NNP Outlook

babyNP., APRN · Jan 29, 2015

So, this is part of a PM conversation that ICUman and I have had regarding his potential interest in NNPs. I thought that it might be useful to share publicly since there isn't a lot of chatter on allnurses about them. My one disclaimer is that I am a new nnp and certainly don't speak for the field.

But these are my opinions/some facts that I've been able to glean from years of research prior to going to school, going to school, and now, a few months into the role.

RonnieNichelle RN · Feb 19, 2015

Thank you for posting this ICUman. I don't see a lot of people posting on here about the NNP role. I really have an interest in becoming an NNP and couldn't find any "real" info about it. At first I had my doubts, but it looks to me like, from your post, that the outlook for NNPs is pretty good thus considering the shortage. I guess that's why people aren't talking about it as much since it is not so much desired role in the nursing profession (I.e., a very confined/limited field). I currently work in an adult ICU and was considering applying for a job in a local NICU to gain some experience. I was hesitant at first, but I think I'll give it a shot to get the feel of it. I guess I had the same fear as most regarding moving into such a confined role.

Trauma Columnist · Feb 19, 2015

This is great guys!

rnkaytee · Feb 19, 2015

Thanks for the info! I'm in my second semester of my MSN-NNP program - can't imagine doing anything else!

babyNP., APRN · Feb 20, 2015

Definitely if anyone has any other questions, please feel free to post them here (ICUman and I had an extensive conversation about his interest in NNPs and I asked him to post part of my responses for the public- it's probably better to post them publicly so that aspiring NNPs can have this benefit)

SteveNNP, MSN, NP · Feb 23, 2015

As an NNP who has worked in NICU for 10 years, nearly 5 as an NNP, I can tell you there are never enough NNPs to go around. Especially as you said with units expanding rapidly, some even with 100+ beds. We are fortunate to be a NNP friendly unit, with many of us having been RNs on the unit who went back to school. The vast majority of our team is in their early thirties. Only 4 are older than that.

Unfortunately the NCC no longer requires NICU experience to take the certification exam, which is ridiculous in my book. We were one of the last specialties to require 2 years of bedside practice in a Level III+ NICU for certification. We have seen many applicants with ZERO practical experience in NICU. Luckily all our in-house NNPs were smart about it and worked as RNs first.

The market is only going to expand. It's true that we are a higher paid specialty due to our shift work, intensivist practice, transport, and some of us rotating. It's also sometimes lacking the perks of our primary care colleagues who work bankers hours, no nights/weekends/holidays etc. But as for me I don't mind. Love what I do. We are building the nation's first Neonatal Cardiac ICU, to care for pre/postop congenital heart disease and cardiac patients, run by neonatologists and NNPs along with cardiologists. We already do it, just not in a dedicated unit, and this will be very exciting for us.

babyNP., APRN · Feb 23, 2015

Good to see you again, Steve! I remember reading your helpful posts about NNP school a long time ago :) And thank you for your perspective- you obviously have great experience to share and it's great to get your input. It's interesting to hear that most of your team is younger- I work in a 150+ bed NICU and I would say about 2/3 or more of our NNPs are in their 40s-50s. I wonder if it's geographic dependent.

I agree about the NCC thing, but I also don't know any school that doesn't require NICU experience. So even if the NCC doesn't require it, I think virtually all applicants will have NICU experience anyway. We had a person in my NNP class who only had 1 year of community Level III experience and this person really struggled with learning and the difference in experience was obvious- the person ended up not making it through the program.

Fascinating about a neo CICU...at my old institution, we kept preemies that lived in incubators with CCHDs in the NICU and everyone else went to the CICU. In my current institution, we keep all cardiacs pre-op, then they live for a few days post-op in the CICU and then come back to the NICU. There's a dedicated section, but not a separate unit. If it's just neo CICU, at what age will you transfer them to the "regular" peds CICU?

kalycat, BSN, RN · Feb 23, 2015

Hi all, thanks for the great info! Would anyone mind sharing their approximate region? Northeast, southeast, etc? I'm in the Pacific Northwest. The reason I'm asking is my state's largest University (and only NNP program) recently discontinued their NNP program. Their website's statement makes it sound as if it is due to limited clinical placement opportunities (odd as they are in a major metro area with MANY nicus) and future employment options. However, the information could be interpreted in different ways, including low enrollment/interest. I didn't get a much clearer response when I contacted them directly.

I'm encouraged to hear that there is demand for the role in other geographic areas; I'm a recent BSN grad who changed careers and who has long dreamed of becoming a NNP. I did my practicum in a level IV NICU and they were certainly using NNPs...and their census was growing consistently. Anyway, I guess the search for a program will continue while I'm gaining experience and obtaining some real world knowledge. I had been a parent advocate and NICU volunteer for many years prior to attending nursing school, but I'm thrilled to actually dig in and serve as a nurse. Thanks again for posting the excellent information!

Trauma Columnist · Feb 23, 2015

I live in central IL and the local tertiary hospital's college of nursing started an NNP program a few years ago to grow their own NNPs.

its worked out well.

babyNP., APRN · Feb 23, 2015

kalycat, I'm originally from the Pacific Northwest and unfortunately there are not nearly as many NICUs there as compared to the southwest, east coast, and places like California. I actually moved from my home state to the east coast to get my NICU RN job and it seemed that there were NICUs coming out of its ears and I suddenly saw so many kids everywhere...

Well, I looked into it and for at least Washington state, they are below the national average for birth rate and their regional children's hospital has a NICU that only has 19 beds. My facility on the east coast that was a regional facility had 60 beds and my facility now (in the southwest) has ~75 beds designated for Level IV, ~85 for Level II/III type infants.

So you can imagine that other geographical areas have a much higher demand for NNPs, based on pure numbers with supply and demand.

I also read that there are literally more dogs and cats than children in Seattle, which blows my mind. Apparently only San Francisco is the same way, hahaha.

kalycat, BSN, RN · Feb 23, 2015

Thanks!! I appreciate all that information. I did my practicum in a NICU with 62 beds (fairly recent expansion) but it's outside the Seattle area, and is really growing due to its geographical position between Primary Children's in Utah and Seattle. That said, I still don't see them offering a lot of the programs that larger metro areas do, nor any opportunity for NNP clinicals or even RN residencies. Sounds like the long term goals may require some relocation....which isn't a bad thing. Part of the reason I waited to return to school was to get my own NICU graduates off to college to have a bit more freedom lol. I sure appreciate all the insight!! And that cracks me up about Seattle, but as much as I love it there, I totally see that statistic working in to the general culture! :)

Edited to add, census wise, where I did my practicum is far, far more level II - III cases and a number of administrative holds. They have a lot of beds, but the acuity is still lower than one might expect. And I love the Southwest!