Questions about Neonatal Nurse Practitioners

R1515J · Jan 17, 2018

1) It depends on where you work and the facility utilizes their NNPs. As an RN in the NICU, the facility where I worked utilized their practitioners only during the day. They attended deliveries throughout the day, saw babies in term nursery and managed a few NICU patients. They worked 10 hours day shifts. My first job as an NNP has me covering a few facilities and it depends where I am as to what the shifts will be like. Some are 24 hours, some 14 or 16 hours. Typically I will see a portion of the patients and the Neo sees the rest. I will also attend deliveries and do procedures as necessary. Over night I am the only provider in house and manage the DR and NICU, with the Neo on call at home.

2) I am not sure about misconceptions, but I think it's important to be clear about where you can work as an NNP and what your expectations are. If your considering this career, I assume you've had some exposure to the NICU and hopefully NNPs. The scope of an NNP only extends to the age of 2, which limits the setting in which you can work. Basically, NICUs are primarily it with some exceptions of those working in developmental care clinics (not super common). Certainly you can teach or work as a nurse manager, but I enjoy the clinical side of the job.

3) I'm not sure I would necessarily call it a residency, although some facilities may if they have a formal new-grad NNP training program, some large teaching facilities do. During the end of my program, I had a "practicum" that was basically a period of time that I worked as an NNP with a preceptor, a full time schedule and managed a full team of patients with them standing by. After graduation, again depending on where you are hired, the orientation will vary. I had 10 years of NICU RN experience when I became an NNP, so my orientation schedule may be different that that of someone with say, only 3 years as an RN. Initially orientation with a Neo on days for a period, and then with an NNP overnight. I was hired to a facility that typically didn't hire new grads so it was a new thing for them, nothing formal in place. Per my understanding, most formal orientations are 4-6 months.

I havent been an NNP for a long time, I think there are a few other regular posters here who can also add some insight. I don't know where you are in your journey, but I would start by working in the NICU as an RN first (a requirement for NNP school anyway) and figure out if working in the NICU is where you want to live your career. This is all I've ever wanted to do, so I truly love it. Hope that helps, good luck!

babyNP., APRN · Jan 20, 2018

R1 gave some good insight, but go ahead and do a search on this forum and the nurse practitioner forum. These types of questions have been asked and answered in thorough detail...

best of luck in your journey to become a NNP if that is what you decide...

AnnieOaklyRN, BSN, RN, EMT-P · Jan 21, 2018

I have a couple questions too...

How is the job market? (I know this can be dependent on area)

Do you have any regrets doing an NP program that is narrow based, meaning you are limited on your population? Do you get bored and wish you could change areas? If you do decide to transition to a FNP role would you have to start over or is there a bridge for that?

Annie

babyNP., APRN · Jan 21, 2018

I have a couple questions too...
How is the job market? (I know this can be dependent on area)
Do you have any regrets doing an NP program that is narrow based, meaning you are limited on your population? Do you get bored and wish you could change areas? If you do decide to transition to a FNP role would you have to start over or is there a bridge for that?
Annie

There is a shortage of NNPs, but not to the point where you can name your own price. You may not get your first choice job in your first choice city as a new grad, but after a couple of years I don't think it would be difficult, broadly speaking.

I do not have any regrets becoming a NNP. I have been asked that many times, some by well meaning relatives who work in healthcare. My answer to them is that I like babies, so why would I work in any other population? I've never taken care of an adult patient in my entire nursing career and have no desire to do so. The only exception might be women's health clinic doing antepartum, but that market for that is very small, poorly paid compared to my profession, and worse hours (IMHO- some would say that having a M-F 8-4 schedule is the ideal, but I like working my 6-7 shifts a month for full time work).

I've been in this field for almost a decade and while I don't feel the hungriness of my earlier days to take care of the sickest of the sick that comes from working in a Level IV NICU, I still derive a lot of satisfaction from my job. I now work in community NICUs (level II/III) and sometimes I feel like I have a bigger impact because there is such a huge need for experienced providers treating these sick babies. While I respect pediatricians and their knowledge to the utmost, they are not experts in neonatal care like I am and I enjoy teaching them what I know along with the staff nurses. I recently had to intubate a baby during a delivery and the nurse that was with me hadn't helped with an intubation in over a year. It was very gratifying to do the post-delivery debrief with her talking about what we did well and what we could work on for next time...

If you wanted to do another specialty, you would get a post-masters certificate which would take about a year or so depending on the school. Learning curve might be a little steeper than normal depending on your clinical background.

infantsonly · Feb 27, 2018

I am graduating from an NNP program in a couple of months. My experience is from my work as an RN in a level III NICU and from my clinical rotations in various NICUs.

I care for 7-10 patients that vary in acuity. We split our patient load amongst provides (residents and NNPs) and we round on our patients with a fellow and an attending, a nutritionist, and many times a pharmacist. The acuity does not play into if a physician is following a patient or the NNP. We may have the sickest kid on the unit, especially because we follow the same patients from day to day and acuity changes.

We present the changes we want to make with the patient and write orders (medications, ventilator or respiratory settings, TPN, etc.).

We attend high risk deliveries and resuscitate infants, admit infants, and perform procedures that include intubation, UVC/UAC line placement, PICC line placement, arterial punctures, chest tube placement, and lumbar punctures.

The NNPs I have worked with work 12-24 hour shifts. I have accepted a position at a large level IV NICU for after I graduate and pass boards and will be working 3 12's a week. The NNPs cover 24/7.