Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
A novel Model of Care (MOC) was developed to address deficits in care amongst medically stable infants within the Special Care Nursery (SCN). Utilising evidence, benchmarking and co-design with nursing staff and parents.
Dates: January 2024 - September 2025
Implementation sites: Mater Mothers' Hospital South Brisbane
Partnerships N/A
Aim
To develop a novel model of care that addresses the deficits in the current model of care related to timely discharge, parental empowerment and confidence, along with top of scope work by nursing staff.
Outcomes
Pilot implementation, in its early phase, has shown promising results. Qualitative feedback received has shown that parents are pleased with the inclusion into the MOC, and overall report feeling a greater sense of autonomy and confidence in decision making and progression of their babies. Nursing staff report feeling satisfied with the increased scope and it has been reported from medical staff that nursing staff have shown greater confidence in decision making, along with increased clinical acuity and appropriate escalation of babies when needed.
Background
In literature searching and unit benchmarking it appears that the primary MOC is the medical MOC that exists within most, if not all, SCN around Australia. Nurses are encouraged to be collaborators and advocates in decision making for the babies for which they are caring however final decisions are made by the medical team during rounding and reviews. What is already known is that SCN nurses are best placed to be providing support, education and information to parents of the inpatient babies(1).
Many of the babies in the SCN do not have significant medical problems and the focus of management is much more within the scope of nursing practice, however the current model of care requires that each baby is seen every day by the medical team. This may result in families feeling like there has been medicalisation of their baby's care and may also result in devaluing the nursing care or disempowering the nursing staff in making decisions that are within their scope of practice. It is well known that parents value the relationship that is fostered between them and nurses caring for their babies, and a positive relationship in turn improves outcomes for babies(2).
The reflection that neonatal nurses are able to provide information and support parental involvement supports the idea that a positive nurse relationship improves parental confidence in their parenting abilities(3).
The literature highlights that parents view nurses as teachers, guardians and facilitators, and learn critical health and parenting skills from the role modelling they provide(4). Recognising the importance of nurses in the provision of care in the SCN highlights the need to place them at the forefront of care and decision making whilst enabling and empowering them to work to top-of-scope.
Care delivery in SCN must evolve to address gaps between the needs of clinically stable infants and the structure of existing MOC. While SCNs manage a diverse cohort, many infants no longer require acute medical oversight. Instead, the primary goals of care are oral feed establishment, growth, parental skill development, and discharge readiness. Conventional MOCs often fail to emphasise the critical role of feed establishment and parent confidence/crafting in infants who no longer require acute care. Within the current Mater Mothers' Hospital (South Brisbane) SCN MOC, care is led by a medical team comprising a Consultant Neonatologist or Paediatrician, supported by junior medical staff, alongside nursing staff including a Team Leader and bedside nurses. Although nurses collaborate in care discussions, final decision-making authority traditionally rests with the medical team, and all infants are reviewed daily regardless of acuity. This structure creates several challenges for stable infants whose care needs fall predominantly within the nursing scope of practice.
On review of the literature and unit benchmarking it appears that the primary MOC that is utilised in most, if not all, of SCN around Australia is the traditional medical MOC. The issues prompting this project included overreliance on medical review for routine progression decisions, underutilisation of nursing scope of practice, and a lack of individualised and timely discharge trajectories. For families, this model may inadvertently reduce parental empowerment and confidence by positioning medical authority as central, even when care priorities relate primarily to feeding, education, and parent crafting acquisition. For nursing staff, it may limit autonomy in areas where they are best placed to lead. Parents of babies requiring admission the Neonatal units have higher risk of complex postnatal depression.
Methods
The Nurse-Led Model of Care (NLMC) was developed using a Participatory Action Research (PAR) methodology. This approach was selected to ensure that those directly involved in SCN practice actively contributed to the identification of problems, design of solutions, and implementation of change. PAR emphasises collaboration, reflection, and iterative cycles of planning, action and review(7).
The initial phase, the planning and exploration phase, involved a targeted literature review examining Models of Care within SCN settings, nurse-led models in acute inpatient contexts, and evidence relating to parental psychosocial outcomes and feeding progression. Concurrently, benchmarking was undertaken with comparable hospitals to understand prevailing SCN MOCs. This confirmed that while collaborative approaches existed, a formalised nurse-led SCN model had not been implemented in similar contexts. Anonymous, digital staff surveys were distributed in the development phase to ascertain their opinions, challenges and needs related to this proposed MOC change. Four parent dyads were also approached and completed an interview, including survey, about the challenges and opportunities for empowerment, as well as opinions and concerns around a conceptual MOC change.
Findings were presented to SCN nursing staff during monthly meetings. These sessions served as collaborative forums to explore current challenges within the existing medically led MOC, including discharge delays, reliance on medical review for routine progression decisions, and underutilisation of nursing scope of practice. Staff feedback shaped the guiding principles of the proposed model.
In the co-design and development phase, a project team consisting of a Nurse Practitioner and Clinical Nurse Consultant facilitated the co-design of the NLMC with bedside nursing staff and parents. Key initiatives developed through this process included:
- Defined inclusion and exclusion criteria for infants suitable for nurse-led care
- Clear nursing role expectations and decision-making parameters
- Escalation criteria for medical review
- Introduction of structured weekly multidisciplinary NLMC rounds
- Implementation of documented 'Weekly Goals of Care' centred on feeding progression, parental involvement and discharge planning
The weekly NLMC round involved the Nursing Team Leader, bedside nurse, Neonatologist or Paediatrician on service, and Allied Health as available. The bedside nurse presented the infant's progress, identified barriers to discharge, and collaboratively set individualised goals with the family's input central to planning.
For the action and reflection phase, many processes were undertaken. Prior to implementation, an education package was developed and delivered to nursing, medical and allied health staff through in-person presentations and recorded sessions. The Nurse Practitioner attended the first two weeks of NLMC rounds to support adherence to the model and facilitate reflective discussion regarding workflow challenges and role transition.
Ongoing feedback was actively sought from staff, and minor refinements were made to documentation processes and eligibility criteria during early implementation. This cyclical process of action and reflection ensured the model evolved in response to frontline experience.
Discussion
Strong leadership and nursing ownership were essential for the implementation. Ownership is driven by staff having robust understanding of the rationale and evidence behind the new MOC and being able to provide their input in the design and development. Medical and nursing staff must feel empowered to collaborate in the best interests of these medically stable infants. To optimise outcomes, as well as ensure nursing decisions are consistent and evidence-based, robust education and support needs to be provided to nursing staff. This is scaffolded with nursing leadership being available and supportive to bedside nursing staff. Families must also be involved in the communication of implementation, with staff clearly able to understand, explain and answer questions about the MOC.
Many lessons have been learned since the implementation of the NLMC. Active participation of the nursing staff, as well as medical staff input, is vital in ensuring optimal uptake of the MOC. The implementation also required governance oversight to ensure alignment with scope-of-practice guidelines as well as clinical documentation. Clear articulation of inclusion criteria and escalation pathways was essential to prevent reversion to traditional medical MOC and to ensure clinicians felt confident practising within defined boundaries. It has become clear during implementation that parental involvement in the development of the Weekly Goals of Care is vital, and this expectation may take time to embed in culture. Handing power back over to parents to create their goals may be uncomfortable for them until it becomes the normal cultural expectation in a unit and as such, the optimisation of this element of the MOC will be seen over time.
The main limitation of this project is the short time since its implementation. It is anticipated that there will be more iterations as we cycle through feedback and improvements to optimise workflow and outcomes. Post-implementation data mirroring pre-implementation staff and parent surveys have not yet been collected, and long-term data relating to discharge efficiency, parental confidence, and clinical outcomes are not yet available. As a single-site initiative, generalisability may also be limited without broader evaluation.
The NLMC would be suitable for other Special Care Nurseries caring for medically stable infants whose primary goals are discharge readiness and parental skill development. Successful replication would require strong multidisciplinary collaboration and leadership support. The model may be particularly beneficial in regional SCNs where medical staff presence is limited, and nurse-led progression could enhance efficiency while maintaining safety.
Next steps include formal evaluation of parent confidence, discharge timelines and nursing self-efficacy to determine measurable impact. Continued PAR cycles will allow refinement of eligibility criteria and workflow processes. Sustained leadership support and ongoing reflective cycles will be essential to embed the NLMC as standard practice and to ensure its long-term impact on parent confidence, discharge readiness, and nursing autonomy.
The NLMC demonstrates that collaboratively developed, nurse-led care can empower staff, enhance parental engagement, and better align care with the needs of clinically stable infants. With supportive leadership, structured processes, and iterative reflection, this model has potential to be successfully implemented across other SCNs within Queensland and comparable neonatal services.
References
1. Jones L, Peters K, Rowe J, Sheeran N. The influence of neonatal nursery design on mothers' interactions in the nursery. Journal of Pediatric Nursing. 2016;31(5):e301-e12.
2. Jones L, Taylor T, Watson B, Fenwick J, Dordic T. Negotiating care in the special care nursery: Parents' and nurses' perceptions of nurse'parent communication. Journal of pediatric nursing. 2015;30(6):e71-e80.
3. Kowalski WJ, Leef K, Mackley A, Spear M, Paul D. Communicating with parents of premature infants: who is the informant? Journal of perinatology. 2006;26(1):44-8.
4. Boucher CA, Brazal PM, Graham-Certosini C, Carnaghan-Sherrard K, Feeley N. Mothers' breastfeeding experiences in the NICU. 2010.
5. Ciciolla L, Shreffler KM, Quigley AN, Price JR, Gold KP. The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission. Matern Child Health J. 2024;28(1):11-8.
6. Shandra Bos L, Shorey S, Kulantaipian TS, Sng JSP, Tam WWS, Koh SSL. Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress. J Perinat Neonatal Nurs. 2018;32(4):E11-E21.
7. Garne Holm K, Brodsgaard A, Zachariassen G, Smith AC, Clemensen J. Participatory design methods for the development of a clinical telehealth service for neonatal homecare. SAGE Open Med. 2017;5:2050312117731252.
Key contact
Tenille Cross
Neonatal Nurse Practitioner
Mater Mothers' Hospital, South Brisbane
Email: tenille.cross@mater.org.au