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What Does a Neonatal Nurse Practitioner Do? (15 Daily Typical Duties & Responsibilities)


Written By: Jennifer Schlette MSN, RN

Have you ever heard someone say, “how can something so small, need so much attention?” Well, in the world of the Neonatal Intensive Care Unit, this statement is never truer. At the forefront of care for this vulnerable population is the Neonatal Nurse Practitioner. These specialized healthcare providers manage the care of the Neonatal Intensive Care patient in multiple settings and in many ways, but what does a Neonatal Nurse practitioner do? In this article, we will explore the Neonatal Nurse Practitioner duties and responsibilities, and you will see just how vital their role is in the healthcare environment.


Where Do Neonatal Nurse Practitioners Typically Work?


Neonatal Nurse Practitioners typically work in a Neonatal Intensive Care unit (NICU). This type of unit provides care to neonates who require close observation after birth, those infants who are ill or premature. The neonatal nurse practitioner can work in Neonatal Intensive Care Units of various degrees of intensity or referred to as levels. You may also see them working in the delivery room or specialty clinics.


Typical Work Hours for Neonatal Nurse Practitioners


Neonatal Nurse Practitioners (NNP) will usually have a 40-hour workweek. This 40-hour workweek may not always be the Monday thru Friday 8-hour day that other professions have. You may have a schedule that is rotating, meaning some days and some nights working 12-hours. Or you may work four 10-hour days. Your schedule will be impacted by the type of environment you choose to work in.


Neonatal Nurse Practitioner Scope of Practice Laws: What You Need to Know?


Neonatal Nurse Practitioner’s scope of practice will be determined by their education, certification, the license they hold, and the institution they are employed by. Furthermore, the scope of practice will also be defined by the state's Nurse Practice Act. Overall, Neonatal Nurse Practitioners will work in collaboration with the neonatologist to provide care to this vulnerable population. In some states, Neonatal Nurse Practitioners can diagnose and treat their patients independently from a physician and have full prescriptive authority. In other states their role is much more restricted. To understand the Neonatal Nurse Practitioner's full scope of practice, refer to your state’s Nurse Practice Act.


Following are the 15 Daily Typical Neonatal Nurse Practitioner Duties & Responsibilities


1. Perform a comprehensive physical and gestation age assessment on their patients.


One of the key Neonatal Nurse Practitioner duties will be to perform a head to toe physical assessment of their patients. This will be intertwined with assessing the baby's critical physical and neuromuscular attributes to complete the gestational age assessment. Conclusions that the Neonatal Nurse Practitioner reaches about the patient are based on this assessment and will help guide the Neonatal Nurse Practitioner’s treatment plan for their patient. This will also allow the Neonatal Nurse Practitioner to make consults with other disciplines to aide in the best care for these babies.

2. Collaborate with other healthcare providers from other disciplines.


In collaboration with healthcare providers from different disciplines, Neonatal Nurse Practitioners can ensure that they provide optimum care for their patients. The Neonatal Nurse Practitioner responsibilities may include managing all the other disciplines' recommendations to formulate one concise treatment plan for their patient.

3. Ordering, performing, and interpreting the diagnostic test.


The Neonatal Nurse Practitioner can order, perform, and interpret diagnostics tests to drive the patient's treatment plan. Based on the conclusions reached from the data they obtain from these diagnostics tests; the Neonatal Nurse Practitioner will then develop an even more specialized treatment plan for the patient. Keep in mind the extent of independence the Neonatal Nurse Practitioner has in ordering, performing, and interpreting diagnostic tests will be driven by the state’s Nurse Practice Act and the rules and regulations of the institution the Neonatal Nurse Practitioner works for.

4. Collect a detailed history


Obtaining a detailed maternal, obstetric, and newborn history on their patient and their mother will be included in the Neonatal Nurse Practitioner responsibilities. The information gathered during these interviews or chart review will serve as a tool to help ensure proper care is delivered.

5. Line placement


Depending on the rules and regulations of the institution the NNP is working for, the Neonatal Nurse Practitioner may be placing peripheral, central, arterial, or umbilical lines on the Neonatal Intensive Care patient. The placement of these lines can provide these babies with life-saving medicine, fluids, and nutrition.

6. Assess and intervene where a patient may require respiratory support.


The Neonatal Nurse Practitioner is responsible for the assessment of their patient, as discussed earlier. In some instances, the Neonatal Intensive Care patient may require interventions to support them should they become unstable. The Neonatal Nurse Practitioner will decide based on their education and clinical judgment if they need something as simple as a nasal cannula or an advanced airway such as an endotracheal tube when in distress. In the event, the patient requires an advanced airway, depending on the institution and state regulations, one of the Neonatal Nurse Practitioner duties would include performing intubation and ventilatory management.

7. Write orders


Writing orders for their patients in order to manage their care will be one of Neonatal Nurse Practitioner duties. These orders may be in the form of new special equipment that will be needed, medication, and fluids or to order physical therapy. Once again, these orders may be independent or in collaboration with a physician.

8. Newborn Resuscitation


In the unfortunate event that a baby may require resuscitation, the Neonatal Nurse Practitioner duties will include overseeing the patient's resuscitation efforts. This can consist of various degrees of resuscitation from ordering the delivery of fluids to assisting in bedside surgical procedures.

9. Education of neonatal families


Another one of the Neonatal Nurse Practitioners responsibilities will be to educate the family of the patient. This education that is delivered may be tailored to the patient who requires intensive care in the Neonatal Intensive care Unit or the Neonatal Intensive Care patient's family getting ready to bring their baby home. For the patients' families in the Neonatal Intensive Care unit, some of the treatment modalities can be intimidating. Education may help alleviate any fears they may have.

The Neonatal Nurse Practitioner will also provide education for the family who can finally take their baby home from the Neonatal Intensive Care Unit which can also be scary. Education is the key here to ensuring the families feel safe and ready for this new chapter. Keep in mind some Neonatal Intensive Care patients do go home with equipment such as oxygen, pulse oximetry, and tube feeds, to name a few. This will require education in order for this equipment to be safely used at home.

10. Education of Colleagues


The Neonatal Nurse Practitioner may be charged with the duty of supplying education to their colleagues, such as staff nurses, physicians, and other Nurse Practitioner’s. The Neonatal Nurse Practitioner may educate their colleagues on necessary Neonatal Intensive Care skills or emerging research that will change practice and may provide better outcomes for the Neonatal Intensive Care patient.

11. Assisting in caregiver/baby attachment


When a child has been admitted to the neonatal intensive care unit, the Neonatal Nurse Practitioner duties include assisting with caregiver bonding. This may be in the form of kangaroo care or just helping the caregiver or parent feel comfortable touching the baby. Having a sick or premature baby can be very intimidating for parents and caregivers. The Neonatal Nurse Practitioner can help alleviate those fears and facilitate attachment and create a meaningful relationship.

12. Transportation of the Neonatal Intensive Care patient.


The infant's transportation with the Neonatal Nurse Practitioner will again fall within the state and institution realm. If allowed, the Neonatal Nurse Practitioner will transport the Neonatal Intensive Care patient to diagnostic tests and, in a certain circumstance, to other hospitals if more of a specialty care is needed. The Neonatal Nurse practitioner will monitor the patient’s vital signs and implement interventions if necessary, to ensure the safe transport of the Neonatal Intensive Care patient.

13. Consultation


Suppose a neonatal nurse practitioner works in the area of a specialty, such as with the pulmonary service. In that case, the NNP will consult on neonatal conditions such as bronchopulmonary dysplasia—these specialty nurse practitioners aide in the care of this susceptible population. They will also collaborate with the Neonatal Nurse Practitioner, assuming the role of the primary care provider.

14. Carry their own caseload


The Neonatal Nurse Practitioner will carry their own caseload meaning that they will oversee the care of a specific group of patients. They will follow every aspect of care for these patients. When the Neonatal Nurse Practitioner takes on their own caseload, this will help ensure continuity of care for these babies. Continuity of care has been shown to have better patient health outcomes.

15. Ensure the baby is receiving proper feeding


The Neonatal Nurse Practitioner may help with infant feeding and breastfeeding, depending on what the child’s caregiver chooses by ensuring the patient is receiving the proper nutrition. The Neonatal Nurse Practitioner would ensure that patients receive the appropriate formula for their condition and confirm the infant is receiving any additional supplements that they may need if breastfed. Most importantly, the Neonatal Nurse Practitioner ensures that these babies gain weight regardless of the feeding method.


Conclusion


So, what does a Neonatal Nurse Practitioner Do? Well, to sum it up, they care for those who are one of the most vulnerable in this world. The Neonatal Nurse Practitioner duties and responsibilities encompass every aspect of care from supporting the family to bedside procedures and emergent care. Their day to day activities can be unpredictable because let’s face it; caring for sick patients, in general, can be unpredictable, but overall, they are a primary healthcare provider with so many critical duties and responsibilities within the health care environment.


Jennifer Schlette MSN, RN
Jennifer Schlette is a registered nurse in pediatric critical care in New York City. She is the former Director of Undergraduate Nursing at a college located in New York. After obtaining her BSN from the College of Mount Saint Vincent, she went on to complete her MSN.