NICU PA vs NICU RN

**NICU Guy, BSN, RN** · May 5, 2017

I am not sure what you are attempting to do. Do you want to work as a staff RN in the NICU and forget PA or get experience as a NICU nurse to help get a job as a PA in the NICU?

These are skills that you need as a PA in the NICU. All of them are out of the scope of an RN.

Procedural skills:

Endotracheal intubation

Lumbar puncture

Umbilical line placement

Chest tube placement

Thoracentesis

Ventricular reservoir tap

Peripheral arterial line placement

I don't know the answer to this question which would be parallel to your situation. Does a FNP with NICU RN experience= NNP?

babyNP., APRN · May 5, 2017

Hey, welcome to the forum.

The shortest path for you would be to do a 1 year residency in neonatology. It's possible to get a job in NICU without this but the places are fewer and farther between now that they have a few residencies abound. If you can possibly move out of Florida to do this- would be the best thing (Florida is a terrible place to practice as a NNP anyway from what everyone's told me- NPs only just got schedule II rights within the last year- last state in the union! Plus the pay is horrendous)

If you absolutely have to stay in Florida, then yes you could get a nursing degree, practice as a NICU RN for 2 years, and then you could do grad school in Florida to become a NNP. You can't practice the scope of a provider level without doing this. This would take 5+ years most likely and no guarantees that you could get a job in NICU in the first place. You may be stuck doing some other RN job for a couple of years (especially if you're not flexible on location).

By far (in your situation as someone who already has PA degree) it's much better to just do a residency. There are more than just 2 residencies, they are starting to crop up around the country. They may not necessarily be widely advertised though, so you would have to do some searching and probably call up some of the neo departments at some large academic institutions.

adventure_rn, MSN, NP · May 5, 2017

Are you able/willing to move long-term? If you're confined to a single region, before you commit to a residency program I'd ask around at your local neonatology practices to see if they'd be willing to accept a PA, even with a neonatology residency.

For better or worse, PAs are rarely utilized in the NICU world. A 2 year PA program only briefly touches on neonates (just like a nursing degree); by contrast, NNPs must have at least 2 years of NICU RN experience to even apply to school, and spend their entire 2-3 year programs focusing exclusively on neonates. New grad NNPs come to the table with at least four or five years of focused experience working with neonates, which you won't have even after completing a one year neonatology residency. Babies are a whole different species from adults. Even the most common, fundamental concepts in neonatology (i.e. a brady/desat event) may be entirely foreign to you.

That said, I agree with Guy, simply getting a NICU RN job wouldn't count for much as experience for PA job-hunt purposes. Also, you can run into some sticky legal situations if you try to 'practice below your degree,' meaning that if you practice as an RN and miss a diagnostic/treatment issue that a PA ought to have caught, you can be held liable. There are a bunch of AllNurses articles on this topic if you look up 'Nurse Practitioner working as an RN.'

I'm sorry, I'm sure that isn't what you want to hear, but this may provide insight as to why it's so difficult to break into NICU without an NNP degree. However, there is a national NNP shortage, so if you have some flexibility in location I'm sure you could find a NICU job somewhere after completing a residency.

Best of luck!

pro-student · May 6, 2017

I just wanted to chime in and say most RN programs include little to nothing specific to NICU nursing. So even if you got your RN, the problem would still remain that you're not experienced in NICU (at least in the eyes of employers). If your heart is set on NICU, I would try and do whatever you can to make a fellowship work. I know it sucks to have to relocate. Maybe try to contact the fellowships and find out more about the resources they have for families with young kids. It's a long shot but I'm sure they've had alumni with young kids who could offer advice. A 24 hour day care and/or a really flexible partner and you could tough if our for 1 year. As much as we would love to have you as a nursing colleague, it don't think it will advance your cause.

Best of luck!