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26

Ball, C.; and Cox, C.L. 2004. "Part Two: The Core Components of Legitimate Influence and the
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Karlowicz, M.G.; and McMurray, J.L. 2000. "Comparison of Neonatal Nurse Practitioners' and
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28

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31


Country
United
States

Title
NNP / PNP
(Neonatal Nurse
Practitioner /
Pediatric Nurse
Practitioner)

Focus
Improved
Quality of
Service and Care
for NICU patient

Role
To act as primary health care
manager of NICU patient
effectively based on a masters
level education and years of
clinical experience.

Leadership
(a) Educator - resource to nursing staff and students
(b) Researcher - Develop standards of care
(c) Counselor - Support parents
(d) Expert Practitioner/Clinician - Provide physical
assessment, medical diagnosis and diagnostic testing
based on advanced knowledge
(e) Also too: motivate RNs, provide outreach education,
publish research

United
Kingdom

ANNP
(Advanced Neonatal
Nurse Practitioner)

Clinical focus
toward
replacement of
"middle grade"
staff

To act as primary caregiver by

using advanced practice skills
acquired through NP training.
Also serves as a consultant and
educator for other medical
professionals in the NICU and
participant in protocol writing for
the unit.

(a) Expert Practitioner/Clinician - Attend High Risk

Deliveries and performance of resuscitation, Initiate
complex procedures
(b) Primary Care Provider - Presence at Ward Rounds
(c) Educator - Teacher for nursing skills and Junior
Medical Staff

Ireland

ANP (Advanced
Nurse Practitioner in
(Neonatology)

Quality
Assurance

Serves to promote and facilitate

Quality Assurance, wherein s/he
practices evidence-based care at
an advanced level while
encompassing a family-centered
care framework. This position
also serves to create an
advancement of career path for
registered nurses.

(a) Researcher - conducts quality assurance research on

procedures
(b) Educator - teach staff as mentor
(c) Future: part of ANP-led transport team in the
National Transport Service

31

Country
Canada

Title
ARNP (Advanced
Practice Registered
Nurse -not specific
to neonates)

Focus
Complete care
combining
medical and
nursing aspects
of care and
treatment

Role
Acts under supervising physician
to provide complete care and
management of patient through
lenses of medicine and nursing.

32

Leadership
(a) Complete Care Provider - Manage specific patients
and their families
(b) Clinical leadership
(c) Researcher - Participate in research team, Publishes
in reference articles
(d) Educator - Presents at conferences
(e) Expert Practitioner/Clinician - Performs medical
diagnosis and orders medications and investigations

Country
United
States

Title
NNP / PNP
(Neonatal
Nurse
Practitioner /
Pediatric Nurse
Practitioner)

Management
(1) Primary provider - Bedside Clinical Management for
specific number of patients (tend to be assigned to sicker
babies)
(2) Performs Medical intervention with both medical and
nursing frameworks (ventilator adjustment, fluid
management, acute situation takeover).
(3) Supervised by physician

Medical Skills
Intubation of infant, Lumbar puncture, Insertion of
umbilical catheters, Insertion of peripheral lines, Insertion
of chest tube. Also found: Supra pubic taps, exchange
transfusions

United
Kingdom

ANNP
(Advanced
Neonatal Nurse
Practitioner)

(1) Attend high risk deliveries and lead Resuscitation teams

when trained
(2) Primary provider - Manages caseload of specific
neonates and their families (by incorporating both
medical and nursing perspectives).
(3) Performs Medical Intervention - Perform initial exam of
specific newborn problems and initiate complex
procedures
(4) Cover for any staff shortages
(5) Not officially permitted to prescribe, but prescribe
nevertheless

Intubation of baby (with extra training), Intravenous

cannula insertion, Take blood by venous puncture,
Withdraw blood from arterial catheter, Administer IV
antibiotics, Administer IV other drugs, Calculate and order
TPN (.5), Order x-rays, Prescribe medication (.5),
Prescribe fluids (.5), Administer surfactant (.5) ,

33

Also found: Lumbar puncture, Insertion of umbilical

catheter, Insertion of peripheral arterial lines, Insertion of
chest tubes
With extra training: Drying, stimulation and facial O2
administering, Mask ventilator, Intubation and ventilation,
Intubation, cardiac massage, and drug administering

Country
Ireland

Title
ANP
(Advanced
Nurse
Practitioner in
(Neonatology)

Management
(1) Initial manager - Initial resuscitation and stabilization of
premature and term infants, Physical assessment and
diagnosis, Referral for screening tests (eye, cerebral,
ultrasound, audiology, x-rays, metabolic).
(2) Management of psychosocial aspects of premature
delivery (family).
(3) Detailed Clinical Management of abnormalities and
disorders (see end for details).
(4) Long term management - Initiates and receives
appropriate referrals, Discharge planning and follow up
(5) Not to Prescribe: blood transfusions, medications,
parenteral fluids(TPN), and electrolyte solutions, but
must know when to request physician to prescribe

Medical Skills
Insertion of endotracheal tubes, Lumbar puncture,
Initiation of resuscitation, Initiation of mechanical
ventilation, Setting ventilation parameters, Ordering and
signing for blood and laboratory test and x-rays, Surfactant
administration (within a collaborative protocol) ,
Venipuncture and capillary blood sampling, Percutaneous
arterial sampling, Peripheral and umbilical venous
cannulation, Peripheral and umbilical arterial cannulation,
Insertion of percutaneous central venous lines.
Insertion of chest drains and diagnostic needle insertion
into the intra-pleural space when pneumothorax is
suspected, Ultrasound scans.

Canada

APRN
(Advanced
Practice
Registered
Nurse - not
specific to
neonates)

(1) 24 APRN care with "in house" neonatology backup

(2) Works under supervision of physician

Intubation, Lumbar puncture, Insertion of umbilical

catheters, Peripheral arterial lines, Chest drains, Supra
pubic taps, Exchange transfusions.
Also found: Resuscitation, Write orders for parenteral
nutrition, Writing orders for dopamine infusion.

34

The Ashington Audit Group. 2003. "Evaluating a Nurse-Led Model for Providing Neonatal Care".
Journal of Advanced Nursing 47(1):39-48.
Aubrey, W.R.; and Yoxall, C.W. 2001. "Evaluation of the Role of the Neonatal Nurse Practitioner in
Resuscitation of Preterm Infants at Birth". Archives of Disease in Childhood - Fetal and Neonatal
Edition 85: F96-F99.
Dillon, A.; and George, S. 1997. "Advanced Neonatal Nurse Practitioners in the United Kingdom:
Where are they and What Do They Do?" Journal of Advanced Nursing 25(2): 257-64.
Hall, M.A.; and Smith, S.L. 1995. "Neonatal Nurse Practitioners: The First 4 Years". Current
Paediatrics 5:201-203.
Karlowicz, M.G.; and McMurray, J.L. 2000. "Comparison of Neonatal Nurse Practitioners and
Pediatric Residents Care of Extremely Low-Birth-Weight Infants". Archives of Pediatrics and
Adolescent Medicine 154:1123-1126.
Lee, T.W.R.; Skelton, R.E.; and Skene, C. 2001. "Routine Neonatal Examination: Effectiveness of
Trainee Paediatrician Compared with Advanced Neonatal Nurse Practitioner". Archives of Disease in
Childhood - Fetal and Neonatal Edition 85:F100-F104.
Redshaw, M.E. and Harvey, M.E. 2002. "Working together: Neonatal Nurse Practitioners in
Practice". Acta Paediatrics 91:178-183.
Srivastava, N.; Tucker, J.S.; Draper, E.S.; and Milner, M. 2008. "A Literature Review of Principles,
Policies and Practice in Extended Nursing Roles Relating to UK Intensive Care Settings". Journal of
Clinical Nursing 17:2671-2680.

Furlong, E.; and Smith, R. 2005. "Advanced Nursing Practice: Policy, Education and Role
Development". Journal of Clinical Nursing 14:1059-1066.
The National Maternity Hospital, Holles Street. 2008. Annual Report 2008. Dublin, Ireland. 64
pages.

Bryant-Lukosius, D.; and DiCenso, A. 2004. "A Framework for the Introduction and Evaluation of
Advanced Practice Nursing Roles". Journal of Advanced Nursing 48(5):530-540.
Bryant-Lukosius, D.; DiCenso, A.; Browne, G.; and Pinelli, J. 2004. "Advanced Practice Nursing
Roles: Development, Implementation and Evaluation". Journal of Advanced Nursing 48(5):519-529.

35

McMillan, D.; Perreault, T.; Watanabe, M.; Chance, G.; Askin, D. F.; and Hall, J. 1997. "Neonatal
Personnel in Canada". Paediatric Child Health 2(3):193-197.
Paes, B.; Mitchell, A.; Hunsberger, M.; Blatz, S.; Watts, J.; Dent, P.; Sinclair, J.; and Southwell, D.
1989. "Medical Staffing in Ontario Neonatal Intensive Care Units". CMAJ 140 1321-1326.

-
American Academy of Pediatrics. 2003. "Policy Statement - Advanced Practice in Neonatal Nursing".
The Journal of Pediatrics 111(6):1453-1454.
Britton, J.R. 1997. "Neonatal Nurse Practitioner and Physician Use of a Newborn Resuscitation Team
in Community Hospital". Journal of Pediatric Health Care 11:61-65.
Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education.
2008. APRN Joint Dialogue Report. 41 pages.
Ostrea, E.M. Jr.; and Schuman, H. 1975. "The Role of the Pediatric Nurse Practitioner in a Neonatal
Unit". The Journal of Pediatrics 86(4):628-631.

36

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