Neonatal nurse practitioner
The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (January 2020)
|Healthcare, advanced practice registered nurse|
|Master's degree or Doctorate degree|
|nurse midwife, nurse anesthetist, clinical nurse specialist|
A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a beside registered nurse in a level III NICU, who is prepared to practice across the continuum, providing primary, acute, chronic, and critical care to neonates, infants, and toddlers through age 2. Primarily working in neonatal intensive care unit (NICU) settings, NNPs select and perform clinically indicated advanced diagnostic and therapeutic invasive procedures. In the United States, a board certified neonatal nurse practitioner (NNP-BC) is an APRN who has acquired Graduate education at the master’s or doctoral level and has a board certification in neonatology. The National Association of Neonatal Nurse Practitioners (NANNP) is the national association that represents neonatal nurse practitioners in the United States. Certification is governed by the National Certification Corporation for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC).
The first modern day NICU opened in 1960 at Yale-New Haven Hospital under the auspices of Louis Gluck, a pioneer in the emerging pediatric specialty, neonatology. Dr. Gluck’s NICU concept demonstrated improved outcomes of sick and preterm infants and led to the emergence of NICUs across the country by the late 1960s. Most NICUs were located in large, university settings with patient management provided by medical interns and residents supervised by a neonatologist. To meet the needs of this vulnerable population, nursing roles expanded to include tasks previously relegated to physicians, such as initiating intravenous access and phlebotomy.
In 1965, the first nurse practitioner program in the United States was developed at the University of Colorado to prepare pediatric nurse practitioners for primary care. By the 1970s, neonatal intensive care was an integrated medical service in many large teaching hospitals across the country, providing successful management of the preterm and sick newborn and reducing the neonatal mortality rate. Neonatal transport services were established to move newborns from their birth facility to the nearest NICU, enabling expansion of the NICU nursing role as nurses filled these new positions. Guidelines published by the American Nurses Association (ANA) in 1975 set the NNP program standards until NANN published Education Standards and Guidelines for NNP Programs in 2002. These ANA standards led to the proliferation of hospital-based, certificate programs to train nurses as NNPs.
National certification for NNPs began in 1983 by the NAACOG Certification Corporation, now the National Certification Corporation (NCC) for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC). NANN was established in 1984, providing support to foster the neonatal advanced practice nursing movement.
In the 1990s, states began requiring national certification or master's degree as entry into practice for the NNP. In the early 2000s, nurse practitioners lobbied for prescribing privileges to make their provider status fully operational. In 2007, NANNP, a division of the National Association of Neonatal Nurses (NANN), was founded as the only national association dedicated solely to NNPs.
Today, neonatal APRNs are recognized as professional providers, and they have become an integral part of the neonatal health team at all levels of care. According to the NCC, there are presently approximately 5,200 NNPs with national certification. Fifty-two states and jurisdictions already require advanced certification for APRNs.
An NNP may have a Master’s and/or Doctoral degree from an accredited nursing school with a specialty in neonatology. Most states require a national certification through the National Certification Corporation (NCC) and must participate in continuing education to maintain the certification.
Following educational preparation at the master's or doctoral level, most states require NNPs to be certified board certified by an approved certification body. Board certification must be maintained by obtaining continuing nursing education credits. In the US, board certification is provided through the National Certification Corporation (awards the NNP-BC credential).
Scope of practice
The neonatal nurse practitioner provides specialized care for newborns with a wide range of acuity (level of illness) and conditions from prematurity, infections, genetic conditions, heart disease, surgical diagnoses, respiratory problems, and other disorders. NNPs primarily work in the hospital setting in well-baby nurseries, special care nurseries, neonatal intensive care units and the delivery room. Their specialized training allows them to provide individualized care to infants from the moment of delivery and from well babies to critically ill newborns . NNPs typically work in collaboration with Neonatologists and/or Pediatricians but (in most states) are licensed, independent providers who can diagnose and treat patients. NNPs have prescriptive authority and can prescribe medications as needed for the neonatal population (in most states).
- Honeyfield, M.E. (2009). "Neonatal nurse practitioners: Past, present, and future". Advances in Neonatal Care.
- Johnson, P.J. (2002). "The history of the neonatal nurse practitioner: Reflections from "Under the Looking Glass."". Neonatal Network.
- Trotter, C (1994). "Neonatal nurse practitioners: A descriptive evaluation of an advanced practice role". Neonatal Network.
- American Nurses Association. (1975). Guidelines for short-term continuing education programs for the nurse clinician in intensive neonatal care and the nurse clinician in intensive maternal-fetal care. Kansas City, MO.
- National Association of Neonatal Nurses. (2000). Position statement 2201: Advanced practice neonatal nurse role. Glenview, IL.
- National Association of Neonatal Nurse Practitioners. (2007). About NANNP. Retrieved from www.nannp.org
- Nagle, C. W., & Perlmutter, D. F. (2000). The evolution of the nurse practitioner role in the neonatal intensive care unit. American Journal of Perinatology, 17(5), 225–228.
- National Certification Corporation. (2013). Certification. Retrieved from www.nccwebsite.org/default.aspx
- National Council of State Boards of Nursing. (2013). APRN maps. Retrieved from www.ncsbn.org/2567.htm
- "Certification exams". NCC. Retrieved 12 January 2014.