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1) It depends on where you work and the facility utilizes their NNPs. As an RN in the NICU, the facility where I worked utilized their practitioners only during the day. They attended deliveries throughout the day, saw babies in term nursery and managed a few NICU patients. They worked 10 hours day shifts. My first job as an NNP has me covering a few facilities and it depends where I am as to what the shifts will be like. Some are 24 hours, some 14 or 16 hours. Typically I will see a portion of the patients and the Neo sees the rest. I will also attend deliveries and do procedures as necessary. Over night I am the only provider in house and manage the DR and NICU, with the Neo on call at home. 2) I am not sure about misconceptions, but I think it's important to be clear about where you can work as an NNP and what your expectations are. If your considering this career, I assume you've had some exposure to the NICU and hopefully NNPs. The scope of an NNP only extends to the age of 2, which limits the setting in which you can work. Basically, NICUs are primarily it with some exceptions of those working in developmental care clinics (not super common). Certainly you can teach or work as a nurse manager, but I enjoy the clinical side of the job. 3) I'm not sure I would necessarily call it a residency, although some facilities may if they have a formal new-grad NNP training program, some large teaching facilities do. During the end of my program, I had a "practicum" that was basically a period of time that I worked as an NNP with a preceptor, a full time schedule and managed a full team of patients with them standing by. After graduation, again depending on where you are hired, the orientation will vary. I had 10 years of NICU RN experience when I became an NNP, so my orientation schedule may be different that that of someone with say, only 3 years as an RN. Initially orientation with a Neo on days for a period, and then with an NNP overnight. I was hired to a facility that typically didn't hire new grads so it was a new thing for them, nothing formal in place. Per my understanding, most formal orientations are 4-6 months. I havent been an NNP for a long time, I think there are a few other regular posters here who can also add some insight. I don't know where you are in your journey, but I would start by working in the NICU as an RN first (a requirement for NNP school anyway) and figure out if working in the NICU is where you want to live your career. This is all I've ever wanted to do, so I truly love it. Hope that helps, good luck!

Dansko or sanitas here, never have any tired feet. I work NICU and am constantly moving.

Sending you a pm :)

Oh my gosh. I am so happy to read this post!! I have been looking everywhere for the same information! I am starting there in the NNP program next month.

Can you suggest your educator host a skills day to simulate those skills? We have done that with our code cart to give exposure and talk through a mock code for our newer nurses.

We have a level III NICU, up to 22-23 patients

I can't speak to have gone from PP to NICU, as NICU is 100% of my nursing experience, but I have precepted a couple of nurses who can from PP into our level III NICU and both have done very well. I think if you have a strong foundation for normal newborn assessment and what is "right" then you will probably do ok. You'll have the maternal history, too which I think helps see the big picture too. Good luck!

I wouldn't worry about a stethoscope. Every Nicu I've ever worked in provides their own for each baby...for infection control.

Congrats! That's great. I have never worked anything but NICU, so I hope you love it. If I could give you some advise....and this is coming from both someone who has been there, and also as a preceptor in a large NICU. Listen to your preceptor. They have been doing this a long time and won't steer you wrong (hopefully ). I know that when you graduate you feel on top of the world and at the top of the totem pole, but coming in to the NICU, you float right back down to the bottom. The majority of what you learned in nursing school is not NICU specific and everything you will need to be effective in NICU will be learned on the job. Huge learning curve here. Ask questions if you do not understand! Know that you will get frustrated. It is tough to come in to a complex world like NICU and expect to have it mastered in the first week. You will make mistakes. It happens, you learn from it, and you move on. You won't do it again. Be prepared for mean nurses. There will be some. There always are in those big units and they will try to make you feel like you don't know what you're doing. Keep your head up and show them that you deserve to be there by taking every opportunity to learn and observe and gain your skills. It will be tough in the beginning, but I can't imagine ever doing anything else! I am starting NNP school this fall and can't wait! Welcome to the wonderful world of NICU!

Case by case here, too. Most of our intubated patients have an order for fentanyl PRN and is up to the bedside nurse's discretion as to whether the baby gets it or not. We have some nurses that give it per the order around the clock, and others that treat symptomatically. I am the latter. That said, if I have a baby who has been given the med frequently I would never deny it if there is a risk for withdrawal. Anyway, I think this, like most things NICU, are institution based.

Do your patients ever get neb treatments? Albuterol is used frequently in my unit.

I feel like I had to input my manager's name and contact information when I applied to take the test because you have to have those 2 years of experience to test. My manager never said anything to me, so who knows. I never told anyone in my unit I was testing either. Good luck if you decide to take your test!

2, and one has to be a banded parent.

I took the NICU solutions review course a couple of years ago when I was studying for my RNC-NIC and they had a version of the course that was catered for the LR exam. It was a great review and I imagine the other would be, as well.

I wouldn't beat yourself up. Gut issues are hard because all you can do, really is watch and wait. As the bedside nurses we definitely know our babies better than the docs lots of times because we are there constantly to see the subtle changes. But, I have also had patients who I was sure were headed in THAT direction (you know where) that wound up being benign symptoms. It's our job to advocate for your patients and honestly, you'd be scrutinized even harder if you didn't and something happened. Also, you should be able to count on your co-workers. The NICU is a 24 hour operation and the next shift should be able to pick up where you left off. We don't just wrap up our days with 100% of our tasks completed like an office job. When we get a sick kid in our unit, that baby becomes everyone's priority. Everyone pitches in. Same with an admission. They shouldn't leave you drowning. I'm sorry you had a bad day, but good job on catching your baby's issue! That's a sign of a good NICU nurse!