PNPs with Neonatals

guest769224 · Jun 26, 2015

No, absolutely not true.

However, some programs have closed and applicants seem to be on a downswing, for unknown reasons. PNP's do work in well baby nurseries, but they do not work in NICU. NICU is for NNP's. I feel NNP is a great career choice.

Elvish, BSN, DNP, RN, NP · Jun 26, 2015

We have PNPs in our NICU, but they work with the step-down babies, not the most critical ones. They also work in our well nursery. NNPs go to high risk deliveries as well.

Jolie, BSN · Jun 27, 2015

Yes, PNPs can and do work in NICUs. In some units, they focus on the older babies, in others they function similarly to the NNPs.

They have a lot to offer in the areas of growth and development, well baby care, safety, education, discharge planning, etc. One of the most respected NPs I ever met was a family nurse practitioner. She took a NICU job because she couldn't find anything else at the time. We were lucky to have her.

babyNP., APRN · Jun 28, 2015

It is possible for a PNP to work in the NICU, but it's extremely rare. I can't think that a hospital would hire a FNP now- that wouldn't fit in the Consensus Model by the ANA; primary care PNPs can't work in hospitals anymore either unless they have an acute care designation (or it's phasing in right now as I remember from a grad school lecture on the subject).

More likely what will happen is that PAs will increase their presence in the NICU. There are 2 residency programs, one in Kentucky, one at CHOP that let them learn how to do the NICU since their graduate education has very little to do with NICU and focuses more on adults. They can do a rotation in NICU, but that's not enough to work in a NICU without extensive orientation.

adventure_rn, MSN, NP · Jun 29, 2015

I think it may be very heavily influenced by the region where you work. For better or worse, the employers who hire NPs (i.e. hospitals and physician practices) determine whom they prefer to hire to perform the designated work. Their perceptions can vary dramatically over time or across geographic areas.

I went to a school in a metropolitan area with two large academic hospitals affiliated with universities. One university had a great PA program, and so the employers affiliated with that university hospital preferred PAs; the other university had a great nursing program, and so the employers affiliated with that hospital preferred NPs. A third large hospital system in the area, not affiliated with either university, hired a mix of both PAs and NPs.

I've known multiple PNPs that cover both the NICUs and mother-baby units at my hospital. One of the PNPs told me that she had her dream job in peds primary care while living in Philidelphia, but had to move to a new state for her husband's job. When she arrived, she discovered that peds primary care providers in this state were only hiring FNPs, NOT PNPs, so the PNPs were getting pushed into neonatal care (which was neither her passion nor her professional goal). Furthermore, the experienced PNPs being hired into the neonatal/NICU were crowding out any new NNPs trying to enter the field.

My concern with the APRN field in general is that NPs are subject to the whims of their employers. A NICU nurse is a NICU nurse no matter where that nurse goes, but if the mindset of hospital/practice employers in your area sours toward your advanced practice degree (be it NNP, NP, PA, or what have you), you're fresh out of luck. I'd say that the best thing any aspiring NP can do is to try to understand what advanced practice degrees are favorable in your area so that you can be as competitive a candidate as possible.

Like the OP, I've also had instructors at my university tell me that NNP programs are being phased out. Their rhetoric was that it is harder for new NNPs to find employment because they are so specialized; if they can't find a NICU/neonatal job right out of school, then they aren't qualified to do anything else in pediatrics. In contrast, they claimed that PNPs with an interest in neonatal could be oriented to NICU, but would still be able to fall back on general peds if no neonatal jobs were available at a given time (and perhaps eventually move into NICU). I know lots of NNPs will probably disagree with this mindset, but I've also heard the rumblings from the Ivory Tower. Perhaps the solution would be a PNP degree with a 'Neonatal Focus' option, similar to the 'Oncology Focus' that many programs offer to supplement adult NP degrees?

I feel like I keep hearing more and more people suggesting that nurses get as general an APRN degree as possible to improve their chances of new grad employment (though it could just be my region, which is relatively saturated with NPs).

babyNP., APRN · Jun 29, 2015

Well, I also went to an Ivy League school for my MSN and was told the opposite of what you've been told and what's more- my DNP program in the mid-west director told me that she has not heard about anything that you've said. This is also not what Ensearch & Linkous Recruiting (they recruit exclusively for NNPs) has said to our graduating class. Perhaps as you've said, it's location dependent.

But I really can't imagine that a hospital would pick a PNP over a NNP (all experience equal) for NICU.

And again, the ANA Consensus Model is changing things so that people can only work with their population foci- and some boards of nursing are starting to require this as well. It's not across the United States, but some states are starting to implement it.

adventure_rn, MSN, NP · Jun 30, 2015

But I really can't imagine that a hospital would pick a PNP over a NNP (all experience equal) for NICU.
And again, the ANA Consensus Model is changing things so that people can only work with their population foci- and some boards of nursing are starting to require this as well. It's not across the United States, but some states are starting to implement it.

Very interesting insights, babyNP. That model sounds like it would be great for advanced practice nursing, and for patients in general. I'm sure that NNPs are much better prepared to care for high acuity neonates than PNPs.

More than anything, I think that we as a profession need to advocate for our APRNs. If nurses don't have a seat the table, we're on the menu!

guest769224 · Jun 30, 2015

I personally wish NICU's would allow for NNP's only, and that PA's would work elsewhere. I feel like an NNP, has in a way, earned their "right" to be there, by practicing at the bedside for at least two years on a professional level. PA's come in with a random background and very little NICU focus while in school.

PA's don't need to be crowding out limited NICU positions that NNP's are more capable and competent of doing.

adventure_rn, MSN, NP · Jun 30, 2015

Lol, that's kind of the nature of PAs, neonatal and otherwise. Most APRNs will have a background in their field of specialty, and most PAs will not.

Some (myself not included) might argue that they're more adaptable providers because they don't have to 'unlearn' the emphasis on RN tasks. I know a nurse midwife who never had any L&D experience because she went straight through Yale's ABSN-CNM program; she was convinced that she adapted better to the midwife role than her experienced L&D peers since "they were always running around checking on drips and other nursing activities" while she "saw the big picture." :sarcastic:

SteveNNP, MSN, NP · Jul 3, 2015

I am from the NYC area, and it's true that the number of schools offering NNP degrees have decreased recently, including Columbia University, my own grad school. The NNP market is a bit oversaturated here on the island of Manhattan, and even in NJ and the rest of NY. You can find the occasional NNP position on Long Island or upstate.

My personal opinion is that it's just not profitable for schools to pay for an NNP program, which involves hiring a director, doctorally/masters prepared professors, clinical sites, etc when there are only 3-5 applicants per year, which was the case at Columbia. That program closed because of low demand, and transition periods within the school of nursing. Stonybrook has a large and popular NNP program, which a lot of RNs gravitate to, because most NNPs are working as FT NICU RNs and prefer the distance option, AND it's a third of the cost of Columbia's program.

To answer your question about PNPs...my hospital no longer hires PAs or PNPs for the NICU. We have a few left from before the new rule, but now our directors only want board-certified NNPs, which helps with Magnet and US News & World Report status.

A lot of our NICU RNs got their PNP only to get screwed out of a job in our unit. It's a shame because they would bring such a wealth of needed knowledge.

ChrisB718 · Mar 30, 2016

Hi Steve,

I was really interested in becoming a NNP until I saw your post that the specialty is oversaturated. What specialty in NYC do you think is great to go into? My first choice was Family Nurse Practitioner but I thought maybe it would be oversaturated as well? I look forward to your response. Thank you!