NNP versus PNP?

future-peds-np · Apr 1, 2017

I'm in the same boat as you on this debate. I'm so torn!

In regards to PNP, I can understand being more "marketable" as a PNP since you'd be certified to work with patients from newborn all the way into young adulthood. That being said, you may or may not work in a clinic if you're a acute care PNP. (Just speculation, but the clinic would maybe have to be some kind of specialty clinic if you specialize in acute care.) Maybe a primary care / acute care dual track program? There are some that exist out there.

As far as NNP, I love the NICU and the babies. I have a huge interest in neonatology, and I thoroughly enjoyed my time studying that material in my BSN program. As a very family-oriented person, I could definitely see how the work schedule as an NNP could be more strenuous on a family since you'd be on call and working 24-hour shifts most likely.

They are definitely different career paths and will affect your personal life much differently.

babyNP., APRN · Apr 2, 2017

You want to possibly do acute care PNP? Then you will probably have to work nights, holidays, and weekends too. Children that are in the hospital need 24/7 care just like babies. There might be a few places that offer days only for acute care, but I wouldn't count on it being the norm in the marketplace. There are some places that have primarily daytime NNP schedules as well (my last job at an academic center I got to choose days or nights and there was a wait list to get to nights).

NNPs are paid significantly more than PNPs because we are in an intensivist role with ventilators, vasopressors, oscillators, nitric oxide, etc etc. Just like a hospitalist wouldn't get paid as much as an ICU doctor.

If you want to switch to primary care later down the line, keep in mind that with the new consensus model guidelines, you are only supposed to work in that which you are trained. So if you get your graduate degree in acute care, you can't work primary care unless you do a post-masters to get that certification. This is by no means universal right now, but states are starting to adopt these guidelines and enforcing them.

24 hour shifts are common in neonatology, but it's not hard to find a job that doesn't require them. Most positions are 12s, 24s with a handful places that are 8s and 10s.

Ultimately you have to decide what you want to do with your career whether it's babies only, peds only, or babies and peds (possible, but more schooling to do and trickier to do career transitions).

I was never worried about losing "skills" because I have been in NICU since day 1 as a RN and don't want to do anything else. I wouldn't know what to do with a child, much less an adult. I'm so in-tune with babies that when I watch medical shows and see an adult heart rate on the monitor in the 50s, my gut reaction is...so...are we doing CPR yet??? And I couldn't be happier.

adventure_rn, MSN, NP · Apr 3, 2017

I am currently a nursing student and at the point where I have to decide on where I want to go in my nursing career.

The awesome thing about nursing is that you don't have to make any immediate decisions about the rest of your nursing career. Unlike med school, when you graduate you don't have to choose a residency that will determine your scope for the rest of your career.

Once you graduate, you'll need to get a couple of years of bedside RN experience before getting your NP degree (for NNPs it's mandatory, for PNPs it's recommended). Try to get a job in the NICU or a peds floor, and observe what the NNPs or PNPs actually do. Once you work with NNPs, you may have a better sense for whether you'd actually like the role.

You mention that you're concerned about the crappy hours and degree of specialization that NNPs have; I'd argue that's precisely why they're so well-paid. Also, the nature of the work is totally different. As an outpatient PNP, you'd be spending most of your time doing office visits. As an NNP, you have to be ok with having a sick baby in front of you who is actively dying, performing the difficult intubation, running the code, calling the shots, informing the family, etc. Seeing the huge amount of responsibility (and liability) has been enough to make me not want to become an NNP, at least in the foreseeable future. However, some people thrive in that kind of environment.

I'd also add that if you're favorite part is working closely with the babies, you'd probably be happiest sticking around as a bedside NICU nurse. Nurses are the ones actually doing the feeds, changing the diapers, rocking the grumpy kids, doing most of the parent education, etc. In general, the NP role (both PNP and NNP) involves taking a few minutes to do an assessment, then spending most of the shift sitting at a computer writing notes, looking at labs, ordering meds, asking for consults. There's very little 'hands on care,' if that's what you're hoping to do.

For now, I'd hang tight, get the best new grad job you can, keep asking questions, and continue soul searching about what is really most important to you.