Neonatal Nurse Practitioners-Salary Range

SteveNNP, MSN, NP · Mar 26, 2007

I will be starting my NNP this fall.... From what I have learned/researched, the NNP primarily practices in the hospital setting, from followup clinics to well-baby nurseries, Level II's and Level III nurseries. They can also do ground and air neonatal transport. They regularly assume a patient caseload which includes a variety of patients/acuities/diagnoses under the supervision of an attending physician who usually only is involved when consulted by the NNP. NNP's can place chest tubes, umbilical/arterial/PICC lines, perform delivery room resuscitation, intubation, orders all meds/IV's/nutrition. The only thing that I've found that NNP's can't do with supervision is surgery. Sometimes in a rural setting NNP's practice without a MD backup. Hope this helps!

Stephen

NeuroNP · Mar 27, 2007

I can't find any information online about Neonatal Nurse Practitioners. Is there anyone on the board that is one?
I'm curious if the degree would be worth the trouble, and I would also like to know, what is the primary function of a NNP in a hospital function in a NICU?
I'm looking at a couple of other specialties, but this one is still near and dear to my heart.
Thanks!

I'm also looking into this and I found a private group on SDN (yes, the dreaded SDN, but Neo folks are MUCH nicer to nurses!) and asked the question. I got a really good response from a Neo MD which I've copied and pasted below. Hope this helps!

Bryan

"NNP's are an integral part of NICU care "almost" everywhere in the US. I was actually surprised very recently to tour an NICU and be told they had no NNP's. I didn't think Level 3 NICU's existed anymore without them.

As you might imagine, the roles of an NNP varies at different places. I'll describe some of them here.

Most commonly, NNPs serve as "primary" patient medical caregivers. Roughly speaking that translates into taking a role similar to that of the pediatric resident. In our center, that means seeing a group of usually 5-8 patients in the morning, doing rounds, writing orders and dealing with problems. We have teams consisting of NNPs and faculty and teams consisting of residents and faculty, so the roles are very, very similar. NNPs in this role will write admission notes and orders, daily progress notes, speak to the families and referring docs, etc. The degree of independence they have in making decisions is highly dependent both on location and the acuity of the patient. In our center, they will make ventilator changes, TPN changes, etc, under the general guidance of the plan made with the attending on rounds. In other centers, they will still have that guidance, but for less sick babies may be fairly independent in making care plans.

The second primary role is in transport of infants from outside hospitals (and sometimes the delivery room) to the NICU. This was actually the ORIGINAL role for which NNP's, then called, "nurse clinicians" were principally introduced into neonatal care. NNPs in our center do over 95% of all transports (probably 99%, actually). This includes directing transports of very, very sick babies, managing and directing CPR in transport, etc. The faculty "supervises" the transport via the phone, but that obviously, is limited in utility. We'll decide with them whether to give surfactant, iNO or prostaglandin (for hearts) on transport, but we can only make these decisions based on the info they give us. This means they have to read and interpret the chest X-rays as well as assess the baby's clinical status. Blood gases and vent settings can be called to us, but as of now, we can't get X-rays from community hospitals transmitted to our hospital in real-time so we could assist in diagnosing patients during tansport. Now, you might imagine that the referring doctor is there to guide things. NOT! Or, at least, not very often outside of hospitals our own faculty work at. Usually, the referring doc is gone or turns care over to the transport team completely on arrival. Usually, we prefer it that way.

The third role is that of "procedure nurse". NNP's will routinely place UACs and UVCs (umbilical artery and vein catheters), place PICC lines (percutaneous central lines), and in some centers do radial artery catheters. Just like bedside nurses are much better at peripheral IV's than most docs in an NICU, the NNP's tend to get very good at these. Not surprisingly, some are better than others and we, like other centers, identify a few of the best to do the toughest lines. NNP's teach these procedures (PICC lines) to fellows and residents (UAC/UVC). It goes without saying that any resident that is bothered by being taught procedures by an NNP will have a miserable and useless month in our NICU. This isn't a problem for our fellows. They know better or they'd never have wanted to become neo fellows. NNP's also intubate babies and will needle-aspirate pneumothoraces. I suppose in some centers they place chest tubes, although I haven't seen that.

The last role to mention is in the delivery room. NNP's routinely handle a majority of deliveries for which we are called. There are billing issues with this and it sometimes can be in flux whether a physician has to physically be present or not, but, regardless, for most deliveries, I barely bother to put on gloves or stop snoring. Now, a 24 weeker or a diaphragmatic hernia is another story and you would be amazed how fast I can go from schmoozing with the RT on a routine delivery to doing a full code on a surprise disaster, but generally, I let the rest of the team handle the deliveries.

As far as NNP hours - again, very variable. Some work 8 hour shifts and some work up to 24 hour shifts, although I think that is uncommon. Many NICU's have NNP's present all-night in-house, others may have an NNP available at home on-call for transports. In general, most work about 40 hours/week in the NICU, although they may have meetings etc that add a bit to this. I'll defer on salary - it is higher than bedside NICU nurses, but how much higher is so variable that I can't really say what factors determine this. NNP's are still and likely to remain in very high demand. Pick where you want to live and go there! But, as with anything, finding the right working environment isn't so easy.

As you can imagine, the overwhelming majority of NNP's were former NICU nurses (?it might even be a requirement for some programs). NNP's therefore have bedside nursing skills and will be called up to place peripheral IV's, draw blood, suction, etc. How much of this depends on the nature of the job and the NNP.

Drawbacks to the job? Well, first of all, it currently requires a master's and a fairly long training period. Whether NNP's will someday be forced to become DNP's is unclear. Our NNP's mostly hate the thought of course. But, who knows? Second it is a relatively high-stress job at times and a difficult one. An NNP who has been pushing meds and dealing with a baby with a low sat for a 60 mile ambulance ride is not a happy camper at times. We have had NNP's "wash out" and we've forced some out. It is not necessarily more high-stress than bedside NICU nursing, but some nurses have not done well with the transition. In my experience however, bedside nurses who choose to become NNP's are carefully "self-selected" and mostly do very well.

Related careers? Well, the cardiology service and the PICU have, in recent years, discovered how much benefit NP's can be and have taken to it with a passion. I don't know much about the details in a PICU cuz I avoid that place like the plague, but the cardiology NP's work in our NICU and do much the same thing as ours do. I see them spend a lot of time doing family counseling as well."

simplyVy · Mar 27, 2007

thank you so much for sharing the post Bryan...its very helpful and informative :)

EricJRN, MSN, RN · Mar 28, 2007

Good find, Bryan! I'm sure that will be helpful to many of our members.

NeuroNP · Mar 28, 2007

thank you so much for sharing the post Bryan...its very helpful and informative :)

Thanks. The real props go to OldBear Professor over at SDN. He put a lot of thought and work into that post!

justme1972 · Apr 3, 2007

I really appreciate the posts. When my twins were in the NICU, they had a NP there, but I didn't realize that this was an entire program that you go to school for to specifically work with neonates. Obviously, I'm going to wait until I get my RN (I start this Fall Woo! Hoo!), but since I'm going to be pushing 40 when I graduate, I felt I needed something beyond a BSN to try to get my income level higher.

I totally believe that Neonatologists are probably mostly great to work with...I mean, how can a person possibly be a jackass and work with the most critical of babies?

Thanks for all of the advice. I found a couple of NNP schools...I'm looking in the Kentucky, TN, VA, NC, SC area.

Thanks again!

llg, PhD, RN · Apr 3, 2007

I totally believe that Neonatologists are probably mostly great to work with...I mean, how can a person possibly be a jackass and work with the most critical of babies?
QUOTE]
Trust me, it happens.

RN4NICU, LPN, LVN · Apr 3, 2007

I totally believe that Neonatologists are probably mostly great to work with...I mean, how can a person possibly be a jackass and work with the most critical of babies?

Quite easily - I've worked with several.

Dream_Chaser14 · Apr 25, 2010

So Appreciative of this post!! :redpinkhe

Veryyyyyyyy helpful and informative

Thanks, Peace & Blessings To You all~!