Can all neonatal resuscitation be managed by nurse practitioners?

The amount of supervision trainees receive during neonatal resuscitation is variable and often dependent on subjective criteria

OBJECTIVE

Measure variation in delivery room supervision provided by neonatologists using hypothetical scenarios and determine the factors used to guide entrustment decisions.

STUDY DESIGN

A survey was distributed to members of the American Academy of Pediatrics Section on Perinatal Pediatrics. Neonatologists were presented with various newborn resuscitation scenarios and asked to choose the level of supervision they thought appropriate and grade factors on their importance in making entrustment decisions.

RESULTS

There was significant variation in supervision neonatologists deemed necessary for most scenarios (deviation from the mode 0.36-0.69). Post-graduate year of training and environmental circumstances influence the amount of autonomy neonatologists grant trainees. Few neonatologists have objective assessment of a trainees' competence in neonatal resuscitation available to them and most never document how the trainee performed.

CONCLUSION

Delivery room supervision is often determined by subjective evaluation of trainees' competence and may not provide a level of supervision congruent with their capability.

Subjective and Objective Measurement of Neonatal Nurse Practitioner Workload

BACKGROUND

Neonatal nurse practitioner (NNP) workload is not well studied, and metrics specific to NNP practice are lacking. Factors such as changes in resident duty hours, increasing neonatal intensive care unit admissions, and a shortage of NNPs contribute to NNP workload. Increased workload has been shown to be detrimental to providers and can affect quality of care.

PURPOSE

This study quantified NNP workload using a subjective workload metric, the NASA Task Load Index, and a newly developed objective workload metric specific to NNP practice.

METHODS

The NNP group at a level IV academic medical center was studied. The sample included 22 NNPs and 47 workload experiences.

RESULTS

A comparison of scores from the NASA Task Load Index and objective workload metric showed a moderate correlation (r = 0.503). Mental demand workload scores had the highest contribution to workload. Feelings of frustration also contributed to workload.

IMPLICATIONS FOR PRACTICE

The NASA Task Load Index can be utilized to measure the workload of NNPs. The objective workload metric has potential to quantify NNP workload pending further validation studies and is a simple, straightforward tool.

IMPLICATIONS FOR RESEARCH

Additional research is needed regarding NNP workload and methods to quantify workload. Larger studies are needed to validate the objective workload metric.

A survey of the current neonatal nurse practitioner workforce

OBJECTIVE

To assess the adequacy and characteristics of the US neonatal nurse practitioner (NNP) workforce.

STUDY DESIGN

Internet-based survey of 271 NNP conference participants. Data were analyzed using SPSS (version 14; Chicago, IL, USA); descriptive statistics, including chi(2)-tests of independence, were performed (alpha=0.05).

RESULT

Respondents were primarily masters-prepared females, working in level III newborn intensive care units. Unfilled NNP positions were common; time estimated to fill positions averaged 6-18 months. One-third of the respondents' practice settings had substituted other providers. The mean NNP salary was $86,700. Motivators for becoming an NNP included autonomy and increased knowledge; challenges identified were overload of responsibilities and the NNP shortage.

CONCLUSION

This study provides the first data about NNP education and workforce characteristics in the United States. The use of an internet-based data collection process facilitated the rapid response of a large sample of NNPs and demonstrated the effectiveness of this method of data collection. The results of this survey suggest a mismatch between the need for NNPs the available NNP workforce supply.

Neonatal nurse practitioner role transition: the process of reattaining expert status

Neonatal nurse practitioners (NNPs) have managed care for high-risk hospitalized infants in the United States for over 30 years. The journey from being expert nurse to being novice NNP and then finally to being expert NNP is fraught with many challenges. This study used a qualitative descriptive design to describe advanced practice role transition among 70 NNPs. The data consisted of participants' written responses to open-ended questions. Four themes emerged that depicted a linear progression of the transition process from school preparation to beginning feelings in the new role and then development into a more confident practice. Theme 1: First impressions emphasized the ambivalence novice NNPs experienced regarding their preparedness for the role during a stressful and exciting adjustment period. Theme 2: The transition demonstrated the overwhelmingly similar feelings of anxiety, insecurity, exhaustion, and lack of confidence that plagued decision making. Theme 3: Making it as a real NNP indicated that the 1-year mark was a consistent, significant timeframe for feeling like a real NNP. Theme 4: The helpers and hinderers revealed the vulnerability of the novice NNPs to harsh criticism as well as the importance of support, especially from nurse colleagues. NNPs are a valuable resource; thus, enhancing transition is a worthy goal.