Parents, healthcare professionals, professional societies, education providers, health services, and regulators of the profession
Statement of standard
All nurses providing care to infants and their families have access to and undergo education and training using a competency-based curriculum and assessment framework.
Rationale
For over thirty years several countries have recognised neonatal nursing as a specialty with either training in the neonatal unit, or at an academic institution, resulting in a neonatal diploma or master’s degree. (1) Infants in the NICU are among the most nurse-intensive patients. To intervene before the onset of life-threatening problems, nurses must make complex assessments, implement highly intensive therapies, and make immediate adjustments dependent on infant response. Maintaining optimal respiratory, cardiac, and feeding status may result in improved development and behavior, lower levels of morbidity, and shorter hospitalisation. (2,3)
Standardised orientation and training programmes developed by neonatal care experts in collaboration with nursing organisations, and academic institutions can decrease mortality and morbidity of newborn infants. (4) In addition to staffing levels, neonatal outcomes have been shown to be associated with levels of patient volume, and training of medical and nursing staff. (5) In order to ensure that infants and families receive a standardised level of care, nurses should develop competencies through an integrated, developmental curriculum, both in university and practice settings (6) using an hybrid approach comprising classroom and digital based education/training. (7)
Benefits
More competent nurses are related to increased survival (8)
Significantly reduced rates of mortality and morbidity (5)
Improved nurse retention and satisfaction (9)
Consistency in quality of care delivery in neonatology (consensus)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents contribute to the delivery of nurse education programmes.
B (Low quality)
Training documentation
For healthcare professionals
Neonatal nurses are qualified in specialty as evidenced by the following criteria:
Registered nurse, period of preceptorship or mentorship including defined foundation learning within the specialty, completion of a programme of post-registration (post-licensure) education which links the following theory and practice elements:
Theory modules relating to the care of the neonate and their family within special care, high-dependency care and intensive care, delivered and assessed within a higher education institution.
Achievement of core skills set, undertaken with supervision of an experienced qualified neonatal nurse, assessed in practice and supported by evidence of learning.
Clinical decision-making skills.
B (Moderate quality)
Certificates of award, professional portfolio
For neonatal unit
Infrastructure for educational programmes is provided (see NICU design).
B (Moderate quality)
Audit report1
For hospital
N/A
For professional societies
Standards of care, including competencies at the local level are developed and regularly updated, disseminated, and promoted. (10)
B (Low quality)
Guideline
For education providers
A (post) graduate programme focused on neonatal nursing, including the following domains is provided: neonatal physiology and pathophysiology, family-centred care, clinical practice, leadership and teamwork, professional development and research. (10)
B (Moderate quality)
Training documentation
For health service and regulators of the profession
Common national training frameworks aligned with the relevant European Qualifications Framework are available and regularly updated. (11)
B (High quality)
Training documentation
1The indicator “audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
Parents are provided with the opportunity to review and revise neonatal nurse curricula.
B (Very low quality)
For healthcare professionals
Undertake a minimum of 6 days per year of continuing professional development (CPD). (12)
B (Low quality)
For neonatal unit
N/A
For hospital
Support healthcare professionals to undertake CPD.
B (High quality)
For professional societies
Develop, disseminate, and promote neonatal care competencies at regional, national, and international level. (6,10)
B (Very low quality)
For education providers
Develop and provide specialty postgraduate programmes using a digital/classroom based blended (hybrid) approach (7) with a focus on neonatal care.
B (Very low quality)
For health service and regulators of the profession
International mutual recognition of specialty qualifications in neonatal nursing is facilitated.
B (Moderate quality)
Getting started
Initial steps
For parents and family
Parents are involved in the delivery of nurse education programmes.
For healthcare professionals
Attend specialty training through on the-job training or through professional education programmes.
For neonatal unit
N/A
For hospital
Support healthcare professionals to participate in neonatal nurse training.
Provide opportunities for on-the-job training, and experiential learning environments (clinical placements) for students undertaking professional education programmes.
For education providers
Include basic neonatal care content in undergraduate (bachelor) nursing and midwifery curriculum. (6)
For health service and regulators of the profession
Develop and implement common training frameworks aligned with the relevant European Qualifications Framework. (7,11)
Council of International Neonatal Nursing (COINN). Position Statement on Neonatal Nursing Education [Internet]. 2018 [cited 2018 May 15]. Available from: https://coinnurses.org/wp-content/uploads/2018/03/COINN-PS-0100-Neonatal-Nursing-Education.pdf
Lake ET, Staiger D, Horbar J, Cheung R, Kenny MJ, Patrick T, et al. Association Between Hospital Recognition for Nursing Excellence and Outcomes of Very Low-Birth-Weight Infants. JAMA. 2012 Apr 25;307(16):1709–16.
Lake E, Patrick T, Rogowski J, Horbar J, Staiger D, Cheung R, et al. The Three Es: How Neonatal Staff Nurses’ Education, Experience, and Environments Affect Infant Outcomes. JOGNN. 2010;(39):S97–8.
Prullage GS, Kenner C, Uwingabire F, Ndayambaje A, Boykova M, Walker K. Survey of neonatal nursing: Staffing, education, and equipment availability in Rwanda. J Neonatal Nurs. 2022 Jun 1;28(3):192–9.
Grandi C, González A, Meritano J, Grupo colaborativo Neocosur. [Patient volume, medical and nursing staffing and its relationship with risk-adjusted outcomes of VLBW infants in 15 Neocosur neonatal network NICUs]. Arch Argent Pediatr. 2010 Dec;108(6):499–510.
Council of International Neonatal Nurses (COINN) News page. J Neonatal Nurs. 2019 Oct;25(5):258–64.
Hao X, Peng X, Ding X, Qin Y, Lv M, Li J, et al. Application of digital education in undergraduate nursing and medical interns during the COVID-19 pandemic: A systematic review. Nurse Educ Today. 2022 Jan 1;108:105183.
Hamilton KES, Redshaw ME, Tarnow‐Mordi W. Nurse staffing in relation to risk‐adjusted mortality in neonatal care. Arch Dis Child Fetal Neonatal Ed. 2007 Mar;92(2):F99–103.
Cooper E. Creating a culture of professional development: a milestone pathway tool for registered nurses. J Contin Educ Nurs. 2009 Nov;40(11):501–8.
Reid S. Australian Standards for Neonatal Nurses. Canberra: Australian College of Neonatal Nurses; 2012.
Dury C, Hall C, Danan JL, Mondoux J, Aguiar Barbieri-Figueiredo MC, Costa M a. M, et al. Specialist nurse in Europe: education, regulation and role. Int Nurs Rev. 2014 Dec;61(4):454–62.
Royal College of Nursing. A joint statement on continuing professional development for health and social care practitioners [Internet]. 2007 [cited 2018 May 15]. Available from: https://www.bda.uk.com/training/cpd/cpdjointstatement
September 2022 / 2nd edition / previous edition reviewed by Reimann M / next revision: 2025
Recommended citation
EFCNI, van den Hoogen A, Johnston L et al., European Standards of Care for Newborn Health: A common neonatal nurse training curriculum. 2022.
