Background and Aims The Dutch multidisciplinary evidence based guideline on treatment decisions of infants born with a gestational age of at least 24 weeks was released in autumn 2010. The implementation of this guideline on the NICU of the Women’s and Children Clinic/Academic Medical Center in Amsterdam the Netherlands was a complicated process.

Methods A multidisciplinary workgroup, 5 nurses, 5 neonatologists and a pharmacist composed a phased implementation procedure which consisted of the following activities:

A multidisciplinary meeting before and 10 months after implementation; Existing protocols were made evidence based; Working visits were made; A centre of expertise was established; A group of experienced nurses and doctors were steered as leaders in the care; Clinics and workshops for leading nurses; Clinics for all professionals concerned; Sessions for nurses to reflect and learn from each other; Evaluation of the implementation; and an Inventory to readjust existing guideline.

Results Due to media attention, an early start was forced. Protocols were not ready, material and equipment not available. The number of infants was higher than expected. The decision to perform the care for these infants by leading nurses resulted in agitation amongst other nurses. Their opinion was that complex nursing care should be performed by all experienced nurses. New rules resulted in a lack of clarity.

Conclusions Well-considered choices were made, however it appeared that nurses were in need of training on the job instead of planned theoretical training in advance.