Table 1

Neonatal nursing tasks

Task AreaTask done byFrequency (minimum daily requirement)Comment
 Admission nursing history, clinical evaluation and vital signsNurseOn admission
Routine vital signs and monitoring
 Temperature (including incubator temperature)NurseNormal: four times daily/6 hourly
Category C patients: two times daily/12 hourly
KMC newborns: Vital signs monitoring and monitoring of general clinical condition
 Checking and documenting oxygen saturation for babies not on oxygen (for babies on oxygen see section below).NurseFour times daily/6 hourlyAlthough it is recognised that the availability of pulse oximeters is limited at present, checking oxygen saturation in sick babies not on oxygen should be promoted.
 Skin colourNurseNormal: four times daily/6 hourly
Category C patients: two times daily/12 hourly
Conduct together with vital signs monitoring
 Respiratory effortNurse
 Abdominal distensionNurse
 WeightNurse/clinicianAlternate days
 Input/output - generalNurseFour times daily/6 hourly
 Input - IV fluidsNurse/clinicianFrequency depends on prescription. Infusion rate checked and documented three hourly.Conduct together with vital signs
 Input/output documentation (amount that has been infused)NurseThree hourly
Regular patient checks/care
 Changing diapers/checking for stool and urineNurse/patient’s familyAs requiredDone with vital signs and document passing stool and urine during diaper change
 Cleaning/bathing/clothingPatient’s familyAs required
 Changing bed linensNurse/patient’s familyAs required
 Incubator monitoring and settingsNurseDuring shift changes/per shift
 Wound care (checking/renewing dressings)NurseAs required
Administering interventions/doing investigations
 Taking venous bloodNurse/clinicianAs requiredNurses can perform this task if they have the skills to do so and if the clinicians charged with the responsibility are unavailable.
 Taking heel-prick bloodNurse/clinicianAs required
 Collecting urine/stoolNurse/patient’s familyAs required
 Resuscitation with bag valve maskMultidisciplinaryAs required
Drugs and vaccines
 Drug preparationNurseAs per drug schedule
 Dilutions (compatibility)Nurse
 Oral drug administrationNurse
 IV drug AdministrationNurse
 Cannula patency checkNurseBefore IV drug administrationTest if line is patent with water for injection
 Checking cannula sitesNurseDuring shift changes/twice a dayVisual inspection and palpation of the soft tissue for localised infection
 Giving vitamin KNurseAt birth/as required
 Routine cord care - antiseptic applicationNurse/patient’s familyOnce daily
 Eye care - routine drops applicationNurse/patient’s familyOnce daily
 OPV vaccinationNurseAs required
 BCG vaccinationNurseAs required
 Checking tube position and nostril care/damageNurseEight times daily/3 hourly
 Initiating and regulating oxygen flowNurseAs required
 Documenting oxygen treatmentNurse/clinicianAs required
 Checking and documenting pulse oximetryNurse/clinicianThree hourly/as requiredFor patients on oxygen
 Monitoring/regulating pressureNurse/clinicianThree hourly/as requiredRegulating pressure is done by clinician
 Checking nose/cleaning airwayNurseThree hourly/as required
 Checking respirationNurseThree hourly/as required
 Checking and changing humidifierNurseAs required
CPAP management
 CPAP machine setupNurse/clinicianAs required
 Applying nasal prongs/fixing tubingNurse/clinicianAs required
 Checking eyes for damagePatient’s family under supervision by nurseFour times daily/6 hourly
 Skin colourNurse/familyFour times daily/6 hourlyConduct together with vital signs
 Checking exposure/baby positioningShared by clinical teamContinuous/6 hourly/per shift
 Fixing eye padPatient’s family under supervision by nurseContinuous/6 hourly
 Documenting phototherapyNurse/clinical teamShift change/continuousDone during admissions and as required
Expressed breastmilk and formula milk preparation
 Formula makingNurse/nutritionist/motherEight times daily/3 hourly
 Storage and labelling of expressed breastmilkNurse/nutritionist/motherEight times daily/3 hourly
 Measuring volumes for individual patientsNutritionistContinuous
 Disinfection of cupsNurse/patient attendantEight times daily/3 hourly (after every feed)
 Teaching/counselling on breastfeeding (attachment/suck)Nurse/nutritionistOn admission and as required/daily
 Checking feed prescribed/type of feedNurse/mother under supervisionThree hourly or as per feeding schedule
 Cup feedingNurse/mother under supervisionEight times daily/3 hourly
 Nasogastric tube feeding/checking nostrilNurse/mother under supervisionEight times daily/3 hourlyNostril should be checked by a nurse when administering drugs
 Checking residual gastric volumes (nasogastric aspiration)Nurse/mother under supervisionEight times daily/3 hourly
 Charting feed volumes/timesNurse/mother under supervisionEight times daily/3 hourly
 Nasogastric tube insertionNurseAs required and replace after every 3 days
Blood transfusion/exchange transfusion
 Cross-checking blood for transfusion with co-workerNurseAs required
 Transfusion chart (patient observations/volume of blood)Nurse1/4 hourly
 Pre-administration check of laboratory results/medical recordClinicianAs required
 Exchange transfusion progressNurse/clinical teamContinuous with clinical team during procedure
 Discharge and admission registrationNurseAs requiredNurses would benefit from clerical assistants, but nurses are responsible.
 Patient labelsNurseAs required
 Notifications – BirthNurseAs required
 Notifications – DeathClinician/HRIOAs required
 Treatment sheets reviewNurse/clinicianOnce daily
 Incident bookNurseAs required
 Updating mother/child health book (vaccines, weight etc.)NurseAs required
 Recording in drug booksNurseAs required
 BillingMultidisciplinaryAs requiredServices free in public hospitals, therefore no billing
 Recording of stocks – non-pharmaceuticalsNurseAs required
 Managing medical recordsNurse/clinical teamContinuous/as required
 Parent - counselling, answering questions about clinical/nursing careNurseContinuous/as required
 Support for KMCShared with clinician and patient’s familyAs required
 Supervision of mother during KMCNurse/clinicianAs requiredExperienced mothers could assist in helping the other mothers
 Expressing breastmilkNurse/ nutritionist/ experienced mothersAs required
 Health education and progressNurseAs required
 Post-discharge care adviceNurseOn discharge/as required
 Instructions for drugs/medication on dischargeNurse/pharmacistOn dischargeNurse reinforces medication instructions for post-discharge use during the discharge process after or before patient obtains medication from the pharmacy, depending on hospital policy.
 Family planningNurseAs required
 HIV/STI preventionNurse/counsellor/clinicianAs required
 Bereavement counsellingNurse/clinicianAs required
Infection control and cleaning
 Cot cleaningSupport staffDaily cleaning and thorough cleaning after discharge of a baby before another uses it and as required
 Cleaning incubatorSupport staff
 Hand washingMultidisciplinaryAs required
 Visitors education/practice (on gowns/shoes/hand hygiene)NurseAs required
 Providing input to medical ward roundsNurseDuring ward rounds
 Accompany to lab/X-ray/theatre for procedure or operationNurseAs required
 Accompany on outward referral to another facilityNurseAs required
 Last offices (stopping interventions and preparing documentation after death).NurseAs requiredWashing the body and anything else should be done by mortuary or support staff.
 Pre-operative and post-operative careNurseAs required
 Assistance with portable chest X-rayNurse/radiology teamAs required
 Preoperative and postoperative careNurseAs required
 Setting alarms (incubator)NurseAs requiredPart of 6 hourly review and checks
 Equipment checksNurse/biomedical teamAs per schedule/as required
 Equipment handoverNurseOnce per shift
  • Tasks listed as being done by nurses can also be done by students under supervision of a qualified nurse, who is responsible for confirming that the task has been done correctly and as per hospital policy. However, students are not to carry out any tasks for category A patients. Clinician refers to either a generally trained (non-specialist) physician or a clinical officer (non- physician clinician) with specialist training in paediatrics.

  • HRIO, health records and information officer; IV, intravenous; KMC, kangaroo mother care; STI, sexually transmitted infection; OPV, oral polio vaccine; BCG, Bacillus Calmette–Guérin.