Exploring the Role of the Neonatal Nurse Practitioner Beyond the NICU

Background: The Neonatal Intensive Care Unit (NICU) graduate is at an increased risk of morbidities and mortality after discharge from the acute care setting of the NICU. The lack of experienced healthcare providers with specialized training and knowledge of the NICU graduate creates gaps in follow-up care, medical management, and collaborative care efforts between the acute and continuity care settings. Neonatal Nurse Practitioners (NNP) are educated and trained to medically manage the complex healthcare needs of the NICU graduate in the community and/or primary care settings, from birth through the first 2 years of life. Empowering NNPs to practice to their full education, training, and certification could improve the health outcomes of NICU graduates by providing a continuation of care, reduce parental anxiety, decrease the rate of emergency room visits and hospital readmissions, and provide safe and cost-saving health care management. Methods: A needs-based assessment project was developed to identify the experience and confidence levels of pediatric healthcare providers, in Salt Lake City, in caring for the NICU graduate in the community setting and to present the roles and responsibilities of the NNP beyond the setting of the neonatal intensive care unit. A survey questionnaire was sent, via email, to Pediatricians, Family Physicians, and Pediatric & Family Nurse Practitioners in the primaryand community settings. Survey questions were developed to assess pediatric providers' attitudes, opinions, and perceptions of caring for the NICU graduate and their support of a collaborative healthcare management model with an NNP in the community setting. Ninety-six surveys were distributed and a total of 14 providers, 92% of respondents were medical MDs/DOs and 8% were Advanced Practice Registered Nurse (APRN), completed the survey. Results: Of the respondents, 85% have or currently provide medical management for patients who were born less than 35 weeks gestation and required admission to the neonatal intensive care unit. Confidence in managing the complex medical care and needs of the complex NICU graduate was highest in the categories of managing the diseases, disorders, and issues of the NICU graduate, prescribing and managing medication and medical devices, providing caregivers with referrals and/or community resources, educating parents/caregivers about current and future issues of the complex NICU graduate, managing parental stress and collaborating with specialized healthcare providers. Overall, 82%(n = 9) of respondents would collaborate with and support the role of the NNP in the community care setting.Conclusion: The survey provides preliminary information on the attitudes of pediatric care providers and the role of the NNP beyond the neonatal intensive care setting. More research is needed to assess the attitudes of other healthcare providers, parents and caregivers who provide care to the NICU graduate, throughout the United States.