Any Neonatoal NP (NNP) at your units? - page 2

Hello everyone - Does any of you have have NNPs work in your unit? If so, what is their job like? Do they enjoy it? Do they get stuck with the night shift? I also heard that some NICUs have... Read More

  1. by   CapeMaui
    Quote from katrina4
    One other thought. I have looked into a NNP program at Penn State. They require 3 years of experience in a NICU as an RN before applying to the program. I don't think most PNP programs require this level of expereince.
    Thanks Katrina, for sharing the above info! It's really helpful. Where I am, I have 2 schools to choose from for NNP, one is a distance program (eventhough they are within driving distance) and the other is on campaus. Both require that you work at least 1 year for p/t study or 2 years for f/t study. Not as strict as Penn State. For PNP program of the same schools, they also require the same experience. I know that I won't be going on right after I graduate in Dec., but I like to look ahead and plan, especially since I want to have a baby sometime soon

    I was on a few different children's hospital's sites yesterday (they're all local hospitals) and all of them had listed NNPs on their staff list, along with neonatologists and fellowships. So I think there will be places to work. However, I am worried, like you, that they may be getting the shifts the MD's don't want, ie, nights and weekends. I guess when I start working in Jan/Feb, I can get a better sense of how it works for the hospital I choose.

    I took your advise and looked at some job listings. Most of the ones for NNPs listed 'variable' under shift schedule, so I think it's really up to the person who does the scheduling? thoughts?

    nekhismom - at your old unit with the NNPs, did they work mostly nights and weekends? How were they treated?

    Thanks!
  2. by   nekhismom
    Quote from CapeMaui
    nekhismom - at your old unit with the NNPs, did they work mostly nights and weekends? How were they treated?

    Thanks!
    Well, they were treated great!! We had NNP coverage 24/7, so they worked all shifts. They were "assigned" to a shift, so they had a regular rotation, but they also covered for each other for vacations, sick time, etc. And they did work weekends, but only because everyone had to work eow in order to be employed there.
  3. by   CapeMaui
    Thanks nekhismom! It's great to know that NNPs are very welcomed at some places. I hope whereever I end up in the future will have the same kind of culture!
  4. by   Gompers
    Quote from CapeMaui
    However, I am worried, like you, that they may be getting the shifts the MD's don't want, ie, nights and weekends.
    I don't know about other hospitals, but the ones I've been at that had NNPs didn't work like that at all. The MDs and NNPs aren't even employed under the same department and their schedules have nothing to do with each other. NNPs cannot work alone, they need to have MD support for legal reasons. At least that's what I've always known. They can order meds and such, but a nurse can't give them until they've been approved by an MD, etc. So it's not like the MDs are some gods that get to pick and choose nice weekday schedules while the NNPs are stuck with nights and weekends. Basically, residents and fellows usually have to pull the long hours, overnights, weekends, etc. The attendings have more of a normal schedule but sometimes do have to come in during the night or weekend if things are crazy. And NNPs, it depends on the unit.

    Like I mentioned before, we don't have very many left so they only work days. But it's not some fantastic set-up!!! It actually sucks really badly, to tell you the truth. The NNPs work days so they can do rounds on the babies and plan their care. Then when they go home for the night, the fellows cover their babies. The problem is that there is a constant war going on between the docs and the NNPs because of this. The NNPs will go home for the night and don't like the docs to change their orders. But when things go wild overnight and it must be done, either the doc doesn't want to rock the boat so he won't change the order and the kid will suffer until morning - or he'll change it and get hell from the NNPs for it. So really, it's kind of miserable. It was much better when we had an NNP on the unit 24/7.
  5. by   BittyBabyGrower
    In the state I live in, NNP's do have prescriptive privledges...they all went and took an exam and we can now take off their med orders without a co-sign. Has made live a whole lot easier on us! Actually, any APN in our state can write scripts as long as they have taken the exam. There is a list of approved meds that they can write for without an MD's cosig.

    Our NNP's work either 7a-7p or 7p-7a. Our step down practioner works 6a-3p. They all take turns covering weekends and holidays. There are residents there all day and night, so they have to find their own coverage is someone bails...they don't even ask the NNP's to do this. They are completely separate from the medical side.
  6. by   nekhismom
    The NNP's where I was at did have prescriptive authority. Didn't need a doc's co-sign. We did not have medical residents or fellows in our NICU, as our director did not want them "experimenting" on our babies. She much preferred NNP's. So, no, NNP's did NOT have to cover the medical staff's "holes" because they were separate from the docs.
  7. by   Gompers
    Quote from nekhismom
    The NNP's where I was at did have prescriptive authority. Didn't need a doc's co-sign. We did not have medical residents or fellows in our NICU, as our director did not want them "experimenting" on our babies. She much preferred NNP's. So, no, NNP's did NOT have to cover the medical staff's "holes" because they were separate from the docs.

    Don't have much choice about having residents if you work in a large university teaching hospital!!! I agree, sometimes they have no clue what they're doing. But how in the world are doctors ever going to become neonatalogists if they don't train fellows? At least here, they have to stay full-time for 3 years, and they cover nights - at times I'd rather have them with me than the attendings because procedures are just second nature to them by the end of their training.

    BUT to answer the NNP-hopefuls' questions - we've all agreed on one thing, and it's that the NNPs and MDs work for separate departments and thus their schedules really don't affect each other at all. NNPs may work days, nights, weekends, and holidays - it all depends on the hospital AND that hospital's current staffing. Things can change in a heartbeat.
  8. by   CapeMaui
    Thank you all for the new information!! That's so helpful!

    I guess how the NNPs and MDs work together really depends on the hospital. Where I volunteered and shadowed, the RNs explained to me that the NNPs actually worked under the neonatology dept, so they all worked under the head neonatologist, alongside other neonatologists. I'm sure if I end up in a teaching hospital (which I have my eyes on), I will get to see how they work together first hand. I'm not sure about their prescription previleges though, I guess it's different with each state? I'm going to have to do some research on that.

    I started this thread to see how NNPs are treated across the nation and wanted to see what they're job/career viability is as it is a pretty unknown field. Even some of my teachers didn't know there's a NNP position!! I was kind of surprised. But now that I've heard from all of you, I am more comforted in the direction I've chosen. Who knows, maybe after I work on the unit and see how they actually work together, I may decide that it's not for me. But for now, I can't wait to start working with the wee ones

    If anyone else has any other info, PLEASE SHARE :chuckle Thanks!!
  9. by   Gompers
    Quote from CapeMaui
    I guess how the NNPs and MDs work together really depends on the hospital. Where I volunteered and shadowed, the RNs explained to me that the NNPs actually worked under the neonatology dept, so they all worked under the head neonatologist, alongside other neonatologists. I'm sure if I end up in a teaching hospital (which I have my eyes on), I will get to see how they work together first hand. I'm not sure about their prescription previleges though, I guess it's different with each state? I'm going to have to do some research on that.
    Yes, they do work under the neonatalogy department with the attendings, but what I meant to say is that they are STAFFED under nursing usually so their schedules and the residents' schedules have no bearing on each other, as they are considered different departments when it comes to budgets and such. Does that make sense?

    As far as prescription priviledges go, that may change before you get your NNP so don't worry too much about that. More states may approve of them, or others may take away the priviledge, who knows. It doesn't make a huge amount of difference on our unit - all it means is that we can't chart the meds off in the computer until the MD has approved it for administration. I've never seen a doc refuse to cosign something, so really just a matter of paperwork, etc.
  10. by   CapeMaui
    Quote from Gompers
    Yes, they do work under the neonatalogy department with the attendings, but what I meant to say is that they are STAFFED under nursing usually so their schedules and the residents' schedules have no bearing on each other, as they are considered different departments when it comes to budgets and such. Does that make sense?

    As far as prescription priviledges go, that may change before you get your NNP so don't worry too much about that. More states may approve of them, or others may take away the priviledge, who knows. It doesn't make a huge amount of difference on our unit - all it means is that we can't chart the meds off in the computer until the MD has approved it for administration. I've never seen a doc refuse to cosign something, so really just a matter of paperwork, etc.
    Thanks Gompers! Yes, that makes a lot of sense! I guess the hospital where I was may be an exception. The RN told me that the NNP always worked nights as the days are covered by neonatologists, that's why i was wondering if that's the norm. I HOPE NOT! I don't think hubby would like that too much

    I won't worry about prescription priviledges, it doesn't make a difference to me one way or the other. I don't mind having someone double check. when it comes to the tiny ones, the more checking the better :chuckle
  11. by   mac23
    mac23 - what school do you go to? that's a great idea, do you know if most schools let you do that? also, does this mean you'll get to sit on 2 boards and get 2 ms degrees? are you currently going for your nnps as well? in your unit, does your nnps pretty much fxn independently?

    here is some info on the combined nnp/pnp program.


    in general three types of nurse practitioners care for children; neonatal nurse practitioners (nnp), pediatric nurse practitioners (pnp) and, to a lesser extent, family nurse practitioners (fnp). traditionally, pnps are outpatient based and nnps are inpatient based. in recent years, there has been an overlap in their roles. for example, pnps examine infants in the hospital, while nnps provide aftercare in outpatient settings for growing young children. the focus on improving health in rural and underserved areas has highlighted the special knowledge required to provide cost effective efficient care in areas that might not have access to all the resources of a larger medical center. this combined program allows the student to have a great deal of latitude when seeking positions after graduation.
    what makes the neonatal and pediatric programs at duke unique?
    several things are unique about our programs. first the total focus will be on infants and children within the context of a family. from the minute you start at duke, you will find that unlike most programs in the nation, our pathophysiology, pharmacology, and physical assessment courses are focused solely on infants and children. we are one of the only programs in the country that offers this total pediatric immersion. second, our faculty practices in the field as clinical nurse specialists, neonatal nurse practitioners, pediatric nurse practitioners, and pediatric clinical pharmacists. you will be surrounded by experts-- faculty who can discuss real cases from the previous week and can integrate theory, research, pathophysiology, pharmacology, and management of the infant or child into classroom discussion. we also have a state-of-the-art simulation laboratory that helps you gain confidence in advance practice procedures.

    how long does it take to complete this program?
    the program of study includes 1216 clinical hours and 56 credits, which can be completed in 5 semesters (fall, spring, summer, fall, spring) of full time study. part time study is also available.
    the neonatal nurse practitioner program is based on guidelines for neonatal nurse practitioner education developed by the national association of neonatal nurses (nann) and the guidelines for pediatric nurse practitioner education developed by the national certification board of pediatric nurse practitioners and nurses (ncbpn/p). graduates of the nnp/pnp program are eligible to take the following certification examinations: national certification corporation (ncc) neonatal nurse practitioner certification examination, the pediatric nurse practitioner certification exam sponsored by the national certification board of pediatric nurse practitioners and nurses, and the pediatric nurse practitioner exam sponsored by the american nurses credentialing center (ancc).
  12. by   CapeMaui
    Thanks so much Mac23! Really appreciate all the info. Unfortunately, Duke is too far and relocation is not an option. I'll be looking into schools in NY, Columbia and Stony Brook. Both have a good reputation, however, Stony Brook's program is a distance learning program, I'm not sure how I feel about that. I think I would prefer to do in class work... How much longer till you graduate and sit for your board?
  13. by   mac23
    I have 6 months to go!!!! I'm really excited. I didn't start at Duke though, I started at MUSC in south carolina and their nnp program you can do distance/online so just wanted to comment on the distance programs. In my opinion, it wasn't at all bad I really enjoyed the freedom actually. It allowed me to work and the on campus stuff they only met once a week anyways. I was required to be on campus for certain things but it allowed me to not have to move to Charleston, as i was living in Columbia, SC at the time. However, the clinical part you had to have a sponser and you could do your clinicals at any one of 4 hospitals in South Carolina one being in columbia so once again i didn't have to move so keep distance/online programs in your mind it really wasn't that bad. I only went to school part time so it has taken me a while to finish and i had to move to north carolina for my husbands job so that's how I ended up at Duke........ but going part time allowed me to gain the necessary experience required before you can sit for the boards and it helped so much with working with the babies. Keep in touch. I'd be interested in seeing what you decide to do as far as NNP or any other type of NP education is concerned. And just keep the info from Duke in mind in case you want to explore doing both NNP and PNP...one of the schools may be able to customise your programs so that even if they don't have a formal combined program you could still do both...that's what MUSC was doing for me. It's something to keep in mind to ask about when you explore different programs.



    Quote from CapeMaui
    Thanks so much Mac23! Really appreciate all the info. Unfortunately, Duke is too far and relocation is not an option. I'll be looking into schools in NY, Columbia and Stony Brook. Both have a good reputation, however, Stony Brook's program is a distance learning program, I'm not sure how I feel about that. I think I would prefer to do in class work... How much longer till you graduate and sit for your board?

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