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Case Study – NHS Tayside

Neonatal Assistant Practitioner role developed and implemented for Neonatal services to provide specialist care of babies and release time to care for Nurses and Midwives, making a more effective workforce for improved patient care

NHS Tayside has developed and plans to implement the role of Assistant Practitioner in neonatal services. Under the supervision of Registered Nurses and midwives, this new NHS Career Framework for Health Level 4 support worker role will provide care for specific groups of special care babies enabling Registered Nurses and Midwives to focus on babies with more complex care needs as well as releasing time to undertake other elements of their roles.

NHS Tayside wanted to release time for Registered Nurses and Midwives to focus on complex clinical care, training, education, supervision, management, and leadership duties. In addition, it is anticipated that releasing Registered Nurses and Midwives’ time will provide additional assurance and facilitate further quality improvement and patient safety initiatives to be implemented within the service.

National recommendations (Neonatal Care in Scotland: A Quality Framework) suggest a skills mix of 80% registered to 20% non-registered staff in neonatal units. In NHS Tayside over 90% of staff are Registered Practitioners giving scope to move towards the recommended ratio, increasing the overall staff number, through the implementation of the new
support worker role.

The Level 4 Assistant Practitioner was skilled in meeting the needs of specific groups of special care babies and their families, allowing Registered Nurses and Midwives more time with babies needing more complex care, and giving them more opportunity to undertake other important elements of their roles.

“It is anticipated that implementing the role of Assistant Practitioner will effectively free up the senior nurses to take forward initiatives that make a difference and allows them an overview so that they can monitor the quality of patient care.”

Alison Wright, Scottish Neonatal Nurses Group Chairperson and Senior Nurse Neonatal Services, NHS Tayside


Improvements in patient care: the charge nurse has more time to take an overview of the service, and is able to carry out managerial, leadership, supervisory, and teaching responsibilities, leading to higher standards of care. Greater flexibility in staffing numbers and skills mix: freeing up Registered Nurses and Midwives to care for babies with more complex care needs

A better environment for learners: the charge nurse will have more time to support Registered Practitioners undertaking neonatal education programmes, new staff, and students
ability to evidence better compliance in areas such as monitoring of cleanliness and other quality improvement and patient safety initiatives. There is also additional support for parents to educate them in aspects of care for their babies and build their skills and confidence in preparation for discharge home.

NHS Tayside worked with our role development and clinically experienced consultants to define and develop the role. Our team held a workshop, attended by members of the South East and Tayside Managed Clinical Network, for Neonatal Services to identify the career framework level and key tasks and activities of the proposed neonatal support role. This work complemented the work already undertaken by the Scottish Neonatal Nurse’s Group and NHS Education for Scotland in compiling a Career and Development Framework for Healthcare Support Workers Providing Neonatal Care in Hospital Settings in Scotland (SNNG and NES Winter 2012).

It became clear that NHS Tayside required a Level 4 role, and a transferable role template was developed, along with a summary of the required learning and development. The Assistant Practitioner role was introduced in small numbers, to ensure stability and safety and allowing time to monitor the results. An online survey is being used to help assess the outcomes of implementing the role. In addition, the ability to meet the education and support needs of the Assistant practitioners will be evaluated along with parent satisfaction related to preparation for caring for their baby.

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