Content That ProfRN4 Likes

Content That ProfRN4 Likes

ProfRN4, MSN 14,371 Views

Joined Apr 5, '03. ProfRN4 is a nursing professor. She has '20+' year(s) of experience. Posts: 2,253 (22% Liked) Likes: 1,333

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  • Sep 24

    Quote from babyNP.
    Wow, what a thread. Just out of curiosity, where was it located before it was placed in the NICU forum?

    I can speak to your questions as one of the few NNP posters on allnurses who has read a lot about getting into NNP school and the shortage of schools, now working as a NNP for almost two years now. There was a lot of good information laid out for you so far.

    From your initial post:

    1. It's not actually that difficult to get into NNP school as compared to other specialties (FNP might be easier since there are so many, CRNA is definitely harder). What is it that is making it so difficult in your mind? Just the required experience? I'll discuss that in this post.

    2. Why do you have to work in a NICU prior to NNP school as compared to ACPNP or even ACNP?

    Nursing school prepares you to work for adults right out of school. Every rotation is focused around adults (med-surg, elderly, psych, community, etc etc). You may get a smattering of experience with newborns in your OB rotation (although it's largely focused on the mother) and you generally just get one clinical rotation through pediatrics, of which you might get an introduction to the NICU. You certainly don't get a a semester's worth of knowledge in the NICU like other specialties (including peds), but if you're lucky, you might get to do a cap stone/senior practicum/etc rotation in the NICU during your last year in nursing school.

    So while I personally still think it's somewhat questionable for a RN with no clinical experience to become an adult NP, at least if it's with the adult world, the nurse was specifically trained on common adult pathophysiology & treatments. It's a bit more circumspect for a nurse with no experience to become a PNP (particularly acute care PNP), but at least everyone has had a semester of didactic and clinical knowledge regarding pediatrics while in nursing school. I will tell you that it's probably virtually impossible to work in the PICU as a PNP with absolutely no experience as a nurse or a NP.

    Then we come to NICU. The NICU is its own little world with a completely different way of doing things. You have to essentially unlearn nearly everything you learned in nursing school, down to the most basic of things like what a normal vital sign is. For example, adults breathe 12-20 times a minute. Babies breathe anywhere from 30-60 times a minute. Let me assure you that if an adult was breathing 60 times a minute as a regular rate, unless I'm mistaken, a rapid response would be called pretty quickly. An oxygen saturation of 85% may be of no cause for concern in the NICU whereas it can be a panic number on an adult unit. This small bit of representation doesn't take into account any of the "biggies" of just learning that a baby's organ systems are different than that of an adults (even things like basic blood circulation) and there is no way you can learn how it all works in graduate school with no nursing experience (unless we significantly extended the school education). They simply do not have the time to teach you basic pathophys- you are being taught on a much higher level on what to do with treatment and diagnosis differentials and it's expected that you already have a basic knowledge of this. This basic knowledge is not taught in nursing school.

    I will also tell you that in my own experience, new grad nurses flourished much more easily in the NICU as compared to experienced nurses with non-NICU experience. It was very hard for the latter group to transition into this completely different way of thinking and we had very little success in training many of them as compared to our new grad groups.

    Why isn't the NICU taught more in nursing schools? They are trying to prepare you to be a generalist nurse with the expectation that you can specialize later after you pass boards. There is simply not enough time in a nursing program to focus on niche specialties, of which NICU is one of them. NICU also has very little cross-over with other specialties, so there is little incentive for a school to give it any air time. Even a specialty like newborn nursery may be difficult for a NICU nurse to handle at first. For example, my unit sometimes gets newborns who are otherwise completely healthy and normal besides that they have a defect (in this case, an in-utero repaired spinal defect). Newborns do not eat hardly anything for a few days and certainly not much in the first 24 hours. Yet, I had many phone calls from multiple nurses who were concerned that the infant in question wasn't eating "enough" and wanted more interventions, such as placing a nasogastric tube for artificial enteral nutrition or an IV for fluid administration. I educated them and refused the interventions, but they were uncomfortable enough that I kept getting the same phone call for the first two days that this baby was in the unit. They were so far caught up in what they "knew" as a NICU nurse that it was hard for them to break out of that mentality.

    3. Why is there a shortage of NNP programs?

    There are about 20 or so, probably less at this point. I did a whole spreadsheet back in 2010 of all the schools I could find (posted somewhere in the bowels of this forum, but sadly outdated at this point) and read a lot about them. It's a national concern that there are so few and many of them closing. My own MSN program nearly shut down its NNP program. It was avoided by the board of directors who found out about this continual shuttering of programs and they didn't want to be another contributing program, as they are a top-ranked program for graduate nursing school in general and felt a responsibility to continue the torch (for now).

    I am by no means an expert on this topic nor do I claim to know all the factors. I can tell you what I've read, heard, and experienced in my 8 years of working in the NICU. It largely boils down to finding instructors willing to get paid peanuts (when they easily make six figures in clinical practice) and finding clinical sites for students. Some schools flat out tell their students that they are responsible for finding their own clinical site (one of the most ethically wrong things in nursing graduate school, IMO). Hospitals are generally less willing to provide this type of education to students unless they are an academic center because it is completely altruistic on their part. When you put in the fact that many students are trying to get into just a few sites, the competition means that hospitals can be choosy about which schools they will accept students from. I made sure to choose a school who would set up the clinical for me, not the other way around. Another factor is that you are completing nearly all of your clinical time in a NICU (although I did have probably about 50 hours split among newborn nursery, NICU follow up clinic, and shadowing a midwife for L&D). Other specialties do not have this restriction. Adult clinicals can go to any number of floors or settings as well as PNPs, but there is only one NICU in the hospital. The amount of resources this requires of the NICU is large.

    My own hospital is currently orienting 4 new NNP graduates who are FTEs on a 4 month orientation (standard at this hospital and not too far off the mark for other similar hospitals that are Level IV). I was recently asked to precept a NNP student even though it's not an ideal situation since I have <2 years experience as a NNP; showing you our lack of resources.

    I hope to teach one day in a NNP program to give back to my profession, but I am under no illusions that I will put in more than I get out monetarily.

    4. In regards to your question about requiring experience before starting school, that may be the case at that particular school, but it is not the case at all schools. Look further into this because many schools will let you take didactic non-NICU courses (like research or pathophysiology) before you start clinical. You generally have to have the clinical experience before you go into NICU didactic/clinical time though.

    It actually used to be a requirement to become licensed by the NCC (where one takes the board exam to become a NNP), but this dropped a few years ago. It's more driven at this point by schools. It's still a good thing IMO for the reasons I said above. You would simply drown without the experience.

    5. In response to GeneralistRN comparing to the medical field, as llg said, you go to medical school (which prepares you as a generalist in the adult world) and then you are required to have further training in residency and/or fellowship. As she pointed out, to become a neonatologist, it requires 3 years training in pediatrics and 3 years training as a neonatologist. Keep in mind that during these 3 years each, the doctors are working 80 hour weeks, largely clinically based (except in the last years of each). If nurses worked 80 hour work weeks they could probably get away with 1 year of nursing experience for appropriate entry into graduate school to become a NNP.

    6. In response to GeneralistRN's comment about PAs working the NICU, they are very rare for a good reason. PA school is 2 years long and (like nursing and medical school) are equipping them to work in the adult world. A PA without experience working the NICU would require an extensively long orientation and many of those folks do not make it out because they have to (again) unlearn nearly everything they did while in school. They may know the basics of making a diagnosis or knowing basic drugs, but not as it applies to the NICU. Most employers are not willing to train someone for 6 months (paid) with a high risk of them not being able to transition successfully into the job. If they are hired, it's generally at large academic institutions where they can support them more fully. I know that my hospital refuses to hire them (even experienced ones) in my NICU.

    There is a PA residency that has cropped up over the last few years, but only in a few sites as someone else pointed out. As I understand it, it is like a true residency where one is not working the general 40 hour week, but more on par with a medical residency type hours. I want to make it clear that this is not being created out of the desire for PAs to be in the NICU. They are not trained in neonates unlike NICU nurses who go to graduate school and solely focus on NICU. This is being propped up as a response to the national shortage of providers in the NICU and hospitals are becoming desperate just to hire people.

    The average age of a NNP is older than other NPs and with programs shutting down, the shortage will only get worse. Couple that with the fact that pediatric residencies no longer require a full 3 months in the NICU during their training- so many programs have dropped the extra month. Someone has to fill that role for those months that there is no resident. PA residencies are a response to this national shortage.


    I hope this answers some of your questions. I can sense your frustration about the required clinical time, but trust me, it's needed. I had 4 years going into grad school and had 6 by the time I graduated. I didn't necessarily need all of that time (I lacked self-confidence about my own knowledge), but 2 years is definitely a solid number that I think people need. If not, then the clinical time and didactic time in grad school needs to be upped, which will not happen due to shortages as I listed above.

    It's hard to get into the NICU as a new graduate but there are ways. Be the best candidate you can be, read the threads on this forum (for the love of everything, please don't ask on a new thread because there is so much information on this topic littered throughout dozens of threads).

    Best of luck in your journey through nursing school and your transition in the RN role. Keep us posted on how it's going. Let me know if you have any other questions.
    Is there not an applauding smiley? Because this deserves one.

  • Sep 24

    Quote from SunshineeStudent
    My question(s) are why do you have to work in a Level 2/3/4 NICU for 2 years when you can enter an Acute Care Pediatric NP program with 0 experience? Also why is there such a shortage of Neonatal programs? It's almost as if Neonatal education is the last priority when it comes to specialties.
    You could also ask why you have to have (at least) two years of ICU experience to get into a CRNA program when you can get into an FNP program with no experience whatsoever. Because they are entirely different roles, focused on acute, intensive care of sick individuals rather than primary care, and the professionals and accrediting organizations for CRNA and NNP programs feel that the experience is necessary to become a competent practitioner.

    I would imagine that the reason there are fewer NNP programs than PNP programs is because you have to have v. specific and specialized clinical settings and faculty available for NNP programs that you don't have to have for PNP programs. I would guess that NNP programs are v. expensive for schools to operate, compared to primary care NP programs.

  • Sep 24

    Are you seriously asking why you can't be a NNP without any experience as an RN first? That sounds insane to me especially given how scant of an education we get even for pediatric patients. My RN program "covers" peds in our six week Maternity rotation and a few other places. I would be frightened to take on that role without any experience. I am personally interested in AG-ACNP however I want to get into ICU, get my BSN, and become competent as an ICU nurse (pursue CCRN) and have about three years experience before I even apply.

  • Sep 24

    Probably because our little babies are like nothing you have ever dealt with before. Our hospital won't even consider hiring an NNP that doesn't have 2 years of NICU nursing in addition to schooling. Unless you have been oriented to work in a NICU you won't understand the workflow, the protocols, the care. These aren't little adults or little peds patients,they are their own entity. And we get many people who start in NICU and don't make it because it isn't what they envisioned.

    Have you shadowed in a unit? I would do that before you slam schools not taking you without experience. It may open your eyes. You had another thread about "pulling the plug"....well, it isn't all roses and rainbows in NICU and you should have the experience of caring for a baby who has no chance of a normal life, one who survive with multiple issues, dealing with parents and helping guide them thru this process. There are worse things than dying in our world. You need to care for that 22 weeker that has a massive head bleed, failing kidneys, bad lungs to see what it is like. Or that baby that is in your unit for a year with a trach, GT and develops pulmonary hypertension, a baby born with multiple anomolies that requires extensive care on both nursing and doctor end. It will make you a stronger NNP to experience it as a nurse. You will learn the pathophys inside and out. Hands on care is the best way to learn.

    My advice is try to get a job in a NICU, work your two years and then go back to school.

  • Sep 24

    You would be doing our tiny patients a huge disservice by becoming an NNP without NICU experience. Even two years is barely enough. Just because the PNPs do it doesn't make it right.

  • Sep 24

    Quote from SunshineeStudent
    My question(s) are why do you have to work in a Level 2/3/4 NICU for 2 years when you can enter an Acute Care Pediatric NP program with 0 experience?
    I think the more important question is, why would a pediatric NP program accept students with no experience?

  • Sep 23

    Update on cat: She graced us with her indoor presence last night. A breakthrough!

    She acted like she had missed me, a bit needy, as if I had neglected the poor dear.

  • Sep 23

    Quote from Aliens05
    What is text speak, sorry if its something obvious, but ive never heard that term before...are you meaning like the thx for thanks type of deal?
    When you are posting on a professional forum to people with experience in their field, you are posting to professionals. It is considered rude not to make an effort to communicate clearly and professionally. That means typing out "thank you" or "you", using proper grammar and punctuation, capitalizing appropriately, etc. Not only is it more respectful, but it is good practice. One day, you will need to communicate clearly, concisely and professionally both verbally and in writing. It makes sense to start now.

  • Sep 23

    Quote from Aliens05
    Thx cat. I do imagine that stress is in a way subjective..i was kind of thinking of something along the lines of the nurses at my work (6 person non behavioral group home ). They dont wear with mentally challenged persons who are non behavioral etc,but dont rlly use any nursing skills. Their job is almost the easiest job u can imagine but the pay is relatively limited at 28 an hour salaried no overtime. I wouldnt want to cap my earning potential anywhere near 40-50k.

    Idk much about research or nursing informatics. Ive heard a little but dont know anything about it rlly. Same goes for crna altho low stress would not at all be describing crna work.
    Text speak is against our Terms of Service. You're still in school, but that's no excuse. Practice good writing now, and it will come more easily when you're at the end of a very busy shift and staring at a blank box on your computer screen contemplating the nursing note you need to write.

    I think it's a little premature to be thinking about which specialty can get you the most bucks for the least effort. Finish school first. Figure out what you enjoy about nursing and what you dread. You probably will have to get an actual job before you figure that out.

    As far as what's stressful -- we can't answer that for you. My friend considers anything involving babies to be low stress . . . but even a perfectly healthy baby sends my blood pressure and anxiety levels soaring through the roof. Lots of folks on here think school nursing is the bomb, but anything involving kids stresses me out. Home health is often recommended as a low stress specialty, but if I never have to enter another patient's home, it will be far too soon. Lots of folks consider ICU to be maximum stress, but that's MY happy place. Your milage will vary.

  • Sep 8

    Quote from iggywench
    I have a student who was dx with asthma over the summer. Mom sent in an Asthma Action Plan, and when I called to ask her if she was planning to come and check in an inhaler, she informed me that she was planning to send it to school with the student the next day. When I told her that wasn't an option, that parents have to check in medications, she said that she was going to sue the school if her daughter had an asthma attack, and hung up. This was two weeks ago; my AP has made numerous attempts to reach this mom via phone, but she won't return the call. Why is it so hard to understand that students are not allowed to transport medication to and from school? Her daughter has been in our district for at least three years...
    She's not willing to do her part, but she's going to sue the school because it's ... somehow... your fault, right? I love the not-logic.

  • Sep 8

    Quote from Jedrnurse
    Honestly, I MAY have dosed out of an expired inhaler or two while waiting for new ones. The whole expiration date thing is interesting. A pharmacy will label a one year date from the day of dispensing regardless of the manufacturer's date. There are actually a couple of articles about the efficacy of expired inhalers and Epi-pens. (Yes, those are late coming in to...)
    The FDA recently admitted that medications have a longer shelf life than what the label says. No surprises there.

    The expiration date on a dispensed med signifies the expiration date of the Rx, not the med. (I worked as a pharmacy tech in the past.)

  • Sep 8

    Honestly, I MAY have dosed out of an expired inhaler or two while waiting for new ones. The whole expiration date thing is interesting. A pharmacy will label a one year date from the day of dispensing regardless of the manufacturer's date. There are actually a couple of articles about the efficacy of expired inhalers and Epi-pens. (Yes, those are late coming in to...)

  • Sep 8

    That's why I always worked in peds...theirs is cuter and smaller; comes out wrapped in a pink ribbon too.

  • Sep 8

    I think you're the one that wanted to be an ICU nurse.

    Boy, you're in for a ride!

    Break out the wipes, ladies. We're getting a GI bleed .... Smell that sweet metal aroma? That's a GI bleed.... Nothing like the smell of sweet iron to wake you up at 6AM

  • Sep 8

    I love poop. Ha if I know the patient has a good sense of humor I joke about it like oy look at this kernel in there, they get a good kick out of it. Only thing that bugs me is spit in my face, catheters being pulled out of a guy, and the first squirts of arterial bleeding.