Delivered. New Neonatal Nurse Practitioner and Pediatric Nurse Practitioner DNP Options.
by David Meyer, Nursing Magazine, Spring 2014
Ten years ago, Shelby County, Tenn., had the highest infant mortality rate in the United States. Almost 15 per 1,000 children didn’t live to see their first birthday. The Shelby County Health Department made a major effort to improve conditions, soliciting help from hospitals, social workers, businesses, churches and the general community. The result was the infant mortality rate dropping to its lowest recorded level in 2011.
But the number has started to increase again, rising from 9.6 deaths per 1,000 in 2011 to 10.6 in 2012. And in several Memphis zip codes, the infant mortality rate is triple the national average.
“We’re hoping that 2012 was an anomaly and that things will turn around and head back down again,” Yvonne Madlock, director of the Shelby County Health Department, said in an Associated Press interview. “But it does point out to me that it does take sustained, continuous, collaborative effort to really move the needle in a consistent fashion on an issue as complex as infant mortality.”
In response to requests from our community partners and the needs of the population, the College of Nursing is delivering an answer that could help improve the health care of the children of Memphis.
An Urgent Need
Ramasubbareddy Dhanireddy, MD, is the Sheldon B. Korones Professor of Pediatrics and Obstetrics and Gynecology, and chief of Neonatology at UTHSC. He is also medical director of both the Newborn Center at the Regional Medical Center at Memphis and the Neonatal Intensive Care Unit (NICU) at Le Bonheur Children’s Hospital, so he is familiar with the health care challenges facing Memphis newborns.
Dr. Dhanireddy says Memphis’ high infant mortality rate is not due to lower quality medical care. “Medical care for premature babies in Memphis is as good as anywhere in the world. Whether a 2-pound premature baby is born in Memphis, New York, Paris, London or Stockholm, the probability of survival is similar. The reason we have high infant mortality is because we have a high number of premature babies being born who have an inherently higher risk of mortality.”
The urban areas of Tennessee that offer specialized care to critically ill newborns have ongoing shortages of experienced practitioners in the neonatal intensive care units. Dr. Dhanireddy says he could double the number of Neonatal Nurse Practitioners (NNP) at both the Regional Medical Center and Le Bonheur and still have vacancies. To help meet this demand for qualified health care providers, Laura Talbot, PhD, EdD, RN, dean of the College of Nursing, opened a new advanced training option, the Pediatric Nurse Practitioner (PNP), in the Doctor of Nursing Practice (DNP) Program. In addition, the Neonatal Nurse Practitioner option in the UTHSC College of Nursing reopened admissions at the doctoral level.
It can take seven to 10 years of rigorous academic and clinical effort before physicians are ready to practice on their own. Nurses with doctoral degrees give patients in Tennessee and the surrounding region faster access to qualified health professionals on the front lines of care. “There is a shortage of Pediatric Nurse Practitioners and Neonatal Nurse Practitioners to meet the health care needs of the children and neonates in our state and region,” Dean Talbot says, “The UTHSC College of Nursing is committed to educating doctorally prepared advanced practice nurses who are equipped to meet these growing health needs.”
Susan Patton, DNSc, PNP-BC, FAANP, professor in the Department ofAdvanced Practice and Doctoral Studies, is theDNP Pediatric and Neonatal coordinator. Bobby Bellflower, DNSc, NNP, assistant professor in the Department of Advanced Practice and Doctoral Studies, is the concentration coordinator for the NNP Program. Lisa Rinsdale, DNP, CNE, PNP-BC, JD, RN, assistant professor in the Department of Advanced Practice and Doctoral Studies, is the concentration coordinator for the PNP Program.
Dr. Dhanireddy says there is a great need for the new program. “I was so happy when Dr. Susan Patton called me saying they were going to start an NNP program within the DNP degree. In the first group, I have three here enrolled.”
Offering the NNP and PNP options as part of the DNP program provides some crucial and beneficial modifications to how the NNP was offered in the past. “The DNP program is primarily an online curriculum open to applicants with either baccalaureate or master’s degrees in nursing,” says Dean Talbot. “The online classes offer students flexibility in determining their own living arrangements, schedule of study and timing of engagement in coursework. Plus their clinical practicums are arranged within reasonable proximity of where students reside.”
Students take advantage of the core requirements of all DNP programs, which include health assessment, pharmacology, pathophysiology, biostatistics and methods of evaluating practice, but also do additional coursework focusing on NNP and PNP specialties. Since the DNP candidates complete most of their academic work online with only a limited, required on-campus component, they can choose to work part time while they study.
The average prospect for the NNP or PNP degree is older and more established than a student entering nursing school for the first time. Dr. Rinsdale, PNP option coordinator, says, “Most candidates are already adult learners who have to work. They already have jobs and commitments, and they may have community ties that restrict travel. They have decided to make changes and improvements in their lives. The program is optimized to accommodate those needs. They have had success in other programs so hopefully can self-evaluate and regulate.”
The NNP and PNP options combine the best of online and hands-on training. With the bulk of the program online, students only attend three one-week on campus sessions a year. The CON makes the most of these on-campus weeks by providing activities that can’t be done online, such as hands on clinics, simulations and interprofessional assessments with other UT colleges.
Since the majority of the program is carried out long distance, it’s important to locate excellent preceptors in the students’ community to provide local clinical experience for students.
Another benefit to offering the options at the doctoral level is an increase in clinical practice requirements. The master’s requires 600 hours, and the doctoral degree requires 1000. In the case of NNPs, the increased length of the program and additional clinical hours allow students to be able to practice when they graduate.
Dr. Bobby Bellflower, NNP option coordinator says, “It takes at least six months for a master’s grad to be able to practice without a lot of help. For the past six years, institutions have been doing what we should have been doing and providing time for orientation.”
There are only 35 active NNP programs in the country, and since 2005, 17 have closed. UTHSC is the only public university in Tennessee to offer the program.
Providing care for premature and critically ill newborns requires more than just specialized knowledge and skills. It requires a certain temperament not everyone possesses. For this reason, experience is required. Prospective students must have worked as an RN in a Level 3 or Level 4 NICU for a minimum of one year before they will be considered for the NNP program.
Dr. Bellflower says, “The NNP works seven days a week, 24 hours a day. You need to have a calling.” But she adds, “You truly feel like you have made a difference in the lives of these babies and their families.”
A newborn’s health care needs don’t stop at the hospital doors. With advances in technology, more premature infants survive, and when they go home, a larger number of practitioners are required to care for them. These babies have a higher probability of getting diseases and getting them earlier, and will require long-term follow-up. NNPs provide care for the first few critical months, but PNPs will have the next 18 years to take care of these patients.
PNPs are experienced in caring for children in both hospital settings and outpatient environments. There are PNPs at the Regional Medical Center who work in a follow-up clinic for NICU babies. PNPs understand once these babies go home, follow-up care is vital. Having PNPs who work with physicians in private clinic settings is a major plus.
Dr. Rinsdale says, “There were 125 pediatric nurse practitioners licensed in Tennessee. That clearly was a low number. There was also a demand from Le Bonheur, Methodist and Baptist. They needed these programs to be local because a lot of their staff were going to other universities.”
A Confluence of Factors
UTHSC is in a unique position to offer the new DNP options. The university is within a few blocks of the Regional Medical Center, which has a Level 3 NICU, and Le Bonheur, which has a regional Level 4 NICU — the highest level of care available for critically ill newborns. The two units provide a full range of challenges and create the perfect real-world classroom for aspiring NNPs and PNPs. When you add in the excellent preceptors located in the area, the same circumstances that create a dire need for care also create an excellent environment to gain experience.
“This is not only in response to requests from our partners — it is feasible and doable due to the resources and strengths of our partners,” says Dr. Patton. “We are all working together to find out what we can each bring to the table to make things better.”