Responsibilities, roles & staffing patterns of nurse practitioners in the neonatal intensive care unit.

PURPOSE

To describe the unique contribution of the NP in caring for critically ill infants through the study of NP responsibilities, roles, staffing patterns, and patient profiles.

DESIGN

This prospective descriptive study was conducted in conjunction with a regional multi-site outcomes study.

METHODS

Data were collected at five regional level II/III NICUs in Massachusetts and Rhode Island. Twenty-two NPs were surveyed. Existing data on outcomes of 2,146 very low birth weight infants were used to describe patient profiles. NP care was defined as assignment to an NP at admission. Illness severity was measured using the Score of Neonatal Acute Physiology (SNAP).

RESULTS

NP roles included all levels of NICU care as well as antepartal consultation, delivery room management, transport, and outpatient follow-up. NPs were equally involved with patients of all degrees of complexity and birthweights. Patient assignments were most often made by a rotational system with the resident/fellow or by complexity of infant with the NP in some NICUs caring for sicker smaller babies.

CLINICAL IMPLICATIONS

This study documents a blended model of NP MD care in the NICU with each provider bringing unique strengths to the team. Nurse practitioners working in the NICU provide an invaluable contribution in terms of parent support and teaching, post NICU follow-up care, and professional education and research. The NP role in the NICU should not be viewed as a substitution for resident physicians.