Strengthening the NNP Workforce Through Faculty Collaboration
By Jennifer Fitzgerald, DNP NNP-BC
Introduction: Why Faculty Collaboration Matters Now
The first neonatal nurse practitioner (NNP) programs were developed in the early 1970s, with NANN Past President Patricia Johnson, DNP MPH RN NNP, recognized as pioneering the neonatal advanced practice nurse (APRN) role. Initially, these programs were hospital-based and followed the medical model, with the role evolving to encompass clinical management, transport, delivery attendance, and coverage of resident gaps (Honeyfield, 2009). Growing regionalization of neonatal care and increasing technological dependence increased the need for NNPs, with demand continuing to outpace supply.
By 1975, the American Nurses Association (ANA) formalized neonatal nurse clinician education, and in 1983, the organization now known as the National Certification Corporation (NCC) introduced the national certification exam for NNPs (Honeyfield, 2009). It wasn’t until the late 1980s that NNP education transitioned from hospital-based programs to master’s degree programs associated with academic institutions (Honeyfield, 2009). It was at this time that academic faculty began developing curricular content in collaboration with the National Association for Neonatal Nurses (NANN), publishing the first NNP educational standards, Neonatal Nurse Practitioners: Standards of Education and Practice, in 1994 (NANN–AP, 2024).
Today, rising patient acuity and workforce pressures challenge neonatal intensive care units (NICUs) nationwide. NNP faculty play a critical role in aligning education with practice and supporting novice NNPs. Faculty are uniquely positioned to influence national neonatal curricular content and assess practice-readiness of graduates with a goal of sustaining the endurance of the NNP workforce.
Following the development of the advanced practice division of NANN in 2007, the NNP Faculty special interest group (SIG) was created. NANN’s NNP Faculty SIG is a national collaborative bringing together educators from diverse NNP programs to address shared workforce challenges through collaboration instead of isolated programmatic efforts. The SIG focuses on building, supporting, and strengthening the NNP pipeline and clarifying APRN roles within NICU teams.
Faculty collaboration within the SIG is addressing recruitment challenges, role alignment across institutions, and aligning educational standards to the recommendations proposed in the National Organization of Nurse Practitioner Faculty (NONPF) Nurse Practitioner Role Competencies and the American Association of Colleges of Nursing’s (AACN) Essentials. NNP Faculty SIG members representing the neonatal population in the curricular revisions workgroup were tasked with coming to consensus on core curricular content essential for programs preparing an NNP.
NNP programs of study are adapting content and educational delivery to ensure that NNP graduates are “practice ready,” requiring faculty to collaborate on educational methods that are both competency- and evidence-based.
The NNP Workforce Challenge: A Shared National Concern
National workforce analyses emphasize that NNPs are essential to delivering high-quality care across Level II–IV NICUs, yet shortages and role variability threaten workforce sustainability (Keels et al., 2019; Stark et al., 2023). The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care further underscore the complexity of care environments in which NNPs practice, reinforcing the need for a stable and well-prepared advanced practice workforce (Stark et al., 2023).
Beyond supply, NNPs report professional challenges related to workload, shift length, and unclear role expectations. Data, including from a national survey conducted by the National Association of Neonatal Nurses—Advanced Practice (NANN-AP), demonstrate that extended shifts and fatigue negatively harm professional practice and may negatively influence retention (Bell et al., 2025; NANN, 2022a). Role ambiguity and restricted practice environments were found to further erode professional satisfaction and autonomy (Bailey et al., 2021). Variability in how NICU care settings define and utilize APRN roles potentially increases the risk of liability to both the APRN and institution. These issues are systemic and demand coordinated solutions that extend beyond individual NICUs or academic programs.
The NANN NNP Faculty SIG: A Collaborative Framework for Action
Within NANN’s NNP Faculty SIG are faculty who are
- leading and teaching in NNP academic programs at both the master’s and doctoral levels
- leading interdisciplinary advanced practice provider teams within medical centers
- advancing the care of critically ill neonates through research and quality improvement initiatives
- supporting the integration of novice NNPs into practice through mentorship
- advocating for the continued support and utilization of NNPs at local, regional, national and international levels.
The SIG’s shared expertise and collaborative discussion forums help participants identify common barriers, facilitate problem-solving, and encourage faculty-led solutions grounded in evidence and national standards.
Common barriers that are key themes throughout the SIG’s meetings include limited exposure to the NNP role prior to graduation from prelicensure programs and misalignment between role expectations and academic preparation. As highlighted by Carley & Garrett (2022), less than 10% of novice NPs feel prepared to enter practice upon completion of their APRN program. Despite NANN and NANN-AP publications highlighting the need for coordinated action and efforts to support the future of neonatal APRN practice, challenges persist (Staebler et al., 2016; NANN, 2022b).
Faculty Collaboration to Strengthen NNP Recruitment Pipelines
Barriers to recruitment occur early in professional development. Recent literature has highlighted barriers that include limited awareness of the NNP role, lack of structured mentoring, and hesitancy regarding academic readiness to achieve a neonatal advanced practice education (Baker et al., 2024; Morris et al., 2022). The perception of NNP workload, stress, and burnout further challenges the recruitment of nurses to the specialty (Keels, 2019; NANN, 2022b).
Evidence supports development of mentorship as a cornerstone of recruitment and retention efforts (Baker et al., 2024; Morris et al., 2022; Moss, 2024). Mentorship programs increase NICU nurses’ interest in pursuing the NNP role and support academic resilience, professional confidence, and self-efficacy during progression through advanced practice education—facilitators which are shown to support the successful transition from registered nurse to novice neonatal APRN during early clinical practice (Baker, 2024; Jnah & Robinson, 2015; Morris et al., 2022).
Within the NNP Faculty SIG, member discussion and collaboration have led to faculty-coordinated recruitment strategies, such as early outreach to prelicensure nursing students and development of structured mentoring programs for novice NNPs. These efforts build on successful initiatives, such as neonatal fellowship and mentorship programs, shown to strengthen the NNP workforce (Morris et al., 2022). NNP Faculty SIG members have participated in national panels and presentations encouraging neonatal nurses to pursue NNP education. Faculty emphasize inclusive recruitment strategies aimed at reducing barriers for nontraditional and underrepresented learners (Newberry & Bell, 2023).
Faculty-Driven Alignment of APRN Roles in the NICU
Role ambiguity is an ongoing problem on neonatal care teams. Restricted practice environments and unclear, or limited, practice authority limit the scope of the NNP role, professional satisfaction, and recruitment efforts (Bailey, 2021; Staebler, 2016). Studies highlight role confusion among interprofessional team members when APRN roles are not well defined, especially within settings that employ multiple provider types (Dyess et al., 2023).
The unique contributions of NNPs across in-patient and primary-care settings have been well described in the literature, and recent literature highlights the importance of clearly distinguishing the role of the NNP while supporting and promoting collaborative practice (Hull, et al., 2025; Etten, et al., 2022, Snapp & Reyna, 2019). To enhance NNP role clarity, NANN’s NNP Faculty SIG has focused on advocating for the NNP role within interprofessional teams; on national educational taskforces; and within licensure, accreditation, certification, and education (LACE) forums. Intentionally including knowledge of the NP role during NNP education enhances APRN students’ role understanding and transition readiness (Carley & Garrett, 2022).
Academic-Practice Partnerships: Extending Faculty Collaboration Beyond the Classroom
Strong academic-practice partnerships are essential to creating and sustaining the NNP workforce. NNP preceptors play a crucial role in educating, role modeling, and socializing novice NNPs into practice. The NNP preceptor is a highly valued partner in the education of neonatal NP students, facilitating confidence, critical thinking, and diagnostic reasoning, all of which influence satisfaction and retention (Moss et al., 2023). However, the demands placed on NNP preceptors— including workload, acuity, and precepting other educational learners, such as medical students and pediatric residents—create challenges to serving as preceptors (Dyess et al., 2023; Moss et al., 2023). NANN’s NNP Faculty SIG members, in collaboration with NNP preceptors and NICU/APRN leadership, align educational preparation with the needs of real-world practice to enhance NNP graduates’ ability to successfully transition into APRN practice.
Literature examining NICU staffing and the care of neonates calls for diverse, innovative recruitment strategies and coordinated efforts to enhance the NNP workforce (Baker et al., 2023; Keels et al., 2019; Jnah & Robinson, 2015; Moss et al., 2023; NANN, 2022b; Newberry & Bell, 2023; Staebler et al., 2016). Formal partnerships between clinical practice sites and academic programs enable student learning and preceptor professional development, model the role of the NNP preceptor as a mentor, and help NNP student recruitment. Leveraging and expanding successful academic-practice partnerships to recruit and support nurses with financial scholarship or tuition remission/reimbursement, such as “grow your own” programs, may be one strategy to address the NNP supply-demand gap (NANN, 2022a; Keels, 2019). Not a new concept in healthcare, academic-practice partnerships are underutilized in addressing the need for NNPs. The NANN Faculty SIG membership is well-positioned to facilitate conversations with academic institutions and practice partners aimed at increasing NNP recruitment.
Call to Action: Engaging the Broader NANN Community
Strengthening the NNP workforce requires a collective effort and acknowledgment of the NNP’s professional responsibility to educate future clinicians. Faculty, clinicians, and NICU/NNP leaders are encouraged to engage with the NANN NNP Faculty SIG. Through resource development, ongoing dialogue, and action aimed at addressing the challenges of recruitment and role ambiguity, the neonatal community can ensure that the NNP professional role is sustained and remains visible, valued, and well-integrated within NICU care teams—ultimately supporting high-quality outcomes for neonates and families.
Note: The author acknowledges the use of OpenAI’s ChatGPT as a support tool to assist with organization and refinement of this manuscript.
References
Bailey, T., Staebler, S., Pont, M., Christiansen, B., & Champion, J. D. (2021). An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting. Journal of the American Association of Nurse Practitioners. 34(2), 328-339. https://doi.org/10.1097/JXX.0000000000000608
Baker, L. A., Moss, C., Bordelon, C., Savin, M. K. (2024). Growing the neonatal nurse practitioner workforce through mentoring: A scoping review. Journal of Perinatal and Neonatal Nursing. 38(2), 184-191. https://doi.org/10.1097/JPN.0000000000000789
Bell, T. R., Hoffman, J., & Farmer, M. L. (2025). Beyond 12 hours: A national survey of neonatal nurse practitioners perceptions on shift length and professional practice. Journal of the American Association of Nurse Practitioners. Advance online publication. https://doi.org/10.1097/JXX.0000000000001203
Carley, A. & Garrett, L. (2022). Supporting role knowledge and role transition in neonatal APRN students. Neonatal Network. 41(3), 168-171. https://doi.org/10.1891/11-T-752
Dyess, N. F., Keels, E., Myers, P., French, H., Reber, K., LaTuga, M. S., Johnston, L. C., Frontline Provider Interprofessional Writing Group, & Scala, M. (2023). Optimizing clinical care and training in the neonatal intensive care unit: The relationship between front line providers and physician trainees. Journal of Perinatology. 43(12), 1513-1519. https://doi.org/10.1038/s41372-023-01749-7
Etten, K., Hoffman, J., Wallman, C., & Bellflower, B. (2022). The important primary care role of neonatal nurse practitioners in the neonatal intensive care unit. Journal of the American Association of Nurse Practitioners. 34(12), 1258-1262. https://doi.org/10.1097/JXX.0000000000000800
Honeyfield, M. E. (2009). Neonatal nurse practitioners: Past, present, and future. Advances in Neonatal Care. 9(3), 125-128. https://doi.org/10.1097/ANC.0b013e3181a8369f
Hull, W. L., Jones, J., Bell, T., Farmer, M., Staggs, J., & Hoffman, J. (2025). Distinguishing the role of the neonatal nurse practitioner in neonatal care. Journal of Perinatology. Advance online publication.https://doi.org/10.1038/s41372-025-02489-6
Jnah, A. J. & Robinson, C. B. (2015). Mentoring and self-efficacy: Implications for the neonatal nurse practitioner workforce. Advances in Neonatal Care. 15(5), E3-E11. https://doi.org/10.1097/ANC.0000000000000227
Keels, E. L., Goldsmith J. P., & Committee on Fetus and Newborn. (2019). Neonatal provider workforce. Pediatrics. 144(6), e20193147. https://doi.org/10.1542/peds.2019-3147
Morris, A., Smith, R., Fitzgerald, S., & Bosque, E. (2022). Growing neonatal advanced practice providers via mentorship can fill the need: Program description and tool kit. Advances in Neonatal Care. 22(2),140-153. https://doi.org/10.1097/ANC.0000000000000847
Moss, C. R. (2024). Development and evaluation of a neonatal nurse practitioner mentoring workshop. Journal of the American Association of Nurse Practitioners. 36(7), 391-398. https://doi.org/10.1097/JXX.0000000000000989
Moss, C. R., Savin, M. K., Sharpe, E., & Wallman, C. (2023). Preceptors and the new neonatal nurse practitioner educational world. Neonatal Network. 42(6), 329-335.https://doi.org/10.1891/NN-2023-0044
National Association of Neonatal Nurses. (2022a). The impact of advanced practice registered nurses’ shift length and fatigue on patient safety (Position Statement 3076). https://nann.org/wp-content/uploads/2025/04/Impact_of_Advanced_Practice-_Shift-Length_and_Fatigue_2022-214.pdf
National Association of Neonatal Nurses. (2022b). The state of neonatal APRN role and action for the future (Professional Practice Document 3077). https://nann.org/wp-content/uploads/2025/04/State_of_Neonatal_APRN_Role_and_Action_2022-849.pdf
National Association of Neonatal Nurses—Advanced Practice. (2024). Advanced practice registered nurses practicing within the neonatal population: Role, preparation and scope of practice (Position Statement 3059). https://nann.org/wp-content/uploads/2025/04/APRN_Scope_FINAL_May2024-d7c.pdf
Newberry, D. M. & Bell, T. (2023). Racial and ethnic composition of neonatal nurse practitioner faculty and students in the United States. Advances in Neonatal Care. 23(2), 132-139. https://doi.org/10.1097/ANC.0000000000001045
Snapp, B. & Reyna, B. (2019). Role of the neonatal nurse practitioner in the community hospital. Advances in Neonatal Care. 19(5), 402-408. https://doi.org/10.1097/ANC.0000000000000638
Staebler, S., Meier, S. R., Bagwell, G., & Conway-Orgel, M. (2016). The future of neonatal advanced practice registered nurse practice: White paper. Advances in Neonatal Care. 16(1), 8-14. https://doi.org/10.1097/ANC.0000000000000243
Stark, A. R., Pursley, D. M., Papile, L. A., Eichenwald, E. C., Hankins, C. T., Buck, R. K., Wallace, T. J., Bondurant, P. G., & Faster, N. E. (2023). Standards for levels of neonatal care: II, III, and IV. Pediatrics. 151(6), e2023061957. https://doi.org/10.1542/peds.2023-061957