How to Become a Neonatal Nurse Practitioner

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What do neonatal nurse practitioners do?

__Neonatal nurse practitioners (NNPs) minister to premature and sickly babies, one of the most vulnerable populations.__ They are trained to diagnose, treat, and medicate healthy or sick children ages 0 to 2. While many find work in NICUs, others work in well-baby or special-care nurseries as well as the delivery room, where anything can happen. They may work in collaboration with neonatologists and pediatricians. In most states, they are independent providers with the authority to write prescriptions.

Thinking about becoming a neonatal nurse practitioner?

In this article, we’ll cover:

• The history of neonatal care
• Why to become a neonatal nurse practitioner
• How to become a neonatal nurse practitioner
• Accredited online MSN programs for NNPs
• Licensure and accreditation for becoming a neonatal nurse practitioner
• Pros and cons of becoming a neonatal nurse practitioner
• Resources for becoming a neonatal nurse practitioner

How neonatal care has evolved

Only a century ago, premature and sickly babies were sent home from the hospital without any special interventions. Unsurprisingly, many never saw their first birthday. A conservative medical establishment was slow to embrace innovations that could have improved these chances; for nearly half a century, the only neonatal incubators to be found in New York City were at a Coney Island sideshow, where the tiny convalescing infants on display competed with sword-swallowers and a lion-faced man for customers’ quarters.

To get a feel for how dangerous it was to be born early, consider that Jacqueline Kennedy’s baby Patrick was born several weeks early in 1963. Patrick died a few days later from neonatal respiratory syndrome; this was the child of the First Lady, with access to the best care that money could buy. Patrick’s death elevated neonatal care in the national consciousness, and progress slowly followed. By the late 1990s, neonatal intensive care units (NICUs) were available for nearly every baby in the country.

Why become a neonatal nurse practitioner?

NNPs must stay strong for parents dealing with unexpected issues, including premature births, low birth weight, and congenital heart defects. NNP April Farmer learned firsthand how important this is when her own child was born prematurely. In a blog for The Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), Farmer writes about how the experience increased her empathy for suffering families who just want to take their little ones home. She learned how important it is to involve parents in simple acts, like allowing them to bathe their own babies, even in a hospital setting.

“As an NNP,” Farmer writes. “I’m used to making the decisions and caring for the patient. It’s hard to just sit back and feel so helpless. I felt like I had to put on a brave face because I worked in the NICU, but there were days I felt like I was falling apart. I was stressed, exhausted, and anxious.” In such difficult situations, NNPs have their educations, their instincts, and fundamental nursing and professional principles established by the National Association for Neonatal Nurses (NANN) to fall back on.

“What I love about the NICU is that premature infants are fighters,” Farmer writes. “I also love that from the beginning, each one of these little babies has their own personality. They cannot tell you when something is wrong; you have to depend on your assessment skills and their cues to figure out what they need.”

How to become a neonatal nurse practitioner

__If you’re already a registered nurse (RN) with at least a Bachelor of Science in Nursing (BSN), you can study to become an NNP. You can earn a master’s degree (MSN) or a doctorate (DNP) with a concentration in neonatology, or you can finish a two-year Advanced Practice Neonatal Nursing (APNN) program.

Note that many, but not all, schools expect you to have at least two years of current RN experience in a level III or higher NICU before starting their program. (On a four-level graded system, a level III NICU cares for very fragile or sick newborn babies.)

Expect to complete 40 or more credit hours, not including clinical course work, and finish a full-time curriculum in two to three years. DNP programs can take three to four years, with 80 or more credit hours. Part-time study, will, of course, take longer.

After graduation, you should be recognized as an advanced practice registered nurse (APRN) through the Boards of Nursing (BONs) and qualify to sit for the Neonatal Nurse Practitioner National Certification Exam (NNP-BC), which is offered through the National Certification Corporation (NCC).

The number and quality of distance-learning opportunities for all nurse practitioners are on the rise; these online experiences are supplemented with hands-on practice facilitated through local field placements.

Three accredited online MSN programs for NNPs:

• __School of Nursing at Northeastern University, Bouvé College of Health Sciences in Boston: Described on the program website as “a 100 percent online program,” this program offers student support that includes a clinical preceptor to help you with your clinical practicum. Upon graduation, you can make independent decisions in levels II or III NICUs. For experienced nurses who already have an MSN, this program offers a Certificate of Advanced Study (CAGS) in neonatal critical care. Two years experience in a level III or higher NICU is required for admission.
• __School of Nursing and Health Studies at the University of Missouri-Kansas City: This is a hybrid distance learning program, with a mandatory on-campus residency requirement every semester in order to complete clinical courses. Applicants must have two years of full-time clinical practice experience caring for critically ill neonates or infants within the last five years. A minimum BSN or MSN GPA of 3.2 on a 4.0 scale is required for admission.
• __College of Nursing and Health Innovation at the University of Texas Arlington: This program can be completed in five semesters by full-time students who start during the fall term; those who start in the spring take two years. This program requires two in-person simulation experiences, conducted on the UT-Arlington campus. Students are responsible for identifying board-certified NNPs in their area to serve as preceptors for the 600 hours of clinical in a level III or IV NICU.

Licensure and accreditation for becoming a neonatal nurse practitioner

After you finish NNP graduate, post-master’s, or DNP studies at an accredited school, you have eight years to take the NCC’s Neonatal Nurse Practitioner (NNP-BC) exam. The purpose of the certification is to allow you to provide care for “acutely and critically ill neonatal patients and their families” within hospitals or outpatient settings. The three-hour exam costs $325 and includes 175 multiple-choice items. NNPs should take this test every three years.

Subspecialty certifications

Specialty certifications include the Certificate Neonatal Pediatric Transport (C-NPT) and the Certification in Electronic Fetal Monitoring (C-EFMTM). Both of these two-hour NCC examinations qualify you for important duties, including moving a critically ill neonate and operating and interpreting data from electronic fetal monitoring devices.

Pros and cons of becoming a neonatal nurse practitioner

According to the American Association of Nurse Practitioners (AANP), there are about 270,000 NPs in the United States. Of that number, three percent work as NNPs, according to a 2017 report published in Advances in Neonatal Care.

So, what are the pros and cons of a career as a neonatal nurse practitioner?

Pros

• APRN employment is projected to grow 31 percent from 2016 to 2026, much faster than the average for all occupations, according to the Bureau of Labor Statistics. In a neonatal intensive care unit (NICU), an NNP is one of two types of advanced practice registered nurses (APRN) serving the neonatal population. The other kind is the neonatal clinical nurse specialist (NCNS).
• NNPs tend to earn six-figure salaries, with a national average starting salary of $99,000, according to a 2018 white paper written by NANNP. Salaries can increase based on experience, region, and workplace settings. For example, NNPs at independent or community hospitals make an average salary of $116,000. Those in multi-system networks or university centers earn an average of $118,000.
• Incentives include excellent benefits packages with retirement, health insurance, dental care, professional liability insurance, paid vacation, and life insurance.
• In a National Association of Neonatal Nurse Practitioners (NANNP) survey, 73 percent of NNPs reported career satisfaction.

Cons

• While 73 percent may seem like a high percentage, satisfaction decreased from its high of 85 percent in 2011, according to a 2018 NANNP white paper. Such decreased job satisfaction is a concern because it may lead to NNPs leaving the field.
• Many nurses feel they are not paid enough for what they do, nor are they working their preferred shifts. Among those NNPs who worked the day-to-night rotation, 48 percent wanted to be on the day shift. Meanwhile, 24 percent preferred 24-hour shifts.
• According to the NANNP white paper, 84 percent of all NNPs in the survey reported that they earned paid time off. Yet because of staffing and coverage issues, 70 percent stated they were too busy to take it. Better retirement benefits and more paid time off could be another way to keep NNPs satisfied.
• Satisfaction for these essential workers matters because of rising NNP vacancies. Historically, the number of NNPs “has rarely met the demand for services,” according to a 2016 article in Advances in Neonatal Care. Reasons for NNP shortages include static numbers of NNP graduates combined with fewer NNP faculty in these essential teaching programs.
• Other concerns include an increase in the number of NICUs and NICU beds in the U.S., where “growth in the supply of NICU care has outpaced the need,” according to American Journal of Public Health.

Resources for becoming a neonatal nurse practitioner

“It takes time and money to educate new NNPs,” says NNP Dr. Catherine Witt in Advances in Neonatal Care. “And it appears likely that supply will not keep up with the demand for a while. However, we cannot allow the supply issue to make us obsolete. We have to continue to be involved in issues of education and competency of providers, regulation of practice, and recruitment of new students.”

To help keep your skills sharp and your voice strong, here are four supportive resources for NNPs:

• National Association of Neonatal Nurses (NANN)__: Founded in California in 1984, this organization has developed a code of ethics, publications, and conferences dedicated to NICU nursing. Benefits include the APRN Membership Scholarship, which provides free membership and conference registration for new graduates.
• National Association of Neonatal Nurse Practitioner (NANNP)__: Founded in 2007 as a division of NANN, this organization is “the unified voice of neonatal nurse practitioners (NNPs) and neonatal clinical nurse specialists (CNSs).”
• National Certification Corporation (NCC)__: To become a board-certified neonatal nurse practitioner (NNP-BC), you must take this NCC exam. It’s offered by appointment only at designated test centers, Monday through Saturday at 9:00 a.m. and 1:30 p.m.
• Merenstein & Gardner’s Handbook of Neonatal Intensive Care 8th Edition: Considered the leading resource for newborn care, this must-have text book is in its eighth edition.

“We have to continue to demonstrate our value to nursing and to the families we serve,” Dr. Catherine Witt concludes. “We provide a service that cannot be duplicated by any other group. Now we just have to make sure everybody knows it.”

Questions or feedback? Email editor@noodle.com