title: Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development.
abstract: OBJECTIVE
  The aims of this research were to identify (a) the educational and working experiences and (b) subsequent training needs of graduates of one ANNP course in the UK. The objectives were (a) to assess the medium to long-term impact of the training programme on the professional development of the respondents; (b) identify potential areas of excellence and (c) areas for improvement in this and other training programmes for ANNPs.
  
  
  BACKGROUND
  Neonatal intensive care continues to be a rapidly changing area of work. Nurses and doctors in neonatal intensive care units (NICUs) have to be skilled equally in interpersonal communications and technical expertise. The Advanced Neonatal Nurse Practitioner (ANNP) training programme was introduced in 1992 in the UK in the broader political context of extending nursing roles in a range of specialties. The role of the neonatal intensive care nurse had expanded elsewhere previously, particularly in North America as a response to medical staffing crises where the practice and the training/education programmes were expanded during the 1970s/1980s and continued to evolve to encompass an advanced role for the neonatal nurse practitioner.
  
  
  METHODS
  This was a study of five cohorts of graduates from one university course training programme for advanced neonatal practitioners (ANNPs) to explore their experiences of their role as ANNPs in the context of changes and developments in the British National Health Service and their own personal and professional development.
  
  
  METHODS
  This study employs mixed methods (interviews, focus groups and a survey) and forms of data analysis (qualitative and quantitative) to explore the experiences of the transition to becoming an advanced practitioner. Data were collected from a sample of five cohorts; members of the current course team and the nursing and medical staff at one NICU which employs many of these graduates.
  
  
  RESULTS
  Most graduates value their course experience and the ANNP role and the findings suggest that confidence about practice develops naturally with postcourse experience. However, the more experienced and confident ANNPs frequently reported increased inter-professional role confusion/conflict with junior doctors, and some consultants particularly where there are only one or two ANNPs overall in the team.
  
  
  CONCLUSIONS
  There are personal and professional benefits to individual nurses who have had this training. However more attention needs to be paid to ongoing professional development particularly the management of professional role relationships among all nurses and between nurses and doctors.
  
  
  CONCLUSIONS
  A focus on professional role relationships and more effective communication in the clinical setting would be of benefit to all members of multi-disciplinary teams. A greater level of day-to-day support is required for ANNPs, other neonatal nurses and junior doctors if this is to be achieved, especially in clinical settings where there are few ANNPs or the addition of these clinical specialists is relatively new.
authors.affiliation: University of Sheffield, ScHARR (School for Health and Related Research), Sheffield, UK. p.nicolson@sheffield.ac.uk
authors.forename: Paula
authors.initials: P
authors.lastname: Nicolson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Burr
authors.forename: Jenny
authors.initials: J
authors.lastname: Powell
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003220:Conflict, Psychological; D003299:Cooperative Behavior; D004511:Education, Nursing, Graduate / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D006801:Humans; D015931:Intensive Care, Neonatal / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D017283:Neonatal Nursing / Q000193:education / Q000458:organization & administration; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role; D015402:Nursing Education Research; D015404:Nursing Methodology Research; D009936:Organizational Innovation; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D011361:Professional Competence / Q000592:standards; D036301:Qualitative Research; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D006113:United Kingdom