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How should we respond to the crisis in neonatal nursing?

The RCN’s career guidance on neonatal nursing must address changes in the profession

The RCN’s career guidance on neonatal nursing must address changes in the profession

Nurse and baby in incubator
Picture: Alamy

Neonatal nursing is in crisis. It’s a long story and the result of a number of factors.

There has been difficulty in recruiting into the specialty, poor staff retention and high turnover. Work in a neonatal unit is highly pressurised and emotionally draining, and so does not suit everyone. 

Other issues that do not help the situation include: a lack of educational funds, which has resulted in restricted in-service education; service cuts, which have meant a lack of promotion and career development; and a level of pay that does not reflect nurses’ level of responsibility. The retirement of a core of experienced and committed nurses has also played a part.

This is not good for the development of the neonatal service or the future of the neonatal nursing specialty. But most importantly, it is not good for the infants and families who need our care.

Children’s nurses also play a part in the crisis, however. We do not sell ourselves well and we do not publicise what we do. In part, this is because we respect our patients’ need for a quiet environment to recover and we like to protect the rights of families to a private life.

But by not showcasing what we do, we are missing opportunities. Perhaps we need to do things differently. 

Equal partners

The traditional staff profile in these units involved neonatal nurses and midwives as equal partners.

The career pathway included the English National Board 405 course, which was a standardised programme of specialist preparation overseen by the forerunner of the Nursing and Midwifery Council (NMC), the United Kingdom Central Council (UKCC).

It was a six-month, intensive, full-time course and developed the participant through special care into critical care.

Resource-intensive, it provided a comprehensive curriculum. Achieving the qualification often meant career progression and, in recognition of the additional expertise and responsibility, there was usually an increase in salary. 

In 2002, the UKCC became the NMC and gradually the regulated and standardised neonatal post-registration programmes were lost. Higher education institutions (HEIs) were free to modify or disband neonatal courses.

Where contact hours were lost and assessments changed to prevent attrition, there were differences in the levels of skill and competence between nurses who emerged from some of the HEIs providing the courses.

Career progression 

Changes in the service compounded the difficulties. Cost-cutting often meant a reduction in the numbers of senior grades, which had an impact on promotion.

As a result, an experienced qualified in specialty neonatal nurse no longer expected career or pay band progression. Neonatal nurses can now be trapped on band 5, at the top of the pay structure, for years.

The unseen consequences of this situation include a reduction in the impetus to take on more responsibility and care for the sickest infants. Why expose yourself to more stressful, emotionally draining shifts, with higher professional risks, when you could be paid the same as someone who has decided not to change their career? 

In addition, the neonatal service has been slow to take advantage of the apprentice scheme and write creative programmes to develop direct entry associate neonatal nurses to support the service.

The RCN is reworking its guidance for careers in neonatal nursing. I hope it is pragmatic.   


doreen_crawfordDoreen Crawford is nurse adviser with Crawford McKenzie and consultant editor Nursing Children and Young People

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