Cards, flowers and chocolates are all testimony to the gratitude of families who have been cared for by a team of nursery nurses at Queen's Hospital in Romford, Essex, and last month the hospital itself named them 'Stars of the Month' for their work improving the quality of care within its maternity unit.
'As a team, they're fantastic and totally committed,' says neonatal liaison sister Rebecca Perchard, who supervises their role and nominated them for the award. 'I believe they have become an essential part of Queen's Maternity Services.'
Believed to be the largest of its kind in the country, the 11-strong team is responsible for 'transitional care', which in this context means keeping mother and baby together wherever possible.
It is an approach that was advocated by the Neonatal Taskforce, set up in 2008 to support the NHS in improving neonatal services. As well as raising the quality of provision, a major goal of transitional care is to prevent avoidable admissions to the Special Care Baby Unit (SCBU).
Ms Perchard explains, 'In the 1980s-1990s, all premature babies went into Prem Baby Units, so an awful lot were separated from mums unnecessarily. Now we've discovered that we can keep mothers and babies together safely, and we decided that nursery nurses could do that very well under the supervision of a nurse or midwife.'
The nursery nurses' role is far-reaching. They provide neonatal care 24/7 to babies on the Maternity High Dependency/Recovery Unit, which cares for mothers who are seriously ill or have had caesarean sections.
In the Postnatal Ward, the infants they care for include babies that are premature, at risk of hypoglycaemia or drug withdrawal, or require intravenous antibiotics or close observation due to respiratory distress or the mother's medical history.
They also assist midwives and paediatricians in all aspects of neonatal care, including assisting breastfeeding and supporting skin-to-skin nursing.
The team was extended from four to 11 in 2011 and the newest recruits have a background of working in baby or toddler rooms and have at least an NVQ Level 3.
Their new role required them to undergo intensive training, primarily on observing vulnerable babies and undertaking basic medical procedures such as checking pulse, temperature and blood pressure, carrying out oxygen saturation checks, taking blood and analysing glucose levels.
Observations are a central part of the nursery nurses' job, requiring them to score a child against a set of criteria. In the case of infants with possible drug withdrawal, they would have to look out for symptoms such as irritability, dehydration, sneezing and hiccoughs.
BENEFITS
The benefits that the team brings babies and families are proving enormous. Wendy Matthews, director of midwifery, explains, 'The nursery nurses help keep mothers and babies together, which from a quality point of view is very positive. Without them, the baby may have to be admitted to the Neonatal Intensive Care Unit and going to a high-dependency unit can be quite traumatic for a baby.'
As for the mothers, the nursery nurse role provides reassurance, so reducing their anxiety and risk of postnatal depression. Nursery nurse Lauren Purse says, 'We give the mummies a lot of support. They've just had a baby, they're exhausted and emotional and now they find their baby's ill or needs a little bit of extra help.
'We can consult with them, explain the care plan and work closely with them. We also do a lot of skin-to-skin nursing and that helps with the feeding and the bonding.'
The wider family also benefits. Mrs Perchard explains, 'In the baby units, particularly during the winter months, we don't even allow siblings to visit because of the risk of infection and limit visitors to parents and grandparents.
'By keeping mother and baby together on the postnatal wards, the whole family and friend support network is still there and can visit - though only three at a time.'
Then there are the savings to the NHS. Between 2009 and 2011, the number of admissions to the SCBU halved in the case of babies who were cold and/or had low blood glucose levels. The fall reduces the use of expensive SCBU cots, but also frees them up for those babies that most need them.
Mrs Perchard says, 'Not only do they prevent babies' admissions on to the baby unit, they also make sure that babies that need to be on baby unit are picked up sooner. In their observations they might think that something's not right, call in the paediatrician and the baby is referred immediately.'
Since the team was introduced, the hospital has also seen a reduction in the lengths of stay in hospital and, allied to that, a drop in the rate of hospital-acquired infections. Their presence also frees up nursing and midwifery staff to concentrate on their medical responsibilities.
There are savings on salaries too, as on Pay Band 4 (£18,838-£22,016), they earn less than a qualified nurse on Pay Band 5 (£21,388-£27,901). But Mrs Perchard sees advantages beyond the financial in employing nursery nurses rather than registered neonatal nurses.
'They're much more up on parent craft than nurses,' she says. 'We're also a breastfeeding hospital and they are able to spend more time encouraging mothers to breastfeed. It's in parent craft that the nursery nurses really come into their own.'
CASE STUDY: LAUREN PURSE
'It's the most amazing job and I love it. What's not to like?' says Lauren Purse of her job as nursery nurse at Queen's Hospital maternity unit - a post she has held since the team was expanded in 2011.
She has been in childcare for the past ten years, starting as a nursery assistant and working up the ranks to nursery nurse, deputy manager and finally manager. She has NVQs at Levels 3 and 4 and a Foundation Degree.
As part of the team delivering care 24/7, she works 13 shifts (7.30am-8pm or 7.30pm-8am) a month, in blocks of one to two days or three to four nights.
While her main responsibilities are carrying out observations and providing day-to-day care of infants, her duties range from getting a newborn out of the cot for a mother who has just had a caesarean to helping resuscitate a baby.
Ms Purse enjoys the challenge and derives enormous satisfaction from so many aspects of the job. 'There's the satisfaction of helping mummies with breastfeeding and seeing them relax - and just seeing see that baby bond is phenomenal. There's the satisfaction of talking to and helping a mummy that's got a bit of the baby blues.
'And even when a baby does have to go to SCBU, there's the satisfaction of knowing that I have done everything I could to try to stop them from going. It's great too when you get feedback from the parents.'
It is a job that is also highly pressurised, but with the stresses comes strong teamwork. 'The job is great but I don't think I could do it without such a wonderful bunch of girls for support.
'When you're having a bad day, they provide a shoulder to cry on and they're happy to help you and swap shifts. We all have the same mindset and work so well as a team, so I know that the hard work that I have done will be continued and supported by the nursery nurse who takes over.'