Role of the Neonatal Nurse Practitioner in the Community Hospital

Super-Mentors to Train Multiple Neonatal Advanced Practice Providers: Pros and Cons

BACKGROUND

Despite available training programs for neonatal advanced practice providers (Neo APP), including neonatal nurse practitioners and physician assistants, it is difficult to meet the demand for these providers. There are no publications regarding training models with greater than 1 Neo APP learner per mentor.

PURPOSE

To create and measure outcomes of a 12-month program to educate Neo APP "Super-Mentors" able to train 2 Neo APP learners simultaneously.

METHODS

Super-Mentors were selected and attended monthly classes to learn mentorship concepts and receive support. Learners received didactic content and support through a Fellowship program. Quantitative data regarding recruitment and retention, as well as Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) results were compared pre- and postprogram. Qualitative satisfaction measures via survey from 21 stakeholders were analyzed through a phenomenological approach.

RESULTS

Six Super-Mentors trained 14 Neo APPs, as compared to 7 in the previous year. One Neo APP left after training. Summative preprogram MNPJSS scores were better (5.1 ± 0.37) than postprogram (4.7 ± 0.47) ( P < .001). The most important preprogram subscale item was "vacation" versus "quality of assistive personnel" postprogram. Both pre- and postprogram scores reflected positive job satisfaction so differences may not be clinically significant. Qualitative program benefits included faster and increased onboarding, stronger relationships, and dedicated time. Challenges included role clarity among other stakeholders, learning culture, and spacial/technological logistics.

IMPLICATIONS FOR PRACTICE

Super-Mentors can train twice the number of Neo APP learners, with optimal preparation and support of all stakeholders, adequate space, and appropriate technology.

Blood culture procedures and practices in the neonatal intensive care unit: A survey of a large multicenter collaborative in California

OBJECTIVE

To describe variation in blood culture practices in the neonatal intensive care unit (NICU).

DESIGN

Survey of neonatal practitioners involved with blood culturing and NICU-level policy development.

PARTICIPANTS

We included 28 NICUs in a large antimicrobial stewardship quality improvement program through the California Perinatal Quality Care Collaborative.

METHODS

Web-based survey of bedside blood culture practices and NICU- and laboratory-level practices. We evaluated adherence to recommended practices.

RESULTS

Most NICUs did not have a procedural competency (54%), did not document the sample volume (75%), did not receive a culture contamination report (57%), and/or did not require reporting to the provider if <1 mL blood was obtained (64%). The skin asepsis procedure varied across NICUs. Only 71% had a written procedure, but ≥86% changed the needle and disinfected the bottle top prior to inoculation. More than one-fifth of NICUs draw a culture from an intravascular device only (if present). Of 13 modifiable practices related to culture and contamination, NICUs with nurse practitioners more frequently adopted >50% of practices, compared to units without (92% vs 50% of units; P < .02).

CONCLUSIONS

In the NICU setting, recommended practices for blood culturing were not routinely performed.

Growing Neonatal Advanced Practice Providers via Mentorship Can Fill the Need: Program Description and Tool Kit

BACKGROUND

The need for neonatal advanced practice providers (APPs) has been described. Hospital training programs for neonatal physician assistants (PAs) have been developed by physicians. No publications exist about programs administered by neonatal APPs for both new graduate neonatal nurse practitioners (NNPs) and neonatal PAs.

PURPOSE

The purpose of this work was to mentor, train, and hire neonatal APPs in a program administered by neonatal APPs.

METHODS

We developed a 2-pronged approach to attract PAs and new graduate NNPs. Marketing strategies included receptions, information, and mentorship. A 12-month neonatal PA fellowship program included clinical mentorship and weekly didactics. Case-based presentations were provided by neonatal APPs, neonatologists, and allied professionals. The new graduate NNP program included clinical mentorship and monthly meetings with peer support, lectures, and case presentations. Neonatal APPs were clinical mentors. Team-building activities supported mentorship and collaboration among all care providers.

FINDINGS

In less than 5 years, 10 PAs and 11 new graduate NNPs have been trained and hired, as well as experienced neonatal APPs hired for this regional neonatology program. For the first time in years, locum tenens neonatal APPs are not required. We have developed a "tool kit" of content, activities, exercises, and evaluations to support successful attainment of expected competencies.

IMPLICATION FOR RESEARCH

Future studies can measure retention, satisfaction, and clinical outcomes.

IMPLICATION FOR PRACTICE

A successful training program has been implemented to meet the growing demand. We support the values of integrity, collaboration, and equity to facilitate this successful paradigm shift among all neonatal professional team members.

Fifty Years of Progress in Neonatal and Maternal Transport for Specialty Care

Specialty care for preterm and critically ill infants has evolved over many years. Neonatal intensive care nurseries were developed, and physicians and nurses learned how to provide intensive care for these infants. Neonatal and maternal (in utero) transport to tertiary centers became common in regionalized systems of care to facilitate the specialized care of high-risk neonates when childbirth occurred in settings without specialized personnel or equipment. Annually, nearly 70,000 neonatal transports occur in the United States. Although specialty care helps reduce rates of neonatal mortality, racial disparities and disparities between urban and rural areas exist. The purpose of this article is to review the progress achieved in neonatal and maternal transport over the past 50 years. The knowledge developed can be used to improve the care provided to women, their fetuses, and infants.

2020 Neonatal Nurse Practitioner Workforce Survey: An Executive Summary

BACKGROUND

The National Association of Neonatal Nurse Practitioners (NANNP) partnered with the National Certification Corporation (NCC) to invite all NCC-certified neonatal nurse practitioners (NNPs) to participate in a national survey on NNP compensation, workforce environment, and satisfaction measures.

PURPOSE

To understand the current NNP compensation, benefits, and workforce environment.

METHODS

An anonymous survey was sent to 6558 board-certified NNPs with 845 respondents.

RESULTS

Most of the survey respondents (92%) are in direct patient care (n = 804) with 83% (n=703) working full time (35 hours or more). Those NNPs with less than 5 years' experience had a mean salary of $119,000 per year while more experienced NNPs (30-plus years) earned a mean salary of $134,000 per year. Half of the NNPs (51%) report high satisfaction with their scope of practice and role in their organization. Distribution of NNPs throughout the workforce is suboptimal, with 67% of the administrators indicating they do not have enough NNPs.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The 2020 NANNP workforce survey collected information on NNP compensation, benefits, work environment, and experiences. It identified areas of satisfaction, such as compensation with bonuses and pay increases, and acknowledged areas needing improvement such as the lack of diversity within the profession. Utilizing the results of the survey will help create a more diverse, well-educated, and informed workforce to ensure culturally competent NNPs remain relevant within the healthcare system.