Best time to become NNP

babyNP., APRN · Feb 22, 2015

There aren't many NNPs that post on the boards here and there are a couple who are currently in school that can chime in. My story is that I was a RN for 4 years at a Level 4 NICU (no deliveries) before starting graduate school. I then continued to work up until school was almost over so that I had 6 years of experience by the time I was done. Do you need 6 years? Probably not, and I think 4 years of clinical experience is pretty solid, depending on the acuity of your unit.

And really there aren't many RN skills that you "need" to be a NNP. It's helpful of course to be good at putting in IVs (so you can later do PICC lines), but my facility had many older infants and was 100% transport in, so not as many opportunities for fresh veins to stick. All in all I didn't get much opportunity to do IV starts, but I did manage to get a few in and I'm hoping that this will translate to PICCs (haven't done any yet) since many of the infants I'll be putting them in are "newer" and using the "better" veins in which to do so.

I will tell you that you shouldn't focus as much on procedures as you should on learning the pathophysiology of common neonatal diseases and how babies work. I had 2 preceptors in school (in different institutions) tell me that doing procedures does not an NNP make- but managing an infant's care and knowing what to do and making clinical decisions is much more important. And it's true. I do procedures at my job, but most of my job is managing these infants' daily care and knowing what the answer is when the RN calls me with a new finding or the consult service asks me why we are doing x and not y.

I would recommend being on day shift as much as you can because you will learn a lot more due to more things happening (like trips to fluoro, surgery, etc etc) and rounds. Of course these things do happen on the night shift, but not as much as in frequency. I stayed on night shift (mostly by choice) for about the first 2 years of my NICU RN career and I feel like it stunted my growth initially. I switched to day shift and would read the previous medical progress notes and try to figure out what would be coming next and try to anticipate the new plan. Then when rounds occurred, I'd listen carefully to the resident or NNPs plan and see how it matched up with my own. I was lucky to work at a teaching institution, so I was also able to ask a lot of questions in a friendly environment.

Then when I started school, I really got to see how patient care management worked on the other side and let me tell you- it's much harder than it looks. I mean, it's not rocket science a lot of the time, but I definitely thought it looked a lot easier as a RN. But as I continued to work, a lot of things really came together for me as I thought about how I would manage my own patients and compare management strategies that I learned in clinicals versus what my home institution did and many things "clicked" for me. I really think (although it was hard) that going to school and doing clinical at the same time really helped my knowledge base and growth.

I would also recommend taking a NICU review course and taking the RNC-NIC or the CCRN neonatal test when you get a chance. I did the RNC and it really helped me with my confidence to apply to graduate school, plus it was an awesome overview of neonatology. You might not be eligible to take the RNC for 2 years (by which time you'll have applied to grad school according to your plans), but if you can swing the $$, I definitely think a review course is great for knowledge. Two of the major ones are NICU solutions and the Professional Education Center. I wouldn't do it right now because it might be a bit overwhelming, but maybe when you're a year out of being a RN. You can always study from a textbook too, but many of the texts are dense. If you're looking for something that's straightforward and less dense, I would pick "Manual of Neonatal Care" by Cloherty. It's an awesome book that explains how disease processes work and treatment algorithms for treating them.

And being a planner is a good thing! Shoot, I'm a little crazier. I found every single NNP school (back in 2010, I think) and made a huge spreadsheet looking at cost, length, rank, requirements, etc, hahaha.

Let me know if you have any other questions. Please know that I am not the be-all, end-all expert on being a NNP. Full disclosure is that I've been a NICU RN for 6 years and a NNP for ~4 months. I've just done a lot of research and just putting forth my own experiences- what may work for me may not work for someone else.

Best of luck...and let us know how things go!

SteveNNP, MSN, NP · Feb 23, 2015

BabyNP offers some great advice, so I won't add too much... but I think with that much bedside experience by the time you enter clinicals is great. My added advice is to seek out learning opportunities. Take care of the sicker babies...get used to interpreting labs and Xrays, how to adjust vent settings for gases, putting in IVs, attending deliveries if you do that at your hospital, as well as doing transports. In my opinion, an RN who is confidently caring for all kinds of patients and has a mind to absorb the nuances of neonatal patho makes for a great new NP

NicuRN628 · Feb 23, 2015

Thank you so much for all of the advice, it is truly appreciated! I definitely feel more comfortable applying for the Fall 2015 class after reading your posts. I will gain as much knowledge and experience as I can over the next year and a half and hopefully be able to start the NNP program next Fall. I will be utilizing all of your recommendations, thank you so much!

ittybittie · Feb 27, 2015

Since you are such a planner and you're getting started early, perhaps going back to school quickly will work for you. I have worked with NNPs that had very little experience before school and, while their first year or so out was a little rough, they are now very skilled NNPs. It's definitely possible! I will say though, that the RN staff was very resistant and critical of them at first because they didn't identify and empathize with the RNs quite like those that had been in the RN role, dealing with all its struggles, for a longer time period.

I was a different story... I am just starting as an NNP and had ~7 years experience in different NICUs as a preceptor, council leader, charge nurse, etc... and feel pretty overwhelmed with the new role. (There are, of course, a lot of factors that go into that but that's not the point!) I don't think you can put a time limit on what is adequate, but I definitely drew on my years of experience and ability to recognize and anticipate plans of care for certain babies in order to understand things while studying. (Many ah-ha! moments!)

My advise to you is this:

1. Shadow an NNP for a couple of days when you get your sea legs as a bedside RN. I LOVED school and learning all the interesting patho stuff, but got to the end and started clinicals and found out the job was not at all what I'd expected - and I'd worked along side NNPs as an RN the whole time. It is, as was mentioned before, very different than it looks from the outside.

2. Take your RNC test. It was a really good gauge for me that I was equipped to handle the study time and test-taking skills that were required in graduate school. It also gave me a tiny bit of an idea of all the things NNPs are required to know every day in order to care for babies from a different perspective. It's more than you think!

3. Don't rush your time as an RN, or see it as a means to an end. There is a huge amount of value in being a great bedside nurse that will serve you in a lot of different aspects of life, not just in the NICU.

4. Be open to change. I saw people in NNP school change their minds and decide not to finish, or switch to a different NP or MSN program. They'd been in NICUs for a long time and for whatever reason, they realized it wasn't for them. (For some, it was life reasons, for others they just realized they wanted to stay at the bedside.)

I wish you the best of luck... being new in the NICU can seem crazy overwhelming but it is also incredibly rewarding!

amandapanda057 · May 12, 2016

I'm a planner too. Just finished my first year of undergrad and already planning where I'm going to go to get my DNP/NNP. Thanks for making this thread, it's really helpful. I'm planning on going to grad school as soon after I get my BSN as I possibly can.