Loading...
Please wait, while we are loading the content...
Similar Documents
The role of neonatal nurse practitioners: a viewpoint.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Hale, Peter B. Boxall, Jane Hunt, Marilyn D. |
| Copyright Year | 1987 |
| Abstract | In October 1984 the British Paediatric Association produced a discussion document entitled, 'The Futture in Paediatrics and Child Health. This contained the sentence, 'We wonder if the newborn intensive care nursery could be the place to experiment with nurse technicians in order to reduce the dependence on junior doctors.' In August 1985 the matter was again raised in the editorial of the Lancet; the shortfall in senior house officers and registrars could perhaps be made up by neonatal nurses. Deferring to the North American experience, where nurse clinicians/ specialists were undertaking procedures such as lumbar puncture, exchange transfusion, and arterial puncture. it was stated that neonatal nurses, 'might now be asked to consider a greater degree of responsibility in the neonatal intensive care unit, although ultimate responsibility for medical care will remain with the consultants. The British Paediatric Association has (albeit timidly) already suggested this and its members should now act boldly.' A literature search into the role of the neonatal nurse practitioner showed that this post existed in some units in Canada and the United States and that appropriately trained nurses could replace house officers with no reduction in standards of care. It is not documented as being established in Great Britain, and we are uncertain to what extent practices exist, which fringe on the edge of this role in extended duties of the nurse in neonatal units. Two members of the executive committee of the Neonatal Nurses Association are currently undertaking a national survey of the practice and views of members on this development. The introduction of this role raises many questions that require deep thought and careful assessment to ensure neonatal care is not compromised. If this role is integral to the future of neonatology, as our medical colleagues have suggested, we must consider the safety and effectiveness of such a role and the method by which it could be introduced. But we must first identify the current dilemmas, which pose grave difficulties for this speciality and arc a matter of mutual concern in the United Kingdom. During the past decade the face of neonatal care has changed dramatically. As medical and scientific understanding of the newborn has increased, the complexity and scope of newborn intensive care has demanded more versatile nursing practice and knowledge. Larger numbers of trained neonatal nurses are required to maintain the quality and continuity of care. Staffing neonatal units with discontinuous nursing resources is now the most persistent and critical area of concern to senior nurses. There is wide recognition of problems needing to be addressed as a matter of urgency. These include inadequate nurse establishments, failure to fill establishments, short tenure posts, and retention difficulties, and a lack of training places. Chronic understaffing has resulted in disproportionate nurse:baby ratios, and frustration in role satisfaction. Continuing education and the meeting of training nceds is a major shortfall within the speciality. Many senior nurses lack time for nursing developments, research, and creativity in their chosen field. The starting point must, therefore, he to provide quality care by trained neonatal nurses, albeit to the level recommended by British Association of Perinatall Paediatrics and the Neonatal Nurses Association. 'To introduce the neonatal nurse practitioner without the safcguard of adequate numbers of trained nurses may impose limitations in delivering sound nursing carc. In preparation for a new role it would be important to determine and set our own professional standards and workloads and estimate our own staffing needs. This will entail reappraising use of' trained neonatal nurse activity and using a grcater proportion in direct patient care, tcaching anid training, and so forth. We need to consider the place of a consultant neonatal nurse to make nursing dccisions reg,arding the care of the baby, in conjunction with medical decisions. Then, if we are in a position to welcome this role, we must ask questions of our medical colleagues and ourselvcs: Do we need it'? Do we want it'? What will be the depth of the role? Technician or Clinician'? Will it entail exercisinlg judgment and independent decision making'? Who supervises? What place in unit structurc, and what type of' unit'? How do wc make up the deficit in trained neoinatal nurses'? Would it erode training of junior doctors'? What update will be required'? A nurse technician who attains competence in technicali skills in some invasive procedures is feasible in the currenlt nursing framework. If', however, we are considerilng a medical change in the traditional delivery of neonatal carc, with the introduction of nursc clinicians, we must identil'y their training functions and practice. We would need a national standard training curriculuni at approved cenitres. The programme must considcr the del'icit in the hasic educational background of nurses and establish a scienitific foundation in pathology, physiology, biochemistry etc. To ensure clinical competence skills, aind ability to make decisions, the nurse would need supervision and support by senior medical colleagues. Assuming he or she is proficient and the role is benel'icial, it must be ensured that this proficiency is maintained. Neonatal nursing is still in its intancy-in making changes we must be sure we do not lose the f'ew nursing advances we have achieved and are endeavouring to achieve. In the words of John F Kennedy, 'When it is not necessary to change, it is necessary not to change.' If, however, change becomes inevitable, we must move forward with caution. |
| File Format | PDF HTM / HTML |
| DOI | 10.1136/adc.62.7.760 |
| Alternate Webpage(s) | http://adc.bmj.com/content/archdischild/62/7/760.full.pdf |
| PubMed reference number | 3632031 |
| Alternate Webpage(s) | https://doi.org/10.1136/adc.62.7.760 |
| Journal | Medline |
| Volume Number | 62 |
| Issue Number | 7 |
| Journal | Archives of disease in childhood |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
