They say great things happen to those who wait. In the case of the ambitious practitioners who are NANN's founders, however, forging ahead (vs waiting in the wings) resulted in a dream fulfilled for the neonatal nursing profession.
It was the early 1980s, and staff members working in the NICU at Stanford Hospital and Clinics in Palo Alto, California, were beginning to explore and promote the concept of profession-wide information sharing and the establishment of a regional nursing association. An ambitious West Coast nursing group emerged: Neonatal Nurses of Northern California (NNNC).
Charles Rait, M S Ed, RN, PNC, publisher of Neonatal Network(R): The Journal of Neonatal Nursing and 1 of NANN's 6 founding members, recalls the setting in which neonatal nurses began to organize their efforts.
"NANN's early history is intertwined with that of other early nursing groups," Rait says.
The San Francisco Bay area was unique in that it had a large concentration of Level III NICUs within a small area, as well as many nurses working in advanced roles. Not only was there a concentration of NICUs, but nurses were actively looking for information to improve their nursing practice and had formed the NNNC to share information.
In 1982, 2 nurses, Liz Marienthal and Terry Reid, assembled the first national conference for neonatal nurse clinicians, practitioners, and (clinical) specialists (NNCPSs) in Denver. About 150 advanced practice nurses (APNs) from across the country attended, and a task force was set up with members representing the entire United States. When Marienthal and Reid asked for a West Coast volunteer, Rait raised his hand, and that was how he became involved in starting NANN.
"During the Denver meetings, I was fortunate to share a room with Tracy Karp, who was also a member of the task force along with Pat Johnson, one of the first master's-prepared neonatal nurse practitioners [NNPs] in the country," Rait recalls.
We discussed the situation for hours on end. I already had 4,000 or 5,000 Neonatal Network subscribers. In discussing the fate of the NNCPSs, Tracy and I came to the conclusion that the best way to proceed was to establish an independent neonatal nursing association with a subspecialty group of nurse practitioners, clinicians, and clinical specialists.
Members of the first NANN board of directors included Rait and Linda Bellig, MA, RN, pool nurse (semiretired) at the Munroe Regional Medical Center in Ocala, Florida; Patricia Johnson, DNP, MPH, RN, NNP, staff neonatal nurse practitioner at Maricopa Integrated Health System and Neonatology Associates, Inc (both in Phoenix, Arizona); Tracy Karp, MS, NNP-BC, manager, Neonatal Practitioner Services for 3 Intermountain Healthcare facilities in Salt Lake City, Utah; and Donna Lee Loper, MS, RN, CNS. This interim group developed NANN's structure, its statement of purpose, and its bylaws. This group conducted all association work during the first 2 years and held NANN's first election. Working from an independent office, Rait assumed the role of executive director until 1996. The Neonatal Network staff provided the necessary day-to-day work to keep the association functioning.
"Linda McCollum, PhD, RNC, CNNP, joined NANN's founders as secretary. I doubt we would have had any success without Linda," Rait says. "She was fantastic at keeping the board on task and providing information. She served in that capacity for many years and was indispensable to the association."
NANN's founders especially remember the need for standardized education as an impetus for their organization's creation. Says Bellig, "It was recognized that standardized education and practice for the NNP role was vital; the rapid growth of the NNP role finally placed urgency on the development of its standards."
Multiple, complex, as-yet-unmet needs propelled NANN's formation, according to Johnson. "NANN was created to establish a focused organization for neonatal nurses, especially neonatal APNs, that could offer education, networking, and a professional identity," she recalls. "Neonatal nursing was expanding nationwide and no other organization was interested in addressing the needs of neonatal nurses."
Practice Evolves Over Decades of Change
Since the early 1980s, neonatal nursing has been characterized by changes ranging from a multidisciplinary approach to care to specialized practice to an overall improved and more widely recognized NNP identity and image. NANN's founders are proud of their personal involvement in their profession's evolution.
Johnson especially is awed by what she calls the "explosion" in NNP numbers and NNPs' impact on the profession. "When I piloted the NNP role in the early 1970s, it was received negatively by organized nursing, organized medicine, and other NP groups given its acute care, hospital-based focus," she says. "Now NNPs are considered essential staff for most of the level II and level III nurseries. Much of the popularity and acceptance of NNPs came from sponsored liaisons through NANN."
Tracy Karp has seen the NNP population rise from about 400 to 4000 in the past 25 years. He is impressed not only by numbers but also by these nurses' expertise. "A variety of specific aspects of practice have evolved, from developmental care to vascular access, to roles in research and transport," he says. "Also, we have seen the further development of a cadre of skilled neonatal nursing researchers."
The biggest changes Bellig has witnessed since the early 1980s involve the patient population as much as the practitioners. "It has been exciting to see the multidisciplinary approach to developmental care in the NICU, especially as our patient population becomes smaller and more immature," she says.
Bragging Rights Granted
Twenty-five years allows for plenty of time to take inventory of past accomplishments. In the case of NANN's founders, both personal and association-related accolades come to mind.
Rait still feels the pride that comes with creating a new association that could meet the needs of neonatal nurses in a way that other organizations could not. He says, "My fondest memories are of the early years and the wonderful people I was able to work with who had the enthusiasm and drive to make NANN possible."
For Karp, who was elected as NANN's second president for the 1989-1990 term, his involvement in organizational and neonatal nursing organizations has been the highlight of his career and a key contributor to his abilities to perform as a leader and practitioner. "Throughout my years with NANN, I have been most proud to be a founder of a neonatal nursing group that became a nationally and internationally recognized organization representing neonatal nurses across the world," he says.
Bellig says the mobilization of talent within the NANN membership was the greatest accomplishment during the association's early years. "Our membership included nurses who could write, teach, and practice at levels of excellence that helped the organization accomplish a great deal within the first years," she says. "The networking during that time was extraordinary." Johnson served as the first chair for NANN's APN Special Interest Group during the organization's early years. Her fondest professional memories go back to this time. "I appreciated the opportunity to represent NANN, neonatal nursing, and NNPs on numerous national multidisciplinary committees that helped to promote the contributions of neonatal nursing and NNPs to many healthcare leaders," she recalls. "My fondest memories go back to NANN's early years, when, as a member of a very enthusiastic board of directors, we grew this specialty organization to the seventh-largest among 85 specialty nursing organizations in less than 10 years."
Sage Advice for Newcomers
Nobody is better qualified to advise neonatal nursing newcomers than NANN's founding members. As they look back upon their cumulative century-plus of experience, commitment to ongoing education tops their priority lists.
"Never stop learning," Rait advises. "Do what's right. See a problem? Fix it. Don't believe that you need permission to move ahead. What you do every day affects your patients and their families for a lifetime. They deserve the best care, period."
Johnson tells her novice peers, "Identify your special strength and passion in this profession, align with others with complementary skills and strengths that you can learn from, volunteer to participate, and follow through."
Karp also emphasizes a mandatory commitment to lifelong learning for neonatal nurses who are just starting out. Bellig points to the need for balance between a nurse's work and home life. She says, "Balance provides supportive resources during the down times in both your career and personal life."
Action Points for Today and Tomorrow
Even as NANN's founders reflect upon the last 25 years with pride, they recognize there is a critical need for today's neonatal nursing leaders, scholars, and researchers to address numerous pressing issues. They especially point to the need to employ evidence-based practice (EBP) within the specialty. Rait suc-cinctly describes his viewpoint: "Every action taken by J NICU nurses, scholars, and researchers should be] directed to implementing EBP."
Johnson points to EBP as potentially the mostl important neonatal care movement. She says,
Establishing a culture of EBP will be essential to promoting the best care in our field. Those in practice as well as educators and researchers must champion and promote EBP projects and disseminate findings, successes, and failures to further our profession.
Karp points to a need to develop a clear way to measure neonatal nursing outcomes; he recognizes there is no easy or speedy solution to this need.
Bellig paints a wider picture as she contemplates today's most-pressing neonatal nursing challenges. She says,
How can we mold maternal-child health care to focus on social issues within babies' families so our million-dollar babies can have a better long-term future? These babies require a stable, supportive environment after discharge. We need to look outside the box of our comfortable neonatal work environment and collaborate with our neonatal nursing organization to influence health policy, as there is opportunity for change in this current political climate. We can have greater power to influence outcomes as a united voice within NANN.