Growing the Neonatal Nurse Practitioner Workforce Through Mentoring: A Scoping Review.

OBJECTIVE: The purpose of this article is to highlight evidence specific to the neonatal nurse practitioner (NNP) workforce related to successful mentoring programs. Specifically, the authors of this article explored recent evidence of mentorship to improve job satisfaction and retention of the NNP workforce. BACKGROUND: NNPs are valuable members of neonatal healthcare team. Because of the aging NNP workforce, methods to recruit, train, mentor, develop, and retain new NNPs are imperative. METHODS: Using a quality appraisal tool from the PRISMA extension for scoping reviews, articles were identified through electronic database searches using search terms related to mentoring, nurse practitioners, recruitment, and retention. Studies published in English between 2013 and 2023 were included. Peer-reviewed quantitative and qualitative articles were synthesized and critically appraised by 4 reviewers. RESULTS: The authors identified 46 articles with a focus on mentoring in nursing of which 12 articles include mentoring for nurse practitioners. Research indicates that mentoring relationships are valuable in many healthcare roles and professions. Evidence is limited indicating the impact of mentoring in the highly specialized role of the NNP. CONCLUSION: Mentoring is an invaluable component of professional nursing and counters incivility while advancing competency, job satisfaction, and retention. Additional research is needed regarding NNP-specific mentoring programs.

Development and evaluation of a neonatal nurse practitioner mentoring workshop.

ABSTRACT: New graduate neonatal nurse practitioners (NNPs) need more than an orientation; they need mentoring to facilitate successful role transition and enhance job satisfaction. A gap exists in the literature about mentoring participant training and launching of successful programs for NNPs. This article provides an overview of the development and evaluation of a nurse practitioner (NP) mentoring workshop before the start of a formalized mentoring program. Workshop participants attended a half-day education event with an emphasis on mentoring program expectations, mentor and mentee roles, and effective communication. After the workshop, participants completed an electronic survey to evaluate satisfaction with the teaching and areas for improvement. From January 2022 through January 2023, newly hired NPs paired with experienced NP mentors participated in this structured workshop. Twenty-eight participants in two cohorts evaluated the workshop to identify meaningful aspects of the presentations and areas for improvement. Participants reported high levels of satisfaction with the interactive components of the 4-hr workshop. An interactive mentoring workshop helps participants establish realistic expectations and mutual goals. Further study is needed to identify time- and cost-efficient strategies in the preparation of effective mentoring participants to enhance the quality of mentoring programs.

Neonatal Assessment: Put Your Best Foot Forward.

BACKGROUND: Assessment of the foot is an essential part of the newborn examination. Foot abnormalities range from an isolated deformity due to intrauterine positioning to a functional impairment due to a structural malformation. The purpose of this article is to review assessment, abnormal findings, and current treatment options of common foot deformities. EVIDENCE ACQUISITION: A review of literature was conducted using keywords in PubMed, Google Scholar, and CINAHL databases from 2018 to 2023. RESULTS: Although assessment techniques for the neonatal foot remain the same, recent nonsurgical treatment options are available for a variety of neonatal foot deformities. Early recognition allows for proper evaluation of foot deformities and corrective measures. IMPLICATIONS FOR PRACTICE AND RESEARCH: Neonatal providers equipped with knowledge of common foot problems can provide support and anticipatory guidance to families.

Preceptors and the New Neonatal Nurse Practitioner Educational World.

The need for neonatal nurse practitioner (NNP) preceptors has never been greater. Precepting is a professional responsibility with both rewards and challenges. The recent pandemic has brought about new challenges, not the least of which is burnout from clinical, learner, and environmental demands. A new educational model from the American Association of Colleges of Nursing and the National Task Force outlines educational and preceptor requirements aimed at improving the advanced practice educational experience for students and preceptors. Available research provides evidence of what preceptors value and how to develop best practices with academic institutions to advocate for their students. This article will discuss new nursing educational models and the role of the NNP preceptor and analyze current best practices in preceptor recruitment and retention while discussing national trends impacting personal and professional NNP practices.

Neonatal Fragile Skin: Novel Use of Simulation to Improve Knowledge and Confidence for Neonatal Nurse Practitioner Students.

BACKGROUND: Infants with fragile skin pose challenges to neonatal providers, including the difficult nature of securing lifesaving devices. A paucity of information exists supporting best simulation practices in educating neonatal nurse practitioner (NNP) students on how to care for infants with fragile skin. PURPOSE: To evaluate whether simulation improved student knowledge and self-confidence related to caring for infants with fragile skin. METHODS: This quality improvement project included a pre/posttest survey with a sample of 14 NNP students. Participants practiced application of a multilayered dressing to secure a catheter to a neonatal manikin. Knowledge and self-confidence were measured before and after simulation. RESULTS: Correct responses on posttest survey knowledge items increased along with students' confidence ratings following simulation. Students reported high levels of satisfaction with the simulation experience. CONCLUSIONS: Simulation of caring for fragile skin allows NNP students the opportunity to improve self-confidence, knowledge, and performance of a necessary skill for NNPs.

Perceptions of motivating factors and barriers to precepting.

BACKGROUND: Advanced practice registered nurses (APRNs) and physician assistants (PAs) are integral to health care delivery in the United States. However, the cultivation of APRNs and PAs relies heavily on the model of precepting. Advanced practice registered nurses and PAs frequently precept students or new hires, yet limited data are available to describe the motivations, incentives, and barriers associated with precepting. PURPOSE: The purpose of this mixed-method, cross-sectional study was to better understand APRN and PA preceptors' perceived levels of support during precepting, facilitating factors, and barriers to the precepting process. METHODS: An electronic survey was distributed via REDCap to a convenience sample of APRN and PA preceptors at an academic medical center. Data collected from the survey were analyzed using both descriptive statistics and qualitative thematic analysis. RESULTS: One hundred fifty-four participants completed the survey. Motivating factors for precepting included "giving back" to the profession, and barriers included inadequate time to precept while in the clinical role. Participants indicated that financial incentives, heightened communication, protected teaching time, preceptor training, meaningful recognition, and organizational support could enhance the precepting process. CONCLUSION: This study demonstrated that altruistic intentions frequently motivate APRN and PA preceptors, however, navigating multiple clinical responsibilities while precepting serves as a barrier to the precepting process. Preceptor training, ongoing education, dedicated time for precepting, enhanced communication, and organizational or professional incentives may optimize the APRN and PA precepting process. IMPLICATIONS: Further research should focus on how to optimally incorporate education, professional development, support, and incentives into the APRN and PA preceptor role.

Fluid and Electrolyte Management in the Neonate: Potassium and Phosphorus.

Maintenance of electrolyte balance in the neonate is challenging in the context of illness or prematurity. Imbalances in potassium and phosphorus can occur in neonates, ranging from benign and clinically insignificant to those that can be life-threatening. An individualized approach to fluid and electrolyte management is based on the neonate's gestational age, day of life, maintenance needs, deficits, and ongoing losses. This article reviews normal and abnormal potassium and phosphorus values along with management strategies. Using a case scenario, the reader can apply concepts outlined in this article to management of critically ill neonates with electrolyte disturbances.

Evaluation and Nonsurgical Treatment of Neonatal Ear Anomalies: A Case Report.

BACKGROUND: Inspection and evaluation of the neonate's ears are important parts of the neonatal examination. Neonates display a wide variety of ear size and configuration. In many cases, ear molding techniques obviate the need for future surgical correction. This article provides a review of the fetal ear development and describes common physical examination findings of the newborn's external ear. A case report reviews a successful nonsurgical treatment of a minor ear deformity. CLINICAL FINDINGS: Newborn infant with near absent to very thin bilateral helical rims and otherwise normal bilateral ear shape and structures. PRIMARY DIAGNOSIS: Bilateral Stahl's ear deformity. INTERVENTIONS: The EarBuddies product was applied to bilateral ears in an outpatient pediatric plastic surgery clinic. This product remained in place for 8 weeks. OUTCOMES: The family was pleased with the overall progress and shape of their child's ears. At 18 months of age, the family has no desire to pursue surgical correction of their child's ears. PRACTICE RECOMMENDATIONS: Assessment of the newborn's external ear is part of a routine admission examination. Careful attention to abnormal or unusual findings allows for prompt evaluation and nonsurgical intervention.

Fluid and Electrolyte Management in the Neonate: Sodium and Chloride.

Maintenance of electrolyte balance in the neonate is a challenge in the context of illness or prematurity. Neonatal providers' approach to fluid management changes and adapts based on the newborn's age, maintenance needs, deficits, and ongoing losses. Understanding the total body water content of the fetus and newborn is foundational to management of electrolyte disturbances. This article reviews common imbalances of sodium and chloride, identifies causes of imbalances, and discusses current evidence-based treatment options.

Examining Job Satisfaction and Intent to Stay for Neonatal Nurse Practitioners: The Impact of Mentoring.

BACKGROUND: In 2017, the National Association of Neonatal Nurse Practitioners (NANNP) recommended that organizations implement formalized mentoring programs for neonatal nurse practitioners (NNPs). There is significant evidence to support that mentoring positively impacts nurse practitioners' job satisfaction and retention. However, there is a lack of evidence-based literature specific to NNP mentoring. PURPOSE: Determine the impact of participation in the NANNP formalized mentoring program on job satisfaction and retention for novice and experienced NNPs in an academic medical center in Tennessee. METHODS: This quality improvement project utilized a secure online survey that included the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and 2 intent-to-stay items prior to implementation of a 6-month mentoring program. Neonatal intensive care unit nurse practitioners completed the same electronic survey at 3 intervals after program implementation to determine the impact of the mentoring program on job satisfaction and intent to stay. RESULTS: Project results identified a significant difference in MNPJSS scores for participants in a 6-month formal mentoring program using the NANNP tool kit. The MNPJSS scores moderately correlated with intent to stay at 1 year and strongly correlated with intent to stay at 3 years. IMPLICATIONS FOR PRACTICE: The results of this project support the positive impact of a formalized mentoring program on job satisfaction for new graduate nurse practitioners. Recognizing the challenge to recruit and retain NNPs, organizations should explore creative solutions to develop and support formalized mentoring programs. IMPLICATIONS FOR RESEARCH: Further research is warranted to validate use of the NANNP tool kit in the establishment and evaluation of a formalized mentoring program.Video abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .

Utilization and Meaningfulness of National Association of Neonatal Nurse Practitioners' Mentoring Toolkit Activities.

BACKGROUND: Mentoring is a process in which a more skilled or experienced person builds a supportive relationship with a less experienced person to promote the latter's professional development. The National Association of Neonatal Nurse Practitioners (NANNP) supports the establishment of formalized mentoring programs for neonatal nurse practitioners (NNPs) and published a mentoring toolkit in 2017. Completing suggested activities outlined in the toolkit promotes the incorporation of evidence-based practice into the NNP professional role. PURPOSE: This quality improvement project's purpose was to measure utilization and meaningfulness of NANNP mentoring toolkit activities. METHODS: A convenience sample of 21 nurse practitioners was paired in 2 mentoring cohorts. Dyads were encouraged to meet monthly to complete NANNP mentoring toolkit activities in the context of a formalized mentoring program. Monthly data were collected to evaluate use and meaningfulness of the toolkit activities. Quantitative data included frequency and length of mentoring meetings, activities completed, and ratings of meaningfulness on a Likert-type scale. RESULTS: Six of the 9 (67%) NANNP mentoring activities completed by the 2 cohorts were rated as "meaningful" or "very meaningful" by participants. IMPLICATIONS FOR PRACTICE AND RESEARCH: Activities from the NANNP mentoring toolkit provide structure to mentoring relationship development. Recognizing the challenge to recruit and retain NNPs, organizations are encouraged to explore creative solutions to develop and support formalized mentoring programs. Further research is warranted to validate use of NANNP toolkit activities in the establishment and evaluation of a formalized mentoring program in various neonatal intensive care unit settings.

Neonatal Hypocalcemia in the Infant of a Diabetic Mother.

Neonatal hypocalcemia (NHC) is one of the most common disorders of calcium metabolism in infants admitted to the NICU. Presentation can range from asymptomatic to generalized seizures or tetany. In this case study, an infant with NHC is presented along with an overview of the pathophysiology, prevalence, diagnosis, and management of NHC for neonatal clinicians.

Mentoring New Graduate Nurse Practitioners.

There is a critical shortage of neonatal nurse practitioners (NNPs) in the United States. The NNP shortage increases workload and negatively affects job satisfaction, which ultimately impacts patient safety. Therefore, it is imperative to identify strategies to improve job satisfaction and retention. Authors of current evidence supported the connection between mentoring and role transition, job satisfaction, and intent to stay. Mentorship is key to the success of new graduate nurse practitioners as they develop confidence in the nurse practitioner (NP) role. The aim of this integrative review is to examine the existing evidence regarding mentoring of advanced practice nurses and the potential impact on the NNP workforce.

Efficacy and Social Validity of Peer Network Interventions for High School Students With Severe Disabilities.

This randomized controlled trial examined the efficacy of peer network interventions to improve the social connections of 47 high school students with severe disabilities. School staff invited, trained, and supported 192 peers without disabilities to participate in individualized social groups that met throughout one semester. Compared to adolescents in the "business-as-usual" control group (n = 48), students receiving peer networks gained significantly more new social contacts and friendships. Although many peer relationships maintained one and two semesters later, their spill over beyond the school day was limited. Students and staff affirmed the social validity of the interventions. We offer recommendations for research and practice aimed at improving the implementation and impact of peer network interventions in secondary schools.

Parent assessments of self-determination importance and performance for students with autism or intellectual disability.

Fostering student self-determination is now considered an essential element of special education and transition services for children and youth with intellectual disability and/or autism. Yet, little is known about the pivotal role parents might play beyond the school campus in fostering self-determination among their children with developmental disabilities. We examined how 627 parents of children with intellectual disability or autism attending one of 34 randomly selected school districts (a) rated the importance of 7 component skills associated with self-determination, (b) assessed their children's performance in relation to those 7 skills, and (c) evaluated the overall self-determination capacities of their children. Although parents highly valued all of the self-determination skills, the degree to which their children were reported to perform the skills well was fairly low. Several factors predicted higher levels of self-determination, including educational setting, the presence of challenging behaviors, and perceived disability severity. We conclude by offering recommendations for equipping parents to better support their children's self-determination development.