Learning Across Borders: NANN’s Professional Delegation to Spain
By Kortney Curtman, RN MSN BSN, and Melinda Pariser-Schmidt, MSN RNC-NIC IBCLC
In February 2026, a group of neonatal nursing professionals representing the National Association of Neonatal Nurses (NANN) traveled to Spain for a 7-day international professional exchange focused on advancing neonatal nursing practice and collaboration.
Led by NANN President Taryn Edwards, the delegation spent 6 days exploring Spain’s healthcare system, visiting neonatal units, meeting with nursing leaders, and learning innovative approaches to improving outcomes for infants and families. As was the case with previous NANN delegations, the goal was not only to observe neonatal care in another country but also to build lasting professional relationships, exchange ideas, and return home with new perspectives that could strengthen neonatal practice in the United States.
Due to strong member interest, NANN’s international delegations are now offered annually and include a limited number of members selected through an application process. Recent destinations have included Fiji and Sweden.
This year’s destination, Spain, offered a unique opportunity to examine neonatal care within a universal healthcare system. Throughout the week, delegates discovered that though healthcare systems differ across countries, neonatal nurses share a common commitment to improving outcomes for the smallest and most vulnerable patients.
Welcome to Madrid
Our journey began in Madrid, Spain’s vibrant capital city, where delegates gathered for an orientation and welcome dinner in the historic Plaza Mayor. The evening provided an opportunity to meet members of the delegation and reconnect with colleagues from across the United States.
Learning from two of Madrid’s Leading Hospitals
The delegation’s first professional visit was to the Level IV neonatal intensive care unit at Hospital General Universitario Gregorio Marañón, a public hospital that is one of Spain’s premier academic medical centers. Delegates toured the NICU while learning about strategies for family involvement and approaches to caring for critically ill newborns.
One of the most memorable aspects was the hospital’s donor human milk program. Delegates learned how donor milk is carefully processed, pasteurized, and analyzed for its caloric and nutritional composition. The milk is categorized according to the gestational age of the donor’s infant so that extremely preterm infants can receive milk that most closely meets their developmental needs. Measuring the milk’s caloric content also enables clinicians to individualize fortification, ensuring each infant receives nutrition tailored to support their optimal growth and development. Hospital staff shared how this comprehensive approach has contributed to remarkably low rates of necrotizing enterocolitis and reductions in bronchopulmonary dysplasia within their NICU. The visit demonstrated how innovative thinking and research can influence neonatal outcomes while inspiring new ideas for practice in the United States.
The second professional visit took place at one of Madrid’s private hospitals, Hospital Universitario Vithas Madrid Aravaca. Though delegates were unable to tour the NICU, we were excited to learn about their organizational structure, patient care model, and role within the regional healthcare system. Discussions highlighted collaboration with surrounding healthcare facilities and the importance of ensuring families have access to specialized services close to home whenever possible.
Visiting both facilities offered delegates valuable insight into how different healthcare organizations work to meet the needs of families living within Spain’s large metropolitan areas while providing high-quality, patient-centered care.
Neonatal Care in Ávila
The delegation visited Ávila, a city of about 60,000 people that is about an hour’s drive northwest of Madrid, to explore how neonatal care is delivered within a smaller community at the region’s public hospital, Hospital Nuestra Señora de Sonsoles. This visit provided a complementary perspective on neonatal care within the public healthcare system in Madrid.
Delegates were welcomed by an enthusiastic multidisciplinary team eager to discuss neonatal practice and caring for infants and families in a regional setting. Although the NICU cared for a lower-acuity population than the Level IV unit visited in Madrid earlier in the week, staff demonstrated the essential role of regional hospitals in stabilizing critically ill newborns, coordinating transfers to higher-level centers when necessary, and providing ongoing care for infants who could remain within their community. Conversations also explored regional transport systems and differences in professional roles, including the absence of neonatal nurse practitioners in Spain.
Comparing Public and Private Healthcare
One of the delegation’s most valuable experiences was the ability to compare Spain’s public and private healthcare systems while also observing how neonatal care is delivered across hospitals serving different communities:
- Hospital General Universitario Gregorio Marañón, a large public academic medical center in Madrid
- Hospital Universitario Vithas Madrid Aravaca, a private hospital in Madrid
- Hospital Nuestra Señora de Sonsoles, a smaller public hospital serving the city and province of Ávila
Spain has a dual public-private healthcare system. The publicly funded healthcare system is free at the point of care for residents, providing comprehensive care and serving as the primary source of health care for most of the population. Public hospitals offer high-quality care, but access to some non-urgent specialty services may involve longer wait times because care is prioritized according to clinical need.
A separate private insurance market is widely accepted by private clinics and hospitals. These private hospitals complement the public system by providing timely access to elective and specialty services while collaborating with the public healthcare system to ensure emergency care is available to all residents.
Visiting both large tertiary centers and a smaller regional public hospital also highlighted how the public system adapts to the needs of the communities it serves.
In private and public facilities, delegates observed the same commitment to multidisciplinary collaboration, family-centered care, and meeting the unique needs of the communities served. The experience reinforced that excellent neonatal care exists in many settings where close relationships among healthcare professionals, patients, and families are central to care.
Understanding Nursing Leadership in Spain
Another highlight of the trip was visiting the Official College of Nursing of Madrid (CODEM), where delegates learned how nursing is organized within Spain’s healthcare system. Discussions focused on nursing education, professional standards, regulation, and the important role professional organizations play in supporting nurses throughout their careers. A visit to the CODEM Nursing History Museum provided historical perspective on the evolution of nursing in Spain, back to the 17th century, illustrating how the profession has continually evolved alongside advances in health care while maintaining its commitment to compassionate patient care.
Building International Nursing Partnerships
One of the most meaningful experiences for the NANN delegates was meeting with leaders from the Spanish Society of Neonatal Nursing (Sociedad Española de Enfermería Neonatal; SEEN). Through open discussion and shared experiences, delegates gained a greater appreciation for how neonatal nursing has evolved in Spain and how nurses continue to advance the specialty through education, research, and professional collaboration.
Delegates learned that Spain does not utilize neonatal nurse practitioners or other advanced practice providers in neonatal care. Instead, nurses develop neonatal expertise through extensive clinical experience and specialized postgraduate education. SEEN has played a leading role in advancing the profession through development of a master’s-level neonatal nursing education program and publication of Neonatología para Enfermería, a comprehensive neonatal nursing textbook used to support specialty education across Spain.
SEEN’s commitment to education, advocacy, and professional development reflects many of the same goals shared by NANN. Perhaps most importantly, the meeting fostered meaningful dialogue between two organizations dedicated to improving neonatal nursing. Although healthcare systems differ, both organizations share a commitment to supporting nurses, advancing evidence-based practice, and improving outcomes for infants and families.
Bringing Spain’s Lessons Home
Throughout the week, several themes consistently emerged. Family-centered care was deeply embedded within clinical practice. Innovation, whether through donor milk programs, specialized nursing education, or quality improvement initiatives, was embraced as an ongoing process rather than a destination. Above all, delegates observed a culture that valued lifelong learning, professional development, and collaboration across disciplines.
While not every practice observed in Spain can be directly translated into the U.S. healthcare system, the trip provided countless opportunities to reflect on new approaches, challenge assumptions, and identify ideas that may improve neonatal care at home. International exchanges like this remind us that some of our greatest innovations stem from collaboration and a broadened perspective.
An Unforgettable Experience
As the delegation concluded with a farewell dinner in Madrid, NANN members reflected on the friendships formed, the knowledge gained, and the inspiration they would carry home. The week had been far more than a series of hospital visits—it was an invitation to build relationships across countries, exchange professional perspectives, and strengthen a global community of neonatal nurses united by a shared purpose.
The 2026 NANN delegation to Spain reaffirmed that though healthcare systems differ, neonatal nurses around the world remain connected by a common commitment to improving the lives of infants and families. Through collaboration, curiosity, and the willingness to learn from one another, these international exchanges continue to invigorate, inspire and advance neonatal nursing for generations to come.