Neonatal Nurse Practitioner

happyinmyheart · Aug 1, 2015

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babyNP., APRN · Aug 2, 2015

Besides me and SteveNNP, there really aren't any NNPs that are active on AN here that I know about (any lurkers, feel free to join the party). There have been a few people who have posted in years past once or twice that are NNPs, but aren't active now. There are currently a few active student NNPs and I think they would have valuable insight to add to your question.

That being said, since it's not asked very much or talked about, sure, let me answer from my own perspective. I've been a NNP for almost year now. I knew I wanted to be a NP in nursing school, but thought I would do acute care adults or FNP. I hadn't realized that a special ICU just for babies existed until I heard about it from a NICU RN at a dinner that I went to in college. The idea fascinated me and luckily I started doing my peds rotation during the next semester and fell in love with the idea of pediatrics (I have to laugh now because I can't ever imagine myself doing general peds)- and NICU. I was fortunate enough to be put into a NICU for my senior practicum and being the large planner that I was, went out and sought a NICU job 6 months before I graduated at a top 10 children's hospital across the country. When I worked as a RN, I was pleasantly surprised how much I liked bedside RN care and actually considered not doing NNP school.

But as time went on, I decided that I really wanted to do it and told myself that even if I didn't like it, I could always go back to being a bedside RN (and actually a couple of our senior nurses had done just that). Went to school, loved it, started work, love it, and now can't imagine going back to the bedside. I've written several posts about this before so I won't belabor the point, but there are so many benefits of being a NP over being a RN. One of the biggest is less emotional energy spent at the bedside, i.e. not having to ask someone to "use the bathroom" (because someone has to watch your patients while you do so), the freedom to go eat almost whenever you'd like, not being tied to a monitor that goes off every few minutes, and not having to be with parents all day long who may eat all of your energy. I have the most absolute respect for bedside RNs because I think their job is tougher than mine in many ways.

I currently work at an academic institution in the southwest and I love it. My day usually starts early in the morning when I get report on my patients (depending on acuity, anywhere from 7-12 patients), and then I "pre-round" meaning that I run through all the "numbers" like weights and vital signs, any events overnight, and calculate things like number of calories per kg & weight trend for the previous week, and review the medication list. I make a plan for the day and then start rounding with a physician a couple of hours later. Usually I get a chance to do a physical assessment on all my kids and get to talk to the nurses to see if they have any particular concerns. We round until around lunch time. Sometimes there's a conference to go to to have an hour's lecture on a neonatal topic (I love going when I'm not too busy, but my phone does tend to ring a lot during this). Before this, I have to write in all my orders for the day- especially things like TPN (IV nutrition) and enteral (formula) nutrition because they are on a deadline by our pharmacy & formula room.

Then in the afternoon, I write my "notes" for the day (detailing my assessment & plan- this is the type of thing that hospitals use to bill insurances for payment) and call parents updating them on their child. The afternoon is a mixture of catch-up and putting out "fires," i.e. when the nurse calls me with concerns that I try to troubleshoot and/or admits or discharges (of course the "fires" and admits can come at any time). I also get to do invasive procedures like lumbar punctures, intubations (placing a breathing tube down the trachea for infants that aren't able to effectively breathe for themselves), place umbilical IV lines, go to deliveries, etc etc.

In the late afternoon, I will update a sheet for the night shift detailing all of my patients including their diagnoses, respiratory support, current feedings, and plans/changes made for the day.

There are some very busy days of course, but that's true in most hospitalist type roles, most especially an intensivist role. I love what I do and I can't think of anything else I'd rather be doing. Hope this helps.

happyinmyheart · Aug 2, 2015

Wow! Thank you so much for your detailed answer. That is exactly the type of information I was looking for. I have read all the NNP threads I could find on here, but you're right, there aren't many active NNP posters on this site.

I was just so curious what an NNP could do on a typical day, and your answer rocked :) I am very interested in becoming an NNP, but I know that I totally could change my mind (I haven't graduated nursing school yet) or I might not be able to even get a job in the NICU. I live in IL, very close to an NNP program. There isn't much info about it on the website, and I'm hoping it doesn't discontinue it's program like many others have been discontinued.

Any advice for how to get into a NICU upon graduation? If I were to ever become an NNP, I would want to do it while I am relatively young, and before life gets in the way :)

Once again- thank you so much for taking the time to answer my question. It's one of the most interesting things I have read on AllNurses :)

MKE-NNP · Aug 5, 2015

I completely agree with babyNP. I am a relatively new NNP just started this year. I was a NICU nurse for over 10 years. I always knew I wanted to be a NP when I graduated college. I worked in a NICU in undergrad as a nursing assistant, did an external in a NICU and was happy to get a job as a graduate nurse in the NICU was well.

I love managing patients. It is so gratifying writing and order and seeing your patient get better. Do t get me wrong the bedside nurse is the reason our patients do so well. I am a different kind of busy during my shift nothing like when I was at the bedside but I can still have a busy day. At my hospital I also go to deliveries which I love. It is nice seeing "healthy" babies and participating in the joys of a birth.

I work in a level IV teaching hospital. I learn something new every day. Although I do feel like I have to fight residents for interesting patients but our residents do not do night call so I get to manage them when I am on call. And everyone participates in rounds so I am still learning everyday. This is my dream job and there is nothing else I would rather do!

babyNP., APRN · Aug 5, 2015

MKE- congrats on passing NCC and starting your new job! It's good to see another NNP post on AN :)

happyinmyheart, if you do a search, there is a ton of information on this subject. I myself have posted about half a dozen times or more. But TBH, the market is changing from when I was a new grad in 2008, so I don't know if I'd be the best person to ask at this point. Do a search, but my one liner advice is to get your practicum in NICU if possible, take NRP if able, and be bold and apply out-of-state and ask about working at the NICU even if you have no experience. Just because a posting says you have to have experience doesn't mean that a manager won't take you on.

happyinmyheart · Aug 5, 2015

I completely agree with babyNP. I am a relatively new NNP just started this year. I was a NICU nurse for over 10 years. I always knew I wanted to be a NP when I graduated college. I worked in a NICU in undergrad as a nursing assistant, did an external in a NICU and was happy to get a job as a graduate nurse in the NICU was well.
I love managing patients. It is so gratifying writing and order and seeing your patient get better. Do t get me wrong the bedside nurse is the reason our patients do so well. I am a different kind of busy during my shift nothing like when I was at the bedside but I can still have a busy day. At my hospital I also go to deliveries which I love. It is nice seeing "healthy" babies and participating in the joys of a birth.
I work in a level IV teaching hospital. I learn something new every day. Although I do feel like I have to fight residents for interesting patients but our residents do not do night call so I get to manage them when I am on call. And everyone participates in rounds so I am still learning everyday. This is my dream job and there is nothing else I would rather do!

Thank you for taking the time to answer me! I loved reading about your perspective as a relatively new NNP :) I also appreciate how you talked about what experience you had that landed you in the NICU! I am currently looking into ways that I could perhaps work in the NICU once I graduate :) I'm also curious as to what your role was as a nursing student in the NICU? What tasks did you do and what were you responsible for?

Thanks for taking the time to answer me :)

D

happyinmyheart · Aug 5, 2015

MKE- congrats on passing NCC and starting your new job! It's good to see another NNP post on AN :)
happyinmyheart, if you do a search, there is a ton of information on this subject. I myself have posted about half a dozen times or more. But TBH, the market is changing from when I was a new grad in 2008, so I don't know if I'd be the best person to ask at this point. Do a search, but my one liner advice is to get your practicum in NICU if possible, take NRP if able, and be bold and apply out-of-state and ask about working at the NICU even if you have no experience. Just because a posting says you have to have experience doesn't mean that a manager won't take you on.

Thanks BabyNP! I have to admit that I have stalked a majority of your posts You are one of my favorite posters on this website. Now that I searched more carefully, I have found even more of your posts to read! Thank you for the advice. I will definitely try my hardest to get my practicum in the NICU. I also will look into taking the NRP, and I'm definitely willing to apply out of state (as of now anyways :) ). Thanks for all your advice and knowledge on this subject :)

Samm06, BSN, RN · Aug 5, 2015

I too have been thinking about going for NNP. However, I am only going into my second year of nursing school and only took the basic intro to nursing class with a clinical to nursing homes.

Both my aunt's work with babies (one is a L&D nurse at a local hospital, and the other works for an obstetrician in an office setting) and they inspire me so much with everything they do. I am great with children and babies and can't see myself loving any other kind of profession like an NNP. I have looked into the University of Pittsburg, who have a NNP program but just curious as to which programs anyone went to.

@BabyNP if you don't mind answering, but which hospital did you go to when you mentioned you sought out a NICU 6 months before graduating? (just curious)

MKE-NNP · Aug 5, 2015

The NICU I wanted to work at only took 2 new grads each year so I knew I needed to make sure I stood out. I went to University of Pittsburgh for undergrad and was very lucky to work at their children's hospital. As an aid in the NICU this was 10+ yrs ago I stocked the bedside charts, helped the nurses by holding for procedures, I fed babies, I even got to run TPN/IL through for all the infests in the unit.

i also did an external ship at another hospital out there in the NICU again they only took 2 students. I had a nurse preceptor and had her patient assignment and could do everything but give meds. My senior year when you get to do your lets call it shadow experience because I know each school calls it something different I was not able do go to the NICU since I worked there so I went to the CardiacICU because I would still see infants there. I know working in the NICU is what I am meant to do so I am pretty sure I was just lucky that all of these doors opened for me. The hospital I work at takes senior nursing students and it is those two students who usually have the best chance of getting a job as a new grad so if you are able make that your goal your senior year.

I strongly suggest working in a level III or higher NICU for at least 2 years before going back to school for your NNP. Now a lot of programs are switching to DNP so you will be in school longer. I worked the whole time I was in school not full time the whole time but instilled worked. Coming from being a strong bedside nurse has helped me transition into my role as a NNP a lot. Just my 2 cents í ½í¸€

happyinmyheart · Aug 5, 2015

I too have been thinking about going for NNP. However, I am only going into my second year of nursing school and only took the basic intro to nursing class with a clinical to nursing homes.
Both my aunt's work with babies (one is a L&D nurse at a local hospital, and the other works for an obstetrician in an office setting) and they inspire me so much with everything they do. I am great with children and babies and can't see myself loving any other kind of profession like an NNP. I have looked into the University of Pittsburg, who have a NNP program but just curious as to which programs anyone went to.
@BabyNP if you don't mind answering, but which hospital did you go to when you mentioned you sought out a NICU 6 months before graduating? (just curious)

Thanks for sharing! I'm not out of nursing school yet either, but I always like I explore my future options :)

It's really neat that you have aunts that are in similar fields. What great role models! Perhaps the one that works in L&D could put in a good word for you.

happyinmyheart · Aug 5, 2015

The NICU I wanted to work at only took 2 new grads each year so I knew I needed to make sure I stood out. I went to University of Pittsburgh for undergrad and was very lucky to work at their children's hospital. As an aid in the NICU this was 10+ yrs ago I stocked the bedside charts, helped the nurses by holding for procedures, I fed babies, I even got to run TPN/IL through for all the infests in the unit.
i also did an external ship at another hospital out there in the NICU again they only took 2 students. I had a nurse preceptor and had her patient assignment and could do everything but give meds. My senior year when you get to do your lets call it shadow experience because I know each school calls it something different I was not able do go to the NICU since I worked there so I went to the CardiacICU because I would still see infants there. I know working in the NICU is what I am meant to do so I am pretty sure I was just lucky that all of these doors opened for me. The hospital I work at takes senior nursing students and it is those two students who usually have the best chance of getting a job as a new grad so if you are able make that your goal your senior year.
I strongly suggest working in a level III or higher NICU for at least 2 years before going back to school for your NNP. Now a lot of programs are switching to DNP so you will be in school longer. I worked the whole time I was in school not full time the whole time but instilled worked. Coming from being a strong bedside nurse has helped me transition into my role as a NNP a lot. Just my 2 cents Ã*Â½ÃÂ¸Â€

Wow! You had a lot of great opportunities, all of which you worked hard for! Thanks for sharing what you did as a NICU aid. Your accomplishments are impressive, and I'm not surprised that you're an NNP now. If I ever were to get into the NICU, I definitely would want to work at least 2-3 years before pursuing NNP. I definitely can see how being a strong bedside nurse would help you to become a strong NNP!