Neonatal Nurse vs Neonatal Nurse Practitioner

[nursing5275]

Hello! I am a student interested in neonatal nursing and was wondering about the differences between a neonatal nurse and a neonatal nurse practitioner in terms of job duties.

[TiffyRN, BSN, PhD]

^^ I would respectfully disagree and this AANP: Call us 'Nurse Practitioners' not 'physician extenders' - The Clinical Advisor and this Nurse Practitioners Are Not ‘Physician Extenders' | Off the Charts are good overviews.

I don't know about the scope of practice that NNPs have at your own facility, but the NNPs in my unit take all complex cases-

In closing, I guess we will have to agree to disagree.

I don't think we have to disagree. I can easily concede that NNP practice in other areas is as you described. I would love to see our NNPs operating as your group does.

I am not a fan of how our neonatology group operates and they are the employers for the NNPs. It is a very large group with dozens of MDs and hundreds of NNPs supplying a very large region (multiple heavily populated counties). I find this to be the biggest problem with how our local NNPs practice. Every order the NNP places must be cosigned by MDs. Every telephone order we place for the NNP must have the "supervising physician" listed as well. Every progress note must be co-signed by the MD. Rarely is an NNP given any power to change the plan of care and any changes would be minor things that would be scarcely outside the scope of a bedside RN.

Though the NNPs' education and background enables him/her to function on a nursing model, if they work for the main practice in town, they will be physician extenders operating on a medical model. They pretty much only function semi-independently from 11pm to 7am when they are the go-tos for the unit calls and less acute deliveries, and we all know that's just for the convenience of the physicians.

This is our local situation. I cannot agree that the NNPs I work with are little more than physician extenders.

When my coworkers discuss the possibility of becoming advanced practice nurses, I discuss with them how if they plan to work with our local group, they will likely have a very restricted practice. Not necessarily a "bad job" but perhaps not in alignment with nursing practice principles we generally admire and try to advance. They may be more content pursuing PNP or WHNP and practicing independently or with physicians who allow them more lee-way.

So I think the take home message for the OP is to have some honest chats with your local NNPs. Obviously the nuts and bolts of how they operate is very dependent on where you live and who runs the neonatology practices. I would be thrilled to have an independent NNP practice!

[SteveNNP, MSN, NP]

I don't think we have to disagree. I can easily concede that NNP practice in other areas is as you described. I would love to see our NNPs operating as your group does.

I am not a fan of how our neonatology group operates and they are the employers for the NNPs. It is a very large group with dozens of MDs and hundreds of NNPs supplying a very large region (multiple heavily populated counties). I find this to be the biggest problem with how our local NNPs practice. Every order the NNP places must be cosigned by MDs. Every telephone order we place for the NNP must have the "supervising physician" listed as well. Every progress note must be co-signed by the MD. Rarely is an NNP given any power to change the plan of care and any changes would be minor things that would be scarcely outside the scope of a bedside RN.

Wow this situation sounds ghastly for an NNP. Frankly I wouldn't work for a place that put so many restrictions on me as a practitioner. Where I am now, while I of course involve the fellow and attending in my decision-making, I am fully functional in terms of coming up with a plan of care, consulting my subspecialty colleagues, admitting/discharging, performing complex procedures...etc without any input or oversight from an attending. I *do* have a collaborating physician who acts as a mentor and an intermediary between the practitioner team and the attendings.

I am the one entering orders under my name, interpreting my own studies, transporting patients to CT/MRI, providing deep sedation for bedside open chest closures...I am the primary person managing our critically ill post op open heart CT patients from day one through DC.

I know this isn't the case everywhere, but I would shrivel up and die as a practitioner in that kind of environment where I'm being babysat by an attending.