How to become a neonatal np?

astn · 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.

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: :yeah:

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.")

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.

valx92 · Apr 29, 2009

I understand why it would be worrying that I wrote that I want to be an NNP! ...what do they do? But that isn't exactly how I meant it. I knew a general of what an NNP does, but I was looking for more of a day in the life of kind thing. I did find a thread on that, and I am sure that I want to be in the NICU, but now I'm not so sure about taking the NP route. It might be enough for me to be an RN. I do understand your concern that it might be better for me to be a physicians assisstant, and I do know one (not one in the NICU, but still a PA) so I might talk to her about whether she thinks it's the right choice for me, because she knows me better than any of you. I'm not trying to say that any of you are wrong, I'm just saying she'll know better what's right for me. I am glad for all the of the different points of view and this conversation is really interesting; so if you have more to say on the subject, by all means go ahead.:)

astn · Apr 29, 2009

I am sure that I want to be in the NICU, but now I'm not so sure about taking the NP route.

It can be hard trying to "see" what the NICU is about, because they are pretty security conscious. I don't know if you would be permitted to "shadow" or volunteer on one--I doubt it, but someone else may be able to answer that better. You could always ask, explain why you want to, and the worst they could do is say no.

If you aren't sure you want to go into advanced practice, then I agree completely with the traditional point of view. Go get your BSN, get a job in the NICU, see if you want to go further. Many don't: Being a NICU nurse is usually challenging, generally satisfying, and usually well paid, especially after a few years for you to get your bones. And if you do, there is a pathway to do so, so for someone who is unsure of how far they want to go, it is the best of both worlds.

babyNP., APRN · Apr 29, 2009

We have volunteers in our NICU frequently. They hold the more stable kiddos that just need some comfort largely because of their chronic issues. I'd suggest contacting your local NICU and asking if you can volunteer in there.

littleneoRN · May 1, 2009

We have volunteers and allow shadows.

astn · May 1, 2009

I stand corrected. Who says I never admit when I'm wrong. :)

RNburnout · Dec 30, 2009

It is very well possible for PAs to gain experience within the NICU and be competitive with NNPs. The University of Kentucky has a NICU post-graduate residency program specifically designed for Physician Assistants. This residency can be obtained directly out of school and you receive a stipend and benefits. The length of the program is 12mths and they have a level III, 50-bed unit...just a saying:twocents:

sophie<3 · Jan 8, 2010

I wanted to be a volunteer in a NICU and so I sent e-mails out to the volunteer directors at local hospitals..I got responses too! The one I chose said that they have volunteer opportunities in Mother/Baby and could focus me in on the NICU. I am a college student..I am in nursing school and I have been saying for years that NICU is where I want to be but I still think volunteering is important! I believe that reading, hearing, and imagining what the NICU is like is one thing and actually taking care of those sick babies is another. It is not for everyone and may not be for me..for all I know I could hate it! You MUST MUST MUST expose yourself to the hands on before you make your decision. I think the OP should consider volunteering (some hospitals even allow "cuddlers") and then seeing if nursing and the NICU is really something you want to do..I know that when I was 17 I thought I wanted to be a Physical Therapist...changed my mind 3 or 4 times before picking nursing! Soooo you never know :) good luck!

katie2015 · Jul 14, 2011

I am a Freshman at ASU, and I am in the Healthy Life Styles Coaching Major and I really want to get into the BSN program come my Junior Year. The problem is theres only 60 seats :/// Is there any advice someone could give me on how to stand out to get chosen besides having a 3.8 or 4.0 GPA..I really want to be a Neonatal NP. That's my dream job. I'm currently writing a paper on it right now and doing research. Can anyone help?