The NIDCAP Nursery Program under the auspices of the NIDCAP Federation International (NFI) recognizes the excellence of a hospital nursery’s commitment to and integration of the principles of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) for infants, families, and staff. Hospitals and their newborn intensive and special care nursery systems receive NIDCAP Nursery Certification when they demonstrate that they consistently promote best short and long term development of all infants and families in their care, and support their professionals and staff in accordance with the principle of assuring best personal and professional development towards relationship-based care implementation. NFI certified NIDCAP Nurseries provide a dynamic environment for the full integration of expert medical and nursing care securely embedded within the active pursuit of mutual respect, caring, nurturance of and collaboration with infants and families, and among all professionals and staff members.

NIDCAP Nursery Certification entails formal recognition and validation of the applicant nursery’s characteristics:

• The excellence of a hospital nursery’s commitment to and integration of the principles of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) for infants, families, and staff.
• A hospital and its newborn nursery systems’ promotion of best short and long term development of all infants and families in their care.
• The newborn nursery professionals and staff’s assurance of best personal and professional development towards relationship-based care implementation.
• A nursery’s dynamic environment for the full integration of expert medical and nursing care securely embedded within the active pursuit of mutual respect, caring, nurturance of and collaboration with infants and families, and among all professionals and staff members.
• The quality of a nursery’s developmental orientation and care implementation.
• A nursery system’s strengths and, as indicated, provision of guidance towards growth and further development in order that the nursery may achieve the ultimate goal of NIDCAP Nursery Certification.
• A nursery’s level of individualization, family-centeredness, and developmental support that a nursery provides for the infants and families in its care, as well as for the professionals and staff involved in delivering such care.
• A nursery’s adoption of developmental care as a framework of care delivery.
• A hospital’s standard of care and assistance to mentoring its newborn nursery system in its integration of the principles of individualized, relationship-based, developmental care.
• The nursery’s full integration of environmental and caregiving parameters for the benefit of the infants, families, and staff’s functioning and satisfaction.

Nurseries eligible to apply to the NFI for certification must be part of a hospital system that, if in the USA, is licensed and accredited by the Joint Commission on the Accreditation of Healthcare Organizations, or if outside of the USA, meets the respective country’s accreditation standards. Furthermore, nurseries eligible for certification must provide care to preterm infants under 1500 grams and/or under 30 weeks gestation either from birth on (NICU, Level III Nursery) or in a convalescent mode (Level II Nursery; step-down nursery); and/or provide care for full-term or near full term infants who require intensive or specialized medical care to ensure their survival; and/or provide care for newborns cared for in a hospital setting for various reasons. Such nurseries must employ at least one full-time equivalent (FTE) NFI-certified NIDCAP Professional in good standing for the purpose of promoting individualized developmental care. Hospitals with multiple nursery settings may apply for certification for only one or for more than one of their nursery settings. Hospitals are encouraged to apply ultimately for certification for all the nurseries settings under their purview.

Please see NIDCAP Nursery Program: A Guide to Preparation, Application and Implementation of NIDCAP Nursery Certification, for a complete description of the NIDCAP Nursery Program Eligibility Requirements.

The NIDCAP Nursery Program application process consists of the following six steps:

1. The nursery applicant reviews the NIDCAP Nursery Certification Program: A Guide to Preparation, Application and Implementation of NIDCAP Nursery Certification in order to determine if the nursery is eligible for NIDCAP Nursery Certification;
2. If eligible, the nursery applicant submits the NIDCAP Nursery Program Application: Part I and all supporting evidence;
3. Should the NIDCAP Nursery Program Application: Part I be approved by the NIDCAP Nursery Program Director, the nursery applicant is then invited to submit the NIDCAP Nursery Program Application: Part II, Nursery Self-Assessment Questionnaire, the scored the Nursery Assessment Manual as well as the completed NIDCAP Nursery Program: Provision of Evidence;
4. Once the NIDCAP Nursery Program Application: Part II is reviewed and approved by the designated Site Review Team, the NIDCAP Nursery Program Director, in collaboration with the nursery applicant and the Review Team, develops the Site Review Schedule. This schedule addresses the dates and times that particular activities (e.g., observations, interviews, chart reviews, etc.) will be conducted, and specifies the logistics for the site visit (see Preparation for the NIDCAP Nursery Program Site Review);
5. NIDCAP Nursery Program Site Review: The nursery applicant is evaluated by three Site Reviewers, during a two- to three-day Site Visit, depending on the nursery’s size and complexity. This is followed by a one-day off-site, yet on-location, Site Review Team integration day to review the results of the site assessment; and
6. Following the integration of the Review Process the Site Review Team develops a Summary Report and Recommendations that are shared with the NIDCAP Nursery Program Steering Committee and subsequently forwarded by the NIDCAP Nursery Program Director to the NFI Board of Directors. The NFI Board decides on the ultimate disposition of the application. Upon such disposition the nursery applicant receives the Review Team’s Summary Report and the NFI Board’s decision as to the results of the nursery’s application’s disposition.

Please see the NIDCAP Nursery Certification Program: A Guide to Preparation, Application and Implementation of NIDCAP Nursery Certification, for a complete description of the NNCP application process.

The NIDCAP Nursery Program Application: Part I requests the following information from the nursery applicant:

1. The Identification of a Site Coordinator, the Administrative Leadership, the Nursery NIDCAP Leaders, and the NICU interdisciplinary care team members;
2. A description of the applicant’s hospital and nursery including hospital accreditation and licensure, the population served, and a description of the NIDCAP training that the nursery staff have received;
3. The assurance that the nursery leadership and staff are formally committed, across all disciplines, to practice the NIDCAP approach to care and the assurance that financial resources are available for staff seeking further training in the NIDCAP approach;
4. A description of the strengths and challenges of the applicant’s nursery regarding individualized, developmentally supportive family-centered care; and
5. The provision of supporting evidence including:
   • Two examples of developmental care plans (e.g., NIDCAP write-ups, and/or developmental reports); and
   • Six Letters of Support

For complete information, please see the NIDCAP Nursery Application: Part I.

The NIDCAP Nursery Program Application: Part II, Nursery Self-Assessment Questionnaire requests information from the nursery applicant regarding the following topics:

1. Hospital and nursery characteristics;
2. Specific leadership structures;
3. Hospital/nursery structural and organizational characteristics;
4. Developmental care support characteristics;
5. Developmental care history and goals;
6. The dynamics of the relationships that currently exist among the nursery staff (e.g., nurse-to-nurse relationships, nurse-to-doctor relationships), between staff and administration, and between the families and infants under their care;
7. The scored NIDCAP Nursery Certification Criterion Scales (NNCCS); and
8. The NNCCS Provision of Evidence.

For complete information, please see NNCP Application: Part II, Nursery Self-Assessment Quesitionnaire.

The Nursery Assessment Manual consists of 121 scales grouped into four major categories of a nursery’s characteristics and functioning, as well as of four Category Summary Scales, and one Overall Nursery Summary Scale. The individual and the summary scales address the level of individualization, family-centeredness, and developmental support that a nursery provides for the infants and families in its care, as well as for the professionals and staff involved in delivering such care. Aspects of the nursery considered are the physical environment, the care for the infants, the care for the families, and the care for the professionals and staff members in the nursery, who in turn care for the infants and families. The individual scales are organized into the following four categories:

• (1) Physical Environment of the Hospital and Nursery;
• (2) Philosophy and Implementation of Care: Infant;
• (3) Philosophy and Implementation of Care: Family; and
• (4) Philosophy and Implementation of Care: Professionals and Staff.

The five-point rating scales of the NIDCAP Nursery Assessment Criterion Scales (NNCCS) assess a nursery’s philosophy and implementation of care in reference to the NIDCAP (Newborn Individualized Developmental Care and Assessment Program) model. Each of the five score points on the NNCCS ratings represents a level or degree of NIDCAP implementation as follows:

• (1) Traditional, conventional care;
• (2) The beginning or a minimal degree or level of NIDCAP implementation;
• (3) An inconsistent, variable or moderate degree or level of NIDCAP implementation;
• (4) A consistent well-integrated level or degree of NIDCAP implementation; and
• (5) A highly attuned, distinguished level or degree of NIDCAP implementation.
• (NA) “Not applicable,” is scored when an aspect of care does not apply to a specific nursery system.

Scores derived from the individual ratings within each of the four categories are utilized to describe and characterize an individual nursery in order to assess the nursery’s level of developmental care implementation and integration, and its readiness to be certified as an individualized, developmentally supportive, family-centered NIDCAP Nursery (see “How are NNCCS Scores derived by the NNCP Site Review Team?”).

For complete information, please see Nursery Assessment Manual.

The NIDCAP Nursery Certification Criterion Scales (NNCS) Provision of Evidence offers the applicant the opportunity to demonstrate the nursery’s implementation of relationship-based, family-centered, developmental care. The applicant is asked to provide specific information and documentation that corroborates the scores assigned to the NNCCS. The NNCCS Provision of Evidence lists required evidence for scores of four (4) and five (5) aside from optional evidence for scores one to three (1–3) for each of the 121 scales of the NNCCS. Required information and/or documentation in substantiation of scores may include:

1. Nursery/hospital policies, guidelines, and procedures;
2. Photographs, video-clips and/or audio recordings;
3. Maps of NICU/SCN floor plans;
4. Staff training materials/syllabi, PowerPoint presentations, and/or lists of required journal articles for staff education;
5. Parent educational materials in support of their infant’s care, brochures of hospital/community services, informational materials;
6. Written and/or audio recordings of parent/staff reflections;
7. Hospital Organizational Charts, Department of Pediatrics Organizational Charts, Diagrams/Charts of Nursing Administration/Hierarchy, and Projected Stepwise Outlines of the Nursery’s Goals for the next five years; and
8. A “Table of Contents” of Unit Policies, Guidelines and Procedures, Goal Setting and Multidisciplinary Evaluation Forms and documents such as a Family Centered Care Philosophy, e.g. ‘Parents as Collaborative Members of the NICU Team’, among others.

For complete information, please see NNCCS Provision of Evidence.

Before the Site Visit

If the NIDCAP Nursery Program Application: Part II, Nursery Self-Assessment Questionnaire, and the supporting documents and evidence are deemed by the Site Review Team to reflect in high likelihood successful certification, the NIDCAP Nursery Director, in collaboration with the nursery applicant and the Site Review Team, develops the NIDCAP Nursery Program Site Review Schedule. This schedule addresses the dates and times that particular activities (e.g., observations, interviews, chart reviews, etc.) will be conducted, and specifies the logistics for the site visit.

Please see Preparation for the NNCP Site Review.

During the Site Visit

The NIDCAP Nursery Program Site Visit is typically scheduled for two days of on-site site review, and one day of off-site integration, depending upon the size and complexity of the nursery. During this Site Visit the Site Review Team experiences the same path that families take from the hospital’s entrance, through the hospital, and to their infants’ bedsides. The Team, furthermore, observes overall, as well as specific aspects of the nursery environment, and meets with the hospital and nursery’s administrative leadership; representatives from across and within disciplines; and parents and other family members whose infants are currently cared for in the nursery. On the final day, the Site Review Team members each score the 121 scales, based upon the site’s self-assessment including the written materials submitted in advance, and the on-site observations (See FAQ: “How are NNCCS Scores derived by the NNCP Site Review Team?”)

Please see NIDCAP Nursery Certification Program: A Guide to Preparation, Application and Implementation of NIDCAP Nursery Certification, for a complete description of the NIDCAP Nursery Program application process.

On the final day of the Site Visit, the Site Review Team meets off-site to share with each other what each of the Team members learned in the course of the site review, and integrates this information with the information gleaned from the application materials already reviewed prior to the visit. Then the Team members each score the 121 scales, based upon the Site’s self-assessment and the on-site observations. The scores derived during this process by each of the reviewers yield the Averaged Scale Scores by Category; and the Overall Hospital and Nursery Summary Score.

Towards the end of the final site visit day, the Site Review Team meets briefly with the site’s NICU Leadership Team with the following goals: 1) To convey an overall impression about areas that were exemplary; 2) To convey an overall impression about areas that will require further work; and 3) To provide an opportunity to ask the site for further clarification of any of the points raised during the course of the review of supporting documents, Site Self-Assessment, observations, and interviews that were conducted.

The NIDCAP Nursery Program Summary Report is developed for the purpose of sharing the final results of the review process with the nursery applicant. Each Site Reviewer develops specific recommendations for the NIDCAP Nursery Program Summary Report. These recommendations are shared with the NIDCAP Nursery Program Director, who then integrates the recommendations into the Summary Report. This document is reviewed and edited by each of the Team Members and then returned to the Director for further integration and the creation of a graphic representation of the Team Members’ Nursery Assessment Manual scores. With final approval of the Review Team, the Director sends the Summary Report to the NIDCAP Nursery Program Steering Committee for review, feedback, questions, and/or recommendation to the NFI Board for final disposition.

The Board of Directors of the NIDCAP Federation International (NFI) confers NIDCAP Nursery Certification upon the nursery applicant via sending of the Summary Report letter. Upon certification the successful nursery applicant may wish to plan a NIDCAP Nursery Certification Award Ceremony in collaboration with the NNCP Chairperson and Director, and the NFI Board Regardless of a celebration, in all cases the NFI President contacts the NFI membership to announce the confirmation of the award of NIDCAP Nursery Certification to the applicant nursery.

Should an applicant nursery fail to achieve NIDCAP Nursery Certification yet benefit from further development, the Summary Report Letter will include recommendations for further education and preparation of the site for instance by attending one of the NIDCAP Nursery Program workshops; by further mentoring from a NIDCAP Trainer; and/or by further NIDCAP training. Specific guidance is offered to the site for the next steps of further growth.and the nursery’s developmental leadership team is supported in solidifying their work towards successful NIDCAP Nursery Certification.

Depending upon the size and complexity of the nursery, the application and review process takes a minimum of one year. For some nurseries the process may take longer, from 16 months to two years.

The process includes the submission and review of the NIDCAP Nursery Program Application: Parts I and II; the applicant’s scoring of the NIDCAP Nursery Certification Criterion Scales (NNCCS); the submission of NNCCS Provision of Evidence; and the Preparation for the NNCP Site Review. This is followed by the implementation of the Site Review Visit, the final review of all documents/materials, interviews, observations by the Site Review Team and the arrival of a final disposition regarding the applicant nursery summarized in the NNCP Summary Report.

*Based on a three-day Site Visit.

For complete information, please see Cost Analysis and Budget Justification for NIDCAP Nursery Program Fees and Travel Expenses.

The NIDCAP Nursery Program Certification Renewal Application Process was developed to ensure that hospital

nurseries, that in the past have received NFI NIDCAP Nursery Certification, continue to offer a high standard of NIDCAP care to infants, their families and the caregivers who care for them. This progressive quality assurance practice certifies that these nurseries: 1) demonstrate that they consistently promote best short and long term development of all infants and families in their care; 2) support their professionals and staff in accordance with the principle of assuring best personal and professional development towards relationship‐based care implementation; and 3) provide a dynamic environment for the full integration of expert medical and nursing care securely embedded within the active pursuit of mutual respect, caring, nurturance of, and collaboration with, infants and families, and among all professionals and staff members.

Rodd E. Hedlund, MEd
Director, NFI-NIDCAP Nursery Program
nidcapnurserydirector@nidcap.org
785-841-5440