Neo-Natal Nurse Practioner Question

core0 · Sep 15, 2008

I'm planning to apply to an alternate entry MSN program which offers specializtion in multiple fields. My first and foremost interest is in the NNP option but I am open to others. I want to make sure I find the right fit for me in all regards. My chief concern with this option is the closest Children's Hospital/NICU is over an hour away, and I can't relocate. Travel is not that big of a deal except after time I think I would grow weary of how long the drive is--after a long hard day I don't think I'd like driving an hour and fifteen minutes home each day. I do have a hospital that is thirty minutes away (I travel to that city every day as it is so the travel is not an issue at all) that has a nursery unit and pediatric unit.
My Question is: What are the different venues NNP can work within? From the way people have descibed NNPs they are limited to the NICU. Is this true? If not, would a NNP be useful in a pediatric unit at a non-Children's hospital? What about private practice (on their own or with a pediatric clinic)??
Like I said, this option would be my top choice and if I could be useful at my local hospital in either the nursery, pediatric unit, or in a private practice setting I would be much more comfortable claiming this track (though I probably will anyways).

You realize that you need two years of NICU experience before you can do your NNP? If you think that you are going to have difficulties doing clinicals, how are you going to get nursing experience (unless you already have this)? As far as scope there are a couple of NNPs here that can probably answer your question. The NCC describes the scope as up to one year of age (I've heard of some states defining it as two years for special care nursery). From that it would be pretty tough to find a use in a pediatric clinic. They would still have to find someone (pediatrician, NNP or PA:rolleyes:) to cover any kids older than 1-2. Same for private office. Outside of some very specialized single disease clinics or developmental clinics at tertiary or quatenary medical centers it would be tough to justify in private practice. Not saying impossible, just something I've never even heard of.

There are NNPs that work remote sites (ie Level 2s with limited physician coverage). However these tend to be very experienced NNPs. There needs to be someone to rescuscitate the newborn everywhere there is OB. However in most small hospitals its either the local peds, FP, PNP or PA that does this as part of their other duties. It just doesn't make sense economically.

David Carpenter, PA-C

Adams_Mommy_07 · Sep 15, 2008

You realize that you need two years of NICU experience before you can do your NNP? If you think that you are going to have difficulties doing clinicals, how are you going to get nursing experience (unless you already have this)? As far as scope there are a couple of NNPs here that can probably answer your question. The NCC describes the scope as up to one year of age (I've heard of some states defining it as two years for special care nursery). From that it would be pretty tough to find a use in a pediatric clinic. They would still have to find someone (pediatrician, NNP or PA:rolleyes:) to cover any kids older than 1-2. Same for private office. Outside of some very specialized single disease clinics or developmental clinics at tertiary or quatenary medical centers it would be tough to justify in private practice. Not saying impossible, just something I've never even heard of.
There are NNPs that work remote sites (ie Level 2s with limited physician coverage). However these tend to be very experienced NNPs. There needs to be someone to rescuscitate the newborn everywhere there is OB. However in most small hospitals its either the local peds, FP, PNP or PA that does this as part of their other duties. It just doesn't make sense economically.
David Carpenter, PA-C

No, my program as I said before is an accelerated ALTERNATE ENTRY MSN program offered by East Carolina University. This program is a two phase program that allows students who hold bachelors degrees in an unrelated field (they can NOT be nurses) to become an advanced practice nurse. We become RNs during the first phase then we enter phase two (our advanced practice field) while employed as an RN, gaining experience. We are required to select our field after completion of the "accelerated RN portion" and I am trying to inquire about the advanced practice fields--that is all. Like I said, NNP is my first choice. If you would like more information about the program visit ECU's nursing website for the AE program http://www.nursing.ecu.edu/ae_overview.htm This is not a typical graduate program and the requirements that are for BSN-MSN are not applicable.

I never said I was going to have difficulty doing anything. I am going to have to trave to the very city in which I was referencing for nursing school. However, I am thinking long-term and that I might not want to spend the rest of my life traveling back and forth. Your information was however, very informative. Perhaps it might be more useful for me to get my advanced practice speciality in CNS? I'm looking into that more and more. This may allow me to work in a Peds unit closer to home, rather than NICU. Of course, it isn't the NICU that is problematic it is simply the drive to PCMH.

I was recently at the Burn Center for a family member at UNC Hospitals in Chapel Hill and the doctor who told me it was a "really good program" which sealed the deal for me.

SteveNNP, MSN, NP · Sep 15, 2008

To echo what David said, regardless of what type of program you find yourself in, you are required to have 2 years of Level III NICU experience in order to become licensed/board certified as an NNP. This experience can be obtained while working as an RN after that portion of your education is complete.

As far as scope of practice, it is generally ages 0-2 for NNPs. This limits your practice area to neonatal transport programs, NICU, well-baby nurseries, Level II units and some followup clinics. It would prove difficult, if not impossible to find a peds clinic that would hire you with your limited scope of practice.

You may want to consider a PNP if you desire the flexibility of working in most inpatient/outpatient areas. Some NICUs hire PNPs, though most do not. I would recommend you shadow in a NICU to make sure it is right for you. Most NNPs are experienced RNs who have worked in NICU before deciding on furthering their education. NICU is not for everyone. You might find that it isn't for you, and be too far along in your program to change it....JMHO

Adams_Mommy_07 · Sep 15, 2008

To echo what David said, regardless of what type of program you find yourself in, you are required to have 2 years of Level III NICU experience in order to become licensed/board certified as an NNP. This experience can be obtained while working as an RN after that portion of your education is complete.
As far as scope of practice, it is generally ages 0-2 for NNPs. This limits your practice area to neonatal transport programs, NICU, well-baby nurseries, Level II units and some followup clinics. It would prove difficult, if not impossible to find a peds clinic that would hire you with your limited scope of practice.
You may want to consider a PNP if you desire the flexibility of working in most inpatient/outpatient areas. Some NICUs hire PNPs, though most do not. I would recommend you shadow in a NICU to make sure it is right for you. Most NNPs are experienced RNs who have worked in NICU before deciding on furthering their education. NICU is not for everyone. You might find that it isn't for you, and be too far along in your program to change it....JMHO

Thank you for response. The two years during the advanced practice phase is the point where I would be working in the unit. The problem is we have to decide prior to the advanced phase which area we want to work in!! The only NP programs are NNP, FNP, and Adult Nurse Practitioner--I wish they had PNP!!!

justme1972 · Sep 15, 2008

Thank you for response. The two years during the advanced practice phase is the point where I would be working in the unit. The problem is we have to decide prior to the advanced phase which area we want to work in!! The only NP programs are NNP, FNP, and Adult Nurse Practitioner--I wish they had PNP!!!

Many of these programs are offered with an online study option with minimal trips to campus each year.

Steve has been extremely helpful to me as well in answering my questions, as my goal is to be an NNP.

For example, I'll be moving most likely to the East Tennessee area upon graduation from my RN program. The NNP option at UT Knoxville requires you to be on campus....however the NNP option at UT Memphis has an online option....it's about 10 hours away from East Tennessee, however, you only have to make the trip 2x per semester.

Their tuition was very, very attractive at a graduate level.

I also know that University of Alabama at Birmingham also offers the NNP online as well...but they are steep with out of state tuition...they do offer a great option: If you have a 3.2 GPA....GRE's are waived!!! :yeah:

core0 · Sep 15, 2008

No, my program as I said before is an accelerated ALTERNATE ENTRY MSN program offered by East Carolina University. This program is a two phase program that allows students who hold bachelors degrees in an unrelated field (they can NOT be nurses) to become an advanced practice nurse. We become RNs during the first phase then we enter phase two (our advanced practice field) while employed as an RN, gaining experience. We are required to select our field after completion of the "accelerated RN portion" and I am trying to inquire about the advanced practice fields--that is all. Like I said, NNP is my first choice. If you would like more information about the program visit ECU's nursing website for the AE program http://www.nursing.ecu.edu/ae_overview.htm This is not a typical graduate program and the requirements that are for BSN-MSN are not applicable.
I never said I was going to have difficulty doing anything. I am going to have to trave to the very city in which I was referencing for nursing school. However, I am thinking long-term and that I might not want to spend the rest of my life traveling back and forth. Your information was however, very informative. Perhaps it might be more useful for me to get my advanced practice speciality in CNS? I'm looking into that more and more. This may allow me to work in a Peds unit closer to home, rather than NICU. Of course, it isn't the NICU that is problematic it is simply the drive to PCMH.
I was recently at the Burn Center for a family member at UNC Hospitals in Chapel Hill and the doctor who told me it was a "really good program" which sealed the deal for me.

I understand that this is a direct entry program and figured out it was ECU from your wording. The problem that their website does not mention is that to be certified you have to graduate from a school that meets NANN standards. They can be found here:

http://www.nann.org/pdf/NNP_Standards.pdf

The part you are specifically looking at is on page 5 under practice requirements for perspective students. So if you are allowed into the course there is no way to get certified (as I understand it I would be happy to be corrected by the NNPs here).

You might also consider PNP in either acute or primary care. There is a nice sticky in the CNS forum about the difference between them. Finally as is often stated here, you might want to find out what the market wants (especially since you seem tied to one location). In some more rural areas there are not a lot of pediatricians so FNPs see most of the patients. Also, having lived in NC I will agree that the nursing school is well regarded, I am not sure if that applies to the direct entry program (I haven't heard either way). There are a number of threads here on the advisibility of becoming a nurse practitioner with little or no experience including a thread at the top with the same name. Anectdotally there have been NPs that have no problems getting jobs and there have been MEPN NPs that have been forced to work as RNs. Once again it pays to know your market.

David Carpenter, PA-C

justme1972 · Sep 15, 2008

David,

ECU's program is one that I have looked at extensively.

They are just like any other NNP program, they require the same 2-year work experience in a NICU like any other.

When you start the program, you actually have to complete the GRE's when you have completed the requirements at the BSN level. All of those courses must be completed before you are permitted to start on the Master's level courses.

They have a distance learning option as well.

core0 · Sep 15, 2008

David,
ECU's program is one that I have looked at extensively.
They are just like any other NNP program, they require the same 2-year work experience in a NICU like any other.
When you start the program, you actually have to complete the GRE's when you have completed the requirements at the BSN level. All of those courses must be completed before you are permitted to start on the Master's level courses.
They have a distance learning option as well.

The advantage of a MEPN course is that you go straight through the BSN and on to the Masters. In this case you start the program, finish the BSN, then get 2 years experience in a NICU (one year has to be in a level 3) then take the GRE and then enter the masters part of the program. Hopefully this is what you meant? In that case why not finish the BSN, go to work as a nurse and see what you like? Then you are not tied to an NP degree that may not be practical for the area you are in and may not be employeable.

I can't speak for NPs but a lot of PAs end up in areas they never expected to be because they didn't know about them. I was sure that I was going into neurosurgery and ended up in pediatric GI. You don't know whats out there until you are there.

Just some random advice from a guy on the internet

David Carpenter, PA-C

zahryia, LPN · Sep 16, 2008

The advantage of a MEPN course is that you go straight through the BSN and on to the Masters. In this case you start the program, finish the BSN, then get 2 years experience in a NICU (one year has to be in a level 3) then take the GRE and then enter the masters part of the program. Hopefully this is what you meant? In that case why not finish the BSN, go to work as a nurse and see what you like? Then you are not tied to an NP degree that may not be practical for the area you are in and may not be employeable.
I can't speak for NPs but a lot of PAs end up in areas they never expected to be because they didn't know about them. I was sure that I was going into neurosurgery and ended up in pediatric GI. You don't know whats out there until you are there.
Just some random advice from a guy on the internet
David Carpenter, PA-C

The way I read it was that she works as a NICU nurse concurrently as she does the MSN NNP portion, so by the time she graduates from the pogram, she would have satisfied the two year requirement.

Jolie, BSN · Sep 16, 2008

The way I read it was that she works as a NICU nurse concurrently as she does the MSN NNP portion, so by the time she graduates from the pogram, she would have satisfied the two year requirement.

I believe you are correct.

Boy, I can't imagine tackling NNP education at the same time one begins working in a NICU. Few basic nursing programs offer classroom or clinical experience germane to this area of practice. I can't imagine being adequately prepared to succeed in advanced practice training while at the same time learning basic patient care in an unfamiliar clinical area.

core0 · Sep 16, 2008

The way I read it was that she works as a NICU nurse concurrently as she does the MSN NNP portion, so by the time she graduates from the pogram, she would have satisfied the two year requirement.

If you look at the NANN standards the 4160 hours of clinical experience including the level 3 experience must be done prior to starting the clinical portion. The ECU program like most NNP programs front loads the clinical experience so the full time has clinical practicum in the second semester. The part time does not go there until the fourth semester, but this would still not allow someone to get their clock hours by the fourth semester unless they worked a lot of overtime.

David Carpenter, PA-C