How to become a neonatal np?

Sweeper933 · Apr 27, 2009

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!!!

valx92 · Apr 27, 2009

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?

Sweeper933 · Apr 28, 2009

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.

nakeia · Apr 28, 2009

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.

astn · Apr 28, 2009

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.

babyNP., APRN · Apr 28, 2009

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.

astn · Apr 28, 2009

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?

babyNP., APRN · Apr 28, 2009

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.

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.

astn · Apr 29, 2009

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. 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.

SteveNNP, MSN, NP · Apr 29, 2009

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 :twocents:

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!

babyNP., APRN · Apr 29, 2009

^^ 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.