Neonatal Nurse Practitioner is mainly focused on caring for infants (Tiniest Patient). Nurse provides specialized care and management of neonates particularly those who are premature or sick patients in Neonatal Intensive Care Unit (NICU) and intermediate care nurseries.
Neonate Definition
New born or neonate is a child under 28 days of age. This is the period which is crucial for child who is at highest risk of death. Neonates in NICU are premature and low birth weight. Premature infant’s system has not fully developed and adaptation to extrauterine life complicated.
Neonatal Patients
Patient in the neonatal intensive care unit (NICU) are preterm (37 week), term neonates infants and toddlers through 2 years of age. Patients suffered from chronic conditions as a result of complications of prematurity and neonatal patho-physiology.
Neonatal Nurse Responsibilities
Neonatal nurse is responsible to take care infants, it require specialized care and management of neonates particularly those who are premature or sick patients in the Neonatal Intensive Care Unit (NICU) and intermediate care nurseries. It also includes stabilization and management of ill infants.
NNP has additional education and training to provide advanced clinical skills, make critical management decisions, and facilitate consistent family-centered care as members of a multi-disciplinary team
NNP collaborates with program staff, attending physicians, and specialists to acquire and utilize best practice-evidence and resource needed for individual situations and to make adjustments and optimize program delivery.
NNP participates in program committees, quality improvement programs, and lead nursing research initiatives as well as providing education.
Nurse provides education to AHS personnel delivering neonate care through specific outreach programs (ACORN and NRP) or through organized events such as workshops and simulation.
NNP act in a preceptor capacity and provide mentorship to new NNP’s, NP students and other healthcare providers.
Qualifications for Neonatal Nurse Practitioner
Neonatal Nurse should be active or eligible for registration as neonatal nurse practitioner with the association of Registered Nurses of State Board.
They need permission to practice indicating child population (neonatal) stream of practice.
Nurses need to have current Basic Cardiac Life Support – Health Care Provider (BCLS – HCP)
Neonatal Nurse should have minimum of 3 years of full time (or equivalent number of hours) clinical experience as a NNP level III NICU experience.
NP needs to provide proof of active registration of NP practice permit with CARNA and to maintain registration throughout the duration of employment.
Additional Qualification Required
- Neonatal Resuscitation Program (NRP) Certification
- Experience with the development and/or implementation of evidence based practice. Experience with program development.
- Experience with clinical or scientific research
- Microsoft Office Suite Knowledge
SKILLS NEEDED FOR NNP
NNP need to have knowledge, skills, caring and compassion are all necessary competencies of nurses working in the neonatal intensive care (NICU)
NICU nurse to be able to anticipate, identify and manage these complications.
Types of Neonatal Nurses
Neonatal patients is served by two neonatal APRN roles – the neonatal nurse practitioner (NNP) and Neonatal Clinical Nurse Specialist (NCNS)
NCNS – Scope of Practice
Scope of Practice for NCNS involves collecting data relevant to the three spheres of influence: patient, nurse and system.
NCNS don’t provide direct patient care the majority of the time; will ensure the highest quality of care is provided to all patients and families.
Neonatal APRN – Scope of Practice
NICU rely on the neonatal APRN to play a vital role in caring for critically ill neonates. APRN participate in wide variety of complex patient care activities (includes all levels of neonatal inpatient care in both academic and community-based settings, transport, acute and chronic care, delivery room management; and outpatient settings.
This practice is multifaceted and includes integration of research, education, practice and management with a high degree of professional autonomy in independent or collaborative practice.
APRN need to have advanced health assessment skills, critical decision-making, diagnostic reasoning, and advanced clinical competencies.
Salary for Neonatal Nurse
Registered Nurse (RN) work in Neonatal Intensive Care Unit (NICU) average salary is $72,876 annually. Highest pay for Neonatal Nurse Practitioner is between range 60,570 to 123,285 $.
In California, Nurses earn more about 60.90$ per hours than the other states of America.
Top States Highest Paid Salary for Neonatal Salary
California – Annual Salary: $112,474
New York – Annual Salary: $110,298
Vermont – Annual Salary: $109,489
Maryland – Annual Salary: $105,652
Massachusetts – Annual Salary: $102,703
Nevada – Annual Salary: $101,793
West Virginia – Annual Salary: $100,480
Alaska – Annual Salary: $99,804
North Dakota – Annual Salary: $98,334
Idaho – Annual Salary: $98,859
Montana – Annual Salary: $98,469
Washington – Annual Salary: $98,190
Wyoming – Annual Salary: $97,001
Nebraska – Annual Salary: $96,953
Hawaii – Annual Salary: $96,386
Connecticut – Annual Salary: $96,205
Virginia – Annual Salary: $96,100
Pennsylvania – Annual Salary: $94,230
Arizona – Annual Salary: $94,189
Rhode Island – Annual Salary: $94,005
New Hampshire – Annual Salary: $93,749
Delaware – Annual Salary: $93,190
Louisiana – Annual Salary: $92,750
Oregon – Annual Salary: $92,461
Minnesota – Annual Salary: $91,093
South Carolina – Annual Salary: $90,986
Colorado – Annual Salary: $90,678
Iowa – Annual Salary: $90,270
Kansas – Annual Salary: $90,125
South Dakota – Annual Salary: $90,006
Tennessee – Annual Salary: $89,740
Indiana – Annual Salary: $89,550
Oklahoma – Annual Salary: $89,289
Kentucky – Annual Salary: $89,240
Ohio – Annual Salary: $88,908
Utah – Annual Salary: $88,387
New Jersey – Annual Salary: $88,156
Alabama – Annual Salary: $85,180
Wisconsin – Annual Salary: $83,593
Georgia – Annual Salary: $83,470
Texas – Annual Salary: $82,830
New Mexico – Annual Salary: $81,504
Maine – Annual Salary: $81,372
Michigan – Annual Salary: $81,297
Mississippi – Annual Salary: $81,200
Missouri – Annual Salary: $81,153
Illinois – Annual Salary: $79,483
North Carolina – Annual Salary: $79,192
Arkansas – Annual Salary: $78,900
Florida – Annual Salary: $78,248
Neonatal Nurse Role
Nurse provides a high standard of care for the neonate and family across the health continuum. Nurse possesses knowledge of the stages of fetal and neonatal development, the effects of maternal health, pregnancy, and birth on the developing fetus and neonate, and transition to extrauterine life.
Neonatal nurse is skilled in neonatal resuscitation and the care of neonates who are ill and/or premature.
Neonatal nurse care based on principles of developmentally supportive care (DSC), family centred care (FCC) and culturally sensitive care.
Strategies used by nurses are adult learning to teach, empower and share information to the family.
Nurse will be team up with collaborators and make interprofessional healthcare team, professional organizations, clinical practice facilities and/or academic institutions.
Neonatal Nursing Process
Nursing Process includes four domains of neonatal Nurses such as practice, education, research and leadership.
Neonatal nursing practice includes therapeutic care, health surveillance, health promotion, illness prevention, shared decision-making.
Nursing practice involves continuous assessment, is comprehensive and holistic, and uses all available and appropriate resources for the neonate and family.
Practice involves the identification of actual and potential problems, the evaluation of outcomes of care, and the continuous revision of the plan of care in response to changes in the neonate’s and family’s status.
Practice is collaborative within the interprofessional team.
Infant Acuity Levels Care
LEVEL – 1 Continuing Care
(Infant only requiring PO or NG feedings, occasional enteral medications, basic monitoring may or may not have a heparin locks for meds.)
LEVEL – 2 Requiring Intermediate Care
(Stable infant on established management plan, not requiring significant support. Examples: room air, supplemental oxygen, or low flow nasal cannula, several meds)
LEVEL – 3 Requiring Intensive Care
(Infant is stabilized, through requires frequent treatment and monitoring to assure maintenance of stability. Example: ventilator, CPAP, high flow nasal cannula, multiple IV meds via central and peripheral line)
LEVEL – 4 Requiring Multisystem Support
(Infant requires continuous monitoring and interventions. Example: conventional ventilation, stable on HFV, continuous drug infusions, several IV changes via central line)
LEVEL – 5 Unstable, Requiring Complex Critical Care
(Infant is medically unstable, and vulnerable, requiring much simultaneous intervention. Examples: ECMO, HFO, nitric oxide, frequent administration of fluids, medication)
Notes: PO – by month, NG – nasogastric, CPAP – Continuous Positive Airway Pressure, IV – Intravenous, HFV – High Frequency Ventilation, ECMO – Extracorporeal Membrane Oxygenation)
Shortage of NNP
There are huge shortage neonatal nurse practitioners in United States. Nurse and patient ratio is very less for level 4 and 5 nursing care compare to level 1, 2 and 3.
Acuity Level Patient-to-Nurse Ratio
Continuing Care 2.78
Intermediate Care 2.48
Intensive Care 1.92
Multi-system support 1.39
Unstable/complex critical care 1.04
Common Conditions in the NICU
These are common conditions of Infant requiring special care in NICU
- Intraventricular hemorrhage (IVH)
- Patent ductus arteriosus (PDA)
- Persistent pulmonary hypertension (PPHN)
- Apnea and Bradycardia
- Respiratory Distress Syndrome (RDS)
- Transient tachypnea of the Newborne (TTNB)
- Sepsis
- Necrotizing enterocolitis (NEC)
- Fluid and electrolyte balance
