Neonatal Nurse Practitioners Will Not Go Down Without a Fight!
Tosha Harris, DNP APRN NNP-BC, NANN E-News editor
Over the past weeks, I've had several conversations with colleagues about the future of the neonatal nurse practitioner (NNP) role. What does the future hold for our discipline? In July 2018, NANN E-News published an article written by Ally Kayton entitled Are NNPs Fading Away?
Six years later, I find myself asking that same question.
As a bedside nurse, I worked in a neonatal intensive care unit (NICU) that employed two NNPs; this was my first exposure to the role. They were highly regarded for their extensive knowledge and procedural skills. As a unit, we could always count on them to "fix" our sickest babies. The NNPs were who you wanted in the delivery room when an unanticipated preterm delivery was imminent, when a baby needed resuscitation, or when your baby needed a PICC line because IV access was tenuous.
As an NNP student, they were my preceptors, and I learned much from them. In 2011, I completed my training to become an NNP and set out to emulate their greatness. I have been precepted and mentored by fantastic NNPs. However, over the years, I've slowly seen the role I love stretched to its limits.
NNPs are vital members of healthcare teams. After all, we are trained to care for critically ill and medically complex neonates and infants. The literature has long documented the need for and benefit of NNPs in the clinical setting. The demand remains high for NNPs to care for high-risk infants and infants with long-term health conditions. Also, with the increased emphasis on preventive care and early identification of medical conditions, companies and practices seek NNP expertise (EveryNurse, 2023). But while the demand for NNPs has remained steady, the supply of NNPs has lagged significantly. The NNP supply doesn’t meet the demand. In 2016, there were 5,433 certified NNPs in the United States, and by 2020, that number had increased over 20% to 6,558 (Snapp et al., 2021). Yet, neonatal nurse practitioners comprise only 0.5% of the 355,000 licensed nurse practitioners in the United States (American Association of Nurse Practitioners, 2022). “Although the number of NNP graduates has appreciably increased in the past 6 years, administrator respondents in the 2020 survey indicated they do not have enough NNP coverage and the NANNP workforce surveys from 2014 and 2016 also identified unfilled NNP positions (nearly 50% and 73%, respectively) as a cause for concern” (Snapp et al., 2021). The current trend of utilizing physician assistants and pediatric acute care nurse practitioners to fill NNP positions further bolsters the fact that there are not enough NNPs to meet the demand for them.
Currently, 40 schools of nursing across the country offer NNP education. In 2022, 395 students graduated from these programs (Y. Kliman, personal communication, April 4, 2023). However, enrollment in graduate programs is down (B. Bellflower, personal communication, April 11, 2023). The supply-and-demand divide continues to increase due to decreased student admission rates, an increase in clinicians retiring by 2025, and other workforce concerns (National Association of Neonatal Nurses & National Association of Neonatal Nurse Practitioners, 2022).
In September 2022, the National Association of Neonatal Nurses (NANN) and the National Association of Neonatal Nurse Practitioners (NANNP) published a professional practice document, The State of Neonatal APRN Role and Action for the Future. In this document, NANNP proposed strategies to increase recruitment and retention and to support the current APRN workforce. If you haven't already, I encourage you to read the document and its supporting documents.
The strategies proposed include:
- Ensure full implementation of the APRN Consensus Model in all 50 states and the District of Columbia.
- Empower NNPs to develop collaborative practice models with physician colleagues.
- Make NNPs visible to consumers, regulatory bodies, and legislators to educate these groups about NNP education, training, and role.
- Expand workforce diversity.
- Employ best practices to manage 24-hour shifts and support time off to relieve burnout and fatigue.
- Support senior expert NPs by using an alternative staffing model.
- Enhance retention through decreased workload.
- Decrease workload by redistributing patients with lower-acuity settings and designing protocols to streamline treatment.
- Encourage work and professional organizations to support the ongoing professional development of the neonatal nursing workforce.
- Recommend that organizations offer scholarships or tuition reimbursement for neonatal nurses seeking advanced degrees.
- Actively recruit NNP faculty.
- Improve retention of new graduate NNPs and neonatal clinical nurse specialists (NCNSs) through detailed orientation, mentorship, and fellowship programs.
How are we doing?
Achieving these goals cannot lie at one person’s feet. It will take efforts from every NNP in all sectors to move the needle forward. Let our role’s current and future state serve as a call for us to collectively move beyond our comfort levels and be bold and determined in inciting change. We should take a moment to look inward, remember why we became NNPs, and reflect on what the role means to each of us individually.
The road ahead will not be an easily traveled one. Along the way, we must be willing and prepared to have many difficult conversations with unknowledgeable entities regarding our role and value to the healthcare team. Much must be done if the NNP role is to be saved. We must ask ourselves: Are we willing to sit by and let our role be pushed into irrelevancy?
To my neonatal nurse colleagues, please consider career advancement. I understand that many of you have bedside positions that are lucrative, deterring some of you from considering an advanced degree. Still, I encourage you to make it a professional goal.
To my NNP colleagues who show up every day in the trenches to teach current students and to the clinical areas, I thank you! I know it is not easy. But you matter, what you do for your patients and their families matters, and what you bring to this organization matters!
To my NNP colleagues who are considering retirement and those who may have left, if you are reading this, thank you! Thank you for pioneering this role and educating, precepting, and mentoring future and current NNPs. Job well done!
While this article has primarily focused on the NNP role, I would be remiss if I did not acknowledge our clinical nurse specialist counterparts. Thank you for all that you do in support of nurses and nursing practice and education and on the organizational and systems levels. I welcome your input and feedback and any contributions that you would like to make to our newsletter.
American Association of Nurse Practitioners. (2022, November). NP fact sheet. https://www.aanp.org/about/all-about-nps/np-fact-sheet
EveryNurse. (2023, February 19). Neonatal nurse practitioner (NNP). https://everynurse.org/careers/neonatal-nurse-practitioner/
National Association of Neonatal Nurses & National Association of Neonatal Nurse Practitioners. (2022, September). The state of neonatal APRN role and action for the future (Professional Practice Document No. 3077). https://nann.org/uploads/About/PositionPDFS/State_of_Neonatal_APRN_Role_and_Action_2022.pdf
Snapp, B., Moore, T. A., Wallman, C., & Staebler, S. (2021). 2020 Neonatal nurse practitioner workforce survey: An executive summary. Advances in Neonatal Care, 21(3), pp. 242–246. https://doi.org/10.1097/ANC.0000000000000903