NNP Please Read!

sparkyRN · Jun 13, 2005

Maybe if you post some of your questions, some of us could help you find the answers. Many of us have worked with NNPs and are often involved in their training.

salvati08 · Jun 13, 2005

I actually had a few people pm me and answered all of my questions. But thanks anyway!!! :)

RN4NICU, LPN, LVN · Jun 14, 2005

It is also nice to post your questions so that other people who had the same questions (or had not thought of them) can benefit. That is part of what makes a forum such as this nice. It is rather disappointing to click on a topic that you are interested in to find that it was all discussed in PMs, so no one else can participate in/benefit from the conversation.

salvati08 · Jun 14, 2005

Sorry about that, I actually didn't ask to be pm, that's just what happened. I wanted to see if anyone would even answer me first before listing all the questions like I had done before and got no response. So here is one of the poeple who pm me.

I wrote:

THANK YOU for answering me!!!!!

Ok here goes my questions,

1.) Why did you choose to be a NNP?

2.)what are the typical duties on normal day?

3.) How does it differ from being a RN in the unit?

4.)Are they well respected my the MD's?

5.)Did you work while in school and if so how was it?

6.)Can NNP only work in a NICU?

7.) What are hours like? I know a RN can have the option of three 12 hr shifts/ week and so forth, what about the NP?

8.) I have to ask it, what is the typical starting salary, I can't a straight answer anywhere.

9.)In graduate school do you have clinicals?

10.) What is the job demand?

11.)And anything else you wish you would have known in school or advice you have.

Thanks so much!!!!!!!!!!!!!!!!!

1. I've always wanted to work in the NICU; it was the only reason i became a nurse. So for me, in deciding to do an advanced degree it was the natural choice. I also always wanted to be an MD but never followed through. I eventually had a baby that was a preemie and respected what the NNP's did so much more than the neo's that I knew it was the right choice.

2.Typically if you're working day shift you round on your patients and go over plans for the day. You write orders, look at x-rays, attend deliveries, assess your patients, confer with the docs, help with emergent situations, put lines in, etc etc etc

3. You are making life and death decisions for these patients; just as the MD would. You also can perform more procedures than a regular RN. You write orders etc. your role is just that of an md; but ultimately the final decisions are the MD's but the responsibility is much more than a regular RN's.

4. Yes, but that also depends on where you work. Where I did my training the NNP's were very well respected. They were responsible for some of the teaching of the new residents. Docs there really valued the NNP's opinions.

5. Only did weekends. The learning curve was HUGE. Some of my classmates did more. But only weekends worked for me also because of my daughter. I did a program that was entirely online. So I would have had a lot more flexibility working but for my particular situation weekends was my best option.

6. Yes or a newborn nursery. If you think at a later date you'd be interested in more than nicu I'd do both the nnp and pnp programs.

7. Again varies. Some work 8-5. some work 7-7 it all depends. some do 24 hours shifts every now and then.

8. Varies from regions. As a new grad i've been offered as little as 28.00 per hour to 40 per hour (that was out west though where the cost of living is so much higher) It also depends on if you're working a private hospital or a public one. some private hospital salaries were as high as 120,000 (I was offered that in Texas) but I don't think that high of a salary is the norm. You can do nursing jobs (particularly with traveling) that make just as much as an NNP. In my opinion you have to do it for the love of the job and not the money.

9. Oh yes. There is alot to learn as an NNP.

10. NNP's are so valuable that there is a big demand for them much more so than say a PNP finding a job has not been a problem. As NICU units expand etc there is no way the md's can cover these huge units alone. Besides most nurses would prefer to have an NNP to go to anyway. leave the docs out of it

11. You'll have to work 2 years in a NICU before you can go to school. (a level 3) Learn as much as you can and don't be afraid to get in there and ask NNP's to show you how to read xrays or why they wanted to do what they did. Ask them about the jobs etc MOSt are eager to teach and Love thier job. I couldn't imagine doing any other job. I LOVE my babies.

sddlnscp · Jun 14, 2005

Oooh - thanks for all the good information! I am so excited now! I have contacted a local hospital and asked about their regulations for shadowing in the NICU, now just waiting for a response. What is the difference between Level I, II & III NICU's - I have seen a lot of reference to those, but would like to know what it is I'm talking about when they get back to me (at least a little). Thanks so much!

RN4NICU, LPN, LVN · Jun 15, 2005

Thanks for posting the info. I am contemplating pursuing NNP, but the only thing I am sure of is that every place is different, which leaves me a bit confused as to what questions I should be asking -- meaning to say that our unit's NNPs do not perform the same duties, work the same hours, or get the same pay as the NNPs at the hospital across town (I've worked both places) so it's hard for me to get my mind around what "the norm" would be. And you are correct, it is difficult to get a straight answer when it comes to salary and schedule - I guess because every place IS so different. It is great to know that NNPs are in such demand. I have been worried about being too limited by choosing neonatal over, say, family. Also good to know that someone out there survived a program that was entirely online (I am considering that as well, but hadn't thought to ask about it.) Thanks again for posting.

I have a question for you NNPs out there. Are there travel positions for NNPs? As much as I want to move on to become an NNP, I have enjoyed working as a traveler and do not really want to leave that behind me if I don't have to.

RN4NICU, LPN, LVN · Jun 15, 2005

Oooh - thanks for all the good information! I am so excited now! I have contacted a local hospital and asked about their regulations for shadowing in the NICU, now just waiting for a response. What is the difference between Level I, II & III NICU's - I have seen a lot of reference to those, but would like to know what it is I'm talking about when they get back to me (at least a little). Thanks so much!

Level I is normal newborn nursery

Level II is special care nursery - babies with IV's, antibiotics, oxyhood, nasal cannula, etc. Maybe an uncomplicated vent awaiting transfer.

Level III is neonatal intensive care unit - micropremies, vents, nitric, high frequency ventilation, vasoactive gtts, babies that need surgery, etc.

sparkyRN · Jun 15, 2005

Level I is well baby nursery--for most hospitals it is where babies go right after delivery for admission and observation. At some places, the babies stay there, but at most hospitals the babies room-in with the mom. Boys will go back there for a circ, or if mom is sick, the baby may stay in the nursery until she is feeling better.

Level II is a nursery/unit for several catagories of babies. Usually babies with transient issues--low serum glucose unresolved with feeding, TTN, low birthweight (for us

Level III is the intensive care unit. I could go on for pages on all the kinds of babies we admit to our NICU. Basically all ventilated or nasal CPAP, any baby with a UAC &/or UVC or art line, infants requiring 50% O2 or more and showing deterioration in their resp status. Newly diagnosed NEC, post-ops, any baby under 1200 grams or 28 weeks GA.

Most hospitals that are Level III also have a step-down or Level II unit and likely, if they do deliveries in house, will also have Level I. Our NICU is one huge room divided right down the middle with Level III on one side and II on the other. Level I is upstairs.

sddlnscp · Jun 15, 2005

RN4NICU & SparkyRN, thanks so much for the info, now it all makes perfect sense. :) I am brand new to all of this (just a pre-nursing student), but am trying to absorb as much information as possible and really appreciate all of the detailed information from you both. I am currently a 26 yr. old pre-nursing student and I know that I want to work in neonatal - probably critical care (apparently Level III - yeay, now I know what that means!) quite a long time down the road when I become an NNP (yes, I am dreaming big!). Would it make sense for me to try to get experience as an L&D nurse and then move up the ladder towards neonatal nursing, or should I try to jump right into an NICU once I've finished school? Any idea what proper procedure would be or what NICU's would prefer? Is it better to have experience with recovering moms & healthy babies, or best just to jump right in if possible? I'm sure every place is different, but if you had your choice of who to work with, what would you prefer? Thanks again!!!

RN4NICU, LPN, LVN · Jun 15, 2005

L&D and NICU are two different worlds - one is not a step up the ladder from the other. They are simply two different ladders. :)

Many, if not most NICUs will accept new grads, but I will disagree with many of those who post here that say that new grads are preferred. I have never seen any unit turn down an experienced nurse in favor of a new grad. All candidates are interviewed and those deemed best suited for the NICU environment by the nurse manager are hired on, be they new grad or experienced. I wouldn't say that (in the hiring practices I have seen) that new grads are given any preference. As far as having to "unlearn" things, I don't buy that one either. Our new (to NICU) nurses who have come from adult or pediatric ICU's have by far the easiest transition. Next easiest would probably be the grads, followed by L&D nurses, with M/S nurses usually having the roughest transition. Again this is just what I have observed over the years. You need to do what is right for you. If a NICU position is not available right out of school but you find a position you could be happy in until a NICU position comes available - go ahead and take it. Don't fear that you won't be desirable to a NICU because you are no longer a new grad. Most NICU's give any new nurse the same orientation anyway.

Good Luck.

sddlnscp · Jun 15, 2005

L&D and NICU are two different worlds - one is not a step up the ladder from the other. They are simply two different ladders. :)
Many, if not most NICUs will accept new grads, but I will disagree with many of those who post here that say that new grads are preferred. I have never seen any unit turn down an experienced nurse in favor of a new grad. All candidates are interviewed and those deemed best suited for the NICU environment by the nurse manager are hired on, be they new grad or experienced. I wouldn't say that (in the hiring practices I have seen) that new grads are given any preference. As far as having to "unlearn" things, I don't buy that one either. Our new (to NICU) nurses who have come from adult or pediatric ICU's have by far the easiest transition. Next easiest would probably be the grads, followed by L&D nurses, with M/S nurses usually having the roughest transition. Again this is just what I have observed over the years. You need to do what is right for you. If a NICU position is not available right out of school but you find a position you could be happy in until a NICU position comes available - go ahead and take it. Don't fear that you won't be desirable to a NICU because you are no longer a new grad. Most NICU's give any new nurse the same orientation anyway.
Good Luck.

Wow, thank you so much - see, that's what I get for not knowing what I am talking about (yet, anyway . . . now I am really learning!). Thank you for the help and the support, I will probably have many more questions to come on this journey and I am so excited to learn the answer to each and every one of them!

Thank you, thank you, thank you!!! :)