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.

Respiratory Syncytial Virus Disease: Immunoprophylaxis Policy Review and Public Health Concerns in Preterm and Young Infants.

Globally, respiratory syncytial virus (RSV) is a leading cause of hospitalization due to severe respiratory infections in infants of all gestational ages and children aged 5 years and younger, and it is associated with a substantial health care burden. Approximately, 1% to 3% of infants younger than 1 year are hospitalized with severe RSV disease in the United States. With no specific treatment or vaccine, palivizumab is the only licensed immunoprophylaxis for the prevention of severe RSV disease in high-risk pediatric populations, including infants born at or before 35 weeks' gestational age (wGA). In the United States, the American Academy of Pediatrics (AAP) periodically publishes its recommendation for the use of RSV immunoprophylaxis, which is largely followed by health care professionals and payers. In 2014, the AAP Committee on Infectious Diseases stopped recommending RSV immunoprophylaxis for otherwise healthy infants born at or after 29 wGA and stated that the RSV hospitalization rates in infants 29 to 34 wGA and full-term infants were similar. Several studies have demonstrated that a significant decline in palivizumab use following the AAP 2014 recommendations was accompanied by increases in rates of RSV hospitalization and disease severity and hospital costs in infants 29 to 34 wGA versus full-term infants. Despite the growing evidence demonstrating high RSV morbidity in infants 29 to 34 wGA, the AAP reaffirmed its 2014 policy in 2019. This article will discuss the critical roles and strategies of advocacy groups and nurses in providing the maximum protection with RSV immunoprophylaxis to all high-risk and label-eligible preterm infants.

2016 Neonatal Nurse Practitioner Workforce Survey: Report of Findings.

The National Association of Neonatal Nurse Practitioners (NANNP) conducted its second workforce survey of certified neonatal nurse practitioners in the fall of 2016. National Association of Neonatal Nurse Practitioners partnered with the National Certification Corporation and the American Association of Nurse Practitioners to conduct this electronic survey, containing 69 questions and focusing on practice sites and total compensation packages (including benefits) and workforce deficits.Findings indicate a rising neonatal nurse practitioners (NNPs) position vacancy rate across the country. Regional salary data indicated that the southeast had lower compensation rates for NNPs, with regions 4 and 11 (South) having the lowest rates. A promising trend indicated that new graduate NNPs with a doctorate are earning more. The study findings indicate that tailoring benefit packages to the age and years of experience for the individual NNP may aid in recruiting and retaining NNPs in practice. For experienced NNPs, altered shift lengths (shorter), higher employer matching rates in retirement plans, and less employee cost sharing for health insurance benefits are more appealing strategies.It is critical for NNPs to continually evaluate the profession's workforce data. There are more than 205,000 nurse practitioners practicing in the United States, with neonatal NPs making up approximately 3% of the larger whole. Increased participation in future surveys will assist in creating sustainable solutions to the workforce crisis facing the profession.

Evaluation of the Financial and Health Burden of Infants at Risk for Respiratory Syncytial Virus.

BACKGROUND: Respiratory syncytial virus (RSV) is the leading viral cause of death in infants younger than 1 year. In July 2014, the American Academy of Pediatrics (AAP) Committee on Infectious Diseases concluded that the "limited clinical benefit" for infants born at more than 29 weeks' gestation, together with the associated high cost of the immunoprophylaxis, no longer supported the routine use of palivizumab (Synagis). PURPOSE: To evaluate the impact of the newly adopted AAP palivizumab prophylaxis administration on health and subsequent hospital costs of infants born between 29 and less than 32 weeks' gestation. METHODS: A retrospective cohort analysis from a single institution across the duration of the study comparing the clinical and financial outcomes of infants (aged < 32 weeks) treated under the 2009 AAP guidelines (PRE) and infants (aged >29 weeks) managed after the 2014 AAP guidelines (POST) took effect. RESULTS: RSV-positive admissions were greater in the POST cohort versus the PRE cohort (P = .04). There were no readmission deaths due to RSV infection in either cohort. The number needed to treat to avoid a single RSV-positive hospitalization was 20 infants at an estimated palivizumab cost of $90,000 to avoid an estimated hospital cost of $29,000. IMPLICATIONS FOR PRACTICE: Assessment of individual risk factors and their ability to predict severe RSV risk/disease, thus, would allow providers greater flexibility in determining need for prophylaxis therapy. IMPLICATIONS FOR RESEARCH: Longitudinal evaluation of financial and clinical outcomes is needed to determine the impact of the 2014 AAP revised regulatory guidelines.

The Future of Neonatal Advanced Practice Registered Nurse Practice: White Paper.

In recent years, the National Association of Neonatal Nurses and the National Association of Neonatal Nurse Practitioners have been monitoring aspects of neonatal advanced practice nursing and providing leadership and advocacy to address concerns related to workforce, education, competency, fatigue, safety, and scope of practice. This white paper discusses current barriers within neonatal advanced practice registered nurse practice as well as strategies to promote the longevity of the neonatal advanced practice registered nurse roles.

National Association of Neonatal Nurse Practitioners (NANNP) Workforce Survey.

BACKGROUND: As an integral member of a healthcare team, neonatal nurse practitioners (NNPs) provide care in a variety of settings that include but are not limited to all levels of inpatient care, transport, acute and chronic care settings; delivery rooms; and outpatient care settings. Anecdotal evidence indicates that responsibilities, practice environment, and workload vary widely between regions and practice settings. PURPOSE: Historically, the supply of neonatal nurse practitioners has rarely met the demand for services, although needs vary by region at any given time. Because the NNP role is a collaborative one, a shortage of NNPs leaves a gap in the team approach to care. In 2011, the National Association of Neonatal Nurse Practitioners (NANNP) commissioned the first national study of the current NNP workforce in the United States and Canada. In an effort to further explore the NNP workforce population, the NANNP Council partnered with the National Certification Corporation to perform a second workforce survey of NNPs in the spring of 2014. FINDINGS/RESULTS: The online survey was conducted between March and April 2014. The goal of the study was to describe the demographics, practice environment, scope of responsibilities, benefits and reimbursement, and job satisfaction for the current NNP workforce. IMPLICATIONS FOR PRACTICE/RESEARCH: Key areas of concern identified by the 2014 Neonatal Nurse Practitioner Workforce Survey include an aging workforce; the need for NNP faculty; inadequate staffing ratios; the lack of downtime during prolonged shifts; and the need to assisting practices in developing competency and mentoring programs.

Enteral feeding misconnections in the NICU: a continuing patient safety threat.

Although the first case of tubing misconnection was reported in 1972, this patient safety issue received little national attention until The Joint Commission issued a Sentinel Event Alert in the spring of 2006. This was followed by a "Money and Policy" article in the New York Times in the summer of 2010 that initiated a public awareness outcry against the healthcare system's delayed responsiveness in creating fail safe solutions. Since that time, many manufacturers have devised oral syringes, feeding tubes, and feeding "systems" for patients in the neonatal intensive care unit, but these devices' ability to minimize risk is not well delineated. This article reviews the history of tubing misconnections and provides an in-depth look at current recommendations for manufacturing and device design, human factors contributing to misconnections, and specific strategies for minimizing patient safety risk.

Regionalized systems of perinatal care: health policy considerations.

Over the past 2 decades, perinatal and neonatal health care has become less coordinated and more competitive in the United States. The impact at the state level has been the evolution of a fragmented, perinatal system with limited access and poorer outcomes. The evidence demonstrates lower mortality risk for very low-birth-weight infants born in designated tertiary centers. Regionalized systems of perinatal care are recommended to ensure that each mother and newborn achieve optimal outcomes. This article discusses the factors impacting implementation of this model at either the state or federal level as well as the incorporation of perinatal regionalization as part of the national agenda of health care reform.

An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting.

BACKGROUND: Perceptions of autonomy in practice affect Neonatal Nurse Practitioner (NNP) job satisfaction, retention, and motivation to pursue NNP roles. However, Novice to Expert theory describes the processes for transitioning to nurse practitioner roles are not in relationship with NNP practice autonomy. PURPOSE: Relationships between Advanced Practice Registered Nurse (APRN) practice authority, state restrictions, APRN volume, and health care access exist. However, do APRN perceptions of autonomy relate to motivation to pursue practice authority? This study provides an exploration of perceptions of NNP practice autonomy in this context. METHODOLOGY: Semistructured interviews conducted with NNPs and neonatologists practicing in a restricted setting explored perceptions of practice expertise and autonomy, based on Patricia Benner's Novice to Expert theoretical framework. Laddered methodology organized survey questions, and the Framework Method was used for analysis of results. RESULTS: The majority of eligible NNPs (n = 12, 67%) and neonatologists (n = 8, 67%) agreed to study participation. Identified themes were grouped into larger concepts, including "NNP practice authority," "NNP expertise," and "NNP autonomy." For example, "NNP expertise" included the theme "determining NNP expertise" and associated factors included "procedural skills," "years and acuity of practice level," and "confidence in management plan and emergent situations." CONCLUSIONS: Both neonatologists and NNPs perceived neonatologists as a practice authority with support for NNP autonomy. Factors indicating NNP expertise correlated with domains in Benner Novice to Expert theory. IMPLICATIONS: These findings support previous work concerning the evolution of expertise and transition to practice. More inquiry to understand perspectives of APRNs in restricted practice settings is indicated.

Supporting program rigor in newly developed specialty academic programs: Use of a self-evaluation reporting tool for emergency nurse practitioner academic programs.

The emergency nurse practitioner (ENP) specialty has grown rapidly, responding and adapting to changes in emergency care. Designation and advancement of nurse practitioner (NP) specialties follows a systematic process as defined by the profession. This includes establishment of scope and standards of practice, educational standards, and policy initiatives to ensure quality and safety within the profession. This article serves to detail a process of self-evaluation for newly developed ENP academic programs, including resources and key documents to be considered in the development of NP specialty programs. A transformative tool is included that serves as a model for use in development and self-evaluation of other emerging graduate academic NP specialty programs.

Policy and political advocacy: Comparison study of nursing faculty to determine current practices, perceptions, and barriers to teaching health policy.

PURPOSE: To better understand policy/advocacy concepts and methodology utilized in all levels of nursing educational programs and develop clarity concerning structure of policy content and integration across all levels of education. DESIGN AND METHODS: Cross-sectional analysis of data obtained from a survey sent to 19,043 nursing faculty in the United States; 598 total responses; 514 complete responses. Quantitative data points were analyzed using SPSS and qualitative data was grouped and analyzed by theme. FINDINGS: Barriers and perceptions of student engagement and student learning outcomes along with institutional and faculty development barriers were explored in baccalaureate, masters, and doctoral level nursing programs. Thirty-six percent of respondents reported having experience in development and implementation of policy, ranging from local to international spheres and 21% reported active involvement in current state and federal policy development. Seventy percent of respondents have advocated for the nursing profession through professional organizations while 44% report current activity in legislative advocacy. CONCLUSIONS: The value of nursing policy education, advocacy, and analysis must be valued in higher education.