How to become a neonatal np?

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    Hi! So i'm a high school junior and it's time for me to start looking at colleges and know what I want to do. Ultimately, I want to be a neonatal nurse practitioner. So I've been trying to research it and I'm really confused. I was wondering if anyone could tell me what exactly you have to do to become a neonatal np and then what exactly you do as a neonatal np? Thanks.
  2. Visit  valx92 profile page

    About valx92, BSN, RN

    From 'New Jersey'; 23 Years Old; Joined Apr '09; Posts: 6; Likes: 1.

    20 Comments so far...

  3. Visit  Sweeper933 profile page
    0
    There are some threads in this forum r/t to this topic - just do a search for NNP.

    First, you have to get your nursing degree. Some people choose to get a 4 year degree, then go to nursing school, and others just straight out get their nursing degree (BSN). Then, pass the NCLEX and become an RN.

    Pretty much every NNP program will require you to have at least 2 years of experience working as a neonatal nurse. Most hospitals will hire you into the NICU right out of nursing school. You really need at least 2 years to learn some of the finer points of being a NICU nurse. Most nursing school programs will touch on NICU stuff, and you may even get a clinical day (or 2) in the NICU. But since nursing school mainly focuses on adults, getting (at least) 2 years of experience is truely neccessary.

    There is a "sticky" on this forum r/t different NNP schools in the country. The specific websites for each school may have some more detailed information for you.

    Hope this helped!!!
  4. Visit  valx92 profile page
    0
    Quote from Sweeper933
    There are some threads in this forum r/t to this topic - just do a search for NNP.

    First, you have to get your nursing degree. Some people choose to get a 4 year degree, then go to nursing school, and others just straight out get their nursing degree (BSN). Then, pass the NCLEX and become an RN.

    Pretty much every NNP program will require you to have at least 2 years of experience working as a neonatal nurse. Most hospitals will hire you into the NICU right out of nursing school. You really need at least 2 years to learn some of the finer points of being a NICU nurse. Most nursing school programs will touch on NICU stuff, and you may even get a clinical day (or 2) in the NICU. But since nursing school mainly focuses on adults, getting (at least) 2 years of experience is truely neccessary.

    There is a "sticky" on this forum r/t different NNP schools in the country. The specific websites for each school may have some more detailed information for you.

    Hope this helped!!!
    Thankyou! But, why would you choose to get a degree then go to nursing school when you could just flat out get a nursing degree? Just getting your nursing degree would be faster right? Does doing it the longer route do anything better for you, or is it the same either way?
  5. Visit  Sweeper933 profile page
    0
    Some people didn't know what they wanted to do - and therefore got their degree in something else first. Others wanted something else to fall back on. The list could go on. I was simply saying that you could go either route. Since you know that nursing school is your ultimate goal - I would say that getting a general degree first probably wouldn't be for you.
  6. Visit  nakeia profile page
    0
    if you know you want to be a neonatal nurse practictioner, you need to get a nursing degree. so whatever college/university you choose to go to... major in nursing. i would recommend a BSN program (4 year degree) because eventually you will need that anyway to go for your MSN-NP.
  7. Visit  astn profile page
    0
    This isn't going to be a popular answer on this forum, but I would advise against the nurse practitioner route, unless you are already a nurse and looking for something "more" (and are in a position to evaluate the job better.)

    If as a high school junior, you are already looking towards advanced practice, you should be looking at becoming a Physician Assistant. The opportunities are the same but you are not "trapped" into the Neonatal specialty if you should decide later you want to do something different (for the challenge, schedule, whatever.) Lastly, the politics of nursing, particularly advanced practice, are getting ugly IMO, with fragmentation between Family, Acute Care, Neonatal, Pediatric, Geriatric, etc, and some states (Texas, I think?) forcing people who have worked in a role for years to change their speciality to conform to some BON standard.

    If you want to be a nurse, then by all means, become a nurse. You can always later move up into advanced practice. But if you want to be a midlevel practitioner, save yourself a lot of time and energy and become a Physician Assistant.
  8. Visit  babyNP. profile page
    0
    Physician assistants don't have the experience that neonatal nurses/NPs have, however, and would result in a very large handicap when trying to practice, if this is what the OP wants to do.
  9. Visit  astn profile page
    0
    I'd love for you to have a conversation with my wife and explain her "handicap" to her, as she's been a Physician Assistant working in Neonatology for the last three years, along with six other PAs, working at Children's Hospital of Philadelphia. A coworker of hers started at Yale Medical. Pretty much every well renown NICU in the country either currently has or has had a Physician Assistant working alongside NNPs.

    The argument you're making has some merit, I'll agree. If someone is an experienced neonatal nurse, and wants to go further in the field, they -should- have better experience and knowledge to base their education on. However, if someone already has eyes to be a midlevel, how long are they going to stop at each level to learn and have good experiences? Many nurse practitioners of all specialties are doing a 'zero to hero' as it is, getting their BSN, beginning to work as a nurse, and starting their MSN/NP almost immediately after finishing orientation. I think the NP tract is a good one, for nurses who have done the jobs a while and are looking to do more, but if your goal is to work as a midlevel, why bother with the intermediate step of being a nurse?

    Lastly, by the time the OP is finished her BSN and ready to work as a nurse (and start her NP program...) she'll probably be looking at getting a DNP anyway ... so if you want to work as a midlevel, really, isn't a five year PA program a better recommendation?
  10. Visit  babyNP. profile page
    0
    I'd love for you to have a conversation with my wife and explain her "handicap" to her, as she's been a Physician Assistant working in Neonatology for the last three years, along with six other PAs, working at Children's Hospital of Philadelphia.
    Are you going to tell me that your wife knew as much about the neonatal field than did a NNP from the get-go? I said it was a handi-cap; not something that couldn't be overcome. At my hospital, we have PAs as well and they do an excellent job, but they didn't walk out of PA school like that. It's more rare to have a PA rather than an NNP simply because it's such a specialized field.

    Quote from astn
    Many nurse practitioners of all specialties are doing a 'zero to hero' as it is, getting their BSN, beginning to work as a nurse, and starting their MSN/NP almost immediately after finishing orientation.
    ...except that you can't do that with an NNP program anymore. It's a well-known fact that it's required to have at least two years of NICU experience, most of them require level 3 experience.

    Lastly, by the time the OP is finished her BSN and ready to work as a nurse (and start her NP program...) she'll probably be looking at getting a DNP anyway ... so if you want to work as a midlevel, really, isn't a five year PA program a better recommendation?
    Probably if she didn't have family or financial considerations. In the field of neonatal medicine, I'd recommend NNP over PA, however, because I would probably be scared ******** walking out of school knowing only this much about neonates versus a NNP. The learning curve is already steep; why make it worse for yourself?

    For a general PA, yeah I'd probably go with a PA rather a NP, but it does limit you in some ways. For example, you cannot work with Medicins Sans Frontieres (Doctors without Borders) if you are a PA.

    It's good to have this dialogue. Thank you for your thoughts.
  11. Visit  astn profile page
    0
    Quote from Justine_
    Are you going to tell me that your wife knew as much about the neonatal field than did a NNP from the get-go? I said it was a handi-cap; not something that couldn't be overcome. At my hospital, we have PAs as well and they do an excellent job, but they didn't walk out of PA school like that. It's more rare to have a PA rather than an NNP simply because it's such a specialized field. <snip> It's a well-known fact that it's required to have at least two years of NICU experience, most of them require level 3 experience.
    As I said, some of your statements have merit; I disagree with your terminology and conclusions, though. A Neonatal Nurse Practitioner has a background in the field, which is obviously an advantage, the primary of which is the familiarity with terminology and basic concepts. The knowledge of "neonatal nursing care" is good, but by no means essential, as advanced practice is more akin to medicine then nursing, if you will forgive the generalities. While an NNP may start out with an advantage because of their familiarity, within six months a PA and NNP are virtually indistinguishable, and later in their career as advanced concepts and understanding at deeper levels of pathophysiology become more understandable and important, the Physician Assistant (which usually has a stronger science background) may actually be at an advantage (as was admitted by a colleague of my wife's.) That is not to say the NNP is "handicapped" by the lower science requirements of their program, just that they may not have that advantage.

    I do understand that all NNP programs require experience prior to admission. This is relevant to me for a different reason then you, but I will address your reasoning first. At two years, a NICU nurse is still relatively new to the field, particularly if not working at a major referral center. Two years at a level IIIa program, or even a smaller IIIb program, is a good familiarity, but depending on your facility, average daily census, and the acuity of your patients (some IIIbs are still sending away their most acute patients, even in the absence of a need for ECMO or other advanced procedures) it still may not be enough to give you much more then a passing familiarity with the terminology, and disabuse you of the "fear" of working with neonates (particularly the extremely small/extremely young.) If you were to work two years at UCLA, CHOP, Yale, Mayo, Texas Children's, I definitely agree you have an advantage. If your experience is not one of those facilities (or that "tier,") how much did those two years -really- help you? Yes, it helps. Even working a IIIa for two years is better then nothing, but within six months if you took the name badges off, would you notice a difference? Do you know of any orientation for new neonatal nurse practitioner that is less then six months?

    Probably if she didn't have family or financial considerations. In the field of neonatal medicine, I'd recommend NNP over PA, however, because I would probably be scared ******** walking out of school knowing only this much about neonates versus a NNP. The learning curve is already steep; why make it worse for yourself?
    Now to get to my point on the "two year experience" point you raised ... if you don't want to be a nurse, why drag it out? I would think, since you already should be getting your BSN (hence need at least four years of school) that it would be smarter to do a five-year PA program, graduate -once- and go on to advanced practice. Rather then four years of school, two years of nursing while you begin prerequisites for your nurse practitioner program, begin your NNP program, spend two years part time while working as a nurse, then .. what, eight years later you can -begin- your orientation period to become a midlevel in the NICU? You argue it's financially a better position, probably because you're able to work for four years of that process ... but a PA would have worked for three years of that, and at a much better pay rate then a new grad RN. Loans at the end would largely even out (both PA and NP programs are expensive) so from a family and financial perspective, as a PA you are making better money at an earlier age, can spend more time with your family because you're not at work all day and school all night ..

    Oh, and the Physician Assistant that became a midlevel three years before you has already had -three years- of advanced practice before you even began your orientation. So how much does your advantage of nursing previously help in comparison? I'm not trying to be adversarial, because I feel that becoming an NNP is a smart move for some people--people who are interested in being nurses and later interested in doing something more. If you are a junior in high school and you're telling the world you want to be a midlevel, the -smart- move is to become a PA and go directly to your goal.

    For a general PA, yeah I'd probably go with a PA rather a NP, but it does limit you in some ways. For example, you cannot work with Medicins Sans Frontieres (Doctors without Borders) if you are a PA.
    I blame the French. Actually, I've spent a fair amount of time in various places of the world doing that type of medicine. I've worked with/around (though not for) MSF. They don't use PAs because they don't have PAs in France. They do have Nurses. They treat everyone who isn't a Physician like crap. I would never recommend working with them, unless you're French, smoke, and a doctor. Everyone else should look at medical support missions that appreciate them for what they bring to the table, because there are a lot of medical missions (most supported by a church) that are doing the same or better work with less snobbery. That is simply my opinion, based on my personal experience, on MSF.

    RE: working as an NNP offers more opportunities. I think that is largely a false argument. The factionalization of the Nurse Practitioner world has actually -hurt opportunities- for NPs in the future. I know a girl who had to bust her ass for two years because even though she had worked in the NICU for years as midlevel, she was then told that "oh, I'm sorry, you're a PEDIATRIC nurse practitioner, you can't work here any longer until you get your NNP." I also know a few guys that were FNPs working in ERs that were forced out of their positions because they were FAMILY NPs rather then ACUTE CARE NPs (they actually retired after 20 years in the ER rather then undergo a transition course because it was so insulting.) Opportunities for an NNP exist ... well, solely in the NICU. Not so for a PA. So you are hurting yourself if you're not sure you want to work nights/weekends/on call for the rest of your life on the unit.

    That's a larger conversation then I want to get into (the PA v. NP argument) and I don't think either is better then the other in practice. I believe that they are better for some people, but not in any sweeping statements. I do appreciate the conversation, and welcome it's continuation, even though I feel as if we've slightly threadjacked, the OP still may be interested and learn something. Take care.
  12. Visit  SteveNNP profile page
    4
    Yes, this thread has been hijacked. Let's try to get back on topic.

    First, the OP says, "I want to be an NNP" followed with "What does an NNP do?"

    How can you know you want to be an advanced practice nurse in a highly specialized field without knowing what the job means? That's my question.

    So here's my

    I work at a large tertiary care NICU in Manhattan. We do cardiacs pre AND postop, (Take THAT CHOP ;^P) ECMO, single lung ventilation, etc.... I came from a Level IIIb unit that didn't do complex surgeries or ECMO, but did pretty much everything else. Those 2 years were invaluable in learning about critical thinking, neonatal physiology, delivery room management, etc. Here, I've added some cardiac skills, etc, but the basics are still the same. As an NNP student, I spend 700 hours in a level III NICU managing ONLY NICU patients. PAs are very well prepared as generalists, but the job market in NICUs is tight for PAs. You will generally only find them in a few academic centers. They do not receive nearly as many hours of training dedicated to the neonatal population.

    That's not to say that they don't make excellent practitioners in the NICU setting. I'm just saying that the availability of NICU PA jobs is woefully lacking. I work with several PAs who are functioning fine after a lengthy orientation mentored by NNPs and other PAs.

    Sure it makes sense to go straight for PA if you want to be a generalist-trained midlevel. But not if you want a job in NICU. You will find those jobs few and far between. A PA cannot practice without physician supervision. An NP can.

    My recommendation for the OP is to further explore the role of the NNP, and make sure that is what she wants to do. If it is, get your BSN, and start on your MSN/NNP or BSN-DNP program while working as an RN in a level III NICU. It will take awhile, as any advanced degree does. At least you will be gaining valuable neonatal experience while getting paid as an RN. It is great that you are thinking that far ahead to the NNP role. But you may just find that being a NICU nurse is more than enough!

    Best of luck!
    TaraRae123, BreatheFree, astn, and 1 other like this.
  13. Visit  babyNP. profile page
    1
    ^^ thanks Steve. Best of luck to the OP

    astn, again, thank you for insight. I think we'll have to agree to disagree. Wishing your wife well at CHOP! It's a beautiful hospital.
    astn likes this.
  14. Visit  astn profile page
    0
    Quote from SteveRN21
    Yes, this thread has been hijacked. Let's try to get back on topic. First, the OP says, "I want to be an NNP" followed with "What does an NNP do?" How can you know you want to be an advanced practice nurse in a highly specialized field without knowing what the job means? That's my question.
    A very good point, and something I hadn't given much thought to, myself. Maybe I should read a bit more thoroughly in the future. (Doubt that will happen.)

    I work at a large tertiary care NICU in Manhattan. We do cardiacs pre AND postop, (Take THAT CHOP ;^P) ECMO, single lung ventilation, etc.... I came from a Level IIIb unit that didn't do complex surgeries or ECMO, but did pretty much everything else. Those 2 years were invaluable in learning about critical thinking, neonatal physiology, delivery room management, etc. Here, I've added some cardiac skills, etc, but the basics are still the same. As an NNP student, I spend 700 hours in a level III NICU managing ONLY NICU patients. PAs are very well prepared as generalists, but the job market in NICUs is tight for PAs. You will generally only find them in a few academic centers. They do not receive nearly as many hours of training dedicated to the neonatal population.
    My wife says that she's "sorry your hospital isn't big enough to support the specialist practice, and make sure there's a smiley on that." So here's a smiley:

    I think your experience makes a good point for both sides of the conversation. You were at a unit that kept a lot of high acuity patients, so yes, you are at an advantage early on, but how long is that advantage applicable? NANN guidelines are looking for NNP students to have not less then two years as a NICU nurse, with one year (recently?) in a level III NICU. What if your experience had been that IIIa in the corn belt that is getting rid of anything below 28 weeks? How much of an advantage is that now offering?

    Regarding hours of hands-on with Neonates. Yes. In PA school you have the OPTION to 160-200 hours in the NICU. I would hope if this were the direction you were going you would take it (and make sure you went to a school that offered it, as well.) 200 != 700. There are another 2000 hours or so of other clinicals (that does create a well-rounded generalist, and -may- help, but probably not.) I've only ever talked to a few people who ever felt "ready" for their job immediately after their initial training (in any medical field) so while the extra clinical time is a help, and possibly a big help, I still stand by my statement: "six months after graduation, you can't tell the difference."

    That's not to say that they don't make excellent practitioners in the NICU setting. I'm just saying that the availability of NICU PA jobs is woefully lacking. I work with several PAs who are functioning fine after a lengthy orientation mentored by NNPs and other PAs. Sure it makes sense to go straight for PA if you want to be a generalist-trained midlevel. But not if you want a job in NICU. You will find those jobs few and far between.
    -Mostly- false, though with elements of truth. If you want to "fall into" a job in Neonatology as a PA, good luck, it ain't going to happen. But if you want a job, it isn't hard to find, if you are willing to demonstrate a real desire to be there. There are -many- jobs outside of major academic centers throughout the country (save a few areas, like regions of Tennessee and Alabama). If you were to limit your job search to facilities that are not IIIb/IIIc, you would be very correct that a PA is going to have a harder time (maybe even impossible) to find an initial entry position. My personal opinion is that no midlevel should be starting at anywhere less then IIIb, simply because those first 700 hours aren't going to be enough when a pregnant mom pops out a 24 weeker in your hospital, your attending is on call at home, and you are expected to act -right now-. If you don't have a background with higher acuity other then your initial training, your chances are much less of doing the right thing, and outside of serious comorbid factors, that child should be survivable if handled correctly.

    A PA cannot practice without physician supervision. An NP can.
    You try practicing as an NNP on your own license, without a collaborating physician, and tell me how that works out. For all the talk of the 'independence' of Nurse Practitioners, it is largely a fallacy. Any midlevel working in a NICU is going to require a physician to co-sign. A Neonatal Nurse Practitioner isn't going to be working out of his/her own office in any situation I can think of. Even most Family Nurse Practitioners, operating their own office, are signing collaborative agreements (either due to BON requirements, insurance reasons, or just because it's a "good idea.")

    <snip> At least you will be gaining valuable neonatal experience while getting paid as an RN. It is great that you are thinking that far ahead to the NNP role. But you may just find that being a NICU nurse is more than enough!
    I'm going to use this as a ramp onto another point I think is valid regarding NNP/PAs. The concept of a "Neonatal Nurse Practitioner" is actually a field of finite growth, and I believe it is actually starting to retract. That is not to say the career field is shrinking or there are less jobs--any competent NNP will likely have facilities throwing themselves at them upon graduation (once the economy comes back a bit.) However, they can't staff the positions they have with the output from the programs that exist. If there weren't shortages and other problems with the career field already, they never would have allowed PAs into the NICU in the first place. Face it, the NNP is a one-trick pony, and should completely dominate midlevel practice in the NICU. If that were the case, how did the PAs get their nose in the door to begin with? Over time, you are going to see less NNPs and more Neonatal PAs, likely with some sort of fellowship program put in place (at the major academic centers,) cranking out "trained" PAs for the smaller NICUs.

    Also, many -experienced- neonatal nurses that I know, don't want to become NNPs. These are the people we should be -begging- for, but they have -no interest.- The reasons I hear? "Why should I, I already make as much and don't have the responsibility?" "I only have to work a 36 hour work week and if I work more, I get paid for it." "I make more then the midlevel, once you figure in years, being a charge nurse, night and weekend differential." "Why would I want another 20k in loans to put up with that?" Yeah, most of them are about money, but sometimes "green" is what matters.

    Most new NNPs are (I'm guessing) like yourself. Start in nursing, find the NICU, like it, and -early- in your career, jump on the Nurse Practitioner train. Part of the advantage of the Nurse Practitioner was supposed to be their years of clinical nursing, and experience with a wide variety of patients, having seen all the "zebras" in their career. Younger nurses don't have that, so that part of the system is falling apart. Please understand, I'm not insulting your experience level--you have more then I. I'm just observing that two years is less then ten years, and my understanding was the intention was to give all these 'senior nurses' some possible upward mobility, but that doesn't seem to be the case. So what's the advantage, again?

    I'm not trying to insult anyone, either, I'm just trying to offer my point of view and drum up a good conversation. Plus I just like to hear (see) myself talk (write). I do agree with one thing, if you aren't that familiar with what an NNP or Neonatal PA does, you should investigate it a lot more. Some people can't handle it, whether it's due to the heartbreak, the fact that they have kids (or want kids) or whatever. It's a special field, and not -at all- for me. I get enough of it at dinner.


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