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:

• 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.
• Assists hospitals and their newborn nursery systems to promote best short and long term development of all infants and families in their care.
• Supports newborn nursery professionals and staff in assuring best personal and professional development towards relationship-based care implementation.
• Facilitates 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.
• Evaluates the quality of a nursery’s developmental orientation and care implementation.
• Identifies and confirms a nursery system’s strengths and, as indicated, provides guidance towards growth and further development in order that the nursery may achieve the ultimate goal of NIDCAP Nursery Certification.
• Addresses the levels 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. It includes the evaluation of the:
  (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.
• Documents change in the course of a nursery’s adoption of developmental care as a framework of care delivery.
• Authenticates the standard of care within a newborn nursery and assists in mentoring newborn nursery systems as they integrate the principles of individualized, relationship-based, developmental care.
• Examines the relationship of environmental and caregiving parameters to infant, family, and staff functioning and satisfaction.

These are the benefits that result from applying for NIDCAP Nursery Certification

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 Certification Program: A Guide to Preparation, Application and Implementation of NIDCAP Nursery Certification, for a complete description of the NNCP 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 Program Director, the nursery applicant is then invited to submit the NIDCAP Nursery Program Application: Part II, Nursery Self-Assessment Questionnaire, the completed Nursery Assessment Manual Scoresheets as well as the completed Nursery Assessment Manual: Provision of Evidence;
4. Once the Application: Part II is reviewed and approved by the designated NIDCAP Nursery Program Site Review Team, the Program Director, in collaboration with the nursery applicant and the 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 (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 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 NIDCAN Nursery Program Application: Part I.

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

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 Nursery Assessment Manual; and
8. Submission of the Nursery Assessment Manual: Provision of Evidence.

For complete information, please see NIDCAP Nursery Program Application: Part II, Nursery Self-Assessment Questionnaire.

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 Nursery Assessment Manual 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 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 Nursery Assessment Manual Scores derived by the Site Review Team?”).

For complete information, please see Nursery Assessment Manual.

The NIDCAP Nursery Program 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 scales. The 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. 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 NIDCAP Nursery Program Provision of Evidence.

Before the Site Visit

If the 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 Program 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 NIDCAP Nursery Program Site Review.

During the Site Visit

The 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 five-point scales, based upon the site’s self-assessment including the written materials submitted in advance, and the on-site observations (See FAQ: “How are Nursery Assessment Manual Scores derived by the NIDCAP Nursery Program Site Review Team?”)

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

The Site Review Team members score each of the items in the four categories (Physical Environment of the Hospital and Nursery; Philosophy and Implementation of Care: Infant; Philosophy and Implementation of Care: Family; and Philosophy and Implementation of Care: Professionals and Staff). The Reviewers then identify two-or more-point score discrepancies among their scoring. They resolve these discrepancies in discussion and reconsideration of the evidence, and assign the respectively agreed upon scores to the items in question. Each of the Site Reviewers then calculates the Averaged Scale Score for each of the Categories (Sum of Scale Item Scores per Category/Number of Scales Scored within Category). From the three Averaged Scale Scores by Category the Team Leader forms the average score per Category and rounds it to one digit after the decimal point, in order to arrive at the Category Summary Scale Score. The definitions provided in the Nursery Assessment Manual for the Category Summary Scales present a general scaling per category from most traditional, schedule- and task-focused care to most individualized, developmental, relationship-based and family-focused care. From the four Team-Averaged Summary Scale Scores by Category the Overall Hospital and Nursery Summary Scale Score is then derived by averaging the Team- Averaged Summary Scale Scores by Category (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 and rounding to one digit after the decimal point. It must be noted that Category (1) Physical Environment of the Hospital and Nursery does not carry the same weight as the other three Categories as it more often may be outside of the purview of the nursery itself.

Successful NIDCAP Nursery Certification requires Averaged Category Summary Scale Scores of four or five (≥3.5) on Category Scales (2), (3) and (4), i.e., pertaining to aspects of the philosophy and implementation of care for infants, families, and nursery caregivers. The Averaged Summary Scale Score for Category (1) Physical Environment of the Hospital and Nursery may be lower than four (<3.5) depending on the locus of control of the environment in a particular hospital. Nevertheless, for successful NIDCAP Nursery Certification, the Overall Hospital and Nursery Summary Scale Score must reach a score of four or five (≥3.5).

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 impressions that are provided above, are preliminary only, and do not constitute the final disposition of the results of the review process. The Review Team will inform the site of an approximate time line by which the final results of the review process likely will be available (See FAQ: “What is the NIDCAP Nursery Program Summary Report?”)

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 Summary Report. These recommendations are shared with the 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 Program 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 Program 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 NIDCAP Nursery Program Chairperson and Director, and the NFI Board. The NFI President announces, to the NFI membership, the confirmation of the applicant nursery’s award of NIDCAP Nursery Certification.

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 NNACP 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 Nursery Assessment Manual; the submission of Nursery Assessment Manual: Provision of Evidence; and the Preparation for the 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 NIDCAP Nursery Program 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.

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