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Role of the Neonatal Nurse Practitioner in the Community Hospital

Snapp, Barbara DNP, NNP-BC; Reyna, Barbara PhD, RN, NNP-BC

Section Editor(s): Samra, Haifa A.

doi: 10.1097/ANC.0000000000000638
Professional Growth and Development

Background: The role of the neonatal nurse practitioner (NNP) is well established in the neonatal intensive care unit. The level IV NNP is traditionally supported by large multidisciplinary teams while the level I to III NNP may be the sole in-house provider with limited resources.

Purpose: The purpose of this research project is to identify the NNP role, responsibilities, and barriers to practice in the level I, II, and III newborn care settings.

Methods: This study used a descriptive, exploratory design to examine NNP roles and responsibilities in level I, II, and III care centers via an online survey.

Results: Of the respondents (171), the majority (71.3%) work 24-hour shifts, 51.5% being the single NNP during the day with 67.8% being alone at night. Nearly 27% have limited or are without ancillary support while 29.8% cannot meet some standards of care due to inadequate resources. Almost 22% lack written protocols and procedural opportunities are limited or a concern for 15.8% of the NNPs.

Implications for Practice: A better understanding of the responsibilities of the level I to III NNP will assist with developing staffing guidelines, influence practice models, and guide recruitment and retention of the NNP.

Implications for Research: A systematic literature review yielded articles on the value of nurse practitioners and their ability to deliver safe, effective and cost-conscience care but not on what the role entails on a daily basis. Further studies are needed to specifically compare the role of the level IV NNP to the level I, II, and III NNP to further delineate NNP functionality according to level of care.

Children's National Health System, Washington, District of Columbia (Dr Snapp); and School of Nursing, University of Virginia, Charlottesville, Virginia (Dr Reyna).

Correspondence: Barbara Snapp, DNP, NNP-BC, Mary Washington Hospital, Neonatal Intensive Care, 3rd Floor, 1001 Sam Perry Blvd, Fredericksburg, VA 22401 (

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses