These may be families with new babies and young children, families with mental health problems, addiction or disability issues and vulnerable children. The CNN gives support and non-medical advice to these groups in a number of venues, including GPs' surgeries, clinics, children's community centres and clients' homes.
As part of the Healthy Child Programme, delivered by the Child Health Team, the CNN carries out developmental assessments of babies and young children and may participate in hearing-screenings of newborns.
Advice and support on breastfeeding, child development, behaviour management, nutrition, play, parenting and the importance of social integration are offered to parents and carers.
All new parents may also have access to a post-natal group run by a CNN as delegated by the health visitor. Where necessary, parents and carers are signposted by the CNN to relevant agencies for support and advice.
CNN work involves frequent visits to clients' homes, some of which are in isolated areas. It often necessitates transporting of equipment, such as weighing scales and toys for developmental assessments or behaviour work. At times, the CNN will have to cope with challenging situations such as verbal aggression, un-cooperative parents and distressing matters such as violence or bereavement. Provision is made for managerial support, clinical and safeguarding supervision.
Monitoring and recording of all contacts with families is a continuing aspect of the CNN's role, any of whose concerns are referred to the health visitor and documented in the family records. These CNN interventions may contribute to case conferences, core groups and court reports.
QUALIFICATIONS AND TRAINING FOR THE CNN
The Level 3 Diploma in Children's Care and Education is now superseded by the Level 3 Diploma for the Children and Young People's Workforce. Previous experience of working with groups of children and families is desirable. Community nursery nurses need an excellent level of written and verbal communication and computer skills. They should have a clear understanding of the role of the health visitor and primary healthcare teams, be an effective team member, but also able to work independently.
Induction programmes are provided for CNNs, tailored to both job requirements and individual personal need. An annual personal development review is carried out and a personal development plan put in place, in line with the Knowledge and Skills Framework. It is expected that the CNN will then actively influence the shape of their in-service training to meet their learning needs as they arise.
CNNs need a current driving licence and access to a vehicle. Flexibility in working days may be required. An enhanced Criminal Records Bureau (CRB) check is also essential.
CASE STUDY - VICTORIA WILLMER 
'In 1998, I was taken on as the first community nursery nurse by Winchester and Eastleigh Healthcare Trust (now part of Hampshire Community Health Care, HCHC). Since then, the organisation has employed an increasing number of nursery nurses, within the child health and the school nurse teams.
'Our health visiting team is made up of two health visitors, a community staff nurse, a clerical support worker and myself. Together, we provide a service for the clients of two GP surgeries. We value our skills mix, as it gives opportunities to learn from each other, allowing families access to a wider range of knowledge and skills and so providing the best support for families on the caseload.
'Each day is different. I am delegated new birth follow-ups by the health visitor, where I weigh the baby and support mum with matters such as feeding, or settling the baby. At our weekly child health clinic, I weigh the babies and give advice on care, development and routines. I also maintain the Personal Child Health Records (by recording what has been discussed and plotting the baby/child weight on the centile charts).
'I carry out eight-to-12-month and 18-to-27-month child development reviews and may refer children on to speech and language therapy, audiology, ophthalmology, or to GPs if a medical assessment is required.
'The CSN and I lead a six-week post-natal group in the local children's centre, delivering topics to new parents. These include weaning, healthy eating, baby massage, sleep and routines, common ailments, temperature control and play and development. We liaise with the centre staff and the location allows parents to see the variety of support and activities on offer.
'HCHC is working towards achieving the Breastfeeding Baby Friendly Initiative. Nursery nurses, community staff nurses and health visitors have all undertaken a two-day breastfeeding course. As a result, I have already been better able to support breastfeeding mums and babies. I really enjoy this part of my job.
'I enjoy too being part of the HCHC CNN working group, which is developing the new Induction Programme and Nursery Nurse competencies. These two initiatives will provide a robust structure for the initial training of nursery staff entering the organisation and then ensure ongoing assessment and achievement of the required competencies to undertake the role of nursery nurse in clinical practice.'
FURTHER INFORMATION
Induction Programme, Code of Conduct, Competency Framework and Best Practice Guidelines at www.unitetheunion.org
