Enhanced Neonatal Nurse Practitioner Module

Enhancing the quality of regional neonatal services in London through nursing education and development

Background

In the UK, the Enhanced Neonatal Nurse Practitioner (ENNP) role started to emerge in the late 1990s, when neonatal qualified in specialty (QiS) nurses wished to pursue further academic study and alternative career pathways, in addition to their existing expert nursing skills (Jones & Ashworth, 2016).

In London, this postgraduate qualification was offered by a number of Higher Education Institutions (HEIs) for some time until it was suspended for several reasons.

A learning needs analysis carried out in 2021/2022 by the London Operational Delivery Network (ODN), revealed that senior nurses in all 27 neonatal units across London would like the ENNP training reintroduced as an opportunity for education and growth for their staff. Furthermore, the workforce scoping data on the regional neonatal nursing establishments, identified a need for urgent action to support the recruitment and retention of QiS staff members across the capital.

The redesign of the ENNP Module became a key component of the London ODN’s Education and Workforce strategy to support nursing career pathways, and meet national recommendations on expanding and developing new roles (3rd and 5th, GIRFT Workforce Report, 2022). Additionally, the Service and Quality Standards for Provision of Neonatal Care in the UK (British Association of Perinatal Medicine [BAPM], 2022) stated that ‘Networks must agree a defined level of competency for ENNPs through theoretical and practical assessment of new skills which fit their individual workforce needs.’

Defining the Role

A role descriptor was developed to provide a standardisation of the workforce specification.

The document included the key dimensions of the ENNP role, modelled against the existing ANNP Framework (BAPM, 2021), which included the fours pillars of practice – Clinical Practice, Leadership and Management, Education and Training and Audit, Research and Development. Within each pillar areas of care, such as:

  • Coordinate / Attend deliveries > 34-week gestation under medical/advanced practitioner supervision;
  • Advanced knowledge of mechanical ventilation principles and autonomous decision making;
  • Maintain/develop clinical charge/quality nurse role as appropriate;
  • Participate in neonatal educational projects to set and maintain standards of practice;
  • Take an active role in writing and reviewing unit guidelines.

By providing guidance and clearly outlining areas of care, we would support nurses to expand on their existing skills and on the multiple career pathways that they could consider on completion of the module.

Fig. 1. Proposed Integration into Nursing Career Framework within the London Neonatal ODN (Adapted from the Nursing Career Framework diagrams, GIRFT & NNA, 2022)

In summary, the ENNP module aims to increase participants’ underpinning knowledge and skills to enable them to safely undertake enhanced neonatal clinical skills associated within the holistic care, management and assessment of the neonate.

Stakeholder Involvement

The module was developed in strict collaboration with a dedicated Pan London ENNP Steering Group. The group composed of multidisciplinary stakeholder’s, responsible for overseeing and providing leadership, critical appraisal, governance, and decision-making over the direction of the project. The ethos was to create a module that would support staff development, whilst improving the quality of the care delivered.

In addition, parent feedback and participation played a major role in the project’s development. This was achieved by working closely with the parent advisory group (PAG) chair and our Care Coordinator team, which ensured that the Family Integrated Care Principles (BAPM Framework, 2022) were incorporated into every aspect of the module.

Challenges

The aspiration was to academically credit the module via a work-based learning (WBL) format, where the ODN would run the module independently and the local HEI’s coordinate the academic assessment and respective credits, resulting in lower costs for the neonatal units in the region.

Reducing costs was key, as Trusts and hospitals continue to experience reduced financial capacity following the COVID-19 pandemic, which has negatively impacted education funding in these organisations.

Milestones on Module’s Development

Going Forward

The pilot cohort commenced in April 2024, with 28 candidates from different professional nursing backgrounds and levels of expertise. Feedback will be collected regularly from both candidates and faculty, these will later be compiled to provide an overall review of the module. The data will then be shared with our local governance groups, senior nurses and educators to discuss future project direction.

We look forward to continue to deliver the ENNP module, enhancing the quality of regional neonatal services for our babies and families.

Acknowlegments

The London ODN would like to thank its partners, South West Neonatal Network and University Hospitals Plymouth NHS Trust, for sharing supporting documentation from their experiences with the development of the ENNP role locally. A special thank you to all who have contributed to the development of this education programme thus far. Your contributions are immensely valuable and significantly enhance the programme.

References

Jones, T. and Ashworth, C. (2016) ‘How the enhanced neonatal nurse practitioner role has been integral to one tertiary unit’s workforce plan and Service Delivery’, Journal of Neonatal Nursing, 22(4), pp. 147–151. doi:10.1016/j.jnn.2016.03.008.

Career, education and competence framework for neonatal nursing in the UK (November 2016) Royal College of Nursing The Royal College of Nursing.

Neonatal Qualified in Specialty (QIS) Education and Training Review (June 2021) NHS choices.

Adams, E., Harvey, K. and Sweeting, M. (April 2022) ‘Neonatology – Workforce GIRFT Programme National Specialty Report’. GIRFT, NHS England and NHS Improvement.

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