Education Standards
and Curriculum Guidelines
for
Neonatal Nurse Practitioner Programs
National Association of Neonatal Nurses
8735 W. Higgins Road, Suite 300
Chicago, IL 60631
Phone 800.451.3795, 847.375.3660
Fax 866.927.5321
www.nann.org
2
NANN Board of Directors
Lori Brittingham, MSN RN CNS ACCNS-N, President
Joan Rikli, MSN RN CPNP-PC NE-BC, President-Elect
Susan Meier, DNP APRN NNP-BC, Secretary-Treasurer
Lee Shirland, MS NNP-BC, NANNP Council Chair
Gail Bagwell, DNP APRN CNS
Taryn Edwards, MSN CRNP NNP-BC
Thomasine Farrell, BSN RNC-NC
Annie Rohan, PhD RN NNP-BC CPNP-PC FAANP
Elizabeth Sharpe, DNP NNP-BC
Rebecca South, BSN RNC-NIC
NANNP Council
Lee Shirland, MS APRN NNP-BC, NANNP Council Chair
Elizabeth Welch-Carre, MEd MS APRN NNP-BC, NANNP Council Chair-Elect
Sandra Bellini, DNP APRN NNP-BC
Kristin Howard, DNP APRN NNP-BC
Amy Koehn, PhD APRN NNP-BC
Barbara Snapp, DNP APRN NNP-BC
Moni Snell, MSN APRN NNP-BC RN
Tracy Wasserburger, MSN APRN NNP-BC RNC
Task Force for Revision of NNP Education Standards
Catherine Witt, PhD APRN NNP-BC, Chair
Suzanne Staebler, DNP APRN NNP-BC FAANP FAAN
Lori Bass Rubarth, PhD APRN NNP-BC
Sandra Bellini, DNP APRN NNP-BC CNE
Cheryl Ann Carlson, PhD APRN NNP-BC
Copyright © 2017 by the National Association of Neonatal Nurses. No part of this document may
be reproduced without the written consent of the National Association of Neonatal Nurses.
3
Introduction
Since the mid-1970s neonatal nurse practitioners (NNPs), previously known as neonatal nurse
clinicians, have demonstrated their value in the provision of health care to high-risk infants and
their families. Requirements for education, licensure, accreditation, and certification of NNPs have
been fluid, displaying wide variations among practice jurisdictions. NNPs have consistently
delivered high-quality care and have remained committed to maintaining standards of excellence as
they fulfill increasingly complex roles within the healthcare system.
NNPs are respected as professionals and have earned the trust of interprofessional colleagues and
the patients/families they serve. Trusted professionals must engage in continuous scrutiny to ensure
they keep pace with the ever-changing needs within the healthcare system and must be willing to
revise both preparation and requirements for entry-level and continuing practice, as reflected by the
most current evidence. This is especially true in the current healthcare environment, where nurses
and NNPs are faced with tumultuous changes in the way care is provided.
Professional accountability begins with ensuring the quality of nurse practitioners’ educational
preparation. It is the responsibility of the professional organizations for advanced practice nursing
(American Association of Colleges of Nursing [AACN], National Organization of Nurse
Practitioner Faculties [NONPF]) to define the standards for graduate nursing education in the nurse
practitioner role. Recognizing that NNPs are part of the larger group of advanced practice
registered nurses (APRNs), the National Association of Neonatal Nurses (NANN) and the National
Association of Neonatal Nurse Practitioners (NANNP) collaborate with a number of regulatory,
licensing, education, and credentialing agencies to produce the most current education and
curriculum standards. In response to the expanding numbers and responsibilities of APRNs, the
APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN)
APRN Advisory Committee met in 2008 and formed the APRN Joint Dialogue Work Group. They
developed an APRN regulatory model to clarify and ensure uniformity of APRN regulations. Their
consensus report "defines APRN practice, describes the APRN regulatory model, identifies the
titles to be used, defines specialty practice and preparation, describes the emergence of new roles
and population foci, and presents strategies for implementation" (APRN Consensus Work Group &
NCSBN APRN Advisory Committee, 2008, p. 5). In addition, the APRN Joint Dialogue Work
Group illustrated a need for the establishment of a "formal communication mechanism, LACE,
which includes those regulatory organizations that represent APRN licensure, accreditation,
certification, and education entities" to ensure ongoing effective dialogue among all APRN
stakeholders in these areas (p. 16).
According to AACN, "practice demands associated with an increasingly complex healthcare
system created a mandate for reassessing the education for clinical practice of all health
professionals, including nurses" (AACN, 2006, p. 4). In 2002 AACN convened a task force to
investigate the desirability of the practice doctorate in nursing (DNP). The task force proposed
doctoral-level education as an entry-level requirement for APRNs. This recommendation was
approved by the AACN membership in its 2006 document, The Essentials of Doctoral Education
for Advanced Nursing Practice (AACN, 2006).
AACN published The Essentials of Nursing Education for the Doctorate of Nursing Practice
(2006) to illustrate "curricular expectations that will guide and shape DNP Education." The
document outlines the "curricular elements and competencies that must be present in programs
conferring the doctor of nursing practice degree...and addresses the foundational competencies that
4
are core to all advanced nursing practice roles" (AACN, 2006, p. 8). Clarifying recommendations
regarding the DNP were published in 2015, which provided clarification on the DNP project,
practice hours and experiences, and curriculum considerations (AACN, 2015).
Although doctoral preparation for APRNs is a worthy goal, it is not yet clear when it will become a
mandatory degree for entry-level practice. In updating its Essentials for Master's Education in
Nursing (2011), AACN acknowledges that "Master's education remains a critical component of the
nursing education trajectory to prepare nurses who can address the gaps resulting from growing
healthcare needs and that...these Essentials are core for all master's programs in nursing and
provide the necessary curricular elements and framework, regardless of focus, major, or intended
practice setting" (AACN, 2011, p. 3). Currently, in 2017, there are a number of NNP programs
continuing to provide education and preparation at the master’s level.
Although APRNs are acknowledged as integral members of the healthcare system, there remains a
lack of consistency in regulations across state boundaries in the United States. The barriers to
practice created by the lack of standardization exacerbate the shortage of qualified NNPs that
already exists. With the release of the 2008 APRN Consensus Model, nurse practitioner (NP)
organizations and educational facilities have undertaken efforts to incorporate the model's
components. "Within education, NP programs have focused on changes to align educational tracks
with the NP populations delineated in the model. National organizations have supported these
efforts through collaborative work on the NP competencies that guide curriculum development"
(NONPF, 2013, p. 5).
NONPF, with representation from the major NP organizations, has developed core competencies
for the six population foci described in the APRN Consensus Model. These "NP Core
Competencies integrate and build upon existing master's and DNP core competencies and are
guidelines for educational programs" (NONPF, 2011, amended 2012, p.1). Each individual
population focus within the broader category of advanced practice nursing is charged with
delineating more specific standards of education for its own members. Thus, NANNP, a division of
NANN, defines the educational and preparation standards for those pursuing the NNP role.
In conclusion, the framework for NNP education is built upon the broad standards for advanced
practice nursing (AACN, 2006, 2011) and the evaluation criteria for nurse practitioner programs
(National Task Force on Nurse Practitioner Education, 2016). This document reflects the consensus
of the work summarized above and presented in the Criteria for Evaluation of Nurse Practitioner
Programs (National Task Force on Quality Nurse Practitioner Education, 2016), The Consensus
Model for APRN Regulation (APRN Consensus Work Group & NCSBN APRN Advisory
Committee, 2008), Population-Focused Nurse Practitioner Competencies (NONPF, 2013), The
Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and The
Essentials of Master’s Education in Nursing (AACN, 2011).
This document describes the minimum standards necessary for preparation of NNPs. These
standards are intended to be used in conjunction with other accreditation standards and tools in the
evaluation of graduate educational programs or tracks and reflect updated guidelines for Evaluation
Criteria for Nurse Practitioner Programs (National Task Force on Nurse Practitioner Education,
2016). This edition also adds additional information on use of simulation and addresses educational
criteria regarding care of the infant through the age of 2 years.
Designing or revising programs according to the recommendations in this guideline will ensure that
5
graduates receive the necessary preparation to practice at the novice level. The guidelines serve as
a tool for the development and evaluation of new NNP programs and as a self-study manual for
existing programs. The guidelines are especially valuable in today’s environment, in which hospital
administrators, directors, and managers may consider replacing NNPs with other providers who
have not received neonatal population–specific education. Given the educational components
needed to produce a competent, novice-level NNP, it is clear that filling the gaps with providers
who have a generalist education—such as physician assistants, pediatricians, or nurse practitioners
educated in other population foci—is not in the best interest of providing high-quality, safe, and
cost-effective neonatal care.
6
Each of the following program standard statements is followed by an elaboration that provides
important background on or a rationale for the standard. The statement of the standard is identified
by bold text.
I. Program Requirements
The NNP educational program must
A. be a formal neonatal nurse practitioner graduate or postgraduate (either post-
master’s certificate or postdoctoral) program that is awarded by an academic
institution and accredited by a nursing or nursing-related accrediting
organization recognized by the U.S. Department of Education or the Council
for Higher Education Accreditation
B. be awarded preapproval, pre-accreditation candidacy, or accreditation status
prior to the admission of students
C. be comprehensive at the graduate level
D. prepare the graduate for population-focused practice in the NNP role
E. be supported in its development, management, and evaluation by institutional
resources, facilities, and services
F. prepare the graduate to be eligible to take the national NNP certification exam.
Elaboration
Nurse practitioners are described by the American Association of Nurse Practitioners (AANP) as
“licensed independent practitioners who practice in ambulatory, acute, and long-term care as
primary and/or specialty care providers. According to their practice population focus, NPs deliver
nursing and medical services to individuals, families, and groups” (AANP, 2013).
AANP recommends that NPs complete a formal graduate education program and have a
commitment to lifelong learning and professional self-development to ensure that they develop and
maintain the appropriate understanding of theory and level of clinical skills. AANP clearly
indicates that the graduate degree is needed for entry-level preparation and acknowledges that,
although most NP programs award the master’s degree, the shift toward awarding doctoral degrees
is increasing. This transition has occurred as a result of a 2004 recommendation by AACN that all
advanced practice nurses be prepared at the doctoral level by 2015 “with the degree title of doctor
of nursing practice, or DNP” (AACN, 2004b; AANP, 2010). However, it is unclear when the
doctoral degree will be mandatory for entry-level NP practice.
According to the Consensus Model for APRN Regulation (APRN Consensus Work Group &
NCSBN APRN Advisory Committee, 2008), all APRN education programs must undergo a
preapproval, preaccreditation, or accreditation process before students are admitted. The purpose of
this process is to ensure that students graduating from the program will be eligible for national
certification and licensure to practice and to ensure that programs meet all educational standards
7
before they admit students. Accredited MSN or DNP programs adding a neonatal NP track must
submit a substantive change report to their accreditation body and receive a letter of change
approval within the designated time period set forth by the accreditation body (Accreditation
Commission for Education in Nursing, 2016; Commission on Collegiate Nursing Education, 2012).
The NNP provides population-focused health care to preterm (<37 weeks) and term neonates, and
infants and children up to 2 years of age.
To implement and maintain an effective NNP program or track, there must be an adequate number
of faculty, facilities, and services that support NNP students. There must be a sufficient number of
faculty with the necessary expertise to teach in the NNP program. As a necessary part of the
educational process, access to adequate classroom space, models, clinical simulations and
audiovisual aids, computer technology, and library resources is critical. When using alternative
delivery methods, a program is expected to provide or ensure that resources are available for the
students’ successful attainment of program objectives.
Graduates of NNP educational programs should be eligible to take the nationally recognized
certification exam. This national certification will assess the broad educational preparation of the
individual, including graduate core, APRN core, NNP role/core competencies, and the
competencies specific to the neonatal population (NONPF, 2013; NANNP, 2014).
II. Faculty and Faculty Organization
A. NNP programs must have sufficient faculty members with the preparation and
current expertise to adequately support the professional role development and
clinical management courses for NNP practice.
1. NNP program faculty members who teach the clinical components of the
program must maintain current licensure, state approval to practice as an
advanced practice nurse, and national certification as a neonatal nurse
practitioner.
2. NNP program faculty must demonstrate current, ongoing experience in
clinical practice as an NNP and in teaching through ongoing faculty
development activities designed to meet the needs of new and continuing
faculty members, including adjunct and clinical faculty (National Task
Force on Quality Nurse Practitioner Education, 2016).
B. Non-NNP faculty members must have expertise in the area in which they are
teaching.
C. NNP program faculty competence must be evaluated at regularly scheduled
intervals.
Elaboration
For successful implementation of the curriculum, faculty members must have the preparation,
knowledge base, and clinical skills appropriate to the neonatal area. Recognizing that no individual
faculty member can fill all roles, NNP programs need to maintain a sufficient number of qualified
8
faculty members who have the knowledge and competence appropriate to the neonatal area and
who are able to meet the objectives of the program and neonatal population–focused tracks.
NNP program faculty should include a mix of individuals with expertise and emphasis in research,
teaching, and clinical practice. Although it may be difficult for some faculty members to balance
research, practice, and teaching responsibilities, all faculty members who teach clinical courses
must maintain national certification as a neonatal nurse practitioner.
NNP faculty members may participate in or undertake various types of practice in addition to direct
patient care to maintain currency in practice. Maintaining this currency is important to ensuring
clinical competence in the area of teaching responsibility.
In the event that an NNP faculty member has less than 1 year of clinical or academic experience, it
is expected that a senior or experienced faculty member will mentor this individual in both clinical
and teaching responsibilities. Mentoring new and inexperienced faculty is a positive experience
that helps NNPs transition into the role of NNP faculty educator. Opportunities for continued
development in one’s area of research, teaching, and clinical practice should be available to all
faculty.
Similar to NNP faculty, other faculty who help support the NNP program must have the
preparation, knowledge base, and clinical skills appropriate to their area of teaching responsibility.
III. Practice Experience Requirements for Prospective Students
The equivalent of 2 years of full-time clinical practice experience (within the last 5
years) in the care of critically ill neonates or infants in critical care inpatient settings is
required before a student begins clinical courses. Students may enroll in preclinical
courses while obtaining the necessary practice experience.
Elaboration
NANN recognizes that a solid foundation of clinical practice in a Level III and/or IV NICU is
necessary before one assumes the advanced practice role of NNP. However, critical thinking skills
needed for the care of the critically ill neonate/newborn (birth to 28 days of life) can be derived in a
practice setting other than the neonatal intensive care unit (NICU). Therefore, while the majority of
experience should be in a Level III and/or IV NICU, practice experience in a critical (intensive
care) inpatient setting for infants (1 to 12 months of age) may be considered.
Anecdotal experience suggests that students with at least 2 years of clinical experience in the
neonatal intensive care setting are more successful in transitioning to the APRN role. Although it is
ideal for prospective students to complete their practice experience before beginning graduate
education, maintaining this position may not be feasible in today’s educational market. Appropriate
clinical experience in the care of critically ill newborns or infants is essential prior to beginning the
clinical component of an NNP program.
IV. Program Leadership
9
A. The director/coordinator of the NNP program must be a doctorally prepared,
nationally certified nurse practitioner. He or she has responsibility for overall
leadership of the program.
B. The faculty member who provides direct oversight of the neonatal-specific
program content must be a nationally certified NNP, preferably prepared at
the doctoral level.
C. The program faculty member must be prepared at the graduate level and must
maintain currency in clinical practice, licensure, and national certification as
an NNP. She or he is responsible for development of the NNP role and clinical
courses.
Elaboration
The program director/coordinator must be doctorally prepared, should have a strong foundation in
areas that support the responsibilities of leadership for the program (clinical knowledge, academic
leadership, administration, and scholarship), and must be nationally certified in a particular NP
population focus. She or he has academic oversight for the NNP program.
In programs with multiple tracks, although the program director/coordinator may be certified in
only one population-focused area of practice, she or he is responsible for leadership of all of the NP
tracks (National Task Force on Quality Nurse Practitioner Education, 2016).
The faculty member with direct oversight of the NNP program must be a clinically experienced,
nationally certified NNP with a minimum of 2 years of NNP academic and/or clinical experience.
Doctoral preparation is preferable. She or he provides direct supervision for the NNP track;
provides curriculum oversight for the population-focused content of the NNP education program;
and participates in the identification, development, teaching, and evaluation of the population-
focused content for the advanced practice nursing core (advanced physiology and pathophysiology,
health assessment, and pharmacology). She or he may work in collaboration with the program
director/coordinator on the graduate nursing core (e.g., theory and research). This faculty member
is responsible for the selection, evaluation, and counseling of students in the program and also
participates in the ongoing evaluation of the program’s resources and services.
Members of the program faculty must be prepared at the required graduate level and must maintain
currency in clinical practice, licensure, and national certification as an NNP (AANP, 2013). These
faculty members are responsible for development of the NNP role and clinical courses, and one of
their primary responsibilities is the development, implementation, and evaluation of the NNP
program curriculum. They also should participate in the selection, evaluation, and counseling of
students and in the ongoing evaluation of the program’s resources and services.
Individuals providing didactic instruction should be drawn from the interprofessional team of
healthcare providers caring for infants and their families. Participants should be determined
according to the resources available to the program but should generally include NNPs,
neonatologists, pediatric subspecialists, APRNs, and allied health specialists. These faculty
members should have the “preparation, knowledge, and skills appropriate to their content areas”
(AANP, 2013). The didactic and clinical presentations of participating faculty will be tailored to
the individual needs of the students under the direction of the NNP faculty.
10
V. Curriculum
The curriculum must be designed to provide experiences, both didactically and
clinically, to meet the competencies as stated in the table on pages 19–39.
A. Didactic instruction
1. The curriculum must include three separate graduate-level core courses
in the following areas:
a. advanced physiology and pathophysiology, including general
principles that apply across the lifespan
b. advanced health assessment, including advanced assessment
techniques, concepts, and approaches specific to the neonatal
population
c. advanced pharmacology, including pharmacodynamics,
pharmacokinetics, and pharmacotherapeutics of all broad categories
of agents, including population-specific alterations in global concepts.
2. The curriculum must include a minimum of 200 didactic clock hours.
3. Specific neonatal content and/or courses related to advanced physiology
and pathophysiology, advanced health assessment, and advanced
pharmacology must be included and integrated throughout the other
neonatal-specific didactic and clinical courses.
B. Clinical instruction
1. The clinical component of the NNP curriculum must include a minimum
of 600 precepted clock hours with critically ill neonates or infants in the
delivery room and in Level II, III, and IV NICUs.
2. Precepted clock hours with neonates with surgical or cardiovascular
disease may occur in a pediatric ICU setting and may be included in the
minimum 600 hours.
3. While clinical experience in pediatric ICU and Level II NICUs caring
for critically ill newborns is valid, the majority of the 600 precepted
clock hours must be spent in Level III and IV NICUs.
4. Hours of observational experience may not be included in the minimum
600 hours.
5. Clinical skills, or simulation laboratory hours and clinical seminar
hours, may not be included in the minimum 600 hours.
11
6. Sufficient clinical experiences, including simulation in the care of NICU
graduate patients or long-term hospitalized infants must be included to
provide competency in the primary care component of the NNP scope of
practice. This is in addition to the 600 hours required in the care of
acute/critically ill neonates.
7. While it may be difficult to require a set number of deliveries that must
be attended or procedures that must be performed, attention to building
competence in these areas through clinical or simulation experiences
should be documented.
C. Core content
1. The curriculum must contain sufficient content to enable program
graduates to meet the core competencies and neonatal population-specific
competencies for NNP practice.
2. Recommended population-focused content for NNP education is outlined in
this document.
3. Formal NNP curriculum evaluation should occur at regular intervals.
4. Postgraduate students must successfully complete graduate didactic and
clinical requirements of an academic graduate NNP program through a
formal graduate-level certificate or degree-granting-graduate-level NNP
program. Postgraduate students are expected to master the same outcome
criteria as graduate-degree-granting-program NNP students.
Elaboration
The curriculum design of individual NNP programs is the prerogative of the program faculty.
Although NANN supports the program faculty’s exercise of creativity in designing the NNP
curriculum, it is essential that the curriculum plan meet all current standards, evaluation criteria,
and guidelines that have been iterated in this document. NNP faculty should have ongoing input
into the development and revision of curriculum, progression, and graduation criteria. To ensure
that students achieve successful program outcomes, program and course evaluation should be
ongoing and conducted in real time with formal curriculum overview at least every 5 years.
Not all facilities care for neonates with cardiac disease or post-surgically in the NICU; some
provide that care in the pediatric ICU (PICU). In this situation, precepted clinical hours caring for
such neonates in the PICU may count toward the minimum 600 clinical hours.
Use of Simulation in NNP education. Consistent with the most recent addition of the NTF
Criteria, the use of simulation as part of the NNP program curricula is encouraged, especially in
relation to high-risk/low-frequency situations (NONPF, 2016). However, it must be emphasized
that simulation experiences of any kind cannot be counted toward the required minimum number of
clinical hours (600) in direct patient care for NNP students.
12
The intended role of simulation as of 2017 in graduate nursing education is to augment, not
replace, direct patient care experiences. Examples of such experiences include laboratories for
procedures/skills and demonstration of advanced health assessment competencies. These
experiences may however, play a role in faculty evaluation of student performance, both formative
and summative, which are very valuable, particularly in distance-learning programs where direct
student observation by program faculty is limited.
Simulation can provide a creative space for faculty and students to enhance high-risk skills and
procedures in a safe environment for both students and patients. Additionally, simulation scenarios
can be developed in a uniquely advantageous fashion that both replicates the complex healthcare
environments in which NNPs practice and provides opportunities for integration of APRN
competency areas. For example, a simulation scenario ostensibly about “Patient Safety and Shift
Sign-Out” can easily serve to evaluate student performance related to Scientific Foundation,
Leadership, Quality, Healthcare Systems, etc. Through group simulations, students gain
competence and confidence, and enhance their communication skills. Interdisciplinary scenarios
also can be designed allowing students to work with other healthcare team members or students in
healthcare programs such as pharmacy, physical therapy, and undergraduate nursing programs.
(Faculty resources pertaining to simulation in nursing education are available via the National
League for Nursing’s Simulation Innovation Resource Center,
http://sirc.nln.org/mod/glossary/view.php?id=183.)
Despite the inability to substitute hours in simulation lab with direct patient care hours, the NONPF
recommends that advanced practice programs document their use of simulation as a teaching
strategy and clearly articulate the ways in which simulation is used to augment clinical experiences.
A sample form for this purpose is available in the NTF Criteria (2016) Appendix
(www.nonpf.org/resource/resmgr/Docs/EvalCriteria2016Final.pdf).
Clinical and didactic content related to primary care of the high-risk infant during the first 2 years
of life must be included in the curriculum. This content should be offered in addition to the clinical
and didactic hours required in the care of the high-risk neonate. This content provides necessary
preparation across the entire continuum of the NNP scope of practice. It also provides students with
a more holistic perspective on practice while enhancing role diversity and career opportunities.
NPs expanding into the NNP population-focused area of practice may be allowed to challenge
selected courses and experiences; however, didactic and clinical experiences must be sufficient to
allow the student to master the competencies and meet the criteria for national certification as an
NNP. NPs who have not practiced in the advanced practice role in an NICU must complete a
minimum of 600 clinical hours.
NPs currently practicing in the NICU who are not nationally certified in the neonatal population
focus must complete appropriate didactic coursework and a sufficient number of direct patient care
clinical hours to establish/demonstrate competency. Programs must document credit granted for
prior didactic and clinical experiences for individual students through a gap analysis. A gap
analysis should be completed for certified NNPs originally educated in a certificate program who
are completing a master’s degree
(www.nonpf.org/resource/resmgr/Docs/EvalCriteria2016Final.pdf).
13
VI. Preceptors and Clinical Sites
A. Preceptors
1. Preceptors for the 600 clock hours in the ICU must have their master of
science degree or doctoral degree in nursing (MS, MSN, or higher) and be
nationally certified as an NNP. Preceptors also may be physicians who are
board-certified in neonatology (or seeking board certification).
a. NNP preceptors must have a minimum of 1 year full-time equivalent
experience in the NP role, and have a minimum of 1-year full-time
equivalent employment at the clinical site. These requirements
ensure that the preceptor at a given site has both the clinical
expertise and the familiarity with the site necessary to provide
supervision of the NNP students.
2. The preceptor-to-student ratio should be such that individual learning
and evaluation are optimized. Therefore, the preceptor-to-student ratio
should not exceed 1:2.
3. Preceptors for other clinical experiences (e.g., in antenatal, intrapartum,
and primary care) must possess the clinical expertise necessary to
provide safe guidance and appropriate education for the NNP students.
4. Preceptors must be oriented to NNP program requirements and
expectations for supervision and evaluation of the NNP students.
5. Preceptors must be evaluated annually for the purpose of ensuring the
quality of the NNP students’ learning experiences and defining
preceptor relationships.
Elaboration
Each student should be assigned a primary preceptor to coordinate the clinical experience. For the
duration of the preceptorship, direct onsite supervision and consultation should be available from
the NNP or neonatologist preceptor. The preceptor-to-student ratio should be such that individual
learning is optimized. The recommended preceptor-to-student ratio may vary according to the
extent of clinical responsibilities for a patient caseload. The optimal preceptor-to-student ratio
differs if the preceptor also is seeing patients (1:1 if seeing own patients; 1:2 if not seeing own
patients). The NNP faculty, however, has ultimate responsibility for the supervision and evaluation
of students and for evaluation of the quality of the clinical learning environment (National Task
Force on Quality Nurse Practitioner Education, 2016).
Responsibilities of Clinical Preceptors
1. Meet with the student prior to the preceptorship to discuss clinical objectives, schedules,
and general guidelines. The preceptor should inform the student of any institutional
orientation requirements. These should be completed prior to the beginning of the clinical
experience.
14
2. Refer the student to any standardized procedures and management protocols applicable to
unit management.
3. Assign an initial caseload of patients. Expansion of the caseload will depend on the
evaluation of the student’s readiness, knowledge, and skill level.
4. Permit the student to perform all the required management activities for assigned patients
under appropriate supervision. These activities include, but are not limited to, the following:
a. Participating in resuscitation and stabilization of neonates in the delivery room
b. Admitting patients to the nursery, obtaining the perinatal and neonatal history,
performing physical examinations, developing the differential diagnosis, and
proposing the initial management plan
c. Providing ongoing management of infants in collaboration with the preceptor and
revising the management plan based on the evaluation of the infant’s progress
d. Performing diagnostic tests and procedures as dictated by the status and needs of the
patient
e. Responding to emergency situations to stabilize an infant
f. Documenting the infant’s clinical status, plan of care, and response to therapy in the
medical record
g. Evaluating the need for consultations and requesting them
h. Facilitating an understanding of the infant’s current and future healthcare needs and
providing support to parents and staff
i. Developing discharge plans
j. Participating in post-discharge primary care management
k. Participating in high-risk newborn transport if this service is available and if
permitted by hospital and school protocol
l. Providing staff development by participating in educational programs.
5. Provide direct supervision when the student is involved in patient care. The preceptor
should be available on site for ongoing consultation and evaluation of the care delivered
throughout the clinical experience.
6. Review the student’s documentation and make constructive suggestions for improvement.
7. Meet with the student on an ongoing basis to discuss specific learning objectives and
experiences. These meetings should focus on patient management and documentation,
successful completion of procedures, comprehension of pathophysiology and management,
interaction with staff and family, and role transition. Plans should be made for future
learning experiences to meet the student’s evolving learning needs. This information must
be communicated to the NNP faculty in a timely manner throughout the clinical
preceptorship.
8. Evaluate the student. The preceptor must communicate with the student and the faculty
member or program director. This should include written evaluation(s) of the student’s
performance furnished at specified intervals and upon completion of the preceptorship.
9. Contact the program director or appropriate faculty member in a timely fashion with
concerns or questions regarding the preceptor’s ability to fulfill responsibilities or if there
15
are problems concerning the student’s performance.
Responsibilities of Students
1. Discuss specific clinical objectives, schedules, and general guidelines with the preceptor
and faculty prior to the clinical rotation.
2. Provide the clinical site with the necessary documentation regarding licensure, health data,
liability insurance, and educational information (curriculum vitae or résumé).
3. Observe the policies of the clinical site.
4. Adhere to the standards and scope of professional practice.
5. Communicate with the preceptor and faculty on clinical progress and learning needs.
6. Demonstrate independent learning, diagnostic reasoning skills, and the use of available
resources.
7. Maintain and submit a log of clinical skills and activities.
8. Complete self-evaluations and evaluations of preceptor and clinical site as required.
9. Successfully complete the American Academy of Pediatrics/American Heart Association
Neonatal Resuscitation Program prior to beginning the clinical preceptorship.
B. Clinical sites
Clinical sites should be diverse and sufficient in number to ensure that core
curriculum guidelines can be observed and clinical objectives can be
accomplished.
1. Clinical sites should provide the student with the opportunity to manage
a caseload of newborns and infants so they have the experiences
necessary to achieve clinical competencies.
2. Clinical sites should provide the student with the opportunity to
participate in educational activities, attend high-risk deliveries, and
learn procedural skills.
3. Clinical sites should ensure that direct onsite supervision and
consultation are available from the preceptor.
4. Clinical sites should be evaluated annually to ensure the quality of the
NNP student’s learning experiences.
5. Faculty and student assessments of the clinical experience should be
conducted regularly and documented.
16
Elaboration
The NNP faculty or clinical coordinator is responsible for evaluating the ability of the potential
clinical sites to provide an optimal clinical experience for the student. During the clinical
preceptorship, the student has no legal status as a nurse practitioner and must be supervised by an
APRN or a physician experienced in the care of high-risk infants.
NNP program faculty should provide oversight of the clinical learning environment, which may
include, but is not limited to, physical and virtual site visits, e-mail, and phone consultations with
the preceptor and agency administrators, as well as the student’s appraisal of the clinical learning
environment. A mechanism should be in place to ensure the clinical setting provides the
opportunity to meet learning objectives and to document outcomes of the clinical experiences
(National Task Force on Quality Nurse Practitioner Education, 2016).
Additional topics that may need to be addressed prior to the beginning of the clinical preceptorship
include liability insurance coverage, workers’ compensation benefits, contracts or agreements
between universities and clinical sites, and the relationship between the preceptor and the
university. These matters must be clarified because a wide variety of policies and practices exists.
In the case of distance-learning programs, interstate and international policies may need
elucidation.
Ideally, the clinical site would have established the NNP role description, advanced practice
procedures, and management protocols before the student’s clinical experience begins. However,
this may not be possible if the preceptorship takes place in an NICU where there are no practicing
NNPs. In this case the program director or faculty should be sure that this information is provided
to the student in the didactic portion of the program.
Responsibilities of Program Faculty
1. Develop clinical and didactic portions of the NNP program, as outlined in the section on
curriculum.
2. Provide the preceptor with the program objectives, outlines of didactic material, student’s
required reading list, and clinical course outline prior to the beginning of the clinical
rotation.
3. Develop an evaluation process and the necessary forms to be used for formative and
summative evaluation throughout and upon completion of the clinical preceptorship.
4. Consult with the student and preceptor to provide clarification of clinical objectives,
activities, specific individual responsibilities, and requirements.
5. Ensure that clinical site visits are conducted as outlined in NTF guidelines.
6. Give approval of the student’s clinical evaluation and competency throughout the program.
17
References
Accreditation Commission for Education in Nursing. (2016). Accreditation manual. Section II
policies. Atlanta: GA: Author. Retrieved from www.acenursing.net/manuals/Policies.pdf.
American Academy of Pediatrics; Committee on Fetus and Newborn. (2012). Policy Statement:
Levels of Neonatal Care. Pediatrics, 130 (3), 587-597.
American Association of Colleges of Nursing. (2015). The doctor of nursing practice: current
issues and clarifying recommendations. Washington, DC: Author
American Association of Colleges of Nursing. (2011). The essentials of master’s education in
nursing. Washington, DC: Author.
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for
advanced nursing practice. Washington, DC: Author.
American Association of Colleges of Nursing. (2004b). Position statement on the practice
doctorate in nursing. Washington, DC: Author.
American Association of Nurse Practitioners. (2013). Nurse Practitioner Curriculum. Austin, TX:
Author.
APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory
Committee. (2008). APRN Joint Dialogue Group Report. Consensus model for APRN
regulation: Licensure, accreditation, certification, and education. Chicago, IL: National
Council of State Boards of Nursing. Retrieved from
www.ncsbn.org/7_23_08_Consensue_APRN_Final.pdf.
Commission on Collegiate Nursing Education. (2014). Procedures for accreditation of
baccalaureate and graduate degree nursing programs. Washington, DC: Author. Retrieved
from www.aacn.nche.edu/ccne-accreditation/procedures.pdf.
National Association of Neonatal Nurse Practitioners. (2014). Competencies and Orientation
Toolkit for Neonatal Nurse Practitioners, 2
nd
ed., Chicago, IL: Author.
National Organization of Nurse Practitioner Faculties. (2006). Domains and Core Competencies of
Nurse Practitioner Practice. Washington, DC: Author.
National Organization of Nurse Practitioner Faculties. (2011; Amended 2012). Nurse Practitioner
Core Competencies. Washington, DC: Author.
National Organization of Nurse Practitioner Faculties. (2013). Population-Focused Nurse
Practitioner Competencies. Washington, DC: Author.
National Task Force on Quality Nurse Practitioner Education. (2016). Criteria for evaluation of
nurse practitioner programs (5th ed.). Washington, DC: National Organization of Nurse
Practitioner Faculties.
18
Bibliography
Allan, J., Barwick, T. A., Cashman, S., Cawley, J. F., Day, C., Douglass, C. W., et al. (2004).
Clinical prevention and population health: Curriculum framework for health professions.
American Journal of Preventive Medicine, 27(5), 471–476.
American Academy of Nurse Practitioners. (2013). Position statement on nurse practitioner
curriculum. Washington, DC: Author.
Boyer, E. L. (1990). Scholarship reconsidered: Priorities of the professoriate. Princeton, NJ:
Carnegie Foundation for the Advancement of Teaching.
Brown, S. J. (2005). Direct clinical practice. In A. B. Hamric, J. A. Spross, & C. M. Hanson (Eds.),
Advanced practice nursing: An integrative approach (3rd ed.) (pp. 143–185). Philadelphia:
Elsevier Saunders.
Donaldson, S., & Crowley, D. (1978). The discipline of nursing. Nursing Outlook, 26(2), 113–120.
Ehrenreich, B. (2002). The emergence of nursing as a political force. In D. Mason, D. Leavitt, &
M. Chaffee (Eds.), Policy and politics in nursing and health care (4th ed.) (pp. xxxii–
xxxvii). St. Louis, MO: Saunders.
Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models
and theories (2nd ed.). Philadelphia: Davis.
Gortner, S. (1980). Nursing science in transition. Nursing Research, 29, 180–183.
Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC:
National Academies Press.
National Association of Neonatal Nurses. (1997). Position statement on RN practice experience
and neonatal advanced nursing practice. Petaluma, CA: Author.
National Association of Neonatal Nurses. (2002a). Curriculum guidelines for neonatal nurse
practitioner (NNP) education programs. Glenview, IL: Author.
National Association of Neonatal Nurses. (2014). Education standards for neonatal nurse
practitioner (NNP) education programs. Glenview, IL: Author.
National Association of Neonatal Nurses. (2014). Sample forms and evaluation tools for neonatal
nurse practitioner (NNP) education programs. Glenview, IL: Author.
National Organization of Nurse Practitioner Faculties. (1995). Advanced nursing practice:
Curriculum guidelines and program standards for nurse practitioner education.
Washington, DC: Author.
19
National Panel for Critical Care Nurse Practitioner Competencies. (2004). Critical care nurse
practitioner competencies. Washington, DC: National Organization of Nurse Practitioner
Faculties.
O’Neil, E. H., & Pew Health Professions Commission. (1998). Recreating health professional
practice for a new century: The fourth report of the Pew Health Professions Commission.
San Francisco: Pew Health Professions Commission.
Spross, J. A. (2005). Expert coaching and guidance. In A. B. Hamric, J. A. Spross, & C. M. Hanson
(Eds.), Advanced practice nursing: An integrative approach (3rd ed.) (pp. 187–223).
Philadelphia: Elsevier Saunders.
U.S. Department of Health and Human Services. (2000). Healthy people 2010. McLean, VA:
International Medical Publishing.
19
Competencies
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
Scientific
Foundation
Competencies
1. Critically analyzes data
and evidence for
improving advanced
nursing practice.
2. Integrates knowledge
from the humanities
and sciences within the
context of nursing
science.
3. Translates research and
other forms of knowledge
to improve practice
processes and outcomes.
4. Develops new practice
approaches based on the
integration of research,
theory, and practice
knowledge.
Advanced Neonatal Pathophysiology
Advanced Neonatal Pharmacology
Advanced Neonatal Assessment
Research and Quality Improvement
A. Research process and methods
B. Information databases
C. Critical evaluation of research findings
D. Translational research
E. Research on vulnerable populations
F. Funding for research
G. Research dissemination
H. Institutional review boards
I. Safety
J. Continuous Quality Improvement
Professional Role
A. Nursing theories
B. Evidence-based practice
Leadership
Competencies
1. Assumes complex and
advanced leadership
roles to initiate and guide
change.
2. Provides leadership to
foster collaboration with
multiple stakeholders (e.g.,
patients, community,
integrated healthcare
teams, and policy makers)
to improve health care.
Professional Role
A. Professional leadership
B. Professional accountability/ethical standards of practice
C. Evidence-based practice
D. Role theory
E. Advanced practice role
F. Role of the NNP
G. Scope of practice for the NNP
H. Standards of practice
I. Professional regulation and licensure
J. Credentialing and certification
20
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
3.
Demonstrates
leadership that uses
critical and reflective
thinking.
4.
Advocates for improved
access, quality, and cost
effective health care.
5.
Advances practice through
the development and
implementation of
innovations incorporating
principles of change.
6.
Communicates practice
knowledge effectively both
orally and in writing.
7.
Participates in professional
organizations and activities
that influence advanced
practice nursing and/or
health outcomes of a
population focus.
K. Clinical decision making and problem solving
L. Professional scholarship
Teaching and Education
A. Theories—motivational, change, education,
communication
B. Program planning and evaluation
C. Instructional technology
D. Cultural sensitivity
E. Communication
F. Collaboration
G. Conflict resolution
H. Assertiveness
I. Collaborative practice models
J. Informatics
K. Consultation
Quality
Competencies
1. Uses best available
evidence to continuously
improve quality of
clinical practice.
2. Evaluates the relationships
among access, cost,
quality, and safety and their
influence on health care.
3. Evaluates how
Healthcare Policy and Advocacy
A. Economics of health care
Research and Quality Improvement
A. Information databases
B. Critical evaluation of research findings
C. Translational research
D. Research dissemination
21
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
organizational structure,
care processes,
financing, marketing,
and policy decisions
impact the quality of
health care.
4. Applies skills in peer
review to promote a
culture of excellence.
5. Anticipates variations in
practice and is proactive
in implementing
interventions to ensure
quality.
E.
Institutional review boards
F.
Safety
G.
Continuous quality improvement
H.
Finance and value-added care
Practice Inquiry
Competencies
1. Provides leadership in the
translation of new
knowledge into practice.
2. Generates knowledge from
clinical practice to improve
practice and patient
outcomes.
3. Applies clinical
investigative skills to
improve health outcomes.
A. Research process and methods
B. Information databases
C. Critical evaluation of research findings
D. Translational research
E. Research on vulnerable populations
F. Research dissemination
G. Institutional review boards
H. Safety
I. Continuous Quality Improvement
Technology and
Information Literacy
Competencies
1. Integrates appropriate
technologies for
knowledge management to
improve health care.
2. Translates technical and
Communication
A. Communication theory
B. Collaboration
C. Conflict resolution
22
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
scientific health information
appropriate for various
users’ needs.
2a. Assesses the patient’s
and caregiver’s
educational needs to
provide effective,
personalized health
care.
2b. Coaches the patient
and caregiver for
positive behavioral
change.
3. Demonstrates information
literacy skills in complex
decision making.
4. Contributes to the design
of clinical information
systems that promote safe,
quality, and cost-effective
care.
5. Uses technology systems
that capture data on
variables for the evaluation
of nursing care.
D. Assertiveness
E. Collaborative practice models
F. Informatics
G. Information data bases/technology
H. Consultation
I. Health literacy
Professional Role
A. Information technology
B. Professional boundaries
Teaching and Education
A. Theories—motivational, change, education,
communication
B. Program planning and evaluation
C. Instructional technology
D. Cultural sensitivity
Policy
Competencies
1. Demonstrates an
understanding of the
interdependence of policy
and practice.
2. Advocates for ethical
Healthcare Policy and Advocacy
A. Process of healthcare legislation/administrative policy
B. Maternal and child health legislation
C. Implications of healthcare policy
D. Economics of health care
23
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
policies that promote
access, equity, quality,
and cost.
3. Analyzes ethical, legal,
and social factors
influencing policy
development.
4. Contributes to the
development of health
policy.
5. Analyzes the implications of
health policy across
disciplines.
6. Evaluates the impact of
globalization on healthcare
policy development.
E. Healthcare financing
F. Legislation and regulations concerning advanced
practice
G. Advocacy
Ethical and Legal Issues
A. Ethical decision making
B. Ethical issues—reproductive, prenatal, neonatal, and
infancy
C. Ethical use of information
D. Patient advocacy
E. Resource allocation
F. Legal issues affecting patient care and professional
practice
G. Cultural sensitivity
Global Health Care
Communication
A. Communication theory
B. Collaboration
C. Conflict resolution
D. Assertiveness
E. Collaborative practice models
F. Informatics
G. Consultation
Health Delivery
System
Competencies
1. Applies knowledge of
organizational
practices and
complex systems to
Management and Organization
A. Organizational theory
B. Principles of management
C. Models of planned change
24
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
improve healthcare
delivery.
2. Effects health care
change using broad-
based skills, including
negotiating, consensus-
building, and partnering.
3. Minimizes risk to
patients and providers
at the individual and
systems level.
4. Facilitates the
development of
healthcare systems that
address the needs of
culturally diverse
populations, providers,
and other stakeholders.
5. Evaluates the impact of
healthcare delivery on
patients, providers, other
stakeholders, and the
environment.
6. Analyzes organizational
structure, functions, and
resources to improve the
delivery of care.
7. Collaborates in planning
for transitions across the
continuum of care.
D. Collaborative practice
E. Healthcare system financing
F. Billing and coding for reimbursement
G. Standards of practice
H. Cost, quality, and outcome measures
I. Resource management
J. Evaluation models
K. Peer review
Communication
A. Communication theory
B. Collaboration
C. Conflict resolution
D. Assertiveness
E. Collaborative practice models
F. Informatics
G. Consultation
Healthcare Policy and Advocacy
A. Process of healthcare legislation
B. Maternal and child health legislation
C. Implications of healthcare policy
D. Economics of health care
E. Third-party reimbursement
F. Legislation and regulations concerning advanced
practice
G. Advocacy
25
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
Research and Quality Improvement
A. Safety
B. Continuous Quality Improvement
Ethics
Competencies
1. Integrates ethical
principles in decision
making.
2. Evaluates the ethical
consequences of
decisions.
3. Applies ethically sound
solutions to complex
issues related to
individuals, populations
and systems of care.
Ethical and Legal Issues
A. Ethical decision making
B. Ethical issues—reproductive, prenatal, neonatal, and
infancy
C. Ethical use of information
D. Patient advocacy
E. Bioethics committees
F. Clinical research
G. Resource allocation
H. Genetic counseling
I. Legal issues affecting patient care and professional
practice
J. Informed consent
K. Cultural sensitivity
L. Palliative care
M. End-of-life care
Independent
Practice
Competencies
1. Functions as a licensed
independent practitioner.
2. Demonstrates the highest
level of accountability for
professional practice.
3. Practices independently
managing previously
diagnosed and
undiagnosed patients.
3a. Provides the full
Advanced Neonatal Pathophysiology
Advanced Neonatal Pharmacology
Advanced Neonatal Assessment
Perinatal Issues
A. Perinatal physiology
1. Maternal physiology (physiologic adaptation to
pregnancy, pathologic changes or disease in
pregnancy, effects of pre-existing disease)
2. Fetal physiology
26
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
spectrum of
healthcare services
to include health
promotion, disease
prevention, health
protection,
anticipatory
guidance,
counseling, disease
management, and
palliative and end-of-
life care.
3b. Uses advanced
health assessment
skills to differentiate
between normal,
variations of normal
and abnormal
findings.
3c. Employs screening
and diagnostic
strategies in the
development of
diagnoses.
3d. Prescribes
medications within
scope of practice.
3e. Manages the
health/illness status
of patients and
families over time.
4. Provides patient-centered
3. Transitional changes
4. Neonatal physiology
5. Immune and nonimmune hydrops
B.
Pharmacology
1.
Principles of pharmacology and
pharmacotherapeutics, including those at the cellular
response level
2. Principles of pharmacokinetics and
pharmacodynamics of broad categories of drugs
3. Common categories of drugs used in the newborn
and infant
4. Monitoring of drug therapies including drug levels
when appropriate
5. Effects of drugs during pregnancy and lactation
C. Genetics
1. Molecular genetic testing
2. Genetic screening
3. Specific chromosomal defects and management
4. Human genome project
5. Gene mapping and personalized care
6. Genetic counseling
General Assessment
A. Perinatal history
B. Antepartum conditions
C. Prenatal diagnostic testing
D. Intrapartum conditions
E. Influence of NICU environment on the newborn and
infant
F. Gestational age assessment
G. Physical assessment
H. Behavioral assessment
27
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
care recognizing cultural
diversity and the patient
or designee as a full
partner in decision
making.
4a. Works to establish a
relationship with the
patient characterized
by mutual respect,
empathy, and
collaboration.
4b. Creates a climate of
patient-centered
care to include
confidentiality,
privacy, comfort,
emotional support,
mutual trust, and
respect.
4c. Incorporates the
patient’s cultural and
spiritual preferences,
values, and beliefs
into health care.
4d. Preserves the
patient’s control over
decision making by
negotiating a
mutually acceptable
plan of care.
I. Developmental assessment
J. Growth and nutritional assessment
K. Immunization assessment
L. Pain assessment and evidence-based tools across the
population (up through 2 years)
M. Assessment of family adaptation, coping skills, and
resources
Sociocultural Assessment
A. Family assessment
1. Family function
a. Roles
b. Interactions
c. Effect of childbearing
2. Social, cultural, and spiritual variations
3. Support systems
B. Families in crisis
1. Crisis theory
2. Principles of intervention
3. Crises of childbearing
a. Sick or premature infant
b. Chronically ill or malformed infant
c. Death of an infant
4. Grief
a. Stages
b. Factors influencing grieving process
c. Pathologic grief
d. Sibling reactions
C. Principles of family-centered care
Clinical and Diagnostic Laboratory Assessments
A. Clinical laboratory tests
1. Microbiologic
2. Biochemical
3. Hematologic
28
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
4. Serologic
5. Metabolic and endocrine
6. Immunologic
7. Routine newborn screening
8. Other
B. Diagnostic tests (types and techniques)
1. Ultrasound
2. Computed tomography (CT)
3. Magnetic resonance imaging (MRI), magnetic
resonance angiogram (MRA), magnetic resonance
spectroscopy (MRS)
4. X ray
5. Fluoroscopy
6. Electrocardiogram (EKG)
7. Electroencephalogram (EEG)
8. Echocardiogram (ECHO)
9. Cardiac catheterization
C. Selection of diagnostic tests
1. Indications
2. Reliability
3. Advantages and disadvantages
4. Cost-effectiveness
5. Interpretation of results
D. Performance of procedures for neonates and infants,
including but not limited to:
1. Lumbar puncture
2. Umbilical vessel catheterization
3. Percutaneous arterial and venous catheters
4. Arterial puncture
5. Venipuncture
6. Capillary heel-stick blood sampling
7. Suprapubic bladder aspiration
29
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
8. Bladder catheterization
9. Endotracheal intubation
10. Laryngeal airway placement
11. Intraosseous
12. Needle aspiration of pneumothorax
13. Chest-tube insertion and removal
14. Exchange transfusion
15. Replacement of g-tube
There may be procedures not covered in an NNP program but
that are part of the NNP scope of practice that the NNP
graduate would be allowed to perform if credentialed by the
facility. These may include:
A.
Circumcision
B.
Pericardial tap
C.
Ventricular tap
D.
Superficial suturing
E.
Removal of skin tags or extra digits by suture ligation
General Management (across the population, from neonate
through age 2)
A. Thermoregulation
1. Factors affecting heat loss and production
2. Mechanisms of heat loss and gain
B. Resuscitation and stabilization
1. Assessment of risk factors
2. Physiology of asphyxia
3. Indications for intubation, ventilation, and cardiac
compressions (see also section on neonatal
procedures)
4. Resuscitation equipment
5. Pharmacotherapeutics
6. Stabilization
30
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
7. Neonatal transport
8. Neonatal Resuscitation Program (NRP) provider
9. Therapeutic hypothermia
C. Pain management
1. Physiology of pain
2. Pain management
a. Nonpharmacologic
b. Pharmacologic
D. Palliative and end-of-life care
1. Ethical considerations
2. Pain management at end of life
3. Hospice care
4. Bereavement
Clinical Management
A. Cardiovascular system
1. Embryology
2. Physiology/pathophysiology
3. Fetal, transitional, neonatal circulation
4. Rhythm disturbances/EKG interpretation
5. Myocardial dysfunction
6. Shock, hypotension, hypertension
7. Congenital heart disease (pathophysiology, clinical
presentation, differential diagnosis, medical
management, pre- and postoperative management)
8. Cardiovascular radiology and
echocardiogram interpretation
9. Pharmacotherapeutics
B. Pulmonary system
1. Embryology and pulmonary development after birth
2. Physiology (oxygenation and ventilation, gas
exchange, acid-base balance)
31
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
3.
Pathophysiology
4.
Asphyxia
5.
Pulmonary diseases (pathophysiology, etiology,
clinical presentation, differential diagnosis,
treatment)
6.
Pulmonary radiology
7.
Respiratory therapy
a. Physiologic principles
b. Physiologic monitoring
c. Continuous positive airway pressure (CPAP)
d. Ventilation strategies
e. Extracorporeal membrane
oxygenation (ECMO)
8.
Pharmacotherapeutics
C. Gastrointestinal (GI) system
1. Embryology
2. Anatomy and physiology of the GI tract
a. Structure and function
b. Hormonal influence
c. Motility
d. Digestion and absorption
3. Pathophysiology
4. Digestive and absorptive disorders
a. Disorders of sucking and swallowing
b. Motility
c. Gastroesophageal (GE) reflux
d. Malabsorption
e. Diarrhea
f. Short gut
5. Anomalies and obstruction
6. Necrotizing enterocolitis
7. Spontaneous intestinal perforation
8. Pharmacotherapeutics
32
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
D. Nutrition
1. Effects of maturational changes on management of
nutritional requirements and feeding
2. Caloric and nutritional requirements and calculations
3. Feeding methods
a. Breast
b. Bottle
c. Gavage
d. Gastrostomy
e. Transpyloric
f. Trophic
4. Human milk versus formula
a. Composition
b. Benefits
c. Preterm infants
d. Human milk fortifier
e. Donor human milk and exclusive human milk
diets
5. Parenteral nutrition
a. Composition
b. Indications
c. Benefits
d. Complications
e. Monitoring
6. Dietary supplementation for term and preterm
infants
7. Dietary adjustments in special circumstances
a. Cholestasis
b. Short gut syndrome
c. Osteopenia
d. Inborn errors of metabolism
e. Vitamin deficiencies and associated features,
signs and symptoms
f. Congenital heart disease
33
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
g. Chronic lung disease
E. Renal and genitourinary
1. Embryology and anatomy
2. Renal physiology
3. Pathophysiology
4. Evaluation of renal function
5. Urinary tract infections
6. Congenital anomalies
7. Functional abnormalities of the renal system
8. Renal failure
a. Predisposing factors and etiologies
b. Pathophysiology
c. Management
Fluid and electrolytes
Nutritional modification
Drug modification
Hemofiltration
Dialysis
Transplant
Pharmacotherapeutics
F. Fluid and electrolytes
1. Physiology
a. Electrolyte homeostasis
b. Body composition in fetal and neonatal
periods
c. Transitional changes
d. Insensible water loss
e. Endocrine control, mineralocorticoids,
antidiuretic hormone (ADH),
calcitonin/parathyroid hormone (PTH)
f. Renal function/physiology
34
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
2. Pathophysiology
3. Principles of fluid therapy
a. Assessment of hydration
b. Maintenance requirements
c. Factors affecting total fluid
requirements
4. Disorders of fluids and electrolytes
5. Vomiting and dehydration
G. Endocrine and metabolic system
1. Neuroendocrine regulation
2. Carbohydrate/fat/protein metabolism
a. Inborn errors
3. Infant of a diabetic mother
4. Pathophysiology
5. Hypothalamic-Pituitary axis function and disorders
a. Adrenal gland (embryology, pathways,
and tests)
b. Thyroid (embryology, pathways and tests,
management)
c. Calcium and phosphorus homeostasis
d. Inborn errors of metabolism
e. Newborn screening
f. Ambiguous genitalia, intersex disorders
g. Pharmacotherapeutics
H. Hematologic system and malignancies
1. Development of the hematopoietic system
2. Physiology/pathophysiology
3. Anemia
4. Polycythemia and hyperviscosity
5. Bilirubin
a. Physiology of bilirubin production, metabolism,
and excretion
b. Hyperbilirubinemia
c. Breast milk jaundice
d. Encephalopathy
35
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
6. Hepatic disorders
7. Coagulation and platelets
8. Disorders of coagulation and platelets
I. Immunologic system
1. Development of the immune system
2. Function of the immune system
3. Allo- and auto-immune disorders
4. Pharmacotherapeutics
J. Infectious diseases
1. Physiology/Pathophysiology
2. Evaluation of the infant
a. History
b. Physical examination
c. Laboratory data
d. Other diagnostic tests
3. Treatment
a. Antimicrobial
b. Adjunctive therapy
c. Immunizations
d. Biologic therapies
4. Infection with specific microorganisms
5. Maternal infections
6. Systemic Inflammatory Response System (SIRS)
7. Pharmacotherapeutics
K. Musculoskeletal system
1. Embryology
2. Congenital abnormalities
3. Birth injuries
4. Metabolic bone disease
L. Neurobehavioral system
1. Development of the nervous system
a. Embryology
b. Anatomy
c. Cerebral circulation
36
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
d. Maturation
2. Birth injuries
3. Anomalies and defects of central nervous
system (CNS) and spine
• Malformations
• Ischemic brain injury
• Seizures
• Intracranial hemorrhage
• Periventricular leukomalacia
4. Disorders of movement and tone
5. Growth and development
6. Developmentally supportive care
7. Pharmacotherapeutics
M. Eyes, ears, nose, and throat
1.
Embryology and anatomy
2.
Physiology/pathophysiology
3.
Craniofacial malformations
4.
Abnormalities of the airway
a. Congenital
b. Acquired
5.
Auditory system
a. Physiology of hearing and speech
b. Speech and language alterations
c. Hearing screening methods
d. Abnormalities
6.
Visual system
a. Physiology of vision and visual
development
b. Visual acuity
c. Visual screening
d. Abnormalities
e. Retinopathy of prematurity (ROP)
f. Associated syndromes
7.
Pharmacotherapeutics
37
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
N. Integumentary system
1. Embryology
2. Anatomy and physiology
3. Pathophysiology
4. Terminology
5. Common variations
6. Skin disorders
7. Hair and nail disorders
8. Nutrient deficiencies and skin manifestations
9. Pharmacotherapeutics
O. Intrauterine drug exposure
1. Screening for maternal substance use
2. Assessment of drug withdrawal
3. Laboratory tests
4. Ethical considerations
5. Physiologic effects
6. Clinical management of neonatal abstinence
syndrome
a. Pharmacologic
b. Nonpharmacologic
c. Feedings
7. Social Consideration
Health Promotion and Disease Prevention
A. Discharge planning www.babystepstohome.com
1. Discharge planning process
2. Technologically dependent infants
3. Parent education
a. infant cue recognition
b. emergency measures
c. medical equipment
d. disease-specific instructions
38
Competency Area
NP Core Competencies
Curriculum Content to Support
Competencies
Neither required nor comprehensive, this list reflects only suggested content
specific to the population
e. well-child care (normal growth and
development, nutrition, dental health,
immunizations)
4. Community resources
5. Home care and follow-up
B. Primary care for infants through age 2
1. Physical assessment
2. Immunizations
3. Hearing screening
4. Eye exams/strabismus
5. Neurologic follow-up
6. Developmental screening
7. Safety issues
8. Chronic disorders of the high-risk infant
9. Common pediatric primary care disorders (under age 2)
• Upper respiratory infection management
• Croup
• Bronchiolitis
• Pertussis
• Otitis Media
• Herpangina/thrush
• Hand-foot-mouth disease (enterovirus)
• Vomiting and dehydration
• Nutrition and growth
• Failure to thrive
• Head growth
• Micro- and macrocephaly
• Gastro-esophageal reflux
• Hip dysplasia
• Urinary tract infection
• Dermatologic disorders