Help a student pick the right path!

llg, PhD, RN · Oct 12, 2015

I don't think I have ever seen a PA in NICU -- and I have worked in 6 different NICU's over the years. There may be a few, though. But the overwhelming majority of people in those types of roles are NNP's.

The most common route for becoming an NNP is to go to nursing school and become a nurse -- a staff nurse in a NICU. Then, you go to graduate school (MSN or DNP) and get your advanced role education to become an NNP.

babyNP., APRN · Oct 13, 2015

A PA requires a 4 year degree and a 2 year master's degree. They do a type of "mini-medical" school meaning that they do theory classes & rotations in various specialties. They are viewed as a "generalist" and generally only work with adults. Rarer to see them in peds, OB, and NICU.

A NP is someone who has a BSN (bachelor's in nursing; not all the time, but overwhelming most NPs have a BSN) and who has a master's degree (some now with doctorates) in neonatology. All programs currently (AFAIK) require 1-2 years NICU RN experience. The master's degree exclusively focuses on the NICU.

So, side-by-side, a NP has much more knowledge out the door and has a better understanding of how the NICU works (i.e. what's realistic, that sort of thing) than a PA does since they were bedside nurses first. But I've known many excellent neonatal PAs who knew all their stuff well. The difference is that a PA comes out of school knowing next to nothing about NICU. They might be able to do an elective in the NICU, but that's it, just a month or two.

Recently, neonatal residencies have popped up and are a year long (currently in Kentucky & at CHOP in Philly) where you are essentially doing another year of "school" just learning all about the NICU. But the class size is pretty small. I don't know what the competition is like.

PAs are hired into the NICU, mostly at academic centers like children's hospitals. They generally are not found elsewhere so the job opportunity for PAs is not there like it is for a NNP. My hospital refuses to hire them even though our service is short on providers and we are an academic center with 150+ NICU beds. Where I worked at before on the east coast at an academic center, we had maybe 4-5 PAs and they were great. There were a couple that really couldn't make the switch from adults to neonates and left after a few months.

If you know you want to do NICU as a provider, then I recommend doing it the NNP route. If there's a chance that you don't want to do NICU but be a different sort of provider, then either route can be argued for different reasons (although I still think NP is superior in many ways as long as you go to a decent grad school and have decent bedside experience).

Pay should be the same for both routes, and neonatology pays much better than most specialties since we are in an intensivist role. I was offered nearly 6 figures as a new graduate.

Hope this helps, let me know if you have any other questions.

NICUmiiki, DNP, NP · Oct 13, 2015

I just moved this from another post.

What is the difference exactly?

A physician's assistant is a generalist. They are trained to care for all populations and specialize in the job. A NNP is a neonatal nurse practitioner. A nurse practitioner is a nurse that got an advance degree to become a nurse practitioner and specializes in neonates in school.

Which route would be the best way to go? If you want to work in a NICU, NNP. I don't know any PA's that work in NICU because of the highly specialized care required.

Who makes more money?

Unable to answer. Very dependent. Nurse practitioners in other areas and PA's tend to make about the same amount of money. I've heard that NNP's make more than the average nurse practitioner.

What do hospitals doctors prefer?

In a NICU? Probably an NNP.

Also, can you be a DNP in neonatal?

Yes. DNP is a degree. You can specialize in neonates. You then get licensed as a NP with a specialization in neonates.

To become an NNP, you must first become a nurse by obtaining a associate's or bachelor's degree in nursing and passing a test called the NCLEX. If you get an associate's degree, you will eventually need to obtain a bachelor's degree. Once you are a nurse, you need to get a job in a NICU. It can be very competitive. Most NNP programs require 2 years of nursing experience in a NICU before starting. Complete an NNP program, pass the certification exam, and become licensed as a nurse practitioner in your state.

To become a PA, complete a bachelor's degree following a pre-med curriculum. Apply to a PA program. Once completed, pass certification exam and become licensed in your state. Get a job (NICU will most likely not be an option for you).

abbeyluu10 · Oct 13, 2015

Thank you so much for all the information! I will take everything in! So very grateful.

abbeyluu10 · Oct 13, 2015

A PA requires a 4 year degree and a 2 year master's degree. They do a type of "mini-medical" school meaning that they do theory classes & rotations in various specialties. They are viewed as a "generalist" and generally only work with adults. Rarer to see them in peds, OB, and NICU.
A NP is someone who has a BSN (bachelor's in nursing; not all the time, but overwhelming most NPs have a BSN) and who has a master's degree (some now with doctorates) in neonatology. All programs currently (AFAIK) require 1-2 years NICU RN experience. The master's degree exclusively focuses on the NICU.
So, side-by-side, a NP has much more knowledge out the door and has a better understanding of how the NICU works (i.e. what's realistic, that sort of thing) than a PA does since they were bedside nurses first. But I've known many excellent neonatal PAs who knew all their stuff well. The difference is that a PA comes out of school knowing next to nothing about NICU. They might be able to do an elective in the NICU, but that's it, just a month or two.
Recently, neonatal residencies have popped up and are a year long (currently in Kentucky & at CHOP in Philly) where you are essentially doing another year of "school" just learning all about the NICU. But the class size is pretty small. I don't know what the competition is like.
PAs are hired into the NICU, mostly at academic centers like children's hospitals. They generally are not found elsewhere so the job opportunity for PAs is not there like it is for a NNP. My hospital refuses to hire them even though our service is short on providers and we are an academic center with 150+ NICU beds. Where I worked at before on the east coast at an academic center, we had maybe 4-5 PAs and they were great. There were a couple that really couldn't make the switch from adults to neonates and left after a few months.
If you know you want to do NICU as a provider, then I recommend doing it the NNP route. If there's a chance that you don't want to do NICU but be a different sort of provider, then either route can be argued for different reasons (although I still think NP is superior in many ways as long as you go to a decent grad school and have decent bedside experience).
Pay should be the same for both routes, and neonatology pays much better than most specialties since we are in an intensivist role. I was offered nearly 6 figures as a new graduate.
Hope this helps, let me know if you have any other questions.

Thank you so much! I was also wondering.. Who is a step down from a neonatologist? Also, is getting your DNP worth it? And are they above just the regular NNP with a BSN in the work force?

babyNP., APRN · Oct 13, 2015

What do you mean a step down from a neonatologist?

A neonatologist is someone with a 4 year bachelor's degree, a 4 year medical school degree, 3 years residency as a pediatrician, and 3 years in fellowship to become a neonatologist.

DNP is just something I wanted personally to finish up my education. I purposely decided to get my MSN first so that I could get my license and start working. I think there are good things and bad things (and so far my curriculum has been pretty good) like anything else. There are countless threads on the subject. For the love of everything holy, do not believe anyone that tells you that it is a requirement (you may hear the word number 2015 is the year). Just do not. Do not pass go, do not collect $200. I'm too tired to be bothered to explain this, but don't let people tell you that you are required to have a doctorate.

MSN or DNP: they are no different in terms of job responsibility unless you want to teach or be a hospital exec. You can't get a "BSN NNP" unless you were grandfathered in the 90s. It is masters entry and above.

hope that helps. If you have more Qs feel free, but I will be going to sleep now- the babies kept me busy today

BeachsideRN, ASN · Oct 13, 2015

Thank you so much! I was also wondering.. Who is a step down from a neonatologist? Also, is getting your DNP worth it? And are they above just the regular NNP with a BSN in the work force?

A step down from a neonatologist is a senior resident in a neonatology program. i.e someone who has done 4 years college (BS) 4 years med school (MD) 3 year peds residency and currently in 3rd year neonatal fellowship

Nurses are different from physicians assistants are different from medical doctors. The scope of practice is unique to each field

BeachsideRN, ASN · Oct 13, 2015

Thank you so much! I was also wondering.. Who is a step down from a neonatologist? Also, is getting your DNP worth it? And are they above just the regular NNP with a BSN in the work force?

Also an NNP has a minimum masters degree. You have to have a BSN plus 2 years NICU experience before getting into the NNP programs which could be MSN or DNP level

BSN/ADN prepares you to be a generalist nurse. (RN)

abbeyluu10 · Oct 13, 2015

Thank you all! I appreciate it :)

**NICU Guy, BSN, RN** · Oct 14, 2015

The pecking order is

Attending- Neonatologist

Fellow

Resident

With the Resident at the bottom of the team.

We have two different doctor groups at our NICU. One has a team with NNPs in them. There are no PAs in either groups.

abbeyluu10 · Oct 20, 2015

The pecking order is
Attending- Neonatologist
Fellow
Resident
With the Resident at the bottom of the team.
We have two different doctor groups at our NICU. One has a team with NNPs in them. There are no PAs in either groups.

Just wondering.. Does a nurse with a DNP wear a white coat? Haha just wondering it's always been a dream of mine :)