Advanced neonatal nurse practitioners in the workforce: a review of the evidence to date.

The last decade has seen dramatic changes in the working arrangements and training requirements of junior medical staff employed in neonatal units. As a result, there is a need for the professional roles in service provision to be reappraised. In many neonatal services, advanced neonatal nurse practitioners (ANNPs) have been introduced and have been shown to be effective in providing an alternative option for the provision of neonatal care at both junior and middle-grade medical staffing level. One of the key factors of the success of this role is the underpinning years spent in clinical practice, a foundation that provides a valuable and unique perspective for professional functioning at a senior level. For this potential to be fully exploited, a more integrated approach to the development of career pathways for ANNPs is needed. However, there are challenges related to recruitment, and the relatively small numbers of ANNPs available means that they are unlikely to provide an immediate solution for many units. The introduction of physicians' assistants (PAs) would seem to be worthy of consideration as part of the neonatal workforce, but it is likely that their functioning will be best integrated with that of ANNPs. In the longer term, economic factors will be a powerful determinant of the relative proportion of consultants, trainee doctors, ANNPs and PAs in the workforce.