Neonatal Nurse Practitioners

Influences on Career Choice

Gary L. Freed, MD, MPH; Kelly M. Dunham, MPP; Kristy Martyn, PhD, CPNP-PC; Leanne Nantais-Smith, PhD, NNP-BC; Lauren M. Moran, BA; Laura Spera, MS, MCS


Journal for Nurse Practitioners. 2013;9(2):82-86. 

In This Article

Abstract and Introduction


Background There is a nationwide shortage of neonatal nurse practitioners (NNPs). Strategies to increase NNPs must be informed by an understanding of their career motivations and decision processes.

Methods Mail survey of all NNPs who applied to take the initial certification exam between January 2010 and June 2011 (N = 491).

Results Response rate was 84.6%. Most NNPs (60%, n = 214) decided to pursue education as an advanced practice nurse while in practice as an RN and 22% (N = 80) prior to becoming an RN.

Conclusions To increase the number of practicing NNPs, the most robust recruitment efforts should occur among current RNs.


Neonatal nurse practitioners (NNPs) are important members of the health care workforce that provide care to critically ill newborns. According to the American Academy of Nurse Practitioners, 3,100 NNPs are practicing in the United States today.[1] After completion of Master's-level advanced practice NNP education, NNPs obtain national certification through the National Certification Corporation (NCC). Currently, all states, with the exceptions of California, Kansas, and Indiana, require national certification for NNPs to care for patients.[2] All NPs will be required to be nationally certified in the future with the 2015 proposed implementation of the Advanced Practice Registered Nurses (APRN) Consensus Model.[3]

Over the past several years, reports have suggested that there is a nationwide shortage of NNPs in both academic and community hospitals.[4,5] In 2005, researchers estimated the position vacancy rate to be approximately 15%,[6] and the number of neonatal intensive care beds has risen since that time. Further, the number of NNP graduates has been fairly static over the past several years, despite significant demand for their services.[4,7] Shortages of preceptors and faculty in NNP education programs have been reported, which potentially threaten the future number of graduates and, by extension, the future NNP workforce.[8,9,10] As resident work hours continue to be modified and restructured by the Accreditation Council on Graduate Medical Education, NNPs will likely be called upon to fill the gap created by a diminishing component of pediatric resident labor in academic medical centers.[6,11] As a result, the demand for NNPs is likely to further increase.

Any strategy to increase the number of new NNP graduates must be informed by an understanding of the motivations and decision processes of nursing professionals who choose to pursue this profession. It is unclear at what point in time nurses decide to become advanced practice nurses (APNs) in general or NNPs in particular. Also unknown are the factors that lead newly educated NNPs to begin their careers in academic rather community hospitals.

To meet the future needs of the vulnerable pop-ulation of high-risk and critically ill newborns, attention should likely be focused on mechanisms to increase the numbers of nurses entering NNP education and to better understand their initial work patterns after they finish their education. To investigate these issues among a sample of recent NNP graduates, we conducted a national study of those who applied for initial certification between January 2010 and June 2011.