Evaluation of the Use of Neonatal Nurse Practitioners in Level I and II Neonatal Intensive Care Units

Neonatal Nurse Practitioners (NNPs) play a significant role in providing medical care for neonates in neonatal intensive care units (NICUs) across the United States. NNPs are employed in all levels of neonatal care due to their competence, skills, experience, and lower cost to hospitals and patients. Intermountain Healthcare employs NNPs in higher level III NICUs and one level IIB NICU. In all other Intermountain Healthcare NICUs on-call pediatricians provide this service. A NNP service providing 24 hour full-time coverage would meet all NICU needs and emergencies and could provide a cost savings while providing the same or greater level of neonatal care. Evaluation of NNP use in level I and II NICUs is needed to ensure quality care, reduced healthcare costs, patient satisfaction, and safety. The objective of this project is to compare Intermountain healthcare data from a level IIB NICU with 24 hour NNP service to another level II NICU without 24 hour NNP service according to select measures of cost, patient satisfaction, and safety. This data will then be shared with Intermountain Healthcare for possible expansion of NNP services to all levels of Intermountain Healthcare NICUs. A literature search was completed focusing on the current roles and value of NNPs in the areas of quality of patient care, reduced healthcare costs, and patient satisfaction. The review confirmed that NNPs are being used in all levels of neonatal care and that NNP care is equal to or better than that of other neonatal licensed independent practitioners. General wage information of NNPs and Pediatricians was obtained from the United States Bureau of Labor and Statistics to compare costs. This data indicated a $104,550 difference in wages between NNPs and Pediatricians. This suggests that NNPs are much less expensive to employ than Pediatricians providing the same level of neonatal care. Data was obtained from Intermountain Healthcare "Patient Perceptions of Quality" reports comparing patient satisfaction with NNP led care versus Pediatrician led care in Intermountain level IIB NICUs. This data showed NNP care ranking second out of four NICUs surveyed in "explaining things" and "skills and knowledge" and third out of four NICUs surveyed in "caring and concern". This confirms the results of previous findings in the literature review showing equal or better rating of patient satisfaction among neonatal services with increased involvement by NNPs. Additional data was obtained from Intermountain Healthcare databases to evaluate if 24 hour onsite NNP coverage improved patient safety in neonatal care. The data showed an increased NICU admission rate and a decreased rate of neonatal transport to a higher level NICU in the unit with 24 hour onsite NNP coverage when compared to other level IIB NICUs without 24 hour NNP service. This suggests that 24 hour NNP service not only helps identify infants requiring NICU admission, but improves safety by decreasing response time to life threatening emergencies and preventing complications that would require transport for a higher level of care. There is a continued need to evaluate NNP care as this could provide cost savings in all levels of NICU care. Through the use of NNPs in providing neonatal care, Intermountain Healthcare has the potential to reduce healthcare costs while obtaining the same or greater level of patient satisfaction and potentially improving patient safety at the same time. Further studies are needed to compare NNP care to those of other licensed independent practitioners on measures of cost, patient satisfaction, and safety.