Between 6 and 10 per cent of sick or premature newborns and babies spend time in specialised neonatal units where they receive 24-hour care. There are three levels of care: intensive for the most seriously ill babies, high dependency for those who are not critically ill but still need complex care, and special care for well babies who are catching up on growth and development after a premature birth or those who are getting better after more complex treatment.
Under the guidance of the nurse manager, NNNs take responsibility for the nursing care and daily living needs of babies from admission to discharge. This includes:
care of babies' basic personal hygiene, bathing, nappy changing and oral hygiene planning feeding regimes and carrying out drip and tube feeding, monitoring temperature, pulse, respiration, blood pressure, oxygen saturation and weight monitoring blood glucose levels and/or serum bilirubin levels keeping appropriate records and reporting abnormal findings providing play sessions for older long-stay babies. An important aspect of the role is to give advice, guidance and support to parents. NNNs demonstrate all aspects of baby care to parents, including breastfeeding and milk feed preparation, bathing, temperature control, safety at home, travel safety, cot death prevention and basic life support.
They may also assist with the smooth running of the human breastmilk bank and help facilitate the training of new staff and students. They also maintain their own personal development with support from their departmental manager.
QUALIFICATIONS AND TRAINING
Applicants for NNN posts must hold a Level 3 qualification in childcare and education. They should have some experience of caring for babies, preferably in a hospital setting, although this is not essential.
A comprehensive induction programme and mentorship is provided for new post holders. Induction may include a general corporate induction to the hospital with sessions on fire safety, infection control and equality and diversity, followed by ward orientation and role-specific training.
Mandatory training days cover child protection, basic resuscitation, and health and safety at work including manual handling, fire safety and record keeping.
Post holders are also responsible for maintaining their own knowledge and clinical skills as requested by the unit senior staff and the needs of the service. If the hospital has a milk bank, there may be training on the recruitment of donors and pasteurisation of donor breastmilk.
There are also opportunities to attend short courses. Unicef has designed a three-day Neonatal Breastfeeding Management course and it is often delivered in-house. It provides staff with the background knowledge and practical skills they need to support mothers to initiate and maintain lactation.
St George's, University of London, runs two modules designed to be studied concurrently. The Applied Neonatal Pathophysiology module gives novice neonatal practitioners the necessary grounding in neonatal pathophysiology to develop their evidence-based practice. The module Foundations of Neonatal Special and Transitional Care helps them develop reflective skills, enabling practitioners to analyse the care of the special care baby and family.
The special care baby charity Bliss holds study days. Practical Approaches to Improving Family-centred Care is a one-day course aimed at exploring the innovative approaches and practical solutions of family-centred care that have been developed with limited resources in neonatal services.
With thanks to NNN Jo Kidd at King's College Hospital NHS Foundation Trust for training information.
CASE STUDY: YING GIBSON
I have worked on the Neonatal Intensive Care Unit (NICU) at the Princess Alexandra Hospital, Harlow, since January 2000. My work currently includes taking observations of babies' temperature, heart rate, respirations and blood pressures. I take blood from babies' heels for routine bloodspot tests, jaundice levels and blood glucose levels. I feed babies using nasal gastric tubes as well as working out their feeding requirements. I also look after babies who require oxygen via nasal cannulas and administer some oral medicines.
I particularly love teaching, guiding and supporting parents with the care of their premature or sick babies. Having a baby early or sick is not what parents wanted or expected to happen. As they are so much smaller then a term baby, many parents have missed out on their parent craft classes and may not have even held a baby before. Parents also find the thought of taking their baby home very daunting. I help to build their confidence by providing them with the basic skills to care for and bond with their baby. I also help parents with breastfeeding and bottle feeding, nappy changing and bathing.
Parents find it very helpful when I assist them with holding and supporting their babies. Many have told me that although they had wished their baby had not needed to be admitted to NICU, the positive aspects they got from their experience with us is that they have the time to get to know their baby, have lots of support and are able to build their confidence as a parent before taking their baby home.
I go home from my 12-hour shift knowing that I have helped make a difference - seeing sick or premature babies admitted to the unit, get well and grow, ready to go home with happy and confident parents who are able to care for their baby and continue to become the family that they had planned for.
CASE STUDY 2: JO KIDD
Jo is a NNN at Kings College Hospital NHS Foundation Trust. King’s has one of the largest milkbanks in the UK and Jo’s training has included recruitment of donors and pasteurisation of donor breastmilk. As part of a team, she assists mothers to breastfeed and express. With the support of the Senior Play Therapist in Paediatrics, Jo is currently developing some play sessions for older babies who are long-stay patients