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Responsibilities, Roles & Staffing Patterns of Nurse Practitioners in the Neonatal Intensive Care Unit

Beal, Judy A. DNSc, RN, PNP; Richardson, Douglas K. MD, MBA, FAAP; Dembinski, Sharon MS, RN, CS, PNP; Hipp, Kimberly O'Malley MS, RN, CS, NNP; McCourt, Maureen MS, RN, CS, NNP, PNP; Szlachetka, Diane MS, RN, CS, NNP; Vaccaro, Dawn McBride MS, RN, CS, NNP

MCN, The American Journal of Maternal/Child Nursing: July-August 1999 - Volume 24 - Issue 4 - p 168-175
Feature Articles: Research

Purpose: To describe the unique contribution of the NP in caring for critically ill infants through the study of NP responsibilities, roles, staffing patterns, and patient profiles.

Design: This prospective descriptive study was conducted in conjunction with a regional multi-site outcomes study.

Methods: Data were collected at five regional level II/III NICUs in Massachusetts and Rhode Island. Twenty-two NPs were surveyed. Existing data on outcomes of 2,146 very low birth weight infants were used to describe patient profiles. NP care was defined as assignment to an NP at admission. Illness severity was measured using the Score of Neonatal Acute Physiology (SNAP).

Results: NP roles included all levels of NICU care as well as antepartal consultation, delivery room management, transport, and outpatient follow-up. NPs were equally involved with patients of all degrees of complexity and birthweights. Patient assignments were most often made by a rotational system with the resident/fellow or by complexity of infant with the NP in some NICUs caring for sicker smaller babies.

Clinical Implications: This study documents a blended model of NP-MD care in the NICU with each provider bringing unique strengths to the team. Nurse practitioners working in the NICU provide an invaluable contribution in terms of parent support and teaching, post NICU follow-up care, and professional education and research. The NP role in the NICU should not be viewed as a substitution for resident physicians.

Judy A. Beal is Professor of Nursing and Director of Research, Simmons College Graduate School for Health Studies, Boston Massachusetts. She can be reached at Simmons College Graduate School for Health Studies 300 The Fenway Boston, Massachusetts 02115. E-mail:

Douglas K. Richardson is Associate Professor of Pediatrics, Director Neonatal Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Sharon Dembinski is from the Women and Infant's Hospital, Providence, Rhode Island.

Kimberly O'Malley Hipp is from Texas Women's Hospital, Houston, Texas. At the time of this study, she was with Brigham & Women's Hospital, Boston, Massachusetts.

Maureen McCourt is from Beth Israel Deaconess Medical Center Boston, Massachusetts.

Diane Szlachetka is from Bay State Medical Center, Springfield, Massachusetts.

Dawn McBride Vaccaro is from Tufts New England Medical Center, Boston, Massachusetts.

This research was presented at the American Academy of Pediatrics in New Orleans, November 1, 1997.

© 1999 Lippincott Williams & Wilkins, Inc.