What's the least saturated specialty in APRN?

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What's the least saturated specialty in APRN?

On 11/14/2019 at 12:57 PM, wayemika said:

everyone and their mom is getting the PMHNP cert after family these days

It does seem like it!

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Specializes in NICU.
On 12/2/2019 at 12:22 AM, myoglobin said:

I cannot imagine having to stay up for 24 hours. I would think that the stress on your brain, body and cognition would be tremendous. However, I am a big lover of 12 hour shifts.

Good thing I’ve never had to stay up all nigh, lol. On my worst night I only got 1 hour of sleep. Most of the time I get at least 6, sometimes 8, sometimes 4. Probably similar to a midwife or OB schedule.

this is not to say that it’s for everyone of course. Keep in mind that many groups don’t require it. Different folks different strokes. At one of the places my group contracts at, folks do 36 hour shifts, although it is a small level 2 and mostly seeing just newborns. I don’t think I would do that personally.

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On 11/14/2019 at 11:57 AM, wayemika said:

everyone and their mom is getting the PMHNP cert after family these days

Yep, and I'm one of them??

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Specializes in CTICU.
On 11/15/2019 at 4:32 PM, babyNP. said:

We also have the distinct requirement of at least 1-2 years of NICU RN experience to gain admittance to virtually every school, which also keeps the numbers down (about 300 grads per year) but helps us be a stronger profession.

This seems such a strange requirement to me - especially when PA's can work in NICU as a provider without prior experience. Surely a great adult ICU NP who wants to switch to NICU would be better than or equivalent to a new grad NICU NP with only RN experience?

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Specializes in NICU.
6 hours ago, ghillbert said:

This seems such a strange requirement to me - especially when PA's can work in NICU as a provider without prior experience. Surely a great adult ICU NP who wants to switch to NICU would be better than or equivalent to a new grad NICU NP with only RN experience?

Hi ghillbert,

Virtually no NICU will hire a PA without an extensive orientation (think 6 months) or what is now more common- a year long fellowship. Even then many NICUs will not hire a PA even with a NICU fellowship or even years of NICU experience. I saw this firsthand at a top 5 children's hospital in the northeast who refused to hire PAs into their surgical NICU and another top 5 children's hospital where I worked at in the southwest in any part of their NICU. I even lobbied for it a bit because I know that there are some excellent neonatal PAs but was immediately shot down due to concerns of lack of knowledge and procedural competency. This is due to some traditional bias that I don't agree with, but is currently the case for much of the country.

As far as NP for NP- an experienced adult ICU NP would almost certainly be quite lost from what I know about the adult world and a new grad NNP would almost certainly be superior. Keep in mind that NNPs get a masters specifically about fragile neonates. Beyond the regular Ps, their program is set up to learn specifically about neonates and their clinical is all neonates. I think I got 24 hours in a follow up clinic for ex-preemies, but the rest was all NICU.

Beyond that, I think you are underestimating how niche the NICU is. The very physiology of a baby is completely different than even the population in the PICU. For example, the pathway of blood flow is "backwards" during the extrauterine transition to life and some babies don't transition out of that for a few days. Even basic vital sign norms are completely different (whenever I watch a medical show with the monitor saying a HR of 60, I'm like- code! what are you waiting for? as my reflex). We consider oxygen saturations in the high 80s, low 90s to be normal for most preemies and oxygen is considered toxic and can cause permanent retinal damage leading to blindness- but too little and you also increase the risk of death, so it's a tight rope walk of constantly adjusting the blender.

And these are just your basics- not to mention nutrition (I remember once going to the peds CICU to round on a baby they were freaked out when I wrote for a GIR of 12 in the TPN and I'm like...yeah, this kid needs it and it's totally fine), lung disease treatment, congenital defects, jaundice, fluid management, etc etc.

tl;dr- How you medically treat a baby is eons away from adults and requires extensive knowledge that is not taught in nursing school or in an adult ICU.

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Specializes in ICU, trauma, neuro.
5 hours ago, babyNP. said:

Hi ghillbert,

Virtually no NICU will hire a PA without an extensive orientation (think 6 months) or what is now more common- a year long fellowship. Even then many NICUs will not hire a PA even with a NICU fellowship or even years of NICU experience. I saw this firsthand at a top 5 children's hospital in the northeast who refused to hire PAs into their surgical NICU and another top 5 children's hospital where I worked at in the southwest in any part of their NICU. I even lobbied for it a bit because I know that there are some excellent neonatal PAs but was immediately shot down due to concerns of lack of knowledge and procedural competency. This is due to some traditional bias that I don't agree with, but is currently the case for much of the country.

As far as NP for NP- an experienced adult ICU NP would almost certainly be quite lost from what I know about the adult world and a new grad NNP would almost certainly be superior. Keep in mind that NNPs get a masters specifically about fragile neonates. Beyond the regular Ps, their program is set up to learn specifically about neonates and their clinical is all neonates. I think I got 24 hours in a follow up clinic for ex-preemies, but the rest was all NICU.

Beyond that, I think you are underestimating how niche the NICU is. The very physiology of a baby is completely different than even the population in the PICU. For example, the pathway of blood flow is "backwards" during the extrauterine transition to life and some babies don't transition out of that for a few days. Even basic vital sign norms are completely different (whenever I watch a medical show with the monitor saying a HR of 60, I'm like- code! what are you waiting for? as my reflex). We consider oxygen saturations in the high 80s, low 90s to be normal for most preemies and oxygen is considered toxic and can cause permanent retinal damage leading to blindness- but too little and you also increase the risk of death, so it's a tight rope walk of constantly adjusting the blender.

And these are just your basics- not to mention nutrition (I remember once going to the peds CICU to round on a baby they were freaked out when I wrote for a GIR of 12 in the TPN and I'm like...yeah, this kid needs it and it's totally fine), lung disease treatment, congenital defects, jaundice, fluid management, etc etc.

tl;dr- How you medically treat a baby is eons away from adults and requires extensive knowledge that is not taught in nursing school or in an adult ICU.

Still you can become an FNP without ever working a day as an RN or a PMHNP without a day of psych or an ACNP without a day of ICU. While I believe that the experience is helpful I’m not sure that it is mandatory to be competent. However, from my 8 week experience in NICU (during nursing school at Methodist Hospital in Indianapolis) I believe that the NICU culture is even more “hyper anal retentive” than CVICU which I already felt was overly anal retentive. I honestly felt that many of the RN’s seemed to be in some sort of “OCD” based competition to see who could be the most OCD. Then again I’m an “ADHD” mess of chaos and even the most laid back ICU takes every fiber of my being to just be average.

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On 12/24/2019 at 10:09 PM, myoglobin said:

 Still you can become an FNP without ever working a day as an RN or a PMHNP without a day of psych or an ACNP without a day of ICU. While I believe that the experience is helpful I’m not sure that it is mandatory to be competent. However, from my 8 week experience in NICU (during nursing school at Methodist Hospital in Indianapolis) I believe that the NICU culture is even more “hyper anal retentive” than CVICU which I already felt was overly anal retentive. I honestly felt that many of the RN’s seemed to be in some sort of “OCD” based competition to see who could be the most OCD. Then again I’m an “ADHD” mess of chaos and even the most laid back ICU takes every fiber of my being to just be average.

That made me laugh out loud as it reminded me of my thoughts on Tool's latest album. A phenomenal piece of Tool being a caricature of themselves. ?

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Specializes in NICU.
On ‎12‎/‎24‎/‎2019 at 7:09 PM, myoglobin said:

Still you can become an FNP without ever working a day as an RN or a PMHNP without a day of psych or an ACNP without a day of ICU. While I believe that the experience is helpful I’m not sure that it is mandatory to be competent. However, from my 8 week experience in NICU (during nursing school at Methodist Hospital in Indianapolis) I believe that the NICU culture is even more “hyper anal retentive” than CVICU which I already felt was overly anal retentive. I honestly felt that many of the RN’s seemed to be in some sort of “OCD” based competition to see who could be the most OCD. Then again I’m an “ADHD” mess of chaos and even the most laid back ICU takes every fiber of my being to just be average.

I agree that there is a culture in the NICU of being hyper-alert and anal about care that doesn't really matter (who cares if the duckies are facing the wrong way? lol). But to be fair to our specialty, you do need to be hyper-vigilant. There can be a feeding/growing preemie that is in room air doing great to dead from necrotizing enterocolitis in <12 hours and only presents with subtle symptoms. We are the only specialty in which our patients weights can go by a factor of 10 (500gm to 5kg) and giving 0.1ml more of an intended drug can be catastrophic. I wish this was hyperbole, but it's true. It takes a certain amount of anal-retentive behavior to stay on top of these kinds of things.

As for ACNP & PMHNP not requiring any RN experience- I don't work in those areas but from what I've read on this forum over the years, it's not considered to be a great thing and from what some folks post, can be dangerous. I also find it hard to believe that an ACNP would be hired to work in an ICU without any RN or NP experience. Perhaps, I don't know.

Keep in mind that at the very least, a regular RN program devotes almost 2 years of clinical to the care of adults. They have hundreds of hours of exposure to how adults are treated. There are no dedicated NICU clinical hours (unless in a practicum which is rare) and even newborn hours are pretty limited. Babies are not little adults or even little kids. They are their own little alien species.

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Specializes in Nurse Scientist-Research.
On 12/26/2019 at 11:00 PM, babyNP. said:

(who cares if the duckies are facing the wrong way? LOL).

LOL, but not really. . . (says the NICU nurse who always rearranges her linen and supply drawers as soon as essential cares are completed). I'm not even the most OCD personality in my NICU. Totally agree the specialty cultivates hypervigilence, but that's because hypervigilence has led to catching sepsis in the nick of time cause these kids operate on the narrowest margin of error.

I went back and read this and it might come off as harsh, I totally meant this in a humorous self-deprecating tone.

But I know you understand as a "babyNP" how fast things change. I literally saw one of my patients go from finishing their 8pm feed well to green residual at 11pm, to being bagged at MN, on the oscillator and paralyzed by 6am, and having care withdrawn at 6pm for NEC totalis.

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On 12/30/2019 at 1:23 AM, TiffyRN said:

But I know you understand as a "babyNP" how fast things change. I literally saw one of my patients go from finishing their 8pm feed well to green residual at 11pm, to being bagged at MN, on the oscillator and paralyzed by 6am, and having care withdrawn at 6pm for NEC totalis.

That is literally one of the saddest things I have ever read on AN, and I have been here for over 10 years. ?

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Specializes in CTICU.
On 12/24/2019 at 4:11 PM, babyNP. said:

Hi ghillbert,

Virtually no NICU will hire a PA without an extensive orientation (think 6 months) or what is now more common- a year long fellowship. Even then many NICUs will not hire a PA even with a NICU fellowship or even years of NICU experience. I saw this firsthand at a top 5 children's hospital in the northeast who refused to hire PAs into their surgical NICU and another top 5 children's hospital where I worked at in the southwest in any part of their NICU. I even lobbied for it a bit because I know that there are some excellent neonatal PAs but was immediately shot down due to concerns of lack of knowledge and procedural competency. This is due to some traditional bias that I don't agree with, but is currently the case for much of the country.

As far as NP for NP- an experienced adult ICU NP would almost certainly be quite lost from what I know about the adult world and a new grad NNP would almost certainly be superior. Keep in mind that NNPs get a masters specifically about fragile neonates. Beyond the regular Ps, their program is set up to learn specifically about neonates and their clinical is all neonates. I think I got 24 hours in a follow up clinic for ex-preemies, but the rest was all NICU.

Beyond that, I think you are underestimating how niche the NICU is. The very physiology of a baby is completely different than even the population in the PICU. For example, the pathway of blood flow is "backwards" during the extrauterine transition to life and some babies don't transition out of that for a few days. Even basic vital sign norms are completely different (whenever I watch a medical show with the monitor saying a HR of 60, I'm like- code! what are you waiting for? as my reflex). We consider oxygen saturations in the high 80s, low 90s to be normal for most preemies and oxygen is considered toxic and can cause permanent retinal damage leading to blindness- but too little and you also increase the risk of death, so it's a tight rope walk of constantly adjusting the blender.

And these are just your basics- not to mention nutrition (I remember once going to the peds CICU to round on a baby they were freaked out when I wrote for a GIR of 12 in the TPN and I'm like...yeah, this kid needs it and it's totally fine), lung disease treatment, congenital defects, jaundice, fluid management, etc etc.

tl;dr- How you medically treat a baby is eons away from adults and requires extensive knowledge that is not taught in nursing school or in an adult ICU.

Yes I understand all that, and by no means intend to minimize the super-specialty-ness (?!) of NICU and neonates.

I wasn't comparing a trained adult NP's competence in a NICU to a trained NNP. I was saying for admission to an NNP program, I would think an adult critical care NP would be at least as well-prepared as an RN with NICU experience.

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4 hours ago, ghillbert said:

Yes I understand all that, and by no means intend to minimize the super-specialty-ness (?!) of NICU and neonates.

I wasn't comparing a trained adult NP's competence in a NICU to a trained NNP. I was saying for admission to an NNP program, I would think an adult critical care NP would be at least as well-prepared as an RN with NICU experience.

Yes, we understand, and the answer is still no. The assessment and management of 500 gram (1.5 lb) preemies is obviously radically different than just about anything else in nursing. A NICU nurse who is already familiar with the assessment and overall management of these patients would be vastly better prepared to begin ah an NNP program than an adult critical care NP with no exposure to NICU.

It’s kind of like CRNA school—the specialty is so niche and the margin of error is so small that when you start the program, you already need to have the assessments and general patient management down pat.

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