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Job Duties Confusion

By Bonnie Malmberg posted 12-17-2014 11:27 AM

  
A local hospital recently (May 2014) added 24/7 NNP coverage for their Women's Center.  They currently deliver low-risk 34 weeks and above and have averaged ~500 deliveries/yr.  With the support of NNP's/Neonatology,  the OB providers hope to increase those numbers and decrease the gestational age at delivery to 32 weeks in the future.  We currently attend all deliveries as support and to introduce the role to the staff and community.  Before NNP's, a pediatrician was on-call (not in-house) and would come from home or clinic for risky deliveries such as MSAF, vacuum extraction, NRFHT, etc.  Several pediatricians were lost due to dissatisfaction with this aspect of their job and the remaining pediatric group were instrumental in bringing NNP's on board.  
Administration is concerned with the cost of NNP's to the system.  Much of our shift is spent in support to nursing, assessing neonates, answering questions, education.  At night, if there are no deliveries, we have a call-room in which to sleep.  Administration/management would like us to provide nursing care to babies.  I am not opposed to helping nursing with neonatal care!  But, we are to be trained on the pixis so we can obtain vit. k, erythromycin, and hep b and give it to the babies after delivery.  We will have computer training so we can chart as the RN's do.  It is unclear what happens if there is an OB issue that we must attend while we are providing nursing care.  I am concerned and confused about my NNP role and would appreciate any comments, thoughts or advice. This seems to be a slippery slope! 

Thanks in advance!
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Mary Walters
06-25-2015 09:03 AM

Bonnie, I am curious as to how your situation evolved. I hope that you were able to promote a better understanding of the role and utilization of the NNP. The proposal from administration was fraught with potential for dissatisfaction for the NP's as well as diminishing the role and impact of advanced practice nursing. Sometimes the existing cultural barriers to our contribution to patient care and outcomes, as well as how much we are valued as a profession, can be very discouraging. I hope you and your colleagues were able to begin to effect change in your hospital.

Regina Stoltz
03-09-2015 03:04 PM

Bonnie,
I worked in a hospital that had the same issue when NNPs were first utilized. They ended up taking the NNPs out of the Nursing department and placing them in the medical department/division of neonatology. That administrative separation helped everyone understand how the role differed from that of staff nurses.

Erna Josiah-Davis
03-02-2015 02:18 PM

HI Bonnie, This sounds like a serious problem in your department and institution. Like others have suggested, please make clear what your role is and if that doesn't help, contact your BRN and use their scopes of practice and role definitions. Please let us know how this is resolved. Thank you and best of luck!

Jennifer Fitzgerald
02-04-2015 12:32 PM

Hi Bonnie,
Like Aubrey, I agree that the biggest barrier you are facing is lack of knowledge regarding your role. Regarding the ordering and dispensing of medications, the Joint Commission requires anti-diversion practices be put in place by hospitals and one of the most common practices implemented by an institution is the practice of restricting a LIP from administering and ordering medications. It is also a patient safety concern as it always good to have a double/triple check in place.
One other question I have: Do you bill for your work--as I'm certain your physician colleagues do? If you can demonstrate what revenue you can generate through delivery attendance and any procedures it may help to change the perspective iin which your role is viewed.
Good luck,
Jen Fitzgerald

Audrey Hubbard
12-31-2014 09:28 AM

Bonnie,
Whenever an administration takes on the use of advanced practice nurses and makes a request like has been made of you, it is due to the lack of knowledge of the role. My comment is that if you take a patient assignment, when you do attend deliveries you will put those patients at risk that you are assigned because they will have to be cared for by another nurse who already has a full assignment. If they had a neonatologist in house or a pediatrician in house, would they ask them to train on the PYXIS and EHR to take a patient assignment on that night shift? Of course not! Then that request is not appropriate of a NNP. Keep the course!