Since 2013, the National Association of Neonatal Nurse Practitioners (NANNP) and the National Certification Corporation have partnered on 3 separate occasions to survey the neonatal nurse practitioner (NNP) workforce in the United States.1,2 In the previous edition of Advances in Neonatal Care, the workforce subcommittee published the executive summary of the 2020 NNP Workforce Survey. Although the number of NNPs eligible to participate in the surveys has increased over time, the response rate in 2020 was half of the 2014 survey, which subsequently limits the ability of the data to tell a clear story of the profession.

Overtime and fatigue are genuine issues identified in the workforce surveys across the years-the majority of NNPs are still working 24 hour or rotating shifts. More than 60% of NNPs work more than 40 hours a week routinely, and almost 50% report not being able to take paid time off when requested. For almost a decade, we have known these practices have the potential to decrease longevity and increase the risk for chronic disease exponentially.3,4 It is difficult to be positive and satisfied with your job when you are tired and suffering from burnout ... many of us have become a bad public relations campaign for the role when young nurses are evaluating options. Yet, salary was positively correlated to job satisfaction in this latest survey. It is concerning to see a continued low survey response rate in the younger than 35-year-old age category of the profession; only 3% of participants in 2020 fell into this age category. This may be interpreted as a lack of engagement in the profession, or the organization has not been able to effectively engage this "generation" of NNPs. It is essential to identify strategies to engage early-career NNPs as they are the future of this profession.

It is encouraging to see the increasing "certified NNP" workforce numbers across the surveys (8% increase over 6 years), but this is not as positive as it might seem at first blush. As the first acute care nurse practitioners (NPs) in the United States, many in our workforce are "aging out" of clinical practice and retiring or only working part-time. This increases demand for a group of clinicians already in short supply. This short supply has led our colleagues to find alternative solutions to staff the neonatal intensive care units (NICUs) and that has come in the form of physician assistants (PAs). While there is no neonatal content in PA training programs outside of the normal newborn care, there are now several neonatal fellowship training programs across the country. These programs are offering didactic content and 3 to 9 months of additional clinical "fellowship" training. Some NNP programs are actually filling empty "NNP student seats" with PAs. The training and education of NNPs and PAs are completely different, with the NNP being trained as a specialist in the role and neonatal population exclusively and the PA being trained as a generalist (think medical model and family practice training) and then receiving "on-the-job training" in an NICU. There is no nationally accredited means for PAs to validate their neonatal knowledge as their board certification is as a generalist. NNP training and knowledge competence are validated via the nationally accredited board certification examination offered by NCC. And in relation to safety and patient outcomes, as far back as 1996, the NP role is well established for its cost-effective, safe, and efficient care.5-9

This "threat" to the profession ties directly into the education and training of the workforce. While the demands of the job are high, it is difficult to comprehend how NNPs in practice are so unwilling to precept and train NNP students when the longevity of the profession is at stake. As an NNP program director, I could double my program capacity, but I am limited on clinical sites and preceptors. Most NNP programs in the United States are experiencing this same limitation. In the 1980-1990s, the training model was to recruit nurses from the NICU to go to school and the hospital/practice would pay their salary while they were in clinical training. Perhaps, this model could be reimagined for the current state.

As I review the past workforce survey results, the themes are persistent. It appears a crisis is upon the profession ... and a national strategic plan including well-delineated initiatives to address workforce development, diversity and health disparities, strategic engagement of those younger than 40 years, and advocacy for the profession is required. This cannot be the sole duty of NANNP, which has only 25% of the workforce as members-it will need engagement from all stakeholder organizations, groups, and NNPs. This plan must include the funding and resources necessary to implement the plan. We, as the profession, must be the guardians for the future generations. Our tiny patients are counting on us.

Suzanne Staebler, DNP, APRN,

NNP-BC, FAANP, FAAN

Nell Hodgson Woodruff School of Nursing

Emory University

Atlanta, Georgia

References