rcn competences neonatal

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Competence, education andcareers in neonatal nursing:

RCN guidance

RCN CompetencesRCN Competences


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RCN Legal Disclaimer

This publication contains information,advice and guidance to help members of the RCN.It is intended for use within the UK but readers areadvised that practices may vary in each country and outside the UK.

The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed.Whilst every effort has beenmade to ensure the RCN provides accurate and expert information and guidance,it is impossible to predict all the circumstances in which itmay be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be causeddirectly or indirectly by what is contained in or left out of this website information and guidance.

Published by the Royal College of Nursing, 20 Cavendish Square, London,W1G 0RN

2012 Royal College of Nursing.All rights reserved.No part of this publication may be reproduced, stored in a retrieval system, or transmittedin any form or by any means electronic, mechanical,photocopying, recording or otherwise, without prior permission of the Publishers.Thispublication 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 whichit is published, without the prior consent of the Publishers.

AcknowledgementsIt is hoped that this RCN competency framework will be useful forall health care professionals working within neonatal nursing. TheRoyal College of Nursing and the working group would like to thank everyone who has been involved in their development, particularly Debra Teasdale that led this important initiative.

Fiona Smith RCN Adviser in Children and Young Peoples Nursing

Document reviewgroup

Debra Teasdale, Lead for RCN Career and Education CompetenceDocument Development, RCN Paediatric and Neonatal IntensiveCare Community Steering Committee Member,Head of Health,Wellbeing and the Family, Canterbury ChristChurch University,Kent

DoreenCrawford, RCN Paediatric and Neonatal Intensive CareCommunity Steering CommitteeSenior Lecturer,De Montfort University

DeniseGray , Education Project Manager, NHS Education forScotland

AlisonGibb, BritishAssociation of Perinatal MedicineRuth Moore,Vice Chair, Neonatal Nurses AssociationProject Manager NIC/PIC - Staffordshire, Shropshire & Black Country Newborn Network East

TinaPollard, Chairperson,Neonatal Nurses AssociationClinical Service Manager Neonates,Addenbrookes Hospital,Cambridge

JackieStretton,West Midlands Neonatal Pilot Project ManagerInstitute of Health and Society,University of Worcester

Alison Wright, Scottish Neonatal Nurses Group ChairpersonSenior Nurse Neonatal Services/ANNP Ninewells Hospital

Join the CYP acute care forum

If you want to learn more or getinvolved with the work of the RCNPaediatric and Neonatal Intensive CareCommunity join the CYP acute careforum today.

www.rcn.org.uk/joinaforum


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R C N C O M P E T E N C E S N E O N A T A L N U R S I N G

competency and core skills framework for Scottishneonatal nurses (SNNG,2005).This framework drew onprevious work within Scotland (National Health Service[NHS] Education for Scotland [NES],2002; SNNG, 2004)which was originally supported by a scholarship from theGeneral Nursing Council for Scotland (Education) Fund(1983) and Margaret Callum Rodger Midwifery Award.Inthe latest version (SNNG, 2005), the introduction of theKnowledge and Skills Framework (KSF) for the NHS(2004) allowed career pathways/progression to bedemonstrated.

The SNNG working group, which contributed to thedevelopment of the competency and educationframework, represented all those involved in neonatal careas it included clinical,managerial and neonatal nurseeducator staff from across Scotland.The intention was forit to be used by those Scottish higher education institutesthat provided post-registration neonatal education.

In England, the SNNG (2005) framework was recognised

for its clarity and foresight in the development of neonatalnurses career structure.Following a detailed consultationwith local neonatal stakeholders, the framework was usedduring the revalidation of neonatal education within thehigher education institution in England (Canterbury Christ Church University, 2005). In the absence of any English,Welsh or Irish guidance the SNNG (2005)competency framework was adopted as it broadly mirrored local expectation for those who were toundertake and complete thelocal neonatal educationmodules leading to recognition as a neonatal nurse.

Subsequently, and with minor adjustments,the SNNG(2005) framework has been successfully used as abenchmark of the expected standardised outcomes forcompetence and core skill development for local nursesundertaking education to allow recognition of beingqualified in specialty.The framework has also been usedfor neonatal nurses new to the area to help improve theirknowledge and practice to the required local standard.

It is acknowledged that a number of neonatalunits/networks have developed similar educational andcareer pathways,however,since the SNNG (2005)

framework utilises the KSF (NHS,2004) which has beenimplemented across the UK, it is considered to be easily transferable and understandable in both practice and inhigher education environments.

In February 2008, a neonatal staffing summit wasorganised by the Royal College of Nursings (RCN) childrenand young peoples nursing adviser.Neonatal nursingrepresentatives from all four countries of the UnitedKingdom(Appendix 1, p.28)(UK) met to discuss anddebate the neonatal nurse staffing issues identified inreports during the previous 12 months. The issuesidentified included the need to recruit and retain nursesfrom a variety of backgrounds and to ensure that all thoseundertaking additional education to developqualified inspecialty status,have the same level of knowledge andskills. In addition, it was recognised that neonatal nursesrequire parity in pay and career opportunities.

As a result of the meeting the RCN publishedA right tocare aposition statement on neonatal nurse staffing (RCN,2009) which was developed collaboratively andencompassed the recommendations from all parties at themeeting. One key recommendation was to establish a UK-wide competence and education framework to ensureequity in the expectations of neonatal nurses at differentlevels/stages of careers and in different geographicallocations.

This guidance presents a framework which should be usedby nurses,employers,managers, higher educationinstitutes and policy leads.

The development group also considered the changes thatare required within the current system to improverecruitment,career progression,educational provision andcompetence in this demanding specialty.A number of recommendations are made throughout (and summarised

in Appendix 4) to assist in the successful application of theframework within UK neonatal services.

The backgroundThe concerns raised at the neonatal staffing summitmirrored some of those previously expressed within theScottish neonatal community over the last eight years(Scottish Neonatal Nurses Group [SNNG],2003,2004;Kerr, 2003). In addition,the situation in Scotland wascomplicated by pay inequities between midwives (who hadprovided a substantial portion of the neonatal workforce)and neonatal nurses (SNNG,2004).

As a result, the SNNG developed a document to define a

Introduction


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R O Y A L C O L L E G E O F N U R S I N G

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A framework fit for purposeTo ensure currency,the original Scottish work (SNNG,2005) has been reviewed,adapted and developed to formthis document by representatives from the neonatal

nursing community across the UK. This was undertakenin two phases.

The initial review and amendments were agreed withrepresentatives from the Neonatal Nursing Summit Groupbetween November 2008 and April 2009.This was followedby a nationwide consultation period where further minoramendments were made.

A second consultation and review(seeAppendix 1,p.28)occurred during September 2010 prior to RCN approvaland publication.The draft content had already influencedpublications such as:Toolkit for high quality neonatal services(DH,2009), A career and development for neonatal nurses in Scotland (NES,2010) andStandards for hospitals providing neonatal intensive and high dependency care(BAPM,2010).The second consultation ensured that this 2011document is congruent with these publications andreflects contemporary opinion.

This phase has also supported a mapping exercise of thiswork against the Skills for Health career framework.Inaddition, the nationally agreed job profiles available forNHS employers under the Agenda for Change (AfC)agreement were examined.Whilst there are a range of jobprofiles available in the profile library to support parity inpay scales across AfC Bands 4-7 (including for practiceeducator roles), there are gaps in the library in areas thatwould support specific roles such as the progressive natureof advanced neonatal nurse practitioner (ANNP)development.This document presents an exemplar jobdescription to address this issue and to assure parity inpay and conditions across the UK at all levels of neonatalnursing practice(seeAppendix 2,p.29),reflecting thenature of advanced level nursing practice as defined

nationally (DH,2010).An overview of the RCN competence and educationframework to support careers in neonatal nursing in theUK is represented in table format inSection 1 (page 5),

followed by a supporting narrative within the descriptionsof Benners levels of practice (Benner, 1984).All three

sections (Overview,Competences for neonatal nursing,and the Core skills for neonatal nursing) have beenupdated acknowledging the following:

G recent policy changesG new/re-iterated NHS driversG the changing face of neonatal careG the experience of application of the SNNG (2005)

framework within the English and Scottish HigherEducation environment.

Although the framework makes reference to neonatal

nurses,this term is used inclusively to describe bothnurses and midwives who arequalified in specialty towork within neonatal care.

Supporting the non-registeredneonatal workforceWhilst this guidance focuses on recommendations for theregistered professional workforce, it is recognised that theneonatal workforce includes non-registered support roles

(nursery nurses and assistant practitioners).Individualsin such roles operate under the direct supervision of aneonatal nurse and contribute positively to babies andfamilies receiving care within the special care category. Towork within the neonatal environment, support workersmust also meet acceptable standards by undertakingadditional training and development to acquire skills inneonatal care. Initially, this should be at a minimum levelof S/NVQ 3 and should match appropriate performanceindicators: for example,theSkills for health maternitysupport worker competence summary(Skills for Health,2010).

In this context, career progression opportunities need tobe assured for all sectors of the workforce (Leitch,2006).Following the initial embedding of knowledge to supportthe transition into neonatal care,individuals and theirorganisations may decide that the assistant practitionerrole would be mutually beneficial. The employee couldthen access a foundation degree programme,withneonatal managers determining which of the lower levelcore clinical skills are appropriate to the local neonatal-specific environments.These core clinical skills can thenbe slotted in within the work-based elements of the localfoundation degree to support the development of practicecompetence.This approach will help progression intoprofessional nursing or midwifery careers,since thefoundation degree will allow admission to professional

The RCN,and those involved in the creation of thisUK-wide careerandeducation frameworkforneonatalnurses,are very grateful for theextensiveworkdonebyScottish neonatalnursesand the SNNGduringthelast eight years, andacknowledge that theirworkforms thebackbone of this newdocument.


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registration programmes and continuous careerdevelopment as indicated within theSkills for Health

career framework(2006).Exemplars of how this can betranslated into neonatal environments are already emerging, for example,in NHS West Midlands (2010).

Who enters neonatal nursing?What might assist recruitment of the future workforce?Neonatal nurse recruits have historically come from avariety of different professional groups and many would

argue that this enriches the neonatal teams (Blake andTeasdale, 2008). This variety is reflected in the educationlevel/qualification part of the framework. However, it isacknowledged that registered childrens nurses (RNChild) are considered the most desirable candidatessince their training encompasses core knowledge foreffective nursing of the child and family (RCN, 2003).Midwives are also educated to effectively care for aneonate who requires special care and their parents. InScotland, the predominant professionals within theneonatal workforce have, until recently, been midwives

(SNNG, 2005). Many units in the UK continue to employ and attract those trained as registered general nurses(RGN) or RN (Adult) who have limited, if any, directneonatal experience during their pre-registrationprofessional education.

Although midwives and childrens nurses experienceneonatal care during the required pre-registrationeducational programme, the level of neonatal input varies.This inconsistency is compounded since placementopportunities on neonatal units may be limited due to thecompetitive pre- and post-registration curriculum.

To address the long-term needs of neonatal nurserecruitment the following recommendations have beenmade for the education of pre-registration childrensnurses and midwives:

G all pre-registration childrens nurse and midwifery programmes must include a course of study focusingon the care of the sick or compromised neonate

G this should be complemented by a neonatal placementopportunity of not less than four weeks (for example, intransitional care areas,special care/neonatal units).

There is a disparity in the recruitment policies across theUK, where employers refuse to accept newly qualifiedmidwives but accept newly qualified RN (Child) or RN(Adult) as recruits (Blake and Teasdale, 2008).This

disparity should be addressed at local level.The followingrecommendations are made for those employing newly

qualified nurses and midwives:G newly qualified nurses or midwives who are offered

employment within neonatal care should have access toa full preceptorship package as well as a full range of future neonatal nursing career opportunities

G a contract of employment may offer rotationalplacement through the neonatal unit for the first 18months.

In England,problems with updating skills to maintainmidwifery practice have frequently led to those with dualqualifications opting to lose their midwifery professionalstatus.However, the historical educational shift todirectentry midwifery means that newly qualified midwiveswanting to develop a career within neonatal care must beable to update to maintain their professional status (NMC,2004). Anecdotal evidence suggests that whilst themidwifery skills employed within neonatal nursing aredeemed sufficient for the purposes of updating in someareas,this is not uniformly accepted.As a result midwivesare dissuaded from pursuing a neonatal career.Whenemploying either newly qualified or established midwivesin neonatal care,it is recommended that:

G the organisation has a clear policy to allow for statutory midwifery updating within normal working time in theneonatal unit so as to help maintain registration as amidwife.

Finally, when employing newly qualified staff or staff withno experience of neonatal care:

G all new members of staff who enter into neonatal careare viewed asnovicesregardless of their background.

This last recommendation reflects the starting pointidentified within the work of Benner (1984), which

underpins the levels of practice described within theframework.Additionally, this approach reflects thebackdrop to neonatal care where careers progress atdifferent speeds depending on external factors.Thiscontinuum of development for the neonatal nurseacknowledges that, whilst some nurses will movesystematically through the stages and take on leadershiproles,others may accelerate through the levels of practicedue to prior experience.Finally, some staff may chose toremain at a particular stage according to personal andprofessional need,continuing to make valuable andrelevant contributions within their sphere of competence.


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OverviewTable 1 (p.6)provides a visual representation of howneonatal nurses are able to develop from the point of registration across Benners stated levels of practice.Career progression through these levels of practice isachieved through three elements.

1. Knowledge acquisition demonstrated though specificprogrammes of education either within or external tohigher education.

2. Using this knowledge to demonstrate competence(which has been linked to the KSF (NHS,2004).

3. The practical development of core clinical skills (whichrelate directly to responsibility for patient care).

The development of this framework reflects current goodpractice and the requirements for career progressionwithin health care settings (Skills for Health, 2006). It aimsto ensure equity in the career and educationalopportunities available to meet the needs of neonatalnurses,the employing organisation and the wider neonatalcommunity as a whole.As a result it is recommended that:

G this framework is used throughout the UK to informworkforce development and educational plans inpractice environments

G the associated competences,core clinical skill set and

matched educational requirements should be used atpractice level and by HEIs to underpin and benchmark local provision.

As such thecompetencesin this document are describedin more detail than the broad statements within theToolkit for high quality neonatal services(DH,2009),which will be beneficial during any audit of local neonatalservices following the introduction of the specialistneonatal care quality standards (NICE,2010).

TheBenners level of practiceentry point into thestructure will vary depending on an individuals priorexperience, skill set and educational attainment.To ensureequality in recruitment and career development practicesacross the UK it is recommended that:

G employers should be encouraged to use the knowledge,level of educational achievement,and specified skill setto support the development of job descriptions andspecifications

G the framework may also be used to map priorexperience and competence to determine individualdevelopment needs and potentially accelerate careerprogression.

The educational aspects reflect expected entry qualification for each level of the framework,continuingprofessional education for contemporary practice, and therequirements for progression to allow transition to higherlevel of practice/competence.

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A competence and education framework tosupport careers in neonatal nursing in the UK


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Benner Levelof practice

Minimum professional/educational entry requirements

Continuous professionaldevelopment

Competence level and broaddescription of level of practice/role

SfH career framework*

Novice/advancedbeginner

Registered nurse (RN) (Childor Adult)or registeredmidwife (RM)Diploma /degreequalification.

Preceptorshipprogramme for newlyqualified staff.Induction/foundation education inneonatal care.To remain in role1. Work toward degree qualification(if diplomate).2. One year post qualification - NMCapproved mentorship course.3. Continuous updating to remaincontemporary.

Achieves and maintains competence and coreskills for new entrants.Initially - acquires basic skills and knowledgefor practice for supervised practice in specialcare. Once practice level has reachedconsistently high standards this role mayextend to high dependency care undersupervision, prior to undertaking postregistration qualification.

Level 5 Practitioner

The nurse may remain at this level, maintaining competence but should be encouraged and supported to develop further toprepare for the specialist course.

- Undertake post-registration qualification in neonatal nursing (special, high dependency and intensive care) to supportdevelopment of competence and core skill as neonatal nurse (QIS) status.- Works towards neonatal nurse (QIS) competence and core skills under direct supervision of NMC qualified mentor in highdependency and intensive care environments.

Competent

RN (Child/Adult) or RMPost registration neonatalqualificationEngaged with degree levelstudyNMC mentor.

To remain in role1. Consolidates knowledge andskills development.2. Continuous updating to remaincontemporary.3. NMC approved sign-off mentorship programme.

Achieves and maintains neonatal nurse (QIS)competence and core skills.

The neonatal nurse is qualified to work withinall areas of neonatal care.

Level 6 Seniorpractitioner

The neonatal nurse may remain at this level, maintaining competence or may choose to develop further. Undertake study in neonatal nursing at honours degree/postgraduate level to support development of competence andcore skill at experienced neonatal nurse status and potential role development. Works towards competence and core skills for experienced neonatal nurses under the supervision of an experienced expertnurse with sign-off mentor qualification.

Proficient

RN (Child/Adult) or RMPost registration neonatalqualificationNMC sign-off mentorqualificationHonours degree qualificationor recognition of priorexperiential learning inclinical, education, leadershipor managementroles.

To remain in role1. Consolidates knowledge andskills development.2. Continuous updating to remaincontemporary.3. NMC approved practiceeducator/lecturer programme forthose leading in-house/HEeducation.

Achieves and maintains competenceand coreclinical skills for experienced neonatal nurses.

Experienced neonatal nurses work inprescribed nursing roles such as neonataltransportation, shift management roles (eg,ward charge nurse/sister), development carelead, lactation support, community outreachpractitioner, practice development/clinicaleducator.

Level 6 Seniorpractitioner

Level 7 Advancedpractitioner

The neonatal nurse may remain at this level, maintaining competence or may choose to develop further.- Undertake postgraduate study to support future role development and the development of competence as an expertneonatal nurse.- For clinical practice role development works towards core skills for expert neonatal nurses (or locally determinedequivalent) under supervision (expert nurse with an NMC approved sign-off mentor qualification or an appropriately qualifiedmember of the medical team)

Expert

RN (Child/Adult) or RMPost registration neonatalqualificationNMC mentor/practiceeducator qualificationEducated to Masters levelRecognition of prior

experiential learning inclinical, education,leadership or managementroles.

To remain in role1. Consolidates knowledge andskills development.2. Continuous updating to remaincontemporary.3. Access to doctoral and post -doctoral study to advance neonatal

nursing in the future.

Achieves and maintains competence forexpert neonatal nurses.For those in clinical practice expert roles,achieves and sustains core clinical skills setas specified within expert level or as locallydetermined.Expert neonatal nurse roles include neonatal

unit manager, neonatal practicedevelopment, facilitator/researcher,established advanced neonatal nursepractitioner, neonatal nurse consultant.

Level 7 Advancedpractitioner

Level 8 Consultant


Summary tableTable 1. Overview of RCN competence and education framework to support careers in neonatal nursing

* The career framework levels do not equate directly to Agenda for Change pay bands.


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The application of level of practice to the neonatalworkforce

Benner level The novice/advanced beginner:new entrantFor those with no prior experience of the sick orcompromised neonate following initial registration, thiswould be the point of entry into the RCN career andeducational framework to support neonatal nursing acrossthe UK.

All newly qualified entrants to the neonatal nursing willrequire a period of preceptorship in order to make thetransition from student to accountable practitioner (NMC,2006). Preceptorship programmes should be aligned withlocal induction programmes to help the new entrantbecome familiar with local policies and procedures.

During preceptorship and beyond, thesenoviceswould besupported whilst developing the competences and coreclinical skills needed to help them provide basic carewithin special care situations.This practical developmentwould be complemented by the acquisition of additional

knowledge via in-house,network or HEI study sessions so creating a foundation of knowledge to support initialand subsequent career development (DH,2009).

An established nurse or midwife in this career level (oneyear post-registration) wouldbe expected to commencework towardsan NMC recognisedmentorship qualification.They would then be in a position to mentor student healthcare professionalsduringneonatalplacements in theirspecified area of expertise (NMC,2008a).

Nurses and midwives working at this level would not beexpected to work routinely with complex neonates in any care category and, although they should have insight intohigh dependency/intensive care, they would not beequipped to provide these levels of care without directsupervision.

Career progressionThose who aspire to advance their career should beencouraged to work towards the requirements for thecompetent level of practice by undertaking a recognisedpost registration specialist neonatal education course.Thiswill involve developing care knowledge and skills withinhigh dependency and intensive care environments underdirect supervision of a nurse who is qualified in specialty (QIS), plus the attainment of competence and core skill setof the neonatal nurse QIS.

Benner level Competent: the neonatal nurse(QIS)

Progression to neonatal nurse status can happen aftersuccessfully completing a post-registration course of study and demonstrating the competences and core clinicalskills as a neonatal nurse QIS.

Although the term neonatal nurse is not recordable on theprofessional register, it is essential from a workforceperspective that the knowledge,skills and competencesinferred by this status are transferable across the UK.Therefore the theoretical component of the specialisteducation needed to be a neonatal nurse should be basedwithin the UK HE sector,which is subject to rigorous

quality control to ensure a standardised level of attainment. Such courses of study will be consistent withHE undergraduate degree level,specifically focused on theneonate across all the care categories as defined nationally (BAPM,2001).Currently, in England, neonatal modules of study within higher education are generally 40-60 HEcredits at HE level 5 or 6, which reflects the requirementsin Scotland where courses are 40 credits at SCQF level 9.Asthere is a move towards an all-graduate nursing/midwifery profession it is recommended that:

G future provision of specialist education to support theneonatal nurseshould be offered at a minimum of undergraduate degree level.

This will help those with diploma or equivalentqualifications, gained in the UK or abroad, attain degreesand promote graduate status for nurses1 .All nurses whoundertake this level of study and skill acquisition shouldbe recognised within the neonatal community as neonatalnurses in line with previous recommendations (NES,2002).

Career progressionThe neonatal nurse may choose to remain within thecompetent level of practice,embedding education andcontinuing to demonstrate knowledge,competence and coreclinical skillsof the neonatalnurse QIS.Neonatalnurses willassume personal responsibility for continuing professionaldevelopment to supportpractice (NMC,2010a).Neonatalnurseswill teach and supervise learners in the skills withintheir range of competence,so must work towardsa

1 Whilst postgraduate study may be undertaken by graduatenovices, this is not considered essential, and there is anecdotalevidence to suggest that undergraduate study is more acceptable toNICU due to the novice nature of the nurses in clinical practice. Onesolution is for novice graduate nurses to be accommodated byundertaking 60 credits at a nationally defined level to gain a specificHEI award, e.g., Graduate Certificate in Neonatal Care or transfercredit towards an honours degree.


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recognised NMCmentorship qualification (with sign-off responsibility reflecting the principlesalready evident

within pre-registration assessment [NMC,2009a]).The neonatal nurse can progress if they engage inadditional experience and education to achieve theknowledge,competence and core clinical skill set for theexperienced neonatal nurse who operates at the proficientlevel of practice. Typically, this will require completion of the undergraduate degree programme of study.

Benner level Proficient: the experiencedneonatal nurseExperienced neonatal nurses function at this level of practice and will provide effective management of alllevels of neonatal care. They are sufficiently experiencedto act independently within a multidisciplinary/multi-agency context and include roles such as:

G neonatal transportationG shift management, for example, ward charge

nurse/sisterG development care leadG lactation supportG community outreach practitionerG practice development/clinical educator.

The experienced neonatal nurse will have completed anacademic degree that supports an individuals higher levelfunctioning in the neonatal unit.Such an award may givethem eligibility to record a professional qualification of Specialist Practitioner .

In collaboration with medical staff, the experiencedneonatal nurse will assess, plan, implement and evaluatethe overall management of babies requiring all levels of neonatal care; will assess and manage critical and clinicalevents to ensure safe and effective care, summoningappropriate assistance as necessary; and will facilitatelearning by others in the neonatal unit (NMC,2008a).

Career progression

Experienced nurses working at the proficient level of practice would,like all others, be required to maintainpractice (NMC,2008b) and will demonstrate competenceand core clinical skills as an experienced neonatal nurse.

However, those that aspire to the expert practice level will

do postgraduate higher education study leading towards amasters degree qualification.The experienced nurse canalso work towards developing the competence and coreclinical skills associated with expert roles in neonatalnursing.

Benner level Expert: specific andindependent neonatal nursing roles

Experienced neonatal nurses may choose to furtherdevelop their knowledge, skills and competence to thislevel to become an expert neonatal nurse who is able tofunction in an independent role.An expert nurse will beinvolved in national guidance,debate and policy. Roles atthis level may include the following:

G neonatal manager providing service management fora defined area

G neonatal practice development facilitator/researcher promoting best practice, including undertaking clinicalresearch

G advanced neonatal nurse practitioner providing totalcare for a caseload of babies,achieved through anaccredited educational programme and working withina designated advanced neonatal nurse practitioner role

G neonatal nurse consultant championing strategicpolicy development.

Expert neonatal nurses will have undertaken postgraduatestudy to support and develop their roles.Whilst all operateat expert level of competence,only clinical practice expertswould be operating at expert level of the core skills as thisis not a requirement for those whose role have divertedfrom direct provision of neonatal care.

Career progression

Experts will engage with appropriate CPD opportunities toremain up to date (NMC,2010a) and assist in theeducation and development of the future workforce asrequired locally (NMC, 2008a).To further developexpertise and enhance neonatal care will involve thecompletion of a masters degree and/or commencing adoctoral study.

Ensuring an inclusive approachWhilst the framework identifies a clear role for HEIs, thisshould not preclude those who have undertaken a locally provided in-house course from gaining recognition of thestatus as a neonatal nurse who demonstrates thecompetent level of practice. It is recommended that:

G local HEIs and neonatal intensive care unit (NICUs)should work in partnership to develop the Accreditationof Prior Experiential Learning (APEL) routes availablewithin HEI regulations to allow acknowledgment of neonatal education packages within a recognised HEIbased programme of study.This will help ensure that a


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neonatal nurse isnt disadvantaged by theorganisational approach.

Curriculum content and practicalexperienceThis document does not include a specified curriculum of content for each level, but it is recommended that thecontent of any theoretical programme of study offered tosupport development at any level in the framework should:

G reflect contemporary and evidence-based practiceconcurrent with the level of practice being aspired to

G ideally be determined by partnership,working betweenthe HEI and local neonatal providers

G take account of professional and subject benchmarksas these become available

G be organised as a package to span the requirements forthe full range of nursing care across each neonatal carecategory (BAPM,2001).

It is also recommended that modules or courses of study contributing towards any programme of study should:

G meet the needs of those across the career continuum by offering flexibility.

For example,nurses who choose to remain employedsolely within the special care or high dependency environments should be able to complete discreteelements/ modules of study to meet their needs, whilstother nurses wishing to develop full neonatal nurse statusare able to access additional study.

In order for the nurse to reach the required level of practice which is underpinned by the competence and coreskill set it is recommended that:

G the individual is concurrently accommodated in apractice environment which provides a level of carewhich complements the focus of study and allowssufficient time to develop the required competence.This should be specified within any prerequisite for HEstudy - arranging this would be the responsibility of thesponsor/employer

G all units must have established mechanisms forpreceptorship/mentorship,which may include medicalcolleagues where appropriate

G HEIs develop formal assessment of practice tools tosupport the programme of study (which should bebased on the competence and core clinical skill set) toensure equity in practice outcomes across the UK

G those undertaking the development of practice areformatively and summatively assessed by a mentor who

meets the NMC requirements for the professionG that prior experience is mapped against the competence

set to help acceleration across the career framework where possible.

It is essential that all courses of study should produceneonatal nurses who are able to:

G operate effectively within the dynamic environment of care

G care effectively and advocate for the babies and thefamily

G care for themselves and others within themultidisciplinary team.

Professional developmentopportunitiesThere is a statutory requirement to ensure that individualsupdate their practice in order to ensure currency of theprofessional qualification.This is reflected in the structureat all levels. It is recommended that:

G strategic education and development plans shouldencompass this. In the UK this should be led by networks. The organisation is similar butgeographically determined in Scotland,Wales andNorthern Ireland

G events could also be considered by the local HEIs tocontribute towards academic credits under theAccreditation of prior experiential learning (APEL)system as above

G individual practice must remain contemporary sonetworks should explore rotational opportunities forstaff between units to support this (wheregeographically possible)

G mechanisms,such as the NHS staff passport, be utilisedeffectively to allow development opportunities betweenNHS providers.

It is recognised that all nurses involved in the delivery of neonatal care must conduct themselves in a professionalmanner, to include: confidentiality; empathy; information-giving, and liaising with other staff. Effectivecommunication with parents, carers,staff and othercolleagues is essential at all levels of nursing practicethrough:

G active listening and acknowledging


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G responding and explainingG questioning and negotiatingG analysing and facilitating.

At all levels,nurses should be aware of how to contactrelevant colleagues when required and understand thebarriers and boundaries to effective communication.

Planning, assessment and evaluation are essential parts of all care and the decisions taken at all levels.Accuraterecord keeping and documentation is a fundamental partof all nursing,and midwifery practice and are importanttools in promoting high quality care.Records anddocuments must be legible,accurate,concise and up to

date,and comply with the NMC standards (NMC,2009b).At all levels, the nurse must be able to initiate andmaintain accurate care plans and document the outcomesof nursing and other interventions.

In neonatal environments nurses and midwives need towork in partnership with parents, families and carers.Arguably, this is implicit within the professional educationof child nurses and midwives; however, it is recommendedthat:

G additional input regarding partnership working with

parents, families and carers should be available for allnurses and midwives during the initial preceptorshipperiod.

This is especially important since neonatal nurses are in aunique position to act as an advocate for the neonate andcan play a vital role in child protection.

In addition, all neonatal environments should aspire todevelop and sustain a culture of personal development,lifelong learning and support. It is recommended that:

G clinical supervision is separate to managerial

supervision within neonatal units as a way to promotedevelopment and reflective practice on a personal level

G in addition, the unit processes should providemeaningful opportunities for regular team debriefing,such as neonatal and perinatal audit meetings.


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The development of competences are integral to theneonatal nurse career development as seen above. In orderto fit in with current NHS career structure anddevelopment, the competences were derived with guidancefrom the KSF (NHS,2004) core dimensions. Aspects of

family-centred and developmental care are part of the coredimensions which are presented under the followingheadings:

G communication and interpersonal relationshipsG personal,professional and people developmentG health, safety and security G service developmentG quality G equality, diversity and rightsG responsibility for patient care.

The competences included under each heading overlapwith several of the specific dimensions of the NHS (2004)KSF, therefore these are included as subheadingsthroughout(see Appendix 3,p.42).

Communication andinterpersonal relationshipsIncluding data processing and management,production

and communication of information and knowledge,andthe design and production of visual records.

The neonatal nurse will use a wide range of media tocommunicate effectively with babies,parents, carers andhealth care workers.The neonatal nurse will demonstrateinterpersonal behaviour and skills conducive to developingand maintaining therapeutic and professionalrelationships.

ElementsG Communicate effectively with babies, families, relatives,

carers and other professional colleagues.G Act as the neonates advocate.G Maintain effective and supportive communication

within the neonatal nursing team and with otherprofessionals.

G Contribute to creating an environment that fosters opencommunication and trust with families and colleagues.

G Liaise with health care professionals and individuals inother disciplines from within and outside theorganisation to support quality patient care.

ToolsG All forms of communication oral,written, electronic,

body language,tone of voice.G Active listening.G Facilitating.G Advising and counselling.G Influencing and persuading.

2

Competences for neonatal nursing

7 Appendix 3 Mapping of the proposed competences to NHS(2004) KSF


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Understand the

importance of effectivecommunication.

Demonstrate theability to communicateeffectively andefficiently withcolleagues.

Communicate tactfully,maintaining trust,integrity andconfidence.

Use effectivecommunicationstrategies to work withbabies and inpartnership withparents/carers, givethem all informationnecessary to helpinformed choice, tomeet the needs of theneonate.

Collect, collate, record,input and reportroutine and simple

data and information. Maintain accurate andup to date records.

Develop a rapport andcommunicateeffectively within theneonatal team andwith other health care.professionals, aboutroutine and dailyactivities, overcomingdifferences that mayexist.

Promote effectivecommunication withbabies, families andcolleagues.

Within the realm of allocated responsibilityinfluence and teachothers.

Structure, analyse,interpret and reportfactual data andinformation andsupervise others in themaintenance of accurate and up todate records.

Check information,

confirm accuracy,recognisediscrepancies and takeappropriate action.

Process, modify and managedata and information.

Write complex reports. Prepare and deliver

presentations. Establish and maintain

communication withindividuals and groups aboutcomplex and difficultneonatal matters, overcomingany problems.

Actively support and leadinitiatives to ensure optimalcommunication of local andnational policy directives andinformation relevant toneonatal care.

Persuade, motivate, influenceand negotiate with a widerangeof people to assist withdecision-making and actionas required.

Analyse, interpret and reportinformation and knowledgerelated to ideas andconcepts.

Influence strategic policymaking at local and nationallevel.

Lead meetings, givepresentations and influence awide range of individuals andgroups at strategic level to takeaction and make changes.

Receive and process complex,sensitive and contentiousinformation, initiating actionsrequired.

Establish and maintaincommunication with variousindividuals and groups oncomplex, wide ranging,potentially stressful topicsrelated to neonatal services.

Enable effectivecommunication to overcomebarriers.

Design/develop strategies toprocess and manage data andinformation.

Analyse, synthesize andpresent knowledge andinformation about complex

subjects and concepts toinfluence key decisions.

Competences for the four levels of neonatal nursing practice


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse

Contribute to ownpersonaldevelopment.

Be aware of limitationsof skills, scope of professional practicein neonatal nursing,exercise accountabilityand seek advice andsupport accordingly.

Demonstrate acommitment tocontinuousprofessionaldevelopment andactively participate inthe appraisal process.

Actively participate inteaching programmesand facilitate learning .

Recognise signs of own negative stressand seek appropriatesupport.

Develop knowledgeand skills to remaincurrent in practice,disseminating newknowledge and skillsfor wider benefit.

Identify ownlimitations and/orknowledge and skilldeficits, formulate aplan of action andorganise developmentopportunities toenhance continuousprofessionaldevelopment.

Recognise limitationsof others, providesupport, informationand teaching to othersto help theirdevelopment.

Recognise signs of negative stress inothers, offer support

and work towardsalleviation of tension.

Develop own knowledge,skills and practice andcontribute to thedevelopment of others.

Act as a resource of specialistknowledge and clinicalpractice.

Foster an environment thatencourages staff development, supporting andcounselling staff asnecessary.

Develop, deliver and evaluatestaff developmentprogrammes that support theachievement of clinical skills,leadership and best practicein neonatal nursing.

Demonstrate knowledge of public policies and participatein professional activities thatrelate to the advancement of neonatal nursing practice.

Develop and evaluate own andothers knowledge and practiceacross professional andorganisational boundaries.

Identify and deliver strategiesto ensure the provision of education and developmentprogrammes to meet the needsof the neonatal service.

Support the development of aculture in which professionalslearn together .

Support the development of aculture in which individuals arevalued and interprofessionallearning is encouraged.

Personal, professional and people development

The neonatal nurse will assume responsibility for personal professional development, demonstrating a commitment tolifelong learning and activities that enhance knowledge, skills,values and attitudes required for safe and effective neonatalnursing practice.

ElementsG Practice at all times within current legislation,professional rules,codes and guidelines.G Provide ongoing evidence of competence through maintenance of a personal professional portfolio.G Develop self and others.G Contribute to practice development through active participation in clinical working groups.G Contribute to the development of the philosophy of shared governance within the neonatal team.

G Facilitate and actively participate in clinical support activities and orientation of colleagues and learners.

ToolsG Formal learning.G On-the-job training opportunities.G E-learning.G Access to specific training and awards.G Networking.G Clinical supervision.



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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Be aware of, and

comply with, local andnational health andsafety legislation,infection controlpolicies, and clinicalgovernance and riskmanagementregulations.

Assist in maintaining asafe and secureenvironment.

Identify potential risksin the workplace andtake appropriateaction to minimiserisk.

Participate in thepreparation andmaintenance of neonatal equipment.

Identify emergencysituations, summonhelp and act withinown level of expertise.

Actively implementlocal and nationalhealth and safetylegislation, infectioncontrol policies,clinical governanceand risk managementregulations, andintegrate these intopractice.

Manage emergencysituations, summonappropriate help, andact within own level of professionalcompetence.

Monitor and maintainthe health, safety andsecurity of self andothers in the neonatalunit.

Prepare and maintainequipment.

Support others to deal withemergency situations.

Carry out risk assessmentsrelated to neonatal care andmanage those risksappropriately.

Ensure all appropriatemeasures are taken inrelation to infection control.

Act asa role model andpromote best practice inhealth, safety and security.

Prepare and maintainequipment and ensure staff training is current and up todate.

Contribute to staff training.

Ensure the workingenvironment complies withorganisational, professionaland legal requirements andguidelines.

Monitor safe work practices. Assume line management

responsibility for accident/incident reporting andmonitoring.

Develop a culture that activelyimproves health, safety andsecurity.

Promote risk managementstrategies in the neonatal unit.

Acknowledge/identify trainingneeds of staff, negotiateresources, facilitate training tomeet needs.

Ensure best practice in health,safety and security, includingadequate training for staff.

Develop and provideappropriate trainingopportunities.

Assess the need for, andmanage the purchase of,equipment to support neonatalcare.

Health, safety and security

The neonatal nurse will use a range of policies,procedures and protocols that optimise a safe and secure environment thatsupports neonatal practice.

ElementsMaintain and promote health, safety and security.

Demonstrate knowledge of and comply with local and national health and safety legislation, infection control policies,andclinical governance and risk management regulations.

Contribute to maintaining a safe and secure environment.

ToolsG Health and safety legislation and policies.G Infection control policies.G Clinical governance.G Risk management.G Moving and handling.G Staff governance.G Training/mandatory updates as defined in employers health and safety policies and procedures.



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Assist in maintenanceanddevelopment of theneonatal service.

Act asa role model forjunior colleagues andlearners and superviselearners as appropriatewithinpredeterminedparameters and providefeedback.

Commenton policies,procedures or possibledevelopments.

Participate in partnershipworkingwithin theneonatal unit.

Assist with the logistics of moving babies andequipment within theservice.

Recognise the need toorganise and prioritiseworkload as part of ateam, taking note of activities within theneonatal unit.

Beawareof, andmaintain, the physical

resources in the neonatalunit. Beawareof, and

efficientlyuse, thefinancial resources in theneonatal unit.

Supervise junior staff within predeterminedparameters andprovide feedback.

Develop leadershippotential within theclinical environment,acting as a role modelfor staffand peers.

Participate inpartnership, workingwith individuals,groups and otherswithin the neonatalunit.

Within the realmof allocatedresponsibility,effectively manageresources in theneonatal unit.

Within the realmof delegatedresponsibility,contribute to thedevelopment of neonatal care.

Planown timeand

prioritise over a dailyand weekly time-scale. Organise the logistics

to move babies andequipment.

Activelycontribute and participatein thedevelopment of neonatalservices.

Provideeffective professionalleadership, facilitatingchange anddeveloping the service in responseto changinghealth careneeds.

Proactivelyorganiseandparticipate in resource andneonatalunitmanagement,maximising resources andcontributing to themanagementand development of staff.

Highlight and instigate actionplans to managedeficitsinresources.

Deputisefor the line manager. Beinvolved in the

recruitment/selectionandpersonal professionaldevelopmentof staff.

Developand sustain working withindividuals, groups, agenciesandothers involved in neonatal care.

Propose policy/service changes. Allocate, delegate, co-ordinate,

monitor andassess work of theteamand individuals.

Plan andorganise several complex neonatalcareactivities. Organise and prioritise conflicting

workloaddemands. Prioritise the movement of babies

and equipment.

Develop strategies and policies forneonatalservice development at local and national level.

Monitor staffdevelopment. Lead a team with complex work activities by

establishing objectives and standards. Develop, sustain and evaluate partnership

working with individuals,groups, agencies andothers involved in theprovisionof neonatalcare.

Develop, implementand evaluate policies andstrategies for recruiting,deploying,developingand retaining staff.

Demonstrate a critically analytical approach tostrategicdecision making and judgementsrelated to neonatal care.

Provide leadership and management inneonatal nursing through effectiverolemodelling,offering vision for the advancementof neonatal nursing.

Empower neonatal nurses in practice andstimulateco-operation and enthusiasm withinthe neonatal nursing team.

Prepare, develop and monitor financial andmaterial resource fora range of complex neonatal careactivities.

Identify success criteria and establishmonitoringsystems for neonatal nursingpractice.

Planand manageprojects related to servicedevelopment. Develop strategies to ensure safe and efficient

movement of babiesandequipment. Securephysical and financial resourcesand

establishstrategiesfor theiruse.

Service development

Including logistics,facilitiesmaintenanceandmanagement,partnership, leadership,managementof people,andmanagementof physical and/or financialresources.The neonatal nurse will demonstrate knowledge of effectiveinter-professional working practices that respect and utilisethe contribution of all members of the health care team.The neonatal nurse will contribute effectively to theplanning and organisation of neonatal care services tomaximise the provision of a high quality service to babies,parents, families and carers.

ElementsG Demonstrate ability to co-ordinate, organise and

prioritise workload.G Demonstrate leadership skills within the neonatal

nursing practice.G Maintain collaborative working relationships with the

multidisciplinary team, the general public and externalagencies.

G Setting goals andobjectives

G Supervising andfacilitating

G DelegatingG Equipment

G Operational planningG BudgetingG Controlling and

monitoringG AdministrationG Leading,managing and

developing staff

G Coaching andmentoring

G VisioningG ResourcesG Time managementG PrioritisingG Project planningG People management

G Manage resources effectively.G Be receptive to new developments in the provision of

neonatal care.G Participate in clinical governance initiatives.

Tools



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Adopt aquestioning/reflectiveattitude towardsclinical practice,seeking and utilisingbest evidenceguidelines in theprovision of care tobabies and theirfamilies.

Assist with audit,research anddevelopment projects.

Adopt a criticalapproach to clinicalpractice and encouragequestioning/reflectionin others to promote aculture of best practicein neonatal care.

Identify areas forpractice development,suggest improvementsutilising localmechanisms and assistwhere appropriate withthe change process.

Demonstrate skills andunderstanding of auditmethodology,principles andevidence basedpractice.

Assess and analyseinformation to solveproblems.

Make recommendations thathave a positive impact onneonatal care.

Instigate and facilitateresearch and audit.

Proactively foster a culture of enquiry and facilitate changeto integrate best evidenceinto neonatal care.

Make decisions and developsolutions to problems thatinvolve clear risk and may haveno clear answer.

Make significant decisions thathave a direct impact on themedium or long-termperformance of the neonatalunit.

Analyse and develop solutionsfor complex professional,clinical or managerialproblems.

Identify areas for research inclinical practice.

Participate in and/or leadresearch projects incollaboration with others.

Participate in the systematicreview of protocols, treatmentplans and outcomes todetermine their effectiveness inmeeting established standardsof care.

QualityIncluding research and development.

The neonatal nurse will demonstrate commitment to evidence-based practice, using research, quality standards andclinical audit tools.

The neonatal nurse will demonstrate critical thinking approach to problem solving to enhance neonatal care.

ElementsG Actively use a problem solving approach to care delivery and the needs of the neonate.G Utilise research skills, critically appraise and evaluate neonatal practice.G Contribute to the maintenance of an environment within the neonatal unit where research,quality and clinical audit

are valued.

G In collaboration with the multiprofessional team,audit standards of care delivery.G Use decision-making skills.

ToolsG Creative thinking.G Decision making.G Research.G Audit.G Evaluation.G Making recommendations.

G Reflective practice.



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Assist in maintaining anenvironment in whicheveryone includingbabies, parents/carers,families and colleagues is treated equitablyand with respect.

Act in a manner thatsupports equality,diversity and rights of allindividuals.

Act as an advocate forbabies rights.

Recognise and respectthe preferences andbeliefs of thefamily/carers.

Reflect on and challengepersonal assumptionsand ways of working.

In relation to childprotection, be aware of role and responsibilitiesand activatesafeguardingprocedures whennecessary, seekingsupport as required.

Reflect on andchallenge assumptionsand ways of working of others.

Support anenvironment in whicheveryone includingbabies, parents/carers,families andcolleagues is treatedequitably and withrespect.

Provide parents withthe informationrequired for them tomake informeddecisions regardingtheir baby.

Promote an environment inwhich everyone is treatedequitably and with respect.

Enable parents to makeinformed decisions regardingtheir baby and support themin their decisions.

Identify the potential forandtake action to prevent orrectify discrimination andcompromise of rights.

Interpret and challenge waysof working and developappropriate solutions.

Act as an advocate on behalf of thosewhose rights havebeen compromised.

Actively develop and promotean environment in whicheveryone is treated equitablyand with respect.

Develop anti-discriminatorypolicies/procedures andprovide appropriate supportservices for babies, parents,carers and staff that complywith legislation, professionalregulations and best practice.

Monitor effectiveness of equality, diversity and rightspolicies and proceduresthroughout the neonatal unit.

Regularly reviewimplementation, effectivenessand compliance with equalityand diversity legislation.

Equality, diversity and rightsThe neonatal nurse will practice within a legal,professional and ethical framework that includes local guidance, employerguidance,policies and procedures, ensuring that their own actions support and promote equality, diversity and rights.

ElementsKnow, understand,use and integrate into practice all current legislation,rules and codes that are relevant to neonatalnursing practice, including:

G Code of Professional PracticeG MidwivesRules and StandardsG The ChildrenAct,Safeguarding Framework and local proceduresG International Convention on Human Rights/The Rights of the Child.

ToolsG Creative thinking.G Decision making.G Research.G Audit.G Evaluation.G Making recommendations.G Reflective practice.G Mandatory training and updates.



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Responsibility for patient careIncluding assessment of, addressing individuals,improvement of, and the protection of, health andwellbeing needs,biomedical investigation and thereporting,measuring,monitoring and treating of physiological conditions through the application of specific technologies.

The neonatal nurse will, within agreed parameters, apply knowledge,clinical judgement,and a range of skills toprovide safe, effective care to babies and theirfamilies/carers.

ElementsG Develop and maintain a sound knowledge base relevant

to neonatal care.G Develop and maintain own clinical competence.G Critically appraise own level of competence,identifying

areas for further development.G In collaboration with the family and the

multidisciplinary team,assess,plan,deliver andevaluate neonatal care that reflects individual physical,social, cultural and spiritual needs.

G Ensure that the most appropriate, individual clinically effective neonatal care is achieved within the confinesof available resources.

G Implement care under the direction of current unit andprofessional policies, procedures and guidelines,andthe law.

G Demonstrate effective decision making in the context of current role.

G Use health promotion strategies to support and adviseparents and families.

G Ensure care is taken to safeguard babies and theirfamilies/carers at all times.

G Ensure written documentation is clear,concise, timely,and complies with professional and local guidelines andstandards.

G Demonstrate an awareness of current developments inneonatal practice.

G Demonstrate that neonatal practice is embedded inevidence/best practice.

G Maintain and improve quality in all areas of neonatalpractice.

ToolsG Education and training.G Health promotion.G Guidelines, protocols,policies and standards.

G Biomedical investigations and reporting.G Neonatal care assessment tools.G Quality standards.

G Legislation.

G Specific technologies.


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Develop a sound

knowledge baserelevant to neonatalnursing.

Provide quality basicroutine neonatal carewithin clearly definedguidelines.

Respond to the needsof the neonate and thefamily, providingquality care usingcurrent informationand knowledge.

Undertake routineassessment tasksrelated to the healthand wellbeing of theneonate.

Assist in deliveringprogrammes of neonatal care tosupport future healthand wellbeing,including delivery of specific healthpromotion

information/teaching. Perform routine testsand tasks related toneonatalinvestigations andreporting.

Assess, intervene,evaluate and reportthe outcomes of planned care.

Ensure actions assistthe maintenance of high quality neonatalcare.

Use core clinical skillsand develop criticalreasoning skills toprovide safe andeffective care tobabies in partnershipwith parents/carersand the multi-professional team.

Contribute to practicedevelopment.

Be accountable forown practice.

Be responsible andaccountable for overall

care delivery for adefined group of babies with indirectsupervision.

Plan, implement andevaluate nursing care tomeet the health andwellbeing needs of theneonate when the conditionis stable.

Assist in the care of theneonate whose needs arecomplex and ever changing.

Use critical judgement andreasoning to facilitate anddeliver care to babies inpartnership withparents/carers and themulti-professional team.

Recognise and takeappropriate action when theneonates condition isbecoming unstable or isdeteriorating, includingreferral and initiation of emergency interventions.

Apply technology formeasurement, monitoringand treatment, interpret andrespond to the needs of families/parents/carers.

Assist parents/carers andother staff to assess babieshealth, wellbeing andrelated needs.

Maintain a comprehensiveknowledge and skills basethat relate to neonatalnursing.

Act as a resource tocolleagues.

Supervise care delivery of junior colleagues.

Ensure actions promotequality and alert others torelevant quality issues

Anticipate the need for, planand participate in ,programmes of care tosupport future health andwellbeing including,audiology and ophthalmicscreening, vaccination,discharge planning anddelivering specific healthpromotioninformation/teaching.

Ensure actions promotequality and alert others torelevant quality issues.

Supervise care delivery of junior colleagues. Apply technology for

measurement, monitoringand treatment.

Manage theimplementation of qualitycare/service.

Act as a role model,providing support andguidance to others inimplementing care.

Assess, plan, deliver andevaluate neonatal care toaddress needs that arecomplex and ever changing.

Plan, analyse, interpret andreport biomedicalinvestigationswithin ownlevel of practice.

Plan, monitor and qualityassure the application of technology formeasurement, monitoringand treatment.

Contribute to qualityimprovement.

In partnership withparents/carers and themulti-professional team,use highlydeveloped/specialist

knowledge and clinicalskills in the neonatal unit tocreate a culture and climatethat is proactive andresponsive to meet thehealth care needs of babies.

Supervise the care given byjunior colleagues.

Develop and maintainknowledge, skills andcompetence to the level of the expert who is able tofunction in an independentrole.

Develop practice in applyingtechnology formeasurement, monitoringand treatment.

Develop practice inbiomedical investigationand reporting.

Demonstrate a criticallyanalytic approach tostrategic decision makingand judgements related toneonatal care.

Continuously monitoractivities against qualitystandards, anticipatefactors that may reducequality and take effectiveaction to address them.

Develop, implement andevaluate initiatives andstrategies to improve the

quality of neonatal care. Improve quality of neonatalcare through practicereview.

Develop and implementstrategies for neonatal care,include standards, policiesand guidelines for caredelivery.

Develop policies andstrategies to improve thehealth and wellbeing of babies.

Foster a proactive careculture

Seek opportunities to addvalue to care provision.

Role model effectiveleadership in neonatalnursing and contribute tocreating a vision for theadvancement of neonatalnursing, stimulating co-operation and enthusiasmin neonatal nursing.

Empower neonatal nursingpractice by publishinglocally, nationally andinternationally.



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To achieve the competences expected for each of the fourlevels of neonatal nursing practice (new entrant to expert),the neonatal nurse must develop specific skills.The skillsrequired are diverse (DH,2010 pg.53),may be transferableacross several competences,and will change over time,therefore the working group chose to restrict theclarification of core clinical skills in this document to

those that specifically relate to patient care within thecompetenceResponsibility for patient care.

The categorisation of skills previously used (NES, 2002)have been recently revised by the BritishAssociation of Perinatal Medicine (http://www.bapm.org/ ) in relation toa review of Qualified in Speciality components.The latterrecognised clinical practice elements unique to theneonatal nurse and as a result the clinical headings havebeen amended as follows:

G fluid,electrolyte,nutrition and eliminationmanagement

G neurological,pain and stress managementG respiratory and cardiovascular management

20


3

Core clinical skills for neonatal nurses


Recognise normal gastro-intestinal function, urinarytract function and bilirubinelimination, reportingdeviations.

Implement interventionsto sustain homeostasisaccording to unitguidelines.

Recognise abnormal gastrointestinaland urinary tract function, abnormalbilirubin elimination, acting ondeviations.

Initiate management andfollow guidelines.

Investigate,prescribeand managetreatments forany GIproblems, andproblems withurinarytract function andbilirubin elimination.

Assist the mother tobreastfeed according toevidence base/unitguidelines.

Assist and support mothers tobreastfeed.

Inform and advise on storage of breast milk, breastfeeding, handand mechanical expression andsupplementary methods of feeding.

Participate and involveothers in research anddevelopment of practice topromote breastfeeding.

Devise, audit andreview guidelines forbest practice inpartnership withmedical staff.

Assist parents/carers inother enteral feedingtechniques.

Inform and advise parents/carerson all aspects of other enteralfeeding methods.

Use evidence-basedpractice for enteral

feeding.

Devise, audit andreview guidelines forbest practice inpartnership withmedical staff.

Fluid, electrolyte, nutrition and elimination management

G skin and hygiene managementG management of thermoregulationG managing and supporting the family G investigations and procedures as applied to

neonatal nursingG equipment as applied to neonatal nursing.

The neonatal nurse must have the knowledge and theability to rationalise the strategy chosen in the applicationof all clinical skills.

For all levels:

G all elements of all skills and knowledge reflect anddemonstrate current evidence-based practice

G skills and knowledge achievement includesdemonstration of safe administration of relevant drugsin all situations, in accordance with professionalpolicies,and the ability to assess and evaluate responses

G skills exist within situations where babies require safecare during invasive and non-invasive investigationsand procedures.


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Safely carry out allforms of enteralfeeding (exceptbreast) according toevidence base/unitguidelines.

Monitor the need fornutritional supplements.

Refer to specialist neonatalnutrition advisor (egdietician, speech andlanguage therapist)

Assess enteral feedingneeds, devise plan andreview appropriately.

Deviseprocedures/guidelines forenteral feeding.

Monitorand evaluate,audit and reviewimplementation.

Administernutritionalsupplementsaccording toprescription.

Prescribe nutritional supplements asrequired.

Review the need fornutritionalsupplements.

Safely administerintravenous therapyaccording to unitguidelines,recognising andreportingdeviations/complications.

Set up, maintainand discontinueintravenous/intra-arterialtherapy.

Maintain central lines. Intervene appropriately to

reduce/avoid deviations/complications.

In specific situations,insert peripheralintravenous lines.

Supervise insertion of intravenous lines byothers.

Manage appropriatetreatment fordeviations/complications.

Establish intravenous and intra-arterialaccess.

Remove central lines. Instigate and prescribe treatment. Select and prescribe appropriate fluid

management. Devise, audit and review guidelines for

best practice in partnership withmedical staff.

Monitor input andoutput.

Measure and interpretintake and output,accessing hydration status.

Calculate intake

requirements according toclinical condition andenvironment withinguidelines.

Calculate and prescribe fluid intakeaccording to clinical condition andenvironment.

Measure weightand length.

Monitor growth anddevelopment throughmeasurement of weight andhead circumference.

Identify deviations fromexpected growth and referas requried.

Act on deviations fromnormal growth anddevelopment and referappropriately.

Investigate, prescribe and managetreatments for problems with weight orhead circumference.

Obtain capillary

blood sample tomeasure andmonitor bloodglucose levels,reportingdeviations.

Interpret results of blood

glucose measurement. Implement interventions forblood glucose regulationaccording to locally agreedprotocols.

Ensure implementation of

evidence-basedguidelines.

Interpret and instigate appropriate

management and further investigation. Devise, audit and review guidelines forbest practice in partnership withmedical staff.

Care for babyreceiving bloodtransfusion.

Initiate phototherapyaccording to NICE jaundiceguidelines.

Care for the baby requiringphototherapy.

Care for the baby receivingexchange and partialexchange transfusion.

Prescribe phototherapyaccording toclinical need.

Investigatecause of pathologicalhyperbilirubinemia.

Prescribe blood and blood productsaccording to national and localpolicies.

Perform exchange and partial

exchange transfusion. Devise, audit andreview guidelines forbestpractice in partnership withmedical staff.

Fluid, electrolyte, nutrition and elimination management (continued)


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Recognise normal

behaviour in babiesof differentgestations, includingsleep/awake states.

Report deviationsfrom normal.

Recognise expected reflexes andbehaviour of babies of differinggestational ages.

Recognise deviations fromexpected reflexes and behavioursassociated with neurologicaldeficits and report results.

Recognise physiological andbehavioural differences betweenstress, distress, discomfort, pain,convulsions and drug withdrawal.

Provide anticipatoryguidance and support forstaff to recognisephysiological andbehavioural differences.

Initiate referrals basedon need.

Completeavailable/appropriateassessment tools andreport findings.

Utilise a validated, gestationalage-relevant pain assessmenttool.

Interpret outcomes of painassessment.

Devise, audit and reviewguidelines for bestpractice in partnershipwith medical staff

Initiate appropriatetreatment.

Anticipate potentiallyadverse events andminimise theirimpact.

Implement strategies thatminimise noxious and painfulexperiences.

Alleviate baby's discomfort, painand stress using pharmacologicaland non-pharmacologicalmethods.

Review care andmanagement strategies toavoid/minimise the impactof adverse events.

Devise, audit and reviewguidelines for bestpractice in partnershipwith medical staff.

Recognise and reportovert signs of pain.

Provide routinenursing care toalleviate pain andstress to the neonate.

Recognise and report subtlesigns of pain.

Implement strategies thatminimise painful experiences.

Devise protocols to reducestress and relieve pain.

Audit stress relief andpain reduction protocols.

Recognise behaviourassociated withneonatal abstinencesyndrome (NAS).

Provide routinenursing care toalleviate effects of

NAS.

Interpret the outcomes of assessment of NAS.

Implement strategies thatminimise the adverse effectsof NAS.

Provide support and guidance forstaff/carers involved in the care

associated with maternal drugdependency and NAS. Initiate referrals relating to

ongoing need and support inrelation to NAS.

Develop strategies forstaff regarding maternaldrug dependency andNAS involvingmultidisciplinary/agencygroups.

Initiate referrals based

on need.

Use developmentalcare strategies:includingenvironmentalaspects, positioningand handling.

Assess the neonatal environmentin relation to neurodevelopment.

Implement strategies thatminimise the adverse effects of the neonatal environment onneurodevelopment.

Adapt strategies to meet the

needs of specific babies.

Promote the use of developmental carestrategies.


Neurological, pain and stress management


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Recognise normal

respiratory/cardiovascular function.

Report deviations fromnormal.

Recognise and measuredeviations from normalrespiratory andcardiovascular function.

Interpret trends in theresults of blood gasanalysis.

Intervene torestore/maintainhomeostasis.

Interpret trends andevaluate management,including blood gasanalysis.

Define normal limits. Instigate appropriate

investigations andmanagement.

Observe resuscitation of the neonate.

Initiate basic life supportmeasures.

Recognise need for andrequest assistance.

Recognise the need for,and request assistance inrelation to, basic lifesupport.

Perform basic life support. Assist with advanced

resuscitation andstabilisation.

Team lead in basic lifesupport situation andstabilisation.

(In some situations performthe role of an advancedresuscitator).

Perform and leadadvanced resuscitation.

Safely administer oxygentherapy via the incubator,head box, nasal cannulaeand facially, includingadequate humidificationas prescribed.

Intiate oxygen therapy viathe incubator, head box,nasal cannulae and facially.

Initiate respiratory supportvia the use of nasalcontinuous positive airwayspressure (CPAP).

Safely care for the babyrequiring all methods of mechanical ventilationincluding CPAP.

Adjust respiratory supportaccording to need withinlocal guidelines.

Initiate and managerespiratory support.


Use safe and effectiveoral and nasal suctiontechniques.

Assess the need for suctionof respiratory secretions.

Use safe and effective oraland nasal suctiontechniques.

Use safe and effectiveendotracheal tube/tracheostomy suctiontechniques.

Perform chestphysiotherapy techniquesas prescribed.

Review and evaluate theeffectivenessof physiotherapy and suctioninterventions.

Prescribe chestphysiotherapy.



Recognise the need forintubation/extubation.

Perform extubation. Assist with

elective/emergencyintubation.

Perform intubation.

Assist with theinsertion/removal of chestdrainage.

Provide care for neonatewith chest drain in situ.

Insert, secure andremove chest drainage.

Devise, audit and review

guidelines for bestpractice in partnershipwith medical staff .

Respiratory and cardiovascular management


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Implement correct hand

washing and otherinfection preventionmeasures as per localguidelines.

Ensure compliance withinfection preventionguidelines.

Perform aseptic and non-touch techniques.

Educate family/carers incorrect hand hygienetechniques.

Ensure compliance withinfection preventionguidelines.

Devise, audit and reviewguidelines for best practicein partnership with medicalstaff.

Audit compliance withbest practice in relationto infection controlmeasures.

Research evidence-basedpractice to supportguidelines for infectionprevention.

Examine skin and

mucous membranes,eyes and cord base fordeviations from normaland report.

Implement treatment fordeviations as prescribed.

Assess skin integrity

anticipating the baby at riskof iatrogenic skin damage. Implement strategies to

prevent iatrogenic damageand potential injury.

Utilise strategies tomaintain hygiene and skinintegrity, including stomacare.

Prescribe, manage

therapies to promoteskin integrity. Devise, audit and review

guidelines for bestpractice in partnershipwith medical staff.

Use appropriatemeasures to maintainhygiene and skinintegrity, including stomacare.

Recognise expected woundhealing processes.

Apply therapeuticdressings.

Refer to specialists asrequired eg stoma care.


Prescribe treatments. Refer as appropriate.

Skin, hygiene and infection prevention management


Assess neonatal bodytemperature usingappropriate method andsite report deviationsfrom normal.

Assess neonatal bodytemperature usingappropriate method andsite.

Monitor central andperipheral temperature gap.

Devise, audit and reviewnursing guidelines fortemperature monitoring.

Use appropriatestrategies to maintainbody temperature withinnormal limits, includingenvironmental aspects,clothing and equipment.

Anticipate the baby at riskof temperature deviations.

Intervene to preventtemperature deviations.

Implement strategies tocorrect temperaturedeviations.

Devise, audit and reviewnursing guidelines fortemperature regulationstrategies.


Investigate and treattemperature deviations.

Management of thermoregulation


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New entrant Neonatal nurse (QIS) Experiencedneonatal nurse Expert neonatal nurse

Perform routine diagnostic andtherapeutic proceduresaccording to protocols andguidelines.

Implement prescribedmanagement.

Recognise the significanceof results and seekappropriate management.

Instigateappropriatemanagement.

Request specimens andsamples.

Prescribe appropriatemanagement accordingto results.


Assist in the care of babiesrequiring special care

undergoing non-invasiveinvestigations and procedures.

Assist in the care of aneonate requiring high

dependency and intensivecare, undergoing non-invasive and invasiveinvestigations andprocedures.

Perform non-invasive andinvasive procedures.

Assist in the care of babiesrequiring special careundergoing blood sampling.

Perform capillary bloodsampling.

Assist in the care of babiesrequiring high dependencyand intensive careundergoing blood sampling.

Performvenepunctureaccording to localguidelines.

Perform arterial andcentral linesampling.

Insert arterial,percutaneous centralvenous catheter andcentral lines.

Measure blood pressure usingnon-invasive techniques,reporting deviations fromnormal.

Set up arterial bloodpressure transducer.

Measure arterial bloodpressure.

Interpret bloodpressure recordings.

Prescribe appropriatetherapy to maintainhomeostasis.

Care for neonate receiving bloodtransfusion.

Care for neonate receivingexchange and partialexchange transfusion.

Prescribe blood andblood products accordingto national and localpolicies.

Perform exchange andpartial exchange.

Administer drugs via oral,topical, rectal and intramuscularroutes, according to

professional and local policies. Assess the therapeuticresponse.

Identify side effects and reportappropriately.

Administer drugs via IVroute according toprofessional and local

policies. Assess the therapeuticresponse.

Identify side effects and actappropriately within localguidelines.

Review therapeuticresponse and actaccordingly within

local guidelines.

Prescribe and administerdrugs via all routes,according to national and

local policies. Plan, implement andevaluate drug therapies.

Evaluate therapeuticresponse/side effectsand act accordingly.

Investigations and procedures as applied to neonatal nursing


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New entrant Neonatal nurse (QIS) Experienced neonatal nurse Expert neonatal nurse Clean and store

equipment necessary forthe care of babiesrequiring special care inaccordance with local andmanufacturersinstructions.

Clean and store equipmentnecessary for the care of babies requiring highdependency and intensivecare in accordance withlocal and manufacturersinstructions.

Set up and testequipment necessary forthe care of babiesrequiring special care in

accordance with local andmanufacturersinstructions.

Set up and test equipmentnecessary for the care of babies requiring highdependency and intensive

care in accordance withlocal and manufacturersinstructions.

Devise guidelines for thesetting up and testing of equipment.

Efficiently and safely useequipment necessary forthe care of

rcn competences neonatal

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