Table 1

Neonatal nursing tasks

Task Area	Task done by	Frequency (minimum daily requirement)	Comment
Admission
Admission nursing history, clinical evaluation and vital signs	Nurse	On admission
Routine vital signs and monitoring
Temperature (including incubator temperature)	Nurse	Normal: four times daily/6 hourly Category C patients: two times daily/12 hourly	KMC newborns: Vital signs monitoring and monitoring of general clinical condition
Pulse	Nurse
Respiration	Nurse
Checking and documenting oxygen saturation for babies not on oxygen (for babies on oxygen see section below).	Nurse	Four times daily/6 hourly	Although 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 colour	Nurse	Normal: four times daily/6 hourly Category C patients: two times daily/12 hourly	Conduct together with vital signs monitoring
Jaundice	Nurse
Respiratory effort	Nurse
Abdominal distension	Nurse
Weight	Nurse/clinician	Alternate days
Input/output - general	Nurse	Four times daily/6 hourly
Input - IV fluids	Nurse/clinician	Frequency depends on prescription. Infusion rate checked and documented three hourly.	Conduct together with vital signs
Input/output documentation (amount that has been infused)	Nurse	Three hourly
Regular patient checks/care
Changing diapers/checking for stool and urine	Nurse/patient’s family	As required	Done with vital signs and document passing stool and urine during diaper change
Cleaning/bathing/clothing	Patient’s family	As required
Changing bed linens	Nurse/patient’s family	As required
Incubator monitoring and settings	Nurse	During shift changes/per shift
Wound care (checking/renewing dressings)	Nurse	As required
Administering interventions/doing investigations
Taking venous blood	Nurse/clinician	As required	Nurses 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 blood	Nurse/clinician	As required
Collecting urine/stool	Nurse/patient’s family	As required
Resuscitation with bag valve mask	Multidisciplinary	As required
Drugs and vaccines
Drug preparation	Nurse	As per drug schedule
Dilutions (compatibility)	Nurse
Oral drug administration	Nurse
IV drug Administration	Nurse
Cannula patency check	Nurse	Before IV drug administration	Test if line is patent with water for injection
Checking cannula sites	Nurse	During shift changes/twice a day	Visual inspection and palpation of the soft tissue for localised infection
Giving vitamin K	Nurse	At birth/as required
Routine cord care - antiseptic application	Nurse/patient’s family	Once daily
Eye care - routine drops application	Nurse/patient’s family	Once daily
OPV vaccination	Nurse	As required
BCG vaccination	Nurse	As required
Oxygen
Checking tube position and nostril care/damage	Nurse	Eight times daily/3 hourly
Initiating and regulating oxygen flow	Nurse	As required
Documenting oxygen treatment	Nurse/clinician	As required
Checking and documenting pulse oximetry	Nurse/clinician	Three hourly/as required	For patients on oxygen
Monitoring/regulating pressure	Nurse/clinician	Three hourly/as required	Regulating pressure is done by clinician
Checking nose/cleaning airway	Nurse	Three hourly/as required
Checking respiration	Nurse	Three hourly/as required
Checking and changing humidifier	Nurse	As required
CPAP management
CPAP machine setup	Nurse/clinician	As required
Applying nasal prongs/fixing tubing	Nurse/clinician	As required
Phototherapy
Checking eyes for damage	Patient’s family under supervision by nurse	Four times daily/6 hourly
Skin colour	Nurse/family	Four times daily/6 hourly	Conduct together with vital signs
Checking exposure/baby positioning	Shared by clinical team	Continuous/6 hourly/per shift
Fixing eye pad	Patient’s family under supervision by nurse	Continuous/6 hourly
Documenting phototherapy	Nurse/clinical team	Shift change/continuous	Done during admissions and as required
Expressed breastmilk and formula milk preparation
Formula making	Nurse/nutritionist/mother	Eight times daily/3 hourly
Storage and labelling of expressed breastmilk	Nurse/nutritionist/mother	Eight times daily/3 hourly
Measuring volumes for individual patients	Nutritionist	Continuous
Disinfection of cups	Nurse/patient attendant	Eight times daily/3 hourly (after every feed)
Feeding
Teaching/counselling on breastfeeding (attachment/suck)	Nurse/nutritionist	On admission and as required/daily
Checking feed prescribed/type of feed	Nurse/mother under supervision	Three hourly or as per feeding schedule
Cup feeding	Nurse/mother under supervision	Eight times daily/3 hourly
Nasogastric tube feeding/checking nostril	Nurse/mother under supervision	Eight times daily/3 hourly	Nostril should be checked by a nurse when administering drugs
Checking residual gastric volumes (nasogastric aspiration)	Nurse/mother under supervision	Eight times daily/3 hourly
Charting feed volumes/times	Nurse/mother under supervision	Eight times daily/3 hourly
Nasogastric tube insertion	Nurse	As required and replace after every 3 days
Blood transfusion/exchange transfusion
Cross-checking blood for transfusion with co-worker	Nurse	As required
Transfusion chart (patient observations/volume of blood)	Nurse	1/4 hourly
Pre-administration check of laboratory results/medical record	Clinician	As required
Exchange transfusion progress	Nurse/clinical team	Continuous with clinical team during procedure
Documentation
Discharge and admission registration	Nurse	As required	Nurses would benefit from clerical assistants, but nurses are responsible.
Patient labels	Nurse	As required
Notifications – Birth	Nurse	As required
Notifications – Death	Clinician/HRIO	As required
Treatment sheets review	Nurse/clinician	Once daily
Incident book	Nurse	As required
Updating mother/child health book (vaccines, weight etc.)	Nurse	As required
Recording in drug books	Nurse	As required
Billing	Multidisciplinary	As required	Services free in public hospitals, therefore no billing
Recording of stocks – non-pharmaceuticals	Nurse	As required
Managing medical records	Nurse/clinical team	Continuous/as required
Counselling/support
Parent - counselling, answering questions about clinical/nursing care	Nurse	Continuous/as required
Support for KMC	Shared with clinician and patient’s family	As required
Supervision of mother during KMC	Nurse/clinician	As required	Experienced mothers could assist in helping the other mothers
Expressing breastmilk	Nurse/ nutritionist/ experienced mothers	As required
Health education and progress	Nurse	As required
Post-discharge care advice	Nurse	On discharge/as required
Instructions for drugs/medication on discharge	Nurse/pharmacist	On discharge	Nurse 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 planning	Nurse	As required
HIV/STI prevention	Nurse/counsellor/clinician	As required
Bereavement counselling	Nurse/clinician	As required
Infection control and cleaning
Cot cleaning	Support staff	Daily cleaning and thorough cleaning after discharge of a baby before another uses it and as required
Cleaning incubator	Support staff
Hand washing	Multidisciplinary	As required
Visitors education/practice (on gowns/shoes/hand hygiene)	Nurse	As required
Miscellaneous
Providing input to medical ward rounds	Nurse	During ward rounds
Accompany to lab/X-ray/theatre for procedure or operation	Nurse	As required
Accompany on outward referral to another facility	Nurse	As required
Last offices (stopping interventions and preparing documentation after death).	Nurse	As required	Washing the body and anything else should be done by mortuary or support staff.
Pre-operative and post-operative care	Nurse	As required
Assistance with portable chest X-ray	Nurse/radiology team	As required
Preoperative and postoperative care	Nurse	As required
Setting alarms (incubator)	Nurse	As required	Part of 6 hourly review and checks
Equipment checks	Nurse/biomedical team	As per schedule/as required
Equipment handover	Nurse	Once 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.