Save the Babies: Teach NNPs

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Caroline Sweeney, RN, is a student in the neonatal nurse practitioner program at Thomas Jefferson University (TJU), Philadelphia. TJU is the flagship school for the Neonatal Education Consortium, which was formed to fill a need for NNPs throughout the tri-state region.
Photo courtesy of Thomas Jefferson University.

Neonatal Education Consortium was born of a mutual need among hospitals and schools of nursing to address the burgeoning infant mortality rates in the tri-state region.

Infants are dying at an alarming rate in the Greater Philadelphia/Tri-state region, especially among minority populations and communities without adequate health care services. Exacerbating this problem is the lack of neonatal nurse practitioners (NNPs) to care for critically ill infants.

The national infant mortality rate is 7.2/1,000 live births, which means more than seven out of every 1,000 babies die between time of delivery and 1 year of age. Most babies die of congenital birth defects, complications of prematurity/low birth weight, and sudden infant death syndrome (SIDS).¹ In the tri-state region, the infant mortality rate is two to three times the national average, with great disparities between African-American, Hispanic, and white populations.²

NNPs practice collaboratively with neonatologists and pediatricians to care for critically ill infants and their families, says Mary Bowen, CRNP, DNS, JD, CNAA, associate professor and director of the graduate program in the Jefferson College of Health Professions Department of Nursing. They primarily practice in level II and level III nurseries — hospital units set up to care for the sickest infants. Level II neonatal intensive care units (NICUs) treat infants who need more intensive monitoring and care than those in a regular newborn nursery but less intensive care than is given in level III NICUs, Bowen says.

“NNPs, who possess a variety of highly technical skills that provide support for all physiologic functions, play a crucial role in providing care within the acute care setting that will enhance the infant’s future physical and mental health,” says Susan Bakewell-Sachs, RN, PhD,APRN, BC, dean of the school of nursing at The College of New Jersey in Ewing, N.J.

Other NNPs work in health care clinics where infants’ growth and development are monitored. “The NNP is an important link between the mother and her baby, encouraging and nurturing the development of caregiver competency by providing parent education and support throughout the hospitalization and often through postdischarge care,” Bakewell-Sachs says.

The need for more NNPs became apparent at Thomas Jefferson University Hospital (TJUH), Philadelphia, about two years ago. “TJUH needs more NNPs because NNPs attend all high-risk deliveries and provide care in the NICU 24/7,” Bowen says. “NNPs go on high-risk neonatal transports, and ... are needed for more hours due to the decrease in hours pedatric residents are allowed to work by law.”

Neonatologist Jay Greenspan, MD, vice chairman of the department of pediatrics at Jefferson Medical College at Thomas Jefferson University, Philadelphia, approached Mary Schaal, RN, EdD, chair of the Department of Nursing at Jefferson College of Health Professions, with a plan to establish an NNP program at Jefferson.

Around the same time, Christiana Hospital in Newark, Del., contacted the University of Delaware seeking resources to educate more NNPs in that state. Christiana officials preferred that a program be available locally, so nurses did not have to leave the state to advance their careers.

“Delaware had a critical need for advanced practice nurses, and the need could not be met without sharing resources with Jefferson’s nursing faculty,” says Betty Paulanka, RN, EdD, dean of the College of Nursing at the University of Delaware.

Shortly thereafter, The College of New Jersey accepted an invitation to join the movement to educate NNPs, making it the first New Jersey school to offer an NNP program. Rural communities in southern New Jersey have some of the highest infant mortality rates, Bowen says, mirroring the need for NNPs in the tri-state area.

It was out of this mutual need that the Neonatal Education Consortium was born. “Getting three universities to agree to work collaboratively was a major coup,” Bowen says. The purpose of the consortium — funded by a grant of $650,997 over three years from the federal Department of Health and Human Services/Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing — is twofold. First, Bowen says, “to produce more culturally competent and sensitive neonatal nurse practitioners,” and second, “to increase health care [delivery], primarily to medically underserved populations in both rural and urban parts of Pennsylvania, Delaware, and New Jersey.”

Lower-income families with preterm babies, which often have special needs, tend to have a paucity of resources to draw upon, says Claire Lindberg, RN, PhD, APRN, BC, associate professor and chair of the Division of Advanced Nursing Education and Practice at The College of New Jersey. “These families can greatly benefit from early intervention by culturally sensitive NNPs who can play instrumental roles in helping their infants to grow and develop optimally,” Lindberg says.

Although the HHS grant was not designed specifically to measure whether the work of the consortium leads to a decrease in the infant mortality rates in the tri-state area, “because NNPs work collaboratively in a holistic paradigm with other members of the health care team, we would expect that having a greater number of them who could be involved in the care of high-risk infants and families would significantly improve medical, developmental and health outcomes,” Bakewell-Sachs says.

In fact, the American Association of Colleges of Nursing reports that nurse practitioners are more often the frontline health care providers. “Mounting studies show that the quality of NP care is equal to, and at times better than, comparable services by physicians, and often at lower cost,” the AACN reports. In one study, researchers at the University of Rochester, N.Y., reported that babies in ICUs who were cared for by NNPs stayed in the hospital an average of 2.4 days fewer and care cost $34,000 less than the care provided by medical residents. In addition, the babies cared for by the NNPs were younger and of significantly lower birth weight.³

“The shortage of neonatal nurse practitioners is reflective of the workforce nursing shortage, which is affecting academia, nursing administration, and all areas of clinical practice,” Bakewell-Sachs says. “Because our total pool of nurses is small, the NNP pool, which is composed of advanced practice nurses in a specialized field of care, is small as well.” There are very few graduate nursing programs that offer an advanced practice specialization in neonatology. Until the consortium was formed, the University of Pennsylvania School of Nursing in Philadelphia was the only such program in the tri-state region.

“The Neonatal Education Consortium is a trendsetting, timely, and efficient initiative. Because there is such a widespread nursing faculty shortage, a collaboration such as this one allows educational institutions to share resources and educate practitioners without having to send them out of state,” says Lisa Ann Plowfield, RN, PhD, professor and chairperson of the Department of Nursing at the University of Delaware.

“The nursing literature shows that … nurses tend to remain where they are educated,” Plowfield says. “This is good news for us, since we are hoping that our nurses will continue to work in the NICUs within our state once they have completed the program.”

Students take some of the core graduate-level courses (health policy, epidemiology, research, and others) at their home school, and then go to Thomas Jefferson University for the remaining clinical courses (Neonatal Practitioner I, II, and III). The 36-credit program includes 672 clinical practicum hours, and each student is precepted by an NNP and a neonatologist.

“Because this is a master’s program, potential program entrants must have a BSN, and we would prefer them to be experienced in the neonatal environment and to have some basic skills in working with neonates and mothers,” says Bakewell-Sachs. “We want people who already know that they are interested in becoming NNPs. ”The student’s home university awards the MSN degree. Full-time students can complete the program in 15 months, and part-time students might take two to four years. The curriculum meets National Association of Neonatal Nurses and National Certification Corporation (NCC) competencies for NNPs, and graduates of the program are eligible to sit for NCC’s Neonatal Nurse Practitioner examination.

NNPs are a critical link in the solution to America’s health care crisis, Bowen says. “The role of the NNP is to manage the health care needs of newborns/infants and their families,” she says. “The NNP makes independent and interdependent decisions in the assessment, diagnosis, management and evaluation of the health care needs of neonates and infants, and selects and performs clinically advanced diagnostic and therapeutic invasive procedures.”

Barbra Williams Cosentino, RN, LCSW, is a contributing writer for Nursing Spectrum.

References

1. Ten leading causes of infant mortality. Available at: www.marchofdimes.com/aboutus/1529.asp. Accessed Dec. 12, 2004.

2. Jefferson wins grant to reduce infant mortality in tri-state region establishing consortium to educate neonatal nurse practitioners. Available at www.jefferson.edu/main/news.cfm?durki=17963&site=1284&return=3869. Accessed Oct. 27, 2004.

3. “Nurse Practitioners: The Growing Solution in Health Care Delivery.” American Association of Colleges of Nursing, June 2000. Available at: www.aacn.nche.edu/Media/ Backgrounders/npfact.htm. Accessed Oct. 19, 2004.

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