A term mother arrived for a planned induction at a community hospital west of Houston. The morning felt routine until the care team suddenly needed to move quickly. Texas Children’s Neonatal Nurse Practitioner (NNP) Courtney Jones was already there, ready to stabilize the newborn, begin ventilation and assess whether the baby might require cooling or transfer. It was one of many moments in which an NNP becomes the anchor of neonatal expertise in a community setting.
“You’re there for the critical first steps,” Courtney said. “Things change quickly, and you’re helping parents understand what’s happening while making sure the baby gets exactly what they need.”
Since 2003, Texas Children’s Community Initiatives (CI) program has expanded neonatal, pediatric and maternal-fetal services into hospitals across Greater Houston and surrounding regions. CI now includes 12 partner hospitals, each connected to our clinical guidelines, collaborative practices and pathways for seamless transfer when specialized care is needed. Families often don’t expect their local hospital to have a direct connection to Texas Children’s, but the presence of one of our advanced practice clinicians is reassuring.
“When they realize I work at Texas Children’s, parents are frequently grateful to have the level of care they associate with our reputation,” said Natalie Stephens, an advanced practice provider with CI. “Knowing a Texas Children’s clinician is caring for their newborn brings them reassurance because the same evidence-based guidelines and collaborative model guide their baby’s care.”
Although CI clinicians practice outside the walls of Texas Children’s campuses, they remain closely aligned with our standards, teams and mission. Their work makes it possible for families to receive high-quality neonatal care in their own communities while maintaining a clear connection to our system’s expertise.
Autonomy, Expertise and Trust
Community-based NNPs lead delivery attendance and resuscitation, stabilize newborns with complex needs and perform procedures such as intubations and line placement. They collaborate with neonatologists, but the onsite practitioner is the first to respond when seconds matter.
“At night, you’re the one in-house,” Courtney said. “You have a backup physician on call, but you are the person immediately available to save that baby’s life. You have to have confidence and some years of experience.”
The role blends meaningful independence with a strong clinical framework. Our NNPs follow the Baylor College of Medicine Guidelines for Newborn Care, updated annually, which ensures continuity of care whether a newborn is treated at a Texas Children’s campus or at a partner hospital like Houston Methodist – West or St. Joseph Health.
For many clinicians, this combination of autonomy and structure makes the work uniquely rewarding. Smaller Level II–III NICUs allow long-term relationships to form and create space for connection.
“It’s very rewarding when you see a baby that was once 550 grams come back walking and talking and living a completely normal and great life,” Courtney said. “It always makes my heart so happy.”
Natalie, an FNP, shares similar moments of impact. She has cared for multiple siblings over time and occasionally meets former patients in the community years later. “It’s amazing to see those children growing up.”
Teamwork That Drives Better Care
CI teams work closely with partner hospitals, contributing to collaborative rounding, shared decision-making and smooth communication between nursing, respiratory therapy, pediatrics and care management.
Community settings also allow nurse practitioners to support staff development through teaching, coaching and participation in quality and safety initiatives. Those contributions strengthen local NICUs and help families stay closer to home whenever it’s safe to do so.
Community Initiatives includes a range of environments — from College Station to West Houston and Fort Bend County — each with its own pace and personality. In College Station, staff describe the NICU team as “like a family,” and appreciate the blend of close-knit teamwork and strong community ties.
In west and southwest Houston, nurse practitioners value practicing at a high level without long commutes, allowing them to balance advanced clinical practice with personal and family life.
Across every Community Initiatives site, the work centers on one goal: providing the right care in the right place for newborns and their families. Whether serving major suburbs or rural areas, our nurse practitioners offer consistent, expert care that strengthens Texas Children’s connection to communities across our region.