NNP Phase Out Concerns?

[nurshey]

Is there any concern about the NNP role being phased out or no longer being a viable career path in the future?

I have seen people talk about the dearth of NNP programs & how the number of NNP programs is trending downward. I've also seen that the average NNP is older & there is a shortage of younger NNPs to replace them. Is there concern that the "infrastructure" for becoming an NNP could not really exist in the future? And if that's the case, will hospitals phase out NNPs in favor of some other position that is more readily accessible?

Alternatively, is there concern that the glut of NPs in other fields could negatively impact the perception, pay, or position of NNP? A lot of people express concern about the impact of "NP mills" - but is neonatology specialized enough that other NP areas aren't relevant?

In a nutshell, (based on your experience/opinion) does NNP as a profession have a healthy long-term outlook of continued growth, wage increases (esp. not wage deflation), and lack of saturation?

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Where I am coming from: I am in the tail-end of an ABSN right now and exploring future career paths. I enjoyed my time in the NICU during clinical rotations but will not be able to get more experience in the NICU prior to graduating. NICU is a top choice after graduation, so NNP (after 2+ years bedside) is one of the paths I want to learn more about. My main concern with NNP down the line is the specificity - it would be unfortunate to see NNPs phased out and to then have to start over again in a different area of nursing.

[adventure_rn, MSN, NP]

That's such an interesting, tricky question.

IMO, if you become an NNP, you will always be employable. If anything, the shortages will cause an increase in NNP salaries, which are already quite good compared to most NPs. However, I wonder (just conjecture) if the shortages could ultimately screw up the NNP work-life balance.

The reason that NNP programs are shutting down faster than they're opening is because they have small cohorts and are expensive to run. With an FNP diploma mill, you can pay one single FNP/educator to teach an online class with 100 students; the tuition more than covers the cost of the instructor's salary. Meanwhile, an NNP program may only have 10 or 15 students, and their NNP-trained faculty will probably demand a salary than the other NP faculty to compete with how much more they'd be making working at the bedside (vs. outpatient specialties).

NNPs are fundamental to the way NICUs currently function, and the role itself will never be 'phased out'--the NICUs would fall apart due to lack of providers. Rather, I think that if hospitals are desperate enough, they will start hiring non-NNPs (PAs and acute care peds NPs) to fill the NNP role. There are already some major children's hospitals (CHOP included) that are actively recruiting acute care peds NPs for their surgical NICUs, even without NICU experience.

Of course, NICUs will always prefer an NNP over a PA or peds NP without any NICU experience. Therefore, I don't think you'd ever find yourself in a position where you can't find an NNP job.

Like I said, NNP salaries are already pretty high compared to a lot of other NP roles (mainly because NNP is inpatient and relatively procedure-heavy). Based on supply and demand, the salaries should continue to rise over time if NNP programs continue to close.

However, I'm wondering if that will eventually lead to a poorer work-life balance for NNPs. Whereas most nurses are hourly employees, the vast majority of NPs are salaried, which means that they get paid the same amount no matter how many or few hours they work. They may be promised to work a certain number of shifts per month, but if people start to retire or quit, then everybody else will have to work extra shifts to pick up the slack.

I worked at a NICU that had two NNP positions open for the entire two years I worked there; the physician group wouldn't raise the NNP salaries to make the jobs more competitive in a stiff market, so nobody applied. The NNPs who worked on the unit were promised to only work a set number of shifts a month; however, during the time that the positions were vacant, all of the NNPs had to pick up/cover the shifts for the unfilled positions (with relatively little extra compensation). Somebody had to show up and take care of the babies, so if they refused they risked getting fired.

A lot of NNPs love that they have a ton of flexibility in their schedules. If they work 24-hour-shifts, they can bust out a handful of shifts over a short period of time, then have several weeks off in a row. It will be interesting to see if NNPs are pushed to do work more and more shifts (or take more and more patients) due to the NNP shortage. Plus, if those NNPs become fed up with the role, it will be hard for them to quit and do something else because NICU is basically their only practice setting.

The good news is that if you do become an NNP and eventually decide that you want to do something else, it only takes one year to add on a post-masters certificate and get certified to become a different kind of NP. I've known a few NNPs who have gotten their primary care PNP certifications and switched to outpatient when they got tired of the nights/weekends/24s/holidays required for NICU.

Also, please take my response with a grain of salt, since it includes a lot of conjecture and some anecdotal evidence. The point is, if you want to do NNP, you shouldn't be worried about the role going away.

[babyNP., APRN]

Interesting topic! I am happy to report that the number of NNPs taking their boards is growing and programs are increasing, not decreasing at this point. That being said, yes there are a growing number of neonatal PAs (and I work with several, they are great. they usually do a 1 year fellowship solely focused on neonatology) and some units will use PNPs.

What adventure_RN is referring to is likely the corporate companies that are for-profit. I think it's crazy to be work extra shifts with little compensation or few raises in salary. I would recommend academic centers. They usually pay well and some have a network of community hospitals so that you don't necessarily only need to work at a Level 4. 

We are among the highest (if not the highest) NP specialties for pay and I don't see that changing- we are intensivists that bring good revenue to the hospital.

[Leader25, ASN, BSN, RN]

Our place uses more PAs than NNP because they pay them less and in an emergency(disaster) NNP responded to nursing office,and PA to MDs.So they are in a different category,some staff nurses make more than the PA,so there is a certain friction.Both do 24s,weekends/holidays.Hospital data ours anyhow say PAs do better in technical areas like OR,while NNP do better with families......