Neonatal Nurse Practitioner

Xerath · Sep 12, 2017

Thanks to everyone for this thread! I have 3 years experience in level III NICU as a bedside RN. I am seriously considering NP school, and it seems from the comments this is the minimum amount of experience to start thinking about it. I have just recently hit that point where I realized that I am capable of directing care without doing it myself- a surprising revelation since I have been learning my entire time in NICU how to do bedside better and how to be MORE hands on, and in general be as useful as a bedside nurse as possible. As a result of being charge, precepting new hires, and being involved in various process improvement initiatives, I have had the chance to direct care and keep tabs on patients and nurses on more of the unit level. I feel like in my own ways being in these roles, I experience a little of what babyNP described about the satisfaction of putting an order in and seeing a baby get better. The role of our NPs at my hospital very closely resemble what babyNP has described. My first general topic of questions is, how do you NNPs feel about "leaving bedside"? From what I can tell, the job is different so the skills are different, and managing care of many patients necessitates that you cannot do what you order on the baby yourself. I've read on here that being a solid NICU nurse helps you transition to NP, but what happens to all our technical skills? How often do you feel you get to brush up on basic things like IV starts and bottle feeding difficult PO feeders, just to name a few examples. I guess behind these questions, being a "younger" NICU nurse, is whether or not I will retain skills and be able to rightly gain respect as an NP who is an advanced practice nurse, or will I kind of lose touch with bedside for the sake of a related but different role.

My interest in being an NNP is also driven by the fact that I feel as a bedside nurse I am primarily learning how to carry out orders more efficiently and developing technical skills. I know that experience is the best teacher, but at this point realistically I am not always able to just stand there and learn from NPs and doctors sharing their knowledge during rounds or talking to parents. I would love to learn more about everything so that I can understand what they are thinking about, how they interpret results, and how they make their decisions. This is why I feel going back to school will help me, because it will be a dedicated time to learn something deeper rather than trying to glean information while I have a job to do. Does this sound like I am on the right track, picking NNP?

babyNP., APRN · Sep 12, 2017

To be frank, the skills that you describe- IV starts and feeding babies just aren't part of the job description anymore. You don't expect doctors to do those things, right? NNPs are providers in a similar role to a doctor, so we just don't do them. Do you forget how to feed a baby? Probably not, although you probably will lose some of the nuances. You may do "IV" starts if you place PICCs which some NNPs do, but the majority of units have a dedicated RN team to place PICCs because NNPs are needed to be on-call for deliveries. At one of my community sites, I'm actually not allowed to place PICC lines because at times I'm the only provider in-house (the neo goes home after business hours) and I need to be ready to go to a delivery at that hospital or jump in my car to go to another delivery at one of the sister sites.

The RNs will call me for IV starts when they can't get them or urine cultures and that sort of thing, but because all of my RN experience was at a Level IV, we rarely did our own IVs. The kids either had central lines or poor veins that we saved for the transport team to stick. I joke when they call me nowadays, "well, if you can't get the IV, I doubt I can- but I'll try." I think I've only placed 4-5 IVs in my whole career so far (~9 years). I am down with the urine cultures though. I usually have no problems getting those and they'll call me every so often for that.

I did feed a couple of babies in the Level II NICU I did every so often in my previous job. Of course the last time I did it they called a code in the Level IV NICU next door so I had to jump up and put the baby in the crib. Lost the NGT in the process- poor little baby (and poor nurse!). I haven't fed a baby since then. No good deed goes unpunished

I used to think that procedures made an NNP and it made me really nervous to do NNP school since I didn't have much experience with IV starts, but over and over I've found that it's not true. Even though some RNs may think that way, critical thinking is king above everything. A lot of RNs don't know what they don't know.

I try to remember the workload that RNs have and whenever possible, ease the workload as long as it doesn't have a conflict of interest for the baby. It's not always possible, but that's one way to stay in touch. You'll find that the NNP role is a great bridge between nursing and medicine because you'll pick up on things that aren't right that the neo won't necessarily pick up on. Like a baby that needs to be on servo mode in the incubator- too small to go to air mode but it's usually RN driven when to switch and the baby isn't gaining weight and no one can figure out why. The neos don't have the nursing background that you do and thus you'll be able to pick up on some of the little things more easily which can make a big difference to the baby's care.

hope that helps. best of luck to whatever you decide.

Steph RNC-NIC · Mar 13, 2018

So glad I found this post! I am a NICU RN and have 5 years of experience. I was just thinking the other day that I need a change in my career. I am not sure if I am just bored with the Level III NICU I am on, or if I need to advance to becoming a neonatal nurse practitioner. Trying to figure out what I would like better. This post helps me to know better about what exactly NNPs do! Thank you!