Range of practice in NNP vs Neonatologist?

SteveNNP, MSN, NP · Aug 22, 2009

It depends on where you practice. Most states allow for unrestricted prescribing of drugs by advanced practice nurses.

There are a lot of differences between being a neonatologist and an NNP.

A neonatologist is a physician who has had 4 years of premed, 4 years of medical school, a 3 year peds residency and a 3 year neonatal fellowship. Once out of all that, they are an attending physician that oversees the management of care of the patients on the unit. They often do very little hands-on care, and usually lead rounds in the mornings.

NNPs are very task based. They are usually experience NICU nurses who have gotten their masters degree. They round with the attending, assess pts, create plans of care for the day, including drugs, feedings, tests, labs, umbilical and picc lines, chest tubes, delivery room management, etc. They are definitely more bedside oriented than an MD. Most function quite independently without much input from the neonatologist.

There is a lot more to be said than I have the time for... I would recommend you fully research the difference between the physician and NP roles, since they are VERY different.

nohika · Aug 22, 2009

Thank you so much for your reply! Do you know of any links to where I would find more about the difference? I wasn't able to find much using Google. =/

Love_2_Learn · Aug 25, 2009

Don't know of a specific web site explaining the difference. Look at it this way as Steve said... one is a Medical Doctor (M.D.) who has endured at least 14 years of college obtaining a medical degree and all that goes with it. The other is a Nurse (Neonatal Nurse Practitioner) who has attended about 6 years of college to obtain a Masters Degree in Nursing (M.S.N.) Often times the Nurse Practitioner works "under the direction" of the Neonatologist, meaning that the Nurse Practitioner will sometimes consult with the Neonatologist about a question concerning treatment and the Neonatologist will pretty much have the final say in the orders to be written for the baby. Nurse practitioners usually have several years of experience in the NICU as bedside nurses before they go to nurse practitioner school to obtain their Master's Degree. Most all NNP programs require a few years experience in NICU and from what I've seen over the years, the ones with at least 5 to 10 years bedside experience seem to be very good nurse practitioners. Oh yes, here is an example that may help you out. Where I work, the Neonatologist is only at work in the daytime, like from 9am to 5pm. The nurse practitioner is there 24 hours from 7am to 7am and a new one changes out with the one working each morning at 7am. After the Neonatologist goes home the Nurse Practitioner is responsible for any questions the bedside nurses would have for a doctor. The NNP comes to check on the baby, writes orders to be carried out, performs procedures that bedside nurses don't generally do (put breathing tubes or umbilical lines in babies, etc.) and will call the neonatologist at home if they need the MD's input as they make a decision about what to do for the baby. When a baby less than about 28 weeks gestation is expected to be born the Neonatologist comes to the hospital from home to be present (one of our hospital policies), otherwise the nurse practitioner handles the admission. Another thought, some NNPs in NICUs work day shift doing discharge planning or follow-up clinic assessments; most NNPs work night shift and either 12 or 24 hours at a time. NNPs are nurses at heart and very much focused on direct patient care; Doctors are more focused on diagnosing and planning general care. If you have ever been in the hospital you may remember that you saw nurses there all around the clock, but you only saw your doctor for a few minutes each day. Only doctors can admit patients so we nurses must have them if we want a job caring for the patients they have admitted. I hope my long reply has been helpful in some way or another. Good luck in your searching and I hope you find your answers. Oh yes, about the drugs, nurse practitioners usually have prescriptive authority and how much and what they use it for depends on their job and the patients they work with as well as state laws and such as that. I'll hush now...

nohika · Aug 25, 2009

Oh! That makes a lot more sense. It kind of pulled everything together now. Thank you very much!

littleneoRN · Aug 25, 2009

In my facility, NNPs are the rounding practitioners on all Level II babies. They do review rounds with the physician in the afternoon, but changes from the MDs are rare. So the NNP examines the baby, writes new orders, updates family, etc. They are also available for PICC line placement, difficult IVs or lab draws, etc. The MD examines the baby, hears report from the NNP, and signs off. In the Level III, NNPs run all of our transports of babies from outside hospitals. They take a nurse and/or RT with them and are fully responsible for the baby on the trip back. They also do all our admission orders, H & P, etc. The physician rounds on Level III babies. NNPs attend high-risk deliveries to direct the infant's care there. They also do procedures such as line placements, intubations, LPs, etc. However, we are different from the previous poster in that we have both NNP and MD in house around the clock. NNPs may work 7a-3p, 7a-7p, or 7 p-7a, depending on their job that day. During the night the NNP is the first stop for questions but the MD is always available. Our NNPs never ever work 24 hour shifts. And they all get to work all shifts and responsibilities, so we don't have any straight night NNPs.