Nonphysician Clinicians in the Neonatal Intensive Care Unit: Meeting the Needs of Our Smallest Patients

Regional variations in the distribution of neonatal physicians and dependence on housestaff with restricted work hours have created workforce shortages in many NICUs. Although neonatal nurse practitioners assist in the delivery of high-quality care, availability of these providers may be inadequate in certain regions. Physician assistants represent a historically underutilized resource to resolve neonatology's workforce issues. We have developed a postgraduate training program for physician assistants in neonatology that we hope will improve local and regional workforce shortages. In this article we discuss the history of neonatal nurse practitioners and physician assistants in newborn care and outline the program that we developed. We further discuss some of the barriers we had to overcome in developing this program. Our program can serve as a model for other neonatology programs to adequately prepare physician assistants for a career in the NICU.

[1]  L. Woods Evaluating the clinical effectiveness of neonatal nurse practitioners: an exploratory study. , 2006, Journal of clinical nursing.

[2]  J. Burr,et al.  Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development. , 2005, Journal of clinical nursing.

[3]  L. Eve Defining the characteristics of the nurse practitioner role. , 2005, Nursing times.

[4]  Christian Duffin,et al.  New kid in town. , 2004, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[5]  S. Harrison Racism and the NHS. , 2004, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[6]  C. Roberts,et al.  An evaluation by doctors in training of a pilot programme of physician assistants. , 2004, Hospital medicine.

[7]  P. D'Antonio,et al.  Organizing practice: nursing, the medical model, and two case studies in historical time. , 2004, Canadian bulletin of medical history = Bulletin canadien d'histoire de la medecine.

[8]  S. Denson Advanced practice in neonatal nursing. , 2019, Pediatrics.

[9]  D. Goodman,et al.  Scope of practice issues in the delivery of pediatric health care. , 2003, Pediatrics.

[10]  R. Hooker,et al.  Physician assistants in American medicine , 2003 .

[11]  J. Cawley,et al.  Physician assistants in the United States , 2002, BMJ : British Medical Journal.

[12]  Patricia J. Johnson The History of the Neonatal Nurse Practitioner: Reflections from “Under the Looking Glass” , 2002, Neonatal Network.

[13]  E. Fisher,et al.  Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns. , 2001, Pediatrics.

[14]  M. McEwen,et al.  Theoretical Basis for Nursing , 2001 .

[15]  C. Cox Advanced nurse practitioners and physician assistants: what is the difference? Comparing the USA and UK. , 2001, Hospital medicine.

[16]  R. Cooper,et al.  Health care workforce for the twenty-first century: the impact of nonphysician clinicians. , 2001, Annual review of medicine.

[17]  R L Kane,et al.  Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. , 2000, JAMA.

[18]  D. Hardy,et al.  The role of the nurse practitioner and physician assistant in the care of hospitalized children , 1999 .

[19]  D. Goodman,et al.  General Pediatrics, Neonatology, and the Law of Diminishing Returns , 1998, Pediatrics.

[20]  C. Gilliss,et al.  Nurse practitioners, certified nurse midwives, and physician assistants in California. , 1998, The Western journal of medicine.

[21]  A. DiCenso The neonatal nurse practitioner. , 1998, Current opinion in pediatrics.

[22]  J. Pitts,et al.  The use of nurse practitioners in pediatric institutions. , 1998, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[23]  P. Hilton Theoretical perspectives of nursing: a review of the literature. , 1997, Journal of advanced nursing.

[24]  H. Rt Neonatal manpower needs: the writing's on the wall--we should read it and heed it. , 1997 .

[25]  R. Hall Neonatal manpower needs: the writing's on the wall--we should read it and heed it. , 1997, Journal of perinatology : official journal of the California Perinatal Association.

[26]  G. A. Little,et al.  Transition From Housestaff in the Neonatal Intensive Care Unit: A Time to Review, Revise, and Reconfirm , 1996, American journal of perinatology.

[27]  M. Schulman,et al.  Transition from Housestaff to Nonphysicians as Neonatal Intensive Care Providers: Cost, Impact on Revenue, and Quality of Care , 1995, American journal of perinatology.

[28]  D. Kindig,et al.  The substitution of physician assistants and nurse practitioners for physician residents in teaching hospitals. , 1995, Health affairs.

[29]  S A Finkler,et al.  The potential for using non‐physicians to compensate for the reduced availability of residents , 1992, Academic medicine : journal of the Association of American Medical Colleges.

[30]  Otterbourg Ej The expanding role of physician assistants in neonatology. , 1986 .

[31]  E. J. Otterbourg The expanding role of physician assistants in neonatology. , 1986, Physician assistant.

[32]  P. Donahue,et al.  Nursing: the finest art. , 1985, The American journal of nursing.

[33]  M. Donahue Nursing: The Finest Art : An Illustrated History , 1985 .

[34]  T. Garland,et al.  An emerging profession? The case of the nurse practitioner. , 1980, Image.

[35]  D. Carnevali,et al.  PRIMEX: The professional nurse, responsible, accountable, reaching out and taking an active, frontline position in primary health care , 1972 .

[36]  H. Creighton EXTENDING THE SCOPE OF NURSING PRACTICE , 1971, Sogo kango. Comprehensive nursing, quarterly.

[37]  Robert H. Taylor,et al.  Immune checkpoint inhibitor therapy and outcomes from SARS-CoV-2 infection in patients with cancer: a joint analysis of OnCovid and ESMO-CoCARE registries , 2022, Immuno-Oncology and Technology.