The effectiveness of nurses in new-born critical care units
New-born babies who are born very premature, have congenital anomalies, or develop illnesses after birth may require neonatal critical care, which is a key element of the NHS maternity service . Neonatal critical care involves providing intensive medical and nursing care to these vulnerable babies, as well as supporting their families. The role of nurses in neonatal critical care units is crucial, as they are responsible for monitoring, assessing, and delivering interventions to improve the outcomes and quality of life of these babies . However, the implementation of the nurse’s role in neonatal critical care units faces several barriers and facilitators, which can affect the quality of care and patient satisfaction.
Some of the barriers to the implementation of the nurse’s role in neonatal critical care units are:
– Regulatory and legal aspects: The scope of practice and autonomy of nurses in neonatal critical care units may vary depending on the country, region, or health system. Some nurses may face restrictions or limitations in performing certain tasks or procedures that are traditionally assigned to doctors, such as prescribing medications, ordering tests, or making referrals . This may create role confusion, conflict, or dissatisfaction among nurses and other health professionals, as well as compromise patient safety and continuity of care.
– Cultural and organizational aspects: The culture and structure of the neonatal critical care unit may influence the acceptance and recognition of the nurse’s role by other health professionals, managers, and patients. Some nurses may encounter resistance or lack of support from doctors, who may perceive them as a threat to their authority or expertise . Some managers may not provide adequate resources, training, or incentives for nurses to develop their skills and competencies in neonatal critical care. Some patients may not trust or value the nurse’s role, preferring to consult with doctors instead .
– Training and education: The nurse’s role in neonatal critical care units requires specialized knowledge and skills that are not always covered by the basic nursing education. Nurses may need additional training and education to acquire the competencies needed to provide high-quality care to new-born babies with complex needs . However, some nurses may face barriers in accessing or completing such training and education, such as lack of time, funding, availability, or quality of the programs .
Some of the facilitators to the implementation of the nurse’s role in neonatal critical care units are:
– Adaptability and flexibility: Nurses in neonatal critical care units need to be adaptable and flexible to cope with the changing and challenging demands of their role. They need to be able to work in different settings, such as hospitals, community clinics, or home-based care; with different types of patients, such as premature babies, term babies, or babies with congenital anomalies; and with different levels of acuity, from stable to critically ill . Nurses who can adapt and adjust their practice according to the needs and preferences of each patient and situation can provide more effective and personalized care.
– Patient-centeredness: Nurses in neonatal critical care units need to adopt a patient-centered approach that recognizes the individuality and dignity of each baby and their family. They need to involve the parents in the decision-making process, respect their values and beliefs, provide them with information and education, and support them emotionally and practically . Nurses who can establish a trusting and caring relationship with the parents can enhance their satisfaction and adherence to treatment.
– Teamwork and collaboration: Nurses in neonatal critical care units need to work collaboratively with other health professionals, such as doctors, pharmacists, physiotherapists, social workers, or psychologists; as well as with other stakeholders, such as managers, policy makers, researchers, or educators. They need to communicate effectively, share information and expertise, coordinate care plans, and resolve conflicts . Nurses who can foster a positive and productive team culture can improve the quality and safety of care.
In conclusion, nurses play a vital role in neonatal critical care units by providing comprehensive and holistic care to new-born babies with complex needs. However, they face several barriers and facilitators that affect their practice and performance. To overcome these barriers and enhance these facilitators, some strategies that could be implemented are:
– Developing clear and consistent regulations and policies that define the scope of practice and autonomy of nurses in neonatal critical care units across different countries, regions, or health systems.
– Promoting a culture of respect and recognition for the nurse’s role among other health professionals, managers, patients,
– Providing adequate resources, training, and education for nurses to develop their skills and competencies in neonatal critical care.
– Encouraging nurses to be adaptable, flexible, patient-centered, and collaborative in their practice.
NHS England. Implementing the Recommendations of the Neonatal Critical Care Transformation Review. 2019. Available from: https://www.england.nhs.uk/wp-content/uploads/2019/12/Implementing-the-Recommendations-of-the-Neonatal-Critical-Care-Transformation-Review-FINAL.pdf.
Busca E, Savatteri A, Calafato TL, Mazzoleni B, Barisone M, Dal Molin A. Barriers and facilitators to the implementation of nurse’s role in primary care settings: an integrative review. BMC Nurs. 2021;20:171. Available from: https://doi.org/10.1186/s12912-021-00696-y.
Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, et al. Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Serv Deliv Res. 2014;2(16). Available from: https://doi.org/10.3310/hsdr02160.
Hosseini SM, Zareiyan A, Hosseini SN. Improving nurses’ readiness for evidence-based practice in critical care units: a quasi-experimental study. BMC Nurs. 2021;20:99. Available from: https://doi.org/10.1186/s12912-021-00599-y.
Agency for Clinical Innovation. NSW critical care management of neonatal patients. 2019. Available from: https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/609838/NSW-critical-care-management-of-neonatal-patients.pdf.