A day in the life of an advanced neonatal nurse practitioner

The twins

Twin girls Diya and Avni were born in the Neonatal Intensive Care Unit at the University Hospital of Wales

These beautiful twin girls were born at 32 weeks and five days by Caesarean section due to cord entanglement.

They required some help with their breathing for the first few days but were breathing all by themselves by day seven.

Toyah, their mother, recalls visiting them for the first time and looking in on them in their incubators and feeling like they weren’t her babies. "It was such a whirlwind and the nurses were providing all their needs.

"As the days passed, my husband and I began doing more of their care, giving their milk feeds via the nasogastric tube into their tummies and changing their nappies.

"Over time, less and less equipment was needed as the girls got stronger and bigger and the highlight of our day was having them out for skin-to-skin contact, though my husband didn’t like to do this at first as he was worried about dislodging their intravenous cannula or leads. The nurses were fantastic and supported us every step of the way."

"The twins did very well and progressed well from the ITU setting to HDU and then the nursery," said Heidi Green, advanced neonatal nurse practitioner, who cared for them at every stage of their journey.

"When babies are born prematurely they are at greater risk of a range of complications due to their body’s immaturity. Both Diya and Avni have had an uneventful stay, gradually building up their milk feeds until tolerated fully by day 10 of life then learning to take these feeds for themselves by breast and bottle feeds.

"It takes time for these babies to be ready to go home and we often use their due date as an estimation of when they will be ready. We need to be sure they are taking adequate volumes of milk and gaining weight before we can be confident they will thrive at home.

"I was lucky to be able to support the family until their day of discharge. There is nothing more rewarding than seeing them all wrapped up in their car seats ready for home with their parents and the start of a new chapter."

The nurse

Heidi Green is an advanced neonatal nurse practitioner

 with Cardiff & Vale University Health Board

"I always knew I wanted to work with children but it wasn’t until I completed a diploma in childhood studies and got a feel for caring for children across schools, nurseries and hospital environments that I was certain a career in nursing was for me.

"Upon qualifying, I worked in neonatal intensive care settings, where I have been for 14 years.

"I have a fantastic career, truly rewarding every shift. Yes, there can be long shifts and unsociable hours but how many roles allow you to make a difference to a person’s life each and every day?

"The variety of the role is amazing. I never know what kind of day I'm going to have when I come on to the ward, so that is exciting.

"I could be caring for critically ill babies in intensive care - intubating, performing blood tests and making changes to their ventilation, fluids and medications and so forth. In contrast, I may be working in the special care setting, performing head scans, assisting mothers to breast feed and planning an infant’s discharge.

"If there are any deliveries that are identified as high risk for the infant, I attend to provide resuscitation for the baby at birth should they need it.

"When the baby is well, it's lovely to be part of their birth experience, and when the baby does need help it’s rewarding to be there to ensure they can get high quality care to ensure the best outcome.

Career prospects

"Nursing can take you wherever you want it to. I have worked in north Wales, south Wales, England and Australia. Experiencing nursing care in a variety of settings really makes you question practice; what we do and why we do it.

"I qualified as a Children's Nurse (BN Hons) and then took specialist qualifications in special and high dependency care and intensive care and a Postgraduate Certificate in Education. These additional qualifications allowed me to gain Junior Sister and Senior Sister posts and become a Practice Educator, a crucial role that is responsible for the education and training of all nursery nurses and nursing staff and oversees the quality of care that families receive from nurses.

"My current role is an advanced neonatal nurse practitioner, which required me to take a Masters in Science.

"This role provides me with the best of both worlds. I’m able to work clinically, performing procedural skills and clinical decision-making similar to the role of a doctor, whilst still being involved in the education of staff, research studies and maintaining leadership and management roles too. It’s a really diverse role and I feel honoured to be doing it.

"I've always tried to find my niche in life, discover what it is that I enjoy and gives me satisfaction. Education is a big passion for me - hence all the courses - and I now share my knowledge and experience with nursing students by lecturing at USW.

"I’m still as motivated, excited and enthusiastic about nursing as I was when I did my nurse training and you’ve got to keep hold of that. 


Photographs by Matthew Lofthouse, BA (Hons) Photojournalism student, and Lorna Cabble, BA (Hons) Photojournalism graduate. With thanks to Cardiff and Vale University Healthboard


Find out more about studying Child Nursing at USW