, and others agencies groups, with individuals, of in the provision care neonatal involved ofsupport in which the development a culture and inter-professional valued individuals are learning is encouraged the provision strategies ensure to and deliver identify meetof programmes to and development education the needs of service the neonatal own feelingsidentify and develop death about own and triggers stress recognises for self-awareness; in seeking support self. for is proactive • • • • ofConsolidation critical skills will analysis the enable audit and revise and guidelines research, ANNP to best practice with medical and promote evidence to practice in line with and develop colleagues, nursing advances. technological will the lead in the teaching take ANNPs Experienced and supervision of medical staff limited who have of gradesexperience nursing and other care neonatal progression. help role to the acuity to that not all units have is recognised It level. at an advanced retained that skills are ensure rotation or simulation Strategies as peer review, such of units will retention acute ensure more other to competences. during reviewed annually the individual Sensitively review. performance
103 Return to contents Career, education and competence framework for neonatal nursing in the UK Consultant nurse Consultant
As NICU is one of NICU is one As the specialised NICU services, be equipped so they must can represent nurses the service at both local trust and network board of will these nurses be Many highly levels. board taking pathways had career and have experienced management ANNP and senior through them roles. capital for be responsible may consultants Nurse essential plans for and procurement budget equipment. and educated are consultants nurse How but be bespoke to likely this role equipped for MBA. include could these skills will and retaining Maintaining require of insight and awareness have the individual to to and the autonomy development personal a meaningful development personal develop plan. Advanced neonatal nurse practitioner nurse practitioner neonatal Advanced (ANNP) gain skills in assessing the requirement ofgain specimens skills and in assessing the requirement of and the initiation the interpretation of results samples, management appropriate as supra pubic perform such a range of investigations insertion of pressures, aspiration, monitor lines to means of central by percutaneous etc infusions arterial, lines and so forth and central catheter venous drains suturing chest and chest and stabilising undertake when required drain wounds the lead in the ongoing hip stability for and take check ofmanagement infants. identified The programme of of the acquisition facilitates preparation underpin the ability to of knowledge ANNP theoretical the perform and procedures. a rangeto of investigations the The programme basis for will the theoretical provide of specificpractical required, development skills any and physiology anatomy, embryology, including involved. of system maturational development any meet that students ensure the programme must addition, In statutory/legalsupport to the radiologicalany requirements of and interpretation and the safe request x-rays of environment. management and macro the micro ANNP experienced or The expectation is that the developing will utilise local as a benchmark guidelines unit and national practice expected in this area. for The programme on of will study content include to and leadership collaboration multidisciplinary working, families infants and their for outcomes positive promote and will withwhen faced the procedure an infant requiring competence supportive use the same operational support, of maintenance and ongoing strategy, development as previously stated. competence to: ANNP willThe be required • blood• prescribe and blood products • a range of the same • request and interpret x-rays • • of of the be by the maintenance the skillsEvidence could ofdevelopment a skills log during and reviewed annually the review. individual performance Enhanced practice nurse/ Enhanced practice specialist nurse As part of a clinical educational role, a neonatal a neonatal partAs of role, educational a clinical the teaching for be responsible would specialist nurse use of the staff the safe for and preparation ensure to the range of the unit. used on equipment close involve to is likely a role such for Preparation the and attending withrelationships manufacturers make to them by opportunitieseducational provided a benefit from Theybest may use of the equipment. programme of ensure teaching clinical to preparation are and there strategies effective teaching that their are modules. such who offer HEIs several skills of ofAssessment the retention the practitioner’s meet the as to a way in such be negotiated to likely are of and can be monitored revalidation requirements review. performance annual during the individual’s extracorporeal units use ECMO and other Some use specially or trainedcircuits as perfusionists. nurses The some programme of be similar to may preparation specialisttheatre roles. skill of and retention the practitioner’s Assessment the learning reflect outcomes to be likely would level during the specialist programmeand skills of acquired peers. and by simulation assessed by preparation,
Qualified in speciality Bands 6-8+ All practitioners will supervision care, provide ensure to direction or that the infants requiring equipment supportive receive and monitoring with this commensurate needs.their All practitioners will and promote understand the importance of in the family including plan. care the infant’s Equipment and monitoring – learning outcomes
Return to contents 104 Royal colleGe of nursing Neonatal lecturers and pathway leaders will be required will leaders be required and pathway lecturers Neonatal required the curriculum develop and competences to specialism. and advancing developing the reflecting against an HE educational validated are Programmes framework. ANNPs may be prepared using a combination of using a combination be prepared may ANNPs equip to medical consultants or ANNPs experienced roles. function advanced clinically in their to them against an HE educational validated are Programmes framework. Neonatal clinical educators will educators clinical be experienced Neonatal supervise and educate, to and required nurses neonatal novice workforce, neonatal support the unregistered pathway neonatal on and students nurses neonatal practice. programmes in clinical that insight personal and awareness They have need to exemplary them make to the skills required they have skills their and retain update models, role with role. their commensurate NVQs, nursery nurse NVQs, associate/ curriculums, assistant practitioners be prepared training may in-house and delivered ofin colleges further or The higher education. learning and flexible could approach blended from modules include See health. skills for www.skillsforhealth.org. uk Delivering and supporting nursing curriculum the neonatal
105 Return to contents Career, education and competence framework for neonatal nursing in the UK
References and key documents of interest
British Association of Perinatal Medicine (2010) Service Department of Health (2013) Education outcomes standards for hospitals providing neonatal care (3rd edition), framework indicators: technical guidance 2013/14, London: London: BAPM. Available from: www.bapm.org (Accessed DH. Available from www.gov.uk (Accessed 1 May 2014). 1 May 2014). Department of Health (2013a) Hard truths: the journey to British Association of Perinatal Medicine (2012) Matching putting patients first. Volume one of the government response knowledge and skills for qualified in speciality (QIS) neonatal to the Mid Staffordshire NHS Foundation Trust public nurses: a core syllabus for clinical competency, London: inquiry, London: DH. Available from www.gov.uk (Accessed BAPM. Available from: www.bapm.org (Accessed 1 May 1 May 2014). 2014). Department of Health (2013b) Hard truths: the journey to Bliss (2013) Bliss baby charter audit tool: helping to make putting patients first. Volume two of the government response family-centred care a reality on your neonatal unit, London: to the Mid Staffordshire NHS Foundation Trust public Bliss. Available from www.bliss.org.uk (Accessed 1 May inquiry: response to the inquiry’s recommendations, London: 2014). DH. Available from www.gov.uk (Accessed 1 May 2014).
The Cavendish Review (2013) An independent review into Health Education England (2013) See www.hee.nhs.uk healthcare assistants and support workers in the NHS and (Accessed 1 May 2014). social care settings, London: DH. Available from: www.gov.uk (Accessed 1 May 2014). Institute for Patient and Family Centred Care (2013) Changing the concept from families as visitors to families as Centre for Workforce Intelligence (2010) Recommended partners (toolkit), Bethseda: IPFCC. Available from: workforce models, London: CfWI. Available online only www.ipfcc.org (Accessed 1 May 2014). from: www.cfwi.org.uk (Accessed 1 May 2014). Kain V (2013) An exploration of the grief experience of Council of Deans of Health (2013a) See www.councilofdeans. neonatal nurses, Journal of Neonatal Nursing, 19 (2), org.uk (Accessed 1 May 2014). pp.80-87.
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107 Return to contents The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies
November 2014 Review date: November 2016
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