A shortage of health care providers effects access in all areas of care, including neonatal intensive care units (NICUs) (Staebler & Bissinger, 2017; Dall, West, Chakrabarti, & Iacobucci, 2016). According to a recent neonatal nurse practitioner (NNP) workforce survey, 73% of NNP coordinators report shortages in practice, 34% of practices reported 5 or more vacancies in practice, and 83% reported feeling there will not be enough NNPs to meet practice needs in the next 10 years (Staebler & Bissinger, 2017). The majority of NNPs report rotating between day and night shifts or working 24-hour shifts, while 1 in 5 NNPs report working mandatory overtime or “on-call” (Staebler & Bissinger, 2017). Shortages in NNP practice lead to overtime hours, unsafe patient loads, decreased time for professional development, mentoring students and new NNPs, accumulated NNP sleep deprivation, fatigue and burnout (Dye & Wells, 2017; Kaminski, Meier, & Staebler, 2015; Keels 2016). Additional layers of regulation and restriction on advanced practice registered nurses’ (APRN) practice exacerbates this shortage and decreases access to care (National Council of State Boards of Nursing, 2015).
Both the National Organization of Nurse Practitioner Faculties and National Association of Neonatal Nurse Practitioners provide that NNPs can independently care for level II NICU patients and are cost effective (National Association of Neonatal Nurse Practitioners, 2014; National Organization of Nurse Practitioner Faculties, 2013; Staebler, Meier, Bagwell & Conway-Orgel, 2016; Bissinger, Allred, Arford & Bellig, 1997) A recent study noted that NNPs using telemedicine connection to a consulting neonatologist deliver quality of care equal to care in collaboration with in house neonatologists (McCoy, Makkar, Foulks & Legako, 2014). Decreasing practice restrictions will reduce practice costs, and improve NNP satisfaction, potentially motivating more neonatal nurses to pursue advanced practice as NNPs (Bosque, 2015; Sheldon, Bissinger, Kenner & Staebler, 2017; Staebler, et. al., 2016).
Evidence from states where Advance Practice Registered Nurse (APRN) practice is less restrictive demonstrates an increase in available healthcare providers, however not all APRNs are interested in autonomous practice (Reagan & Salsberry, 2013; Wallace Kazer, O’Sullivan, & Leonard, 2018). Studies focused on exploring physician oversight in APRN autonomy and empowerment found that APRNs who perceive greater levels of physician oversight, whether required by regulations or otherwise, felt more empowered than APRNs with little or no physician oversight (Peterson, Keller, Way, & Borges, 2015; Peterson & Way, 2017). This was contrary to what the authors expected to find, and it is possible the feelings of empowerment in APRNs arises from the collaboration with physicians in an otherwise restrictive environment (Peterson, Keller, Way, & Borges, 2015; Peterson & Way, 2017). There is little literature specifically regarding NNP roles in neonatology practice coverage models, neonatologist oversight of NNP practice, or NNP perceptions and readiness for autonomous practice.
Purpose
This project assesses neonatologist and NNP desire for more autonomous NNP practice.
Methods
Qualitative interviews from an individual neonatology practice will be held in fall 2018 to explore neonatologist and NNP perceptions on expertise and desire for more autonomous practice Patricia Benner’s (2001) From Novice to Expert provides the theoretical framework for this project. NANNP domains and core competencies of neonatal nurse practitioners will guide the structure of questions pertaining to physician oversight and NNP autonomy in patient care rounds (NANNP, 2014). NNP and neonatologist volunteers will be interviewed until data saturation for identified themes is achieved.
Outcomes
Results of this project will inform feasibility of a practice coverage model change to alleviate staffing strain and provide better access to neonatal care. It is anticipated that this will increase NNP autonomy and job satisfaction.
Future applications
Findings from the analysis of the qualitative interviews will be used to create an electronic survey tool. This tool will be distributed to a larger group of NNPs to assess perceptions of the expertise of the NNP population, practice coverage models, autonomy in practice, and institutional barriers to autonomy in practice. Project results will be disseminated to inform NNPs and neonatologists about neonatology practice coverage, NNP roles and expertise.