The use of family nurse practitioners and pediatric nurse practitioners as providers of neonatal intensive care: Safe practice or risky business?

Neonatal nurse practitioners (NNPs) have shown their worth as caregivers in the neonatal intensive care unit. Changes in the health care system, including increasingly complex technology, census growth, decreasing support for residency programs, and reductions in the amount of intensive care training for pediatric residents, have placed a burden on neonatal intensive care units. These changes have resulted in a greater demand for NNPs. There are currently 35 graduate programs for NNPs in the United States, which leaves many geographical areas educationally underserved. Thus, there are too few NNPs to address critical staffing problems. To fill this need, it has become common for family nurse practitioners (FNPs) and pediatric nurse practitioners (PNPs) to function in the NNP role. There are no references in the current literature to support or oppose this practice. Although FNPs and PNPs are advanced practice nurses, the belief that they are adequate substitutes for NNPs in the acute care neonatal setting is fraught with misconception. This article discusses the ethical and legal implications posed by issues surrounding role definition, educational preparation, specialty certification and credentialing, and scope of practice of FNPs and PNPs in the neonatal intensive care unit.