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Celebrating Two Years of NEWTT2: A Milestone in Neonatal Care

What is NEWTT2?

The Newborn Early Warning Track and Trigger 2 (NEWTT2) Deterioration of the Newborn framework, published by the British Association of Perinatal Medicine (BAPM) in 2023, is a novel set of safety tools designed to standardise the enhanced assessment of newborns at higher risk of ill health. NEWTT2 is an evolution of previous early warning systems (EWS), principally NEW (Plymouth, UK, 2010) and NEWTT (BAPM, 2015), developed by a UK multidisciplinary collaborative team, expanding into a set of interlinking tools for consistent identification, observation, escalation and clinical review of the at-risk newborn (www.bapm.org/pages/newtt-2).

The framework brings together national guidance and standards for early care of the newborn whilst acknowledging that there are certain conditions where such national steer does not exist, and local and regional decision making is required.

Who is NEWTT2 for?

NEWTT2 is recommended for use in at-risk newborns, as defined in the framework, in postnatal settings such as postnatal areas, transitional care and delivery suite, for both term and late preterm newborns.

How should NEWTT2 be implemented?

NEWTT2 and its allied tools were designed and tested during 2021-23. Testing, consensus and feedback was taken into consideration when choosing the charts’ colour schemes. Colour is especially important for the teams using paper versions of the charts including those implemented by the early adopter organisations and high-quality printing is required.

Since launching the framework clinical stakeholders have contributed to the development of the digitalisation of these tools. A blueprint for digital specification has been led byNHS England and is expected to launch in June 2025. All digital tools must be available to the entire perinatal team to ensure complete access to data and patient safety.

In your organisation the perinatal safety team would be an ideal collaborator to implement the NEWTT2 tools and wider framework. One of the many strengths is the emphasis on joint working and support between maternity, neonatology and parents to enhance patient safety.

Why should we implement NEWTT2?

A BAPM survey of UK centers in 2021 noted that 79% of respondents used a version of NEWTT. Encouraged by this uniformity, the NEWTT2 working group sought to further minimise unwarranted variation in newborn observation by developing updated and novel universally adoptable tools that are becoming familiar to all, including rotating trainees and temporary perinatal staff. NEWTT2 has become an essential requirement for perinatal teams to deliver (https://www.england.nhs.uk/publication/three-year-delivery-plan-for-maternity-and-neonatal-services/).

 

Which tools are available?

In addition to describing those newborns categorised as at-risk requiring enhanced observation there are three tools:

  1. NEWTT2 Observation Chart: Generates a total NEWTT2 Score
  2. Standardised Escalation Tool: Determines when and who should respond
  3. Joint Review Tool: Ensures a combined standardised response

To access all of the tools click here deterioration-of-the-newborn-newtt-2-a-framework-for-practice

All observations should be conducted every time (except for glucose which should only be measured where and when indicated). The frequency of observations is determined by national guidance or if none exist by local clinical discretion.

BAPM has a dedicated NEWTT2 webpage permitting free immediate access to the entire framework, all the tools, learning packages, FAQs and an enquiry system.

What’s new in NEWTT2?

  1. Involving Parents as Partners in Escalation of Care

One of the key features of NEWTT2 is the inclusion of “parental concern” as a factor in the care process. The framework emphasises the importance of including parents as partners in care, recognising their concerns as a vital part of the process. This acknowledges that there may be various reasons for escalating care beyond clinical observation findings alone and both parents and carers can seek help through escalation whenever necessary.

  • Preventing harm: the big 3!!!
  • The hypothermia blue line

We need to minimise the risk of newborns cooling down after birth as hypothermia is an avoidable harm for all babies not just those categorised as high-risk (https://www.england.nhs.uk/mat-transformation/reducing-admission-of-full-term-babies-to-neonatal-units/). So mild hypothermia, 36.0C-36.4C is a pale blue colour on the chart and prompts actions to warm baby with the goal that the temperature does not fall lower to more serious values. Hypothermia is associated with an increase in morbidity and mortality.

  • Colour assessment and detection of hypoxia

In line with the national publication Review of neonatal assessment and practice in Black, Asian, and minority ethnic newborns report (July 2023, NHS Race and Health Observatory https://www.nhsrho.org/wp-content/uploads/2023/08/RHO-Neonatal-Assessment-Report.pdf) NEWTT2 provides guidance on the assessment of colour in all skin tones and supports the use of pulse oximetry with documentation of the % oxygenation value within the appropriate section of the chart. Hypoxia is an avoidable harm.

  • Glucose measurement where indicated

Only a few newborns require glucose monitoring and NEWTT2 does not recommend unnecessary interventions such as blood tests during what is a transition period for metabolism and an essential time to support the establishment of feeding. Hypoglycaemia however is one of our Big 3 as it can cause life-long brain injury and it is our responsibility to support the feeding and glucose monitoring of newborns where required.

  • Observation Scoring

Guidance is provided on how to complete the observation chart. Each observation is plotted within specific colour-coded boxes: white (score zero), yellow/amber/pale blue (score 1), pink/red (score 2), and purple for critical observations that require immediate escalation. A total score, the NEWTT2 score, is calculated for each set of observations.

  • Escalation Tool

The total NEWTT2 score triggers one of five escalation levels or advises the continuation of routine care. The levels define the speed and seniority of response expected and have an in-built safety back-up response as required. Please note that healthcare professionals can override the NEWTT2 score to request a higher escalation at any time, but they must not dismiss a total NEWTT2 score and not act.

The Future

The NEWTT2 team are supporting implementation within perinatal centres in both paper and digital formats.

Initial feedback from early adopters has been very promising with reports of improvements in avoidable admissions to neonatal units and improved perinatal team working. We are currently developing a simple quality improvement tool for centres to utilise to assess local impact with an option to input into a UK collaborative sharing of data which will subsequently inform a wider evaluation of workload, acceptance and effectiveness.

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The Kate Farrer Foundation was established in memory of Dr Kate Farrer, a distinguished neonatal consultant at Addenbrooke’s Hospital and Transport Lead for the East of England. Sadly, Kate died in 2014 following a short illness. Her family set up a foundation in her name & have funded the Kate Farrer Scholarship since 2021.

Visit the Kate Farrer Foundation website: http://www.katefarrer.org/

The NNA is a member of the Council of International Neonatal Nurses (COINN) who we collaborate and partner with closely. COINN is a global organization that represents nurses who specialize in the care of newborn infants and their families. As a COINN partner, the NNA and its members are part of an international community and voice of neonatal nurses across the world. NNA members are automatically joined to COINN membership and can be a valued and integral part of this global voice.

Visit COINN: https://www.coinnurses.org/

Band 8: Lead Neonatal Nurse Researcher / Neonatal Nurse Research Consultant

Recording

Band 7: Senior Neonatal Nurse Researcher

Coming soon

Band 6: Neonatal Nurse Researcher

Coming soon

Band 5: Neonatal Nurse

Coming soon

Network Governance

To achieve a role in network governance, you will be required to hold a position as a senior neonatal nurse and have an interest in wider governance issues within neonatal services. You will also have a responsibility for completing reports that highlight learning throughout the network and demonstrate learning to national bodies.

Nursing voice

 

Hello, I’m Robyn Smart – I work for the South West Neonatal ODN as a Senior Lead Nurse.

My role has  grown over the course of my seven years in post. One of the joys of working as part of a network is it’s ever evolving and changing in shape. I am proud and feel a sense of privilege to work in this role, particularly as we are able to adapt and support the wider needs of neonatal services within our region.

My career has been exciting and I’ve been grateful to have been inspired from an early stage by committed and passionate senior nurses. I’m thankful for the opportunities that have presented themselves to me and enjoyed a variety of different development activities.   My clinical background has been in tertiary neonatal services in a busy city, working my way from a newly qualified Band 5 to a Band 7 Neonatal Sister.

I’m grateful to work as part of a network that values and demonstrates appreciation for the whole neonatal pathway journey that a family might embark on, and enjoy exploring the different strengths within the units that we support.

I have completed a number of different leadership programmes, enjoyed advancing my communication though the use of coaching and mentoring.  All of which have supported my confidence when working in such a varied role.

As a nurse within the network – I have a number of responsibilities, Workforce planning and development, Network Governance, Team support and leadership.  I am good at holding lots of information in my head, and making connections with various work streams, which supports continuity of projects across the region, as well as strengthens the fruitfulness of the regional work we engage in.

Governance is a significant role of Neonatal Networks – we work collaboratively with neonatal services to provide oversight of the neonatal pathway, though the use of data and regional process. We work hard to ensure that neonatal services are working in alignment with the National Neonatal Service Specification, and are close stakeholders of NHS England, both regionally and nationally. We note trends and themes across a range of different processes. Some of which include, Incidents, Risk, Exceptions, Workforce, Operational Escalation, Guidelines and Policies and Sharing learning and disseminating good practice.

It’s a hugely varied role, with lots of different interesting elements. My strategic perspective and ability to think outside the box allows me to explore neonatal governance in a different way, with a strong focus on compassionate leadership.

Building connections and relationships has always been what I’m pulled towards. While I enjoyed clinical nursing, my passion has always been for listening and understanding more about families to help improve neonatal services, and supporting staff to maximise their professional potential.

If you’re interested in learning from experience, feedback and listening to what’s worked well…and what hasn’t worked so well sometimes, then regional governance might be an interesting place for you.

 

Governance Matron

Coming soon..

Risk Link Nurse

A risk link nurse is a qualified nurse who is responsible for reducing risk and promoting patient safety.
 

As part of their role, risk link nurses will be expected to understand how patient safety and risks are managed on the unit, work with nurses and other neonatal professionals to minimise errors, use or create incident reporting and management systems, and support or develop training in patient safety. In addition, a risk link nurse will be expected to work with other specialities to share learning and ensure the highest levels of safety for patients and their families.

Nursing voice
 

My name is Annamma Binu. I work across sites as a Neonatal Risk Lead at Royal Free and Barnet Hospitals. As part of my role, I take responsibility for leading investigations of significant events and patient safety incidents, producing and monitoring action plans along with the divisional governance leads and departmental leads. I also participate in various patient safety meetings at a departmental, trust level and network level. Learnings from incidents, audits and death are shared with the staff on a regular basis. I review the guidelines and policies and encourage to adopt policies in alignment with the network. I also review the incidents, identify the recurrent themes, present in the clinical risk meetings then adopt an MDT approach to address the issues.

Governance role within wider nursing team

The governance role requires nurses to have a strong understanding of patient safety, risks on the unit and how to minimise errors. Governance nurses often use incident reporting and incident management systems to reduce risk on the unit and to address concerns. 

The role requires nurses to link with other specialities when divisional opportunities arise to allow learning to be shared across all areas of neonatal care. Governance nurses work closely with neonatal educators to support patient safety training and ensure the provision of high-quality care that poses minimal risk to patients. 

Nursing voice

I’m Lora Alexander, one of the Quality Improvement coaches in a busy Level 3 NICU. QI is all about understanding problems, thinking of solutions, implementing ideas and analysing the results.  

I started in QI by working on a national improvement project, through which I received training in QI; Fundamentals of Improvement, Improvement in Practice and then QI Coaching.  It’s a great field to explore. Neonatology is a young speciality, and it’s always changing and developing. QI allows us to make these changes safely, in a way that can be duplicated if it works, and easily changed if it doesn’t. QI gathers the multi-disciplinary team together for one purpose. It takes a whole team, from the most junior to the most senior. Everyone’s voice is valued in QI. It’s wonderful to see the passion and dedication nurses have to improve care for mothers and babies.

Anyone can and should be involved in QI. It’s a challenge some days, and a mental shift from a success – failure mindset. QI is all about learning what works and what doesn’t. There’s no failure, just information gathered to plan the next PDSA cycle. But it’s going to be increasingly important for the nurses of the future, so begin now.

Clinical Educator

The Clinical Educator will develop and deliver educational programs (including mandatory training), support clinical practice improvements, and promote evidence-based care for babies. They will mentor new staff and liaise with multidisciplinary teams to optimise neonatal care quality and safety. They may also work closely with the student nurses and ensure familiarity with equipment and national guidance.

Nursing voice

Network educator

Network educators play an important role in shaping MDT education within neonatal networks. The role requires nurses to consider and respond to local and national education drivers. Network educators are also required to nurture a supportive educational environment to ensure staff learn and develop the skills required to deliver safe, evidence-based care to premature babies and their families.

Network educators may be required to both create and deliver training programmes that support professional development of nurses, AHPs and medical staff, as well as non-registered clinical workforce.

Nursing Voice

My name is Adedoyin Yissau, also known as Dee. I am the Education and Workforce Lead for the London Operational Delivery Network. I came into post as a Network Educator in 2019 and have since developed nursing education region wide, with the current focus on developing a nursing career pathway for London.

My non-healthcare friends often call me an anomaly because I genuinely love my profession. I am passionate about driving change on a larger scale and having the privilege to collaborate with a wide range of talented and innovative professionals, from clinical colleagues to national and governing Bodies.

There are numerous opportunities in neonatal care beyond the traditional clinical nursing role. I chose the management pathway, completing several leadership courses through the Leadership Academy. I became a nurse in charge, deputised for the matron, and later applied for a network education role to expand my practice. I now serve as the Education and Workforce Lead and Chair of the National Educators Forum.

I take pride in bringing diversity to senior leadership and fostering a collaborative environment. I am committed to raising awareness about London’s diverse population; not just in terms of race, but also neurodiversity, inclusivity, equality and openness within the workforce and the service. Training is the key to progress, career development, and feeling valued. Don’t be afraid to challenge the status quo and break down barriers—rise to the challenge.

My motto is: I am not ‘just a nurse’…I am a Neonatal Nurse.

 

Hello, my name is Kim Edwards, and I am a Neonatal Nurse. I am currently the Lead Nurse and Workforce, Education Lead for the Thames Valley and Wessex Neonatal Operational Delivery Network (ODN)

I am an adult trained nurse and I moved into the specialty of neonates from a background in adult and paediatric intensive care. After completing the Neonatal Intensive Care Course in 1991 I have had various roles and responsibilities within neonatal nursing including leadership and managerial as a Senior Sister in a Neonatal Intensive Care Unit and in education.
However, it was my interest and Lead Practice Educator role that led me into a Network Education role where I developed and implemented a Foundation Education Programme for new nurses to the specialty.

During this time, I undertook a master’s degree in professional health sciences at Southampton University which has provided me with skills, knowledge and confidence for my current role as Lead Nurse when writing proposals, business cases, understanding and interpreting data and using all available evidence to support neonatal nursing and services.

 

Neonatal Network Nurse Educator
My name is Rachna, I’m a neonatal nurse. I completed my BSc in Nursing in India. I’ve been fortunate to work within the NHS since 2010. 
In my role, I work to identify the training needs of neonatal staff and I collaborate with the Network and our educator teams to design and deliver training programs. I also have the opportunity to discuss any training gaps at national meetings and work with other neonatal networks and maternity colleagues to put together training days for staff. I genuinely believe in the importance of listening to staff concerns and sharing them with wider national teams to find helpful support programs.
I’m currently working towards a Master’s in Medical Education. My master’s work explores ways to promote equal opportunities and offer support to colleagues as they navigate new work cultures, with a particular interest in how overseas nurses develop their professional identity. As part of this, I developed a three-day transition program for international colleagues, which was recognised with the Neonatal Nurses Association (NNA) Nurse of the Year award.

Education lead

The Education Team Lead will oversee the work & direction of the educator team. They work toward staff competency, compliance with national requirements and lead on performance management.

Nursing voice

Resources

NNA LEaRN Group –  https://nna.org.uk/special-interest-groups/linking-education-research-in-neonatal-care/

HEI Educationalist

A HEI Educationalist designs and delivers specialised education for student nurses. They will deliver the Childrens’ and Young People nursing course, that includes neonatal nursing. They integrate clinical practices and academic research to enhance skills and knowledge. They deliver a programme of education using multiple methods and evaluate and update curricula to reflect current best practice. They will have expertise in the subject area and support students to complete their education.

Nursing voice


 
My name is Dr. Julia Petty, and I am a nurse lecturer specialising in children’s nursing with a particular interest in neonatal care. My nursing career in paediatric and neonatal clinical nursing practice began after a BSc Hons degree in Psychology at Warwick University, when I moved to Great Ormond Street Hospital, London. Here, I trained in children’s and adult nursing before working there for many years in children’s and neonatal surgical care. I then gained my neonatal nursing qualification at St George’s NHS Trust London and worked at the Whittington NHS Trust NICU before moving back to Great Ormond Street for a senior education role on NICU where I worked until 2001. I then worked as Senior Lecturer at City University, London for 12 years leading the neonatal nursing education portfolio. I studied for a MSc, a PGCE and MA in academic practice during this time, In 2013, I moved to the University of Hertfordshire where my role is Associate Professor (learning and teaching) and Senior lecturer child nursing. I teach on the BSc Hons nursing and master’s degree programmes including leadership of modules, face-to-face/online teaching, assessing and supervision of students at all levels up to doctorate level.  I am also research active and have completed a Doctorate in Education. As a nurse, educator and post-doctorate researcher, my interests focus on parents’ premature birth experiences, supporting parents in the transition home from NICU, exploring communication needs of neonates and their carers and studying the educational value of digital storytelling. This combination and variety of roles enriches my working life and brings together my experience as a child / neonatal nurse, educator and researcher. My role and related activities enable me to engage in both education and research while supporting students on their nursing career and education pathway, which is a privilege to be part of.
 

Director

The Network Director maintains overall leadership responsibility for the network. The role is open to clinical and non-clinical staff but it is likely you will be required to complete a Master’s degree.

Network Deputy Director/Senior Lead Nurse

Network structures vary around the country, but many employ a Deputy Director or a Senior Lead Nurse. This role acts as a line manager to the wider network team, including QIS nurses, Care Coordinators, AHPs and Education team.

As a senior lead nurse, you would be required to support and manage each team as they navigate their work programme. The role also includes responsibility for leading region-wide projects and linking regional teams with wide regional and national initiatives.

Before you can apply for this role, you will need to gain extensive experience across a number of neonatal nursing roles including management, education, advanced clinical practice. You would also benefit from experience within a network role and being involved in national groups, which provides experience outside of your neonatal unit.

Nursing voice

Hello, I’m Robyn Smart – I work for the South West Neonatal ODN as a Senior Lead Nurse.

 My role has  grown over the course of my seven years in post. One of the joys of working as part of a network is it’s ever evolving and changing in shape. I am proud and feel a sense of privilege to work in this role, particularly as we are able to adapt and support the wider needs of neonatal services within our region.

 My career has been exciting and I’ve been grateful to have been inspired from an early stage by committed and passionate senior nurses. I’m thankful for the opportunities that have presented themselves to me and enjoyed a variety of different development activities.   My clinical background has been in tertiary neonatal services in a busy city, working my way from a newly qualified Band 5 to a Band 7 Neonatal Sister.

 I’m grateful to work as part of a network that values and demonstrates appreciation for the whole neonatal pathway journey that a family might embark on, and enjoy exploring the different strengths within the units that we support.

 I have completed a number of different leadership programmes, enjoyed advancing my communication though the use of coaching and mentoring.  All of which have supported my confidence when working in such a varied role.

 As a nurse within the network – I have a number of responsibilities, Workforce planning and development, Network Governance, Team support and leadership.  I am good at holding lots of information in my head, and making connections with various work streams, which supports continuity of projects across the region, as well as strengthens the fruitfulness of the regional work we engage in.

 Governance is a significant role of Neonatal Networks – we work collaboratively with neonatal services to provide oversight of the neonatal pathway, though the use of data and regional process. We work hard to ensure that neonatal services are working in alignment with the National Neonatal Service Specification, and are close stakeholders of NHS England, both regionally and nationally. We note trends and themes across a range of different processes. Some of which include, Incidents, Risk, Exceptions, Workforce, Operational Escalation, Guidelines and Policies and Sharing learning and disseminating good practice.

 It’s a hugely varied role, with lots of different interesting elements. My strategic perspective and ability to think outside the box allows me to explore neonatal governance in a different way, with a strong focus on compassionate leadership. 

 Building connections and relationships has always been what I’m pulled towards. While I enjoyed clinical nursing, my passion has always been for listening and understanding more about families to help improve neonatal services, and supporting staff to maximise their professional potential. 

 If you’re interested in learning from experience, feedback and listening to what’s worked well…and what hasn’t worked so well sometimes, then regional governance might be an interesting place for you.

Lead Nurse - Divisional Level

The Lead Nurse role at network level provides an interface between what is happening locally in units, specialised commissioning and nationally. The Lead Nurse at network level represents and advocates for neonatal nurses and the wider multidisciplinary workforce.

Nursing voice

Hello my name is Claire Richards and I’m the Lead Nurse for the Wales Maternity and Neonatal Strategic Network. This covers nursing leadership but also Neonatal transport. I also have a clinical honorary contract in one Health Board.

27 years of my nursing career has been dedicated to neonates although I qualified as an adult trained nurse. As a result of obtaining my Foundation in neonatal care, Qualified in Speciality, a Degree in Professional Practice and being successful in my career progression, I have gained a tremendous amount of knowledge and skills to be in a senior leadership position. I have worked for the Network since its inception, leading in the development and delivery of the transport service, prior to gaining the Lead nurse position.

My role links with many services such as the Neonatal transport Group (NTG), UK Network Lead Nurse group, Welsh Ambulance, EMRTS etc. This is aside of the regular engagement I have with the Leads in Welsh Units and neighbouring services.

I absolutely love my role as every day is different, bringing new challenges and is extremely rewarding.

—

Hello, my name is Kim Edwards, and I am a Neonatal Nurse. I am currently the Lead Nurse and Workforce, Education Lead for the Thames Valley and Wessex Neonatal Operational Delivery Network (ODN)

I am an adult trained nurse and I moved into the specialty of neonates from a background in adult and paediatric intensive care. After completing the Neonatal Intensive Care Course in 1991 I have had various roles and responsibilities within neonatal nursing including leadership and managerial as a Senior Sister in a Neonatal Intensive Care Unit and in education.
However, it was my interest and Lead Practice Educator role that led me into a Network Education role where I developed and implemented a Foundation Education Programme for new nurses to the specialty.

During this time, I undertook a master’s degree in professional health sciences at Southampton University which has provided me with skills, knowledge and confidence for my current role as Lead Nurse. In writing proposals, business cases, understanding and interpreting data and using all available evidence to support neonatal nursing and services.

The Lead Nurse role at Network level is pivotal as it provides an interface between what is happening in the units, specialised commissioning and NHS England, where I represent and advocate as the voice of neonatal nursing and the wider multidisciplinary team workforce.

What I enjoy about my role is that I can influence what happens in neonatal nursing and have a much wider impact by using all my knowledge and experience from many years as a clinical neonatal nurse and now within a senior neonatal nurse leadership role.
Neonatal nursing has always been a privilege.

Chief Nurse

A Chief Nurse is another core role that underpins the visions and goals of a Trust. As a Chief Nurse, you would be responsible for clinical and professional leadership of nurses and other allied health professionals to deliver demonstrable progress in line with a Trust’s values and aims.

A Chief Nurse is responsible for the experience of patients and families within the Trust’s care, and will work closely with the Chief Medical Officer to ensure the highest standards of patient safety and clinical are.

Nursing voice

Head of Nursing

The Head of Nursing is a vital member of the senior leadership team. In this core role, you would take responsibility for all aspects of clinical nursing practice. This includes ensuring neonatal nurses within your team have the skills, confidence and knowledge to deliver high quality care.

A Head of Nursing is also responsible for leading neonatal nurses across services to ensure they have the resources they need and are meeting the standards of care required.

Lead Nurse - Unit Level

Responsibilities include managing nursing staff, ensuring adherence to clinical and national guidelines, and maintaining high standards of patient care and safety. They will review and develop services and care provision.

Nursing voice

Lynn Slade – University Hospitals Derby and Burton

 

Matron

A matron oversees the care of neonates. They manage nursing staff, ensure high standards of clinical practice, coordinate with medical teams, support families, and implement policies. Their role focuses on quality care, staff training, and resource management to ensure optimal neonatal health outcomes.

Nursing voice

Hello, my name is Jean and I am a registered children’s nurse with 27 years experience. I qualified with a DipHE after struggling academically due to dyslexia. Over my career I have worked mainly in PICU, NICU and children’s cardiac critical care. I am dual qualified in speciality (QIS) for both Neonatal and Paediatrics. The QIS program is a post graduate modular course completed at level 6/7. To be considered QIS you must successfully complete 4 separate modules, each have an academic and practical component. Only on completion of the QIS course can you apply for a band 6 role. In addition to the above qualifications it is expected you would have several years proven experience in speciality at Band 6 and 7 prior to applying for a Matron’s role.

I see the role of Matron as a bridge between services, departments, teams and individuals. I really enjoy being able to see middle ground and find new solutions to complex situations. I pride myself on ensuring the family’s interests remain at the heart of any decisions we make as a team. The role can be challenging, and at times frustrating but also extremely rewarding.

Resources

The NNA offers access to a Managers and Matrons Group.

Unit Manager

A neonatal ward manager oversees the care of babies born premature or sick. They manage staff, coordinate with the wider professional team, ensure compliance with regulations, monitor benchmarking and performance, and provide guidance to the team.

Nursing Voice

My name is Lisa Baker, I’m a Ward Manager on a Level 2 Special Care Baby Unit in South Wales and I’ve been in this role since 2020.  
 
I originally qualified as a Nursery Nurse after leaving school and after a few years of working in private day care I started work on SCBU in a Band 4 role. I absolutely loved this role and quickly looked to pursue a nursing qualification. I was lucky enough to be seconded by the Health Board to undertake a BSc in Childrens Nursing and then returned to the unit as a Band 5 Staff Nurse. My passion for neonates grew and I progressed to a Band 6 role with both the HD and IC modules under my belt.
 
In 2020 our Ward Manager retired and I felt ready for my next challenge. I completed a Leadership course at Masters level and this gave me good skills to bring to our unit.
 
My role is predominately non-clinical, based on the ward and I like being visable and accessible to the team. I also enjoy being able to see the families in our care progress through to discharge. My role is varied but includes the day to day management of the ward, including staffing, roster management, sickness and absence plus playing a big part in governance and patient safety.
 
I work alongside many other professionals and in close partnership with our Band 8a Senior Nurse, and our medical team.
 
Every day is different and I love the challenges that my role brings along with the pride in knowing I can support quality improvements that will help the families in our care.

Resources

The NNA offers access to a Managers and Matrons Group.

Shift Coordinator

A Shift Coordinator is responsible for supporting the daily activities on the Neonatal Unit. This role is in place to given nurses and medical staff access to clinical expertise and advice to ensure optimal care for babies and families on the unit.

Shift Coordinators work closely with the multidisciplinary team in assessment planning and delivery of care, providing an enhanced level of care for those staying on the unit. Nurses who take on this role are also required to identify and contribute to development opportunities within the unit on an ongoing basis. The role also required coordinators to organise and coordinate workloads on each shift.

To be considered for this role, discuss with senior members of the MDT team and your line manager. You should also choose a particular area of interest that you would be interested in developing within your unit, both on a day-to-day basis and as part of a project. 

Nurse Consultant

A Neonatal Nurse Consultant is an advanced practice nurse. They provide expert clinical care, lead neonatal nursing practices, develop services and ensure high standards of care.

Nursing voice

Senior ANNP

The Senior ANNP role will likely include line managing ANNPs and trainee ANNPs, as well as covering clinical shifts supporting the consultant and junior medical team on the neonatal unit, delivery suite and the postnatal ward.

Senior ANNPs will also sit on working groups and attend strategic meetings to ensure the highest quality of care for all babies and families.

Nursing voice

Hi, I’m Adele Farrow and I am the Lead ANNP on a level 2 neonatal unit.

My role includes line managing the other ANNPs and trainee ANNPs on the unit, as well as covering clinical shifts where I support the consultant and junior medical team on the neonatal unit, delivery suite and the postnatal ward. I also sit on a number of working parties and attend strategic meetings to ensure we continue to provide the highest quality of care to all our patients. I am currently leading the development of the transitional care unit, working closely with midwifery and neonatal colleagues to decrease separation of families.

I completed by Childrens’ Nursing degree back in 2005 and then started working on a tertiary neonatal unit. I knew neonates was where I wanted to work so I then completed my QIS course and got promotion to Band 6. I observed some fantastic ANNPs in practice and decided that would be my career path. I completed my ANNP course in 2013 in Southampton and then completed my Masters Dissertation in 2016. I then enjoyed a period of consolidating my practice on a tertiary unit and later as a Transport ANNP on a regional transport team.

I enjoy simulation and resuscitation training so also instruct on NLS and ARNI courses. I have also completed a scholarship through the NNA which I thoroughly enjoyed, and this gave me real insight into possible improvements with the neonatal setting and gave me new aspirations for my future.

Last summer I applied for my current job as a Lead ANNP. I can honestly say I feel incredibly lucky to have my dream job and love coming to work. I particularly enjoy the multi-professional working, especially working as part of an established perinatal team. I don’t think I will ever get bored of attending deliveries and supporting babies on their transition to independence as well as using my extended clinical skills. I also enjoy the managerial aspects of my role, developing the service both locally and on a national level.


 

Resources

The NNA offers access to an ANNP Group . Members of the NNA can access the back catalogue of recorded ANNP Group meetings and webinars, each with a focus on one of the 4 pillars of advanced practice. View recorded events.

ANNP (Tier 1 – suggested years 1-5)

The role of the Advanced Neonatal Nurse Practitioner (ANNP) is defined by the four pillars of advanced practice: clinical practice, leadership, education, and research. ANNPs provide advanced clinical care, lead and mentor within the neonatal unit, educate & support healthcare staff and families, and engage in research to improve neonatal outcomes. ANNPs develop and implement care plans, contribute to policy development, and lead quality improvement initiatives, ensuring evidence-based, ethical, and high-quality neonatal care.

Nursing voice

Resources:
The NNA offers access to the NNA ANNP Group.

Members of the NNA can access the back catalogue of recorded ANNP Group meetings and webinars, each with a focus on one of the 4 pillars of advanced practice. View recorded events.

Advanced Neonatal Nurse Practitioner Capabilities Framework: A BAPM Framework for Practice – ANNP_Capability_framework_-_for_publication_10-5-21.docx.pdf (hubble-live-assets.s3.amazonaws.com)

Jonathan O’Keeffe, an ANNP based in Sussex, has given permission for us to feature the video below about advanced practice.

Trainee ANNP

The trainee advanced neonatal nurse practitioner role is an extension and enhancement of the skills acquired as a senior staff nurse in neonatal care. The position encompasses academic work and practical training, necessitating university attendance, completion of relevant assignments and advanced practice competencies with supervision from the medical team. The role involves working with the whole multidisciplinary team, providing support to peers and independently developing skills. These skills include conducting assessments and formulating clinical management plans tailored to the needs of the infants and their families, aiming to gain autonomy within the role.
[Source: Wesell El Hag, Trainee ANNP)

Nursing voice

 

Hello, my name is Wesell, and I am currently a trainee Advanced Neonatal Nurse Practitioner (ANNP) at Great Western Hospital, which is a Local Neonatal Unit (LNU). Prior to this, I gained substantial experience in a tertiary neonatal unit where I completed my QIS course at master’s level. This course, alongside my role as a senior nurse, provided me with the expertise required to develop my career further in neonatal care.

I am presently in the second year of a three-year ANNP apprenticeship course, which I am thoroughly enjoying. The course allows me to enhance my existing clinical skills through a well-structured curriculum that includes both supervised practice and academic learning. During my apprenticeship, I am provided with some supernumerary status, enabling me to work closely with trained ANNP’s and the medical team. This setup facilitates my hands-on learning, ranging from postnatal to intensive care, thereby broadening my practical and clinical capabilities.

In conjunction with workplace training, the apprenticeship includes university modules that focus on the four pillars of advanced practice: clinical practice, leadership and management, education, and research. This academic and practical approach is designed to thoroughly prepare me for a seamless transition into the role of a trained ANNP.

One of the most exciting aspects of my current role is the opportunity to be actively involved in establishing a new ANNP team at our hospital. This initiative not only promises to enhance our unit’s capabilities but also allows me to contribute significantly to shaping our future clinical practice landscape.

As I continue to advance in my training, I look forward to collaborating with the multidisciplinary team to deliver high-quality, evidence-based neonatal care. I am eager to apply my growing knowledge and skills to improve patient outcomes and support our unit’s developmental goals.

Resources

The NNA offers access to the NNA ANNP Group. Members of the NNA can access the back catalogue of recorded ANNP Group meetings and webinars, each with a focus on one of the 4 pillars of advanced practice. View recorded events.

Enhanced Neonatal Nurse Practitioner (ENNP)

The Enhanced Neonatal Nurse Practitioner (ENNP) provides care for newborns with complex health needs. ENNPs perform clinical assessments, diagnose conditions, develop treatment plans, and manage care. Their role integrates enhanced nursing practice, education, and leadership, ensuring high-quality neonatal care and supporting family-centered approaches.

Nursing voice

–

Hannah Wells – Neonatal Surgical Clinical Nurse Specialist

My name is Hannah Wells, and I am a Neonatal Surgical Clinical Nurse Specialist (CNS). 

I have always known surgical nursing was for me. I worked as a health care assistant on a children’s surgical ward for a year prior to undertaking my nurse training. My first job as a newly qualified nurse was on a children’s surgical ward. I then moved to the Neonatal unit and haven’t left! I enjoyed taking care of a variety of neonatal patients but still found I had a particular interest in the infants with surgical pathology, therefore when there was an opening in the surgical team, I jumped at the chance to join. I have since completed 3 masters modules to gain my CNS role.  

Neonatal Surgical Nurse Specialist Role 

The role of the CNS team is to work collaboratively within the wider surgical and Neonatal Multi-Disciplinary team (MDT). The team support the care of families from antenatal/postnatal diagnosis to discharge home or transition into paediatric services. We provide specialist advice, education, and support to health care professionals in the hospital and throughout the Network, and for parents/carers of the neonates in our care, both on the Neonatal Unit and immediately after discharge.  

We work 7 days a week to provide both continuity and expert care for infants and their families. This starts with supporting prenatal counselling and continues through an infant’s inpatient stay and during the early outpatient phase prior to their transfer to paediatric care. The Paediatric surgical consultant and registrar team rely on us as we are based on the NNU are often the ones to provide initial assessments and then prioritise the infant’s care and interventions required accordingly.  

Every day is different as a Neonatal surgical CNS, and so flexibility is key to undertaking a specialist role like this, this is one of my favourite parts about my job! 

Transport

A Neonatal Transport Nurse will:
– Undertake the transfer of critically unwell babies, working closely with other members of the transport team
– Undertake palliative care transfers for babies and families
– Undertake nurse-delivered transfers independently, with remote support from the medical tier

Fundamental to this is:
– Supporting parents during stressful transitions between hospitals
– Supporting referring staff who are involved with the stabilisation of babies prior to transfer
– Teaching and supporting members of the transport team
– Working on audit and service development/QI projects within the transport service
– Day to day elements of this role include:
– Checking transport equipment to make sure it is ready for use
– Maintaining familiarity with all transport equipment to ensure continued expertise
– Planning and prioritising transfers

Nursing voice

 

Resources

The NNA offers access to an Neonatal Transport Special Interest Group. Members of the NNA can access the back catalogue of recorded Neonatal Transport SIG meetings and webinars. View recorded events

There is also the Neonatal Transport Group – NTG webpage

Community Outreach

A neonatal outreach nurse supports families on their transition from the post natal ward, neonatal unit or transitional care service to home. They support families in the community with:
– babies who were born prematurely
– being discharged home at a low weight
– going home on low flow oxygen
– supporting early discharge home part tube feeding to establish full oral feeds at home- offering home phototherapy support to prevent readmission to hospital
– palliative or end of life care at home

Nursing voice

Resources

Blog by Jo Bennett – Family Support on the Neonatal Unit and after Discharge – Neonatal Nurses Association (NNA)

The NNA will soon launch a Neonatal Outreach Special Interest Group. To register interest in this group, please email us.

Transitional Care

Transitional Care (TC) is care additional to normal infant care, provided in a postnatal clinical environment by the mother or other resident carer, supported by appropriately trained healthcare professionals, including neonatal nurses.
If you work on TC you will gain exposure to:
– babies requiring feeding support
– jaundiced babies on phototherapy and requiring frequent blood tests
– stable babies born between 34 weeks to 35+6 weeks gestation
– significant neonatal abstinence syndrome
– babies requiring medication

Resources

You can view recorded webinars about Transitional Care in the Members Area of the NNA website.

You can watch a recorded webinar about Transitional Care in the context of Wales here.

The NNA will shortly launch a Transitional Care Special Interest Group. For more information, please email us.

CPD examples:

East of England ODN Neonatal Transitional Care Programme 

Edinburgh Napier short course ‘Transitional and Special Neonatal Care‘

‘Working with families to transition from neonatal units to home’ e-learning for health module 

Newly Qualified Nurse

A newly qualified nurse will have completed their undergraduate degree and secured a role as a neonatal nurse.

There will likely be an induction programme designed by the Trust, Health Board or Network Clinical Educators to support newly qualified nurses. 

An induction programme might include topics such as:

Basic Clinical Observations and Assessment of the Neonate – Aim: To be able to complete a full and comprehensive assessment of the neonate.

Nutrition and Fluids – Aim: To provide adequate and appropriate nutrition using skills and knowledge to encourage healthy growth.

Infection Control – Aim: To provide a healthy and safe environment and take steps to prevent and treat neonatal sepsis.

Skin Integrity – Aim: To maintain healthy skin integrity

Jaundice – Aim: To identify jaundice and treat accordingly.

Medicines Management – Aim: Can administer medications safely and competently.

Family Integrated Care – Aim: The nurse is able to provide Family Integrated Care.

Recognising the deterioration of the neonate – Aim: The nurse is able to recognise when an infant is deteriorating and initiate resuscitation.

Pain management and assessment – Aim: The nurse understands how to assess and manage infant pain.

Admission, Discharge and Screening – Aim: To provide holistic care from Admission to Discharge.

Professional Conduct, Communication and Documentation – Aim: To work in accordance with the NMC standards and maintain professional accountability.

Thank you to the Network Educators of the Yorkshire & Humber Neonatal ODN for generously sharing this example induction programme content with us, with permission to share here.

Nursing voice

Resources

Neonatal or Perinatal Networks will each offer a programme of educational support. For example, the Yorkshire & Humber Neonatal ODN, offer a Foundation Programme for newly qualified nurses, and those new to neonates, once they’ve completed their induction.

The NNA offers online and in-person learning events & opportunities, as well as Special Interest Groups, scholarships and access to the Journal of Neonatal Nursing.

The NNA has a number of Special Interest Groups hosting regular meetings to share learning, experiences and encourage collaboration. You can join one or more of our Special Interest Groups.

You can access NNA recorded events including ‘Turning your dissertation into a publication’ and ‘Interview Skills’ via the NNA website.

Read this blog about the Neonatal Foundation Programme by Nicola Hunt – Neonatal Nurses Association (NNA).

Quality Roles

Post QIS nurses will be able to move into quality roles including family support roles and risk and governance roles. Other examples of quality roles are below:

Infant feeding

An infant feeding lead supports feeding practices for newborns, ensuring optimal nutrition. They provide guidance on breastfeeding, expressing, bottle-feeding, and managing feeding difficulties. They work closely with the wider healthcare team, educate parents & colleagues, and implement policies to improve feeding outcomes for preterm and sick babies.

Nursing voice

Neonatal Infant Feeding Coordinator

Hi, I am Amanda and work as the Neonatal Infant Feeding Coordinator for a NICU and a SCBU within one service. While the role is not standardised, many neonatal units now have dedicated posts.

I trained as a child branch nurse but knew I wanted to work within the neonatal unit as a student. Upon qualification, I worked within neonatal units and the paediatric community but I always had an interest in infant feeding. I transferred my community skills into neonatal care and gained my Qualification in Speciality.

I worked in a dedicated lead post on a neonatal unit and within the community. I am now back to working in a dedicated role for infant feeding and supporting the units through our Neonatal BFI journey.

As well as my nursing training and ensuring I was up to date with my mandatory infant feeding training in post, I also trained as a volunteer breastfeeding peer supporter and provided support in my community. I became an International Board Certified Lactation Consultant (IBCLC). Since, I have undertaken BFI’s train the trainer course, which supports me in delivering education to colleagues, and developed my skills to carry out audits and embed the neonatal standards.

I work closely with our allied healthcare professionals. I would not be without them, as we learn so much from one another and are able to support families and babies from so many angles. If not combined into one role, posts like mine will also find that they work very closely and synergistically with their Family Integrated Care (FICare) and Developmental Care leads.

This is my dream job, and I love supporting families and my colleagues. Seeing a colleague deliver support to parents that they learned on a teaching update and the pride in a mother’s face when she collects a drop of colostrum for her preterm or sick baby are experiences I never tire of.

Resources

Lactation After Loss: Choices for Bereaved Parents – Online Course – FutureLearn

FICare Special Interest Group

Bereavement & Palliative Care

Neonatal bereavement and palliative care nurses provide support, and practical guidance for parents and families facing or experiencing uncertainty or the loss of their baby or babies. They provide compassionate, individualised care and facilitate memory-making and parental choice at a difficult time. They use parallel planning to optimise care for babies and families. 

They also deliver education and implement policies and guidelines to support their colleagues and wider teams.

Nursing voice

Resources

Blogs: Developing Bereavement Support by Jo Bennett – Neonatal Nurses Association (NNA)

Establishing a Bereavement Care Team by Maddie and Elle (St Michael’s Hospital, UHBW) – Neonatal Nurses Association (NNA)

NNA Palliative Care SIG

The National Neonatal Palliative Care Project

Loss of a Baby in Multiple Pregnancy: Supporting Grieving Parents – FutureLearn

Lactation After Loss: Choices for Bereaved Parents – Online Course – FutureLearn

Developmental Care

Developmental care involves providing individualised care to support preterm or sick babies’ neurodevelopment, minimise stress, and promote bonding with parents.

Nursing voice

Hello, my name is Daniela Machado, and I am proud to be a Developmental Care Specialist/Lead Nurse and a sister/charge nurse, working across two different trusts. I am originally from Porto, Portugal, and have spent 14 years building my nursing career in the UK. My role involves applying and advancing neuroprotective/developmental care practices for our preterm and neonatal patients/families.
 
In my current role as a Developmental Care Specialist Nurse/lead nurse (band 7), I focus on integrating neurodevelopmental principles into neonatal care. This includes creating a healing environment, championing skin-to-skin contact, neonatal pain management, and family-centred care. I also lead or co-lead initiatives that enhance staff education and collaboration across multidisciplinary teams to improve outcomes for babies and their families. This role also involves auditing, teaching and collaborating with different teams. I share the job with a Family Integrated Care Lead Nurse.
 
I began my nursing career in elderly care and cardiology, where I gained leadership experience as a Deputy Sister and Heart Failure Nurse. In 2016, I transitioned into neonatal care, starting fresh as a Band 5 nurse. Over time, I pursued specialised training, including Sensory Beginnings, Fine 1, Core Measures by Caring Essentials, and the Trauma-Informed Care Course by Mary Coughlin.
 
My training includes foundational neonatal courses such as sensory beginnings, advanced certifications in developmental care (fine 1 and core measures by Caring essentials), and trauma-informed care. Each of these programs has equipped me with the skills to address the physical, emotional, and developmental needs of babies and their families.
 
As a Developmental Care Specialist, I bridge clinical care with education and innovation. I work closely with nurses, doctors, therapists, and families to promote best practices in neuroprotective care. My role ensures a consistent and compassionate approach, improving team collaboration and patient outcomes.
 
I find immense joy in advocating for vulnerable babies and empowering families. Additionally, mentoring and inspiring colleagues to embrace developmental care principles make this role deeply fulfilling.
 

Resources

NNA FICare Special Interest Group

CPD examples:
– Sensory Beginnings – Neonatal Nurse Course 
– FINE training – family and infant neurodevelopmental education
– NBO training – newborn behavioural observations 

Consolidation of QiS

Nursing voice

Hello! I am Renjita Raju , a Neonatal Junior Sister working in London. After completing my BSc nursing degree in India, I moved to UK, and completed NMC OSCE to get registered and QIS course to become specialised in neonatal care. I recently qualified as an NLS instructor with the support from NNA scholarship programme. My role involves caring for premature and critically ill newborns, ensuring their safety and health with a highly collaborative multidisciplinary team. I also teach in NLS courses as an instructor following my passion in neonatal resuscitation. I love witnessing infants grow stronger each day and supporting their families through this journey. I’m grateful for the opportunity to provide meaningful compassionate care to the tiniest, most vulnerable patients. 

Completion of QiS

All neonatal nurses undertaking this role essential qualification have access to high quality education and protected time to gain the skills and knowledge required to care for the sickest and smallest patients and their families.

 

Completion of formal preceptorship programme competencies

A preceptorship is a period of structured transition that supports newly qualified nurses as they begin their new role. To find out more about what this might look like across different neonatal setting click here.

A preceptorship or Foundation Programme often includes mentorship by an experienced nurse, who will help with integration, the application of learning to clinical practice, the development of critical thinking skills and the development of confidence within a clinical setting. 

Preceptorship programmes and the support available may vary according to your Trust, Health Board or Network.

When you have completed your preceptorship there will be a period of consolidation in preparation for you to begin your Qualified in Speciality training.

 
Resources
 
Read this blog about the Neonatal Foundation Programme by Nicola Hunt – Yorkshire & the Humber Neonatal ODN Workforce and Education Team.

Nursing Associate

A neonatal nursing associate supports registered nurses in providing care to babies and families. They assist with feeding and monitoring vital signs.

Pre-registration Nurse

As a pre-registration student undertaking a children’s nursing programme, you will hopefully get an opportunity to gain a practice placement on a neonatal unit that offers an opportunity to work within special care, high dependency and intensive levels of care, under the supervision of practice staff. Some Universities accommodate all their students to ensure this neonatal-specific experience happens, while for others, you might need to arrange this experience as an ‘elective’ placement. The latter would also apply to a student on an adult nursing programme.

Placements on a neonatal unit vary between on average 6 to 12 weeks depending on your year of study and whether students have supernumerary status. Student midwives also undertake varying lengths of time on a neonatal unit to gain clinical exposure to babies requiring special care.

Resources

To find out more about neonatal placements as a student, view our NNA webinar -‘Making the most of the neonatal placement‘.

The NNA has a number of Special Interest Groups hosting regular meetings to share learning, experiences and encourage collaboration. You can join one or more of our Special Interest Groups and gain access to the Journal of Neonatal Nursing by becoming a member of the NNA.

As a pre-registration nurse, you can join the NNA for free.

You can access NNA recorded events including ‘Turning your dissertation into a publication’ and ‘Interview Skills’ via the NNA website.”

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