A neonatal nurse practitioner (NNP) is an advanced practice nurse who diagnoses and treats infants with a variety of health problems, including prematurity, cardiac malformations, birth defects, infections, chronic illnesses, surgical complications, and other health issues.
According to the American Association of Nurse Practitioners (AANP 2015), neonatal nurse practitioners (NNPs) compose a tiny subgroup of NPs at 1.1 percent, but are also among the most experienced and satisfied with their jobs. By illustration, AANP (2015) reports that the average years of experience in this subspecialty is 16, much higher than the average years of experience among all NPs (10). It appears that NNPs are staying longer in this field than many of the others, and it’s not difficult to see why.
NNPs work with high-risk newborns—a subfield that can be both challenging and supremely rewarding—and are given generous privileges of practice depending on their state. AANP (2015) reports that in many northwestern and midwestern states, NNPs carry out many of the same duties as physicians, diagnosing illnesses and managing treatment plans without the approval of an overseeing physician. Other states—many concentrated in the south—may restrict the practice of NNPs and give doctors and other healthcare professionals the authority to supervise NNPs.
So how does a person become a NNP?
CareerOneStop (2015)—a data organization sponsored by the U.S. Department of Labor— reports that 77.8 percent of all NPs have master’s degrees, and another 12.7 percent have doctoral or professional degrees. While pursuing a master of science in nursing (MSN) may be the most common way to become a NNP, there is a new terminal degree for the profession on the rise: the doctor of nursing practice (DNP). The American Association of Colleges of Nursing (AACN 2015) recommends the DNP for the most comprehensive, advanced nursing practice training, especially for NNPs aspiring to top organizational or leadership positions. Graduates of MSN or DNP programs may be qualified to work in nurseries for newborns (level I), intermediate care nurseries (level II), or neonatal intensive care nurseries (level III).
Read on to discover how to become a NNP, including the required education and certifications, as well as what to expect from a NNP graduate program.
Here is the typical process for becoming a neonatal nurse practitioner (NNP):
1. Graduate from high school. Those seeking to work as NNPs are advised to excel in secondary school science courses, especially anatomy, psychology, chemistry, and biology. Also, students may want to consider volunteer work with neonates where available, assisting in clinics, hospitals, and other healthcare settings. This coursework and experience can prepare students for the college application process.
2. Pursue a bachelor of science in nursing (BSN) or a similar degree (4 years). While there are a variety of academic points of entry for NNPs (e.g., associate’s degrees, non-nursing bachelor’s degrees), many choose to pursue a BSN which fulfills course prerequisites in nursing. BSN programs typically feature courses such as health assessment, cultural variation & nursing practice, and clinical applications of anatomy & physiology. At this stage, students are advised to seek out nursing programs accredited by a recognized authority such as the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing, Inc. (ACEN). The selective accreditation process gauges program effectiveness, measuring quality of faculty, curricula, and facilities, among other factors. It’s important to seek out accredited programs not only to ensure that they deliver necessary nursing training, but also to qualify students for RN licensure through the NCLEX-RN exam (see below).
3. Become an registered nurse (RN) and get experience working with neonates (2 years). As part of associate’s and bachelor’s degrees in nursing, students typically receive training and earn RN licensure by passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). After that, NNPs must gain two years of RN experience working in level III neonatal intensive care units (NICUs), as all graduate NNP programs call for new students to have at least two years of such experience prior to entering the clinical portions of the program.
4. Pursue a graduate degree in nursing (1 – 3 years). After garnering healthcare experience working with newborns, NNPs typically pursue a graduate degree in nursing. As stated above, there are two main degrees—the master of science in nursing (MSN) and the doctor of nursing practice (DNP)—which may have flexible academic points-of-entry. For example, the University of California, San Francisco (UCSF) offers a master’s entry program in nursing (MEPN), a three-year program for applicants with bachelor’s degrees in a non-nursing major. As part of the curriculum, students become RNs through the didactic coursework, clinical hours, and testing (i.e., NCLEX-RN) which are generally completed by BSN students. After that, they can choose their MS specialty. Other programs such as the online NNP master’s program at East Carolina University admit experienced nurses who achieved a minimum 3.0 GPA in an associate’s degree nursing program. That said, a majority of graduate programs in nursing call for BSN-graduates. In NNP master’s programs, students take courses such as advanced pharmacotherapeutics, pathophysiology of human disease, and diagnostic reasoning & clinical decision-making for NNPs. As part of the programs, students complete at least 500 direct patient care clinical hours in a healthcare setting. Finally, admissions materials for graduate NNP programs may include:
5. Get certified by national and/or state nursing boards (timeline varies). After graduating from an MSN or DNP program, aspiring NNPs typically seek national and state-based certifications. The National Certification Corporation (NCC) offers a three-year, national neonatal NP certification. This certification allows NNPs to use the credential NNP-BC® (Neonatal Nurse Practitioner – Board Certified). Prerequisites for this certification include having a graduate NP degree from an accredited program; being an RN; and passing an exam within eight years of graduation from program. Certification is critical to being able to practice. In fact, the American Academy of Nurse Practitioners (AANP 2015) reports that 96.8 percent of all NPs maintain an active national certification. Finally, there are also local (i.e., state-based) nursing boards which license, register, and certify NPs. The National Council of State Boards in Nursing (NCSBN) provides a useful list of state boards of nursing.
6. Maintain NNP licenses, registrations, and certifications (timeline varies). Every three years, NNPs must renew their NCC national certification by completing a specialty assessment. This evaluation determined the number of required continuing education (CE) hours and subject areas where the NNP needs to brush up on his or her knowledge. The NNP will have to complete the CE as part of the recertification process.
Many practicing NNPs choose to join professional associations which provide a number of opportunities, including job boards, CE classes, networking events, conferences, seminars, and more. Here are some common associations for NPs and NNPs:
Online NNP programs may allow working NPs to fulfill direct patient care clinical requirements in a preceptorship close to his or her home. Courses may be completed online (or as a mix of web-based and on-campus work). These programs may be ideal for people at a distance from NNP schools or with commitments (e.g., parenting) that prevent them from attending campus-based program requirements.
Here are four featured online and hybrid NNP programs:
The University of Texas Medical Branch in Galveston provides an online NNP master’s program and boasts a 90 percent passing rate on the National Certification Corporation (NCC) NNP-BC® exam. This program gives students 780 hours of clinical experience and features courses such as innovations in community health practices, public policy, and pathophysiology. Students are required to travel to Galveston only once per clinical semester. Please note that applicants must have a BSN degree and two years of experience in a level III NICU to be eligible for admission.
Baylor University Louise Herrington School of Nursing in Dallas, Texas provides an online, CCNE-accredited, 75-credit DNP-NNP program for BSN graduates with two years of experience in a level III NICU. The NNP program is delivered in an online format incorporating both synchronous and asynchronous modalities, and requires 3 on-site campus visits (total). Baylor’s comprehensive curricula—including courses such as roles & business of the APRN, scientific inquiry, and clinical epidemiology—adheres to program guidelines established by the National Association of Neonatal Nurses (NANN). Baylor provides a unique curriculum that integrates faith and learning and an emphasis on under-served populations. A goal at Baylor is to educate NNPs to work in a global society. All students have an option to participate in missions, study abroad or complete an international DNP project in India, Africa, Hong Kong, or Vietnam. The spectrum of health from promotion of wellness to management of acute and chronic illness in a variety of settings is incorporated into the program. Baylor is a place where academic excellence and life-changing experiences ignite leadership potential that increases our students’ desire for wisdom, understanding of calling, and preparation for service in a diverse and interconnected society.
The University of Illinois, Chicago (UIC) has a unique, online DNP program for prospective NNPs interested in the superlative, terminal degree training in the field that may qualify them for future leadership positions. UIC gives instruction in areas such as advanced neonatal management (I/II/III), essentials of patient and family-centered care, and advanced training in pharmacology. Students can complete a majority of their academic classes online while completing their preceptorships close to their homes.
In addition to the online NNP programs, here are four featured schools for this subspecialty:
Emory University of Atlanta provides a master of science in nursing (MSN) program for aspiring NNPs, the only program of its kind in the state of Georgia. With advanced training for neonatal NP professionals in primary, acute, and critical care, Emory prepares its students with rigorous coursework (campus-based, hybrid, and online) and more than 700 hours of supervised clinical practicums. Finally, 82 percent of responding MSN graduates at Emory (2013-14) reported finding work immediately after completing the program in a post-program survey.
Northeastern University of Boston offers a MS in NNP to nurses with at least two years of experience in a neonatal intensive care unit (NICU), preparing students to provide healthcare in level II/III NICUs. Northeastern gives instruction in common neonatal diseases, early assessment, and nursing management & technology, rounding out the didactic instruction with ample hands-on experience around local hospitals and clinics (e.g., Massachusetts General Hospital, Beth Israel Deaconess Hospital, UMass Memorial Health Care).
The University of Rochester in New York hosts a NNP master’s degree program, offering an impressive 960 hours of hands-on supervised clinical training. Rochester’s renowned faculty gives students training in nursing care of high-risk neonates, ethics & public policy in healthcare, and advanced pharmacology. Please note that this school also has an accelerated program for non-nurses (APNN) for bachelor’s degree holders in other fields, provided they have completed prerequisite coursework.
The University of Indianapolis offers a NNP master’s program, a partnership between Indiana University’s School of Medicine and IU’s Riley Hospital for Children. It’s the only program of its kind in the state, with 690 required clinical hours and courses taught by experienced physicians. The core courses such as neonatal advanced pathophysiology, issues & policies in healthcare, and nursing research design & methodology are offered in online formats, although clinical courses are predominantly taught in a face-to-face format.
Finally, the National Association of Neonatal Nurses (NANN)—the group responsible for establishing “National Neonatal Nurses Day” on September 15—has a continually updated list of NNP programs available for prospective students in this growing subfield of nursing practice.
Students seeking neonatal nurse practitioner schools should look for programs accredited either through the Accreditation Commission for Education in Nursing, Inc. (ACEN) or the Commission on Collegiate Nursing Education (CCNE). The ACEN accredits diploma, certificate and degree-level programs in nursing, while the CCNE accredits baccalaureate programs, graduate-level programs and residency programs. Accreditation can be important for several reasons. First, it assures the student that they will find the needed rigor and quality in their program and have the training to be able to perform successfully in their field following graduation. Also, accreditation by be necessary for national certification and licensure. In fact, once nurses have completed an accredited NNP program, they may be eligible to sit for national certification available through the National Certification Corporation (NCC).
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