Certified in two specialties?

SteveNNP, MSN, NP · Apr 21, 2008

We have a PNP that works in my NICU. While the PNP will allow you to care for a wider age group, much of what goes on in NICU (I can't remember if you said you ever worked there) is usually not covered in a PNP program.

emtneel · Apr 22, 2008

I think you have a good plan for several reasons. Yes many Neonatal programs require NICU experience, so you could be working towards the PNP.

You may need to consider, are they going to pay for 2 graduate programs? you may have to dish out for the second yourself.

In the meantime i think it will be VERY good to get the NICU experience. I wanted to be a Neonatal Doctor and specialize in multiple births.. I am SOOO glad I did not do that. I have to float to NICU quite a bit (usually in Summer) at my hospital (otherwise I am Peds).

I wouldn't want to work NICU full-time for a few reasons, one the constant beeping of the machines just gets to you, since all the kids are hooked up to CR monitors.

Also I think the work gets monotonous, they are all premies, and although some have different infections or genetic disorders, they are all there for the same reason.

Now as a neonatal NP your role would be different, but as a RN i feel like I am just feeding and changing diapers all night. I like holding the babies and all, but even that you aren't supposed to hold too long or disturb them, b/c stimulous and letting them sleep to grow.

So you may decide you really don't want to do just NICU like you said.

I don't know of many units hiring PNPs, at least here I am pretty sure they want you to be neonatal certified.

I'm an FNP now b/c i wanted a broader scope of practice.

neelia:D

SteveNNP, MSN, NP · Apr 22, 2008

Also I think the work gets monotonous, they are all premies, and although some have different infections or genetic disorders, they are all there for the same reason.

While it's true that the bulk of NICU patients are in various stages of prematurity, and don't usually come with the typical list of adult problems, a lot of units do ECMO, open heart surgeries, various neuro and GI surgeries, etc. which may interest you.... I worked the occasional PICU shift to get away from NICU and challenge myself. I can tell you that the NNPs here get the same pts as the house docs and residents.

Smitty08 · Apr 24, 2008

Although my area is psych, I did pursue both PNP and FNP, I'm glad I did. It opens up more to me later in my career as I start down a teaching track towards retirement. It was tough getting dual certification, as I had to do 6 placements instead of 3. The reason it made sense for me, was that there was so much psych. in primary care and vice versa. :specs:

aviator411, RN · Apr 27, 2008

I'm finishing up a second career BSN in August and starting FNP program in Sept. I like the broad age spectrum this program offers. I'm adding in the few special courses taken by the PNP program so that I will be able to get certified as both FNP and PNP when I'm finished but I'm told it is unlikely that I will ever need the PNP credential since my FNP program specifically addresses infants-peds. There is little difference between the programs at my school; only a few additional courses are needed to do both.

Few of the NP's working in our NICU are NNP's; they just aren't that plentiful. If you value versatility of options, I think FNP makes a great deal of sense; it will not prevent you from doing NICU work most places. NP positions posted for our NICU never specify NNP certification and few, if any, have such.

My wife has been a NICU nurse for 38 years. I will never allow myself to become that "narrow"; it would be extremely difficult for her to work anywhere else now. But if you've got a sick kid, she's the one you want telling the residents what they can and cannot do!

The psycho-social aspect of NICU nursing has become a nightmare since the field was born several decades ago. You often spend as much effort managing "outlaw" parents as you do your patients. Our NICU actually has to lock up the meconium to prevent drug addicted parents from stealing it before it goes to the lab for drug screening.

Good luck!

SteveNNP, MSN, NP · Apr 28, 2008

It sounds like you have an atypical NICU. I cannot imagine a FNP or even a PNP being able to perform delivery room resuscitations, intubate a 23 weeker with a 2.0 ETT, manage a high-frequency oscillator vent, place umbilical venous/arterial lines, 1-2fr PICC lines, etc without the extensive training NNPs receive in addition to their previous NICU experience.

Maybe it's legal for FNPs to work in NICU, but I for one would not feel safe having my child cared for by someone who did not receive advanced training specific to the assessment/diagnosis/management of premature and critically ill neonates.

I'm in the process of painting myself into a corner by studying to become an NNP, but it's a corner I want to be in.

Just my :twocents:

Smitty08 · Apr 28, 2008

I should have mentioned before that my 2 specialty areas are PNP (Psych. Nurse Practitioner) and FNP. Not to be confused with Pediatric Nurse Practitioner -also PNP, I believe. Boy its an alphabet soup in nursing! :bugeyes:

Editorial Team / Admin · Apr 28, 2008

I thought the specialty creds were Adult Psychiatric-Mental Health Nurse Practitioner (APMHNP), Family Psychiatric-Mental Health Nurse Practitioner (FPMHNP), or simply Adult Psychiatric Nurse Practitioner (APNP)....?

aviator411, RN · Apr 29, 2008

It sounds like you have an atypical NICU. I cannot imagine a FNP or even a PNP being able to perform delivery room resuscitations, intubate a 23 weeker with a 2.0 ETT, manage a high-frequency oscillator vent, place umbilical venous/arterial lines, 1-2fr PICC lines, etc without the extensive training NNPs receive in addition to their previous NICU experience.
Maybe it's legal for FNPs to work in NICU, but I for one would not feel safe having my child cared for by someone who did not receive advanced training specific to the assessment/diagnosis/management of premature and critically ill neonates.
I'm in the process of painting myself into a corner by studying to become an NNP, but it's a corner I want to be in.
Just my

Good thoughts; I'm going to investigate a bit further. It's a level 3, one of the first in the country, pretty well established. I know the NP's do these things to some degree but the herds of residents and fellows do more of it. The residents learn to do these things on the job; little reason why NP's can't do the same. RT does most of the vent management; even the residents don't handle that equipment much.

NP specialization/fragmentation seems a bit overdone to many and a large percentage of NP's work outside their specialty according to last month's AANP journal. Supply and demand seems to dictate this at the moment.

There will probably be a time when nursing becomes less fragmented like the medical profession is. Fragmentation/specialization within NP ranks was no doubt a political necessity to overcome resistance from the likes of the AMA initially. That doesn't mean it has to remain that way. Although I'm not a strong advocate of the doctorate in nursing as a clinical credential, it may be the most expedient route to a scope of practice more nearly resembling that of the medical profession. If MD's can be broadly trained, there's no reason why nurses couldn't be similarly trained as long as the training is adequate and appropriate.

I agree, if you like where you are, why leave it. I would prefer to maintain a somewhat broader skill set and pt mix but I am extremely impressed with the work you folks do in NICU.

SteveNNP, MSN, NP · Apr 30, 2008

Good thoughts; I'm going to investigate a bit further. It's a level 3, one of the first in the country, pretty well established. I know the NP's do these things to some degree but the herds of residents and fellows do more of it. The residents learn to do these things on the job; little reason why NP's can't do the same. RT does most of the vent management; even the residents don't handle that equipment much.

Yeah,

It does depend on the facility. My last job, it was a teaching hospital, but we did not have a fellowship/residency program for the NICU. So it was 4 neos and a couple of NNPs managing all the babies. The NNPs were very independent and performed most procedures, except for venous cutdowns, subclavians/broviacs. Other than that, once they were checked off, they did everything else. BUT, they had been trained specifically in neonates.

Here where I'm at now, the NNPs take a resident-like role along with house docs. Fellows and attendings tend to hog all the procedures. I imagine a FNP/PNP could learn to do it all here, but it's be tough at my former unit where you are expected to be autonomous.

aviator411, RN · Apr 30, 2008

Steve,

Indeed, every place seems a bit different. I appreciate you sharing your experiences and observations; it's all very interesting. I've enjoyed reading and have benefitted much from your informative posts in recent years, hope you will keep it up.

When I learn more about the division of labor here I'll pass it along for all to share as well.

John