Time changes everything…except something within us which is always surprised by change. 

-Thomas Hardy

It hasn’t been very long since the traditional model of only doctors and nurses were the primary staffing model in the NICU. Some hospitals still keep this tradition, while many are using the Neo-NNP (neonatologist — nurse practitioner) model. Like everything else, time is also bringing another change into the NICU. Here at ENSEARCH, not only do we help hospitals and NNPs find the right opportunities, but we also pay attention to the growing trends across the United States


The Evolution of the Changes

As the specialty of the NICU has evolved, so has the demand for the NICU. Or maybe it’s vice-versa, the market has incentivized the evolution and staffing has to be found. What has not changed is the passion for making a difference in the world’s tiniest babies. 

There has been a shortage of new grads entering the workforce as well as an aging NNP workforce who are now retiring. Additionally, we are seeing NNPs leaving the bedside to take on non-clinical roles and more supervisory roles— yet the babies still need to be cared for by trained professionals.

As a result, we are now seeing more and more NICUs accepting PAs along with NNPs. In some institutions, they are even using hospitalists to provide the care in their NICUs. According to the Bureau of Labor Statistics, “Physician assistants of all specialties are in high demand, with this occupation expected to grow by 30% from 2014-2024.”


With Great Changes Comes Great Responsibility

One of the issues we have heard about hiring PAs and hospitalists into the NICU is they rarely graduate (come) with a NICU clinical base. Unewillow, from Physician Assistant Forum, said, “As for extra residency, most places willing to hire a new grad don’t require you to have NICU experience (but it’s a bonus). Most places are willing to train you on the job, and as a new grad, you should expect at least 4 months (yes, 4 months!) of basic training before you are allowed to be on your own.”

NICUPAC, on the same forum, chimed in and said, “I am currently a NICU resident in UK’s PA residency program. Honestly, there is such a HUGE learning curve, that I can’t imagine going into the NICU without this year residency under my belt and seeing patients on my own.”

So when comparing a new grad NNP to a new grad PA the time it takes to get the PA up to speed is frequently twice the time it takes to get a new grad NNP up and running. 

Until recently there was only one PA school that offered a program with a NICU base but more and more are popping up. We’ve heard there are now as many as five. There is also a rumor that one NNP program is looking to expand the program to include PAs.


So Now What?

Change is hard. Nurses traditionally despise changes to the status quo; however, history has shown us that just as nurses became NNPs and firmly established their roles in the NICU, there is a glimmer of hope that PA’s and hospitalist can also do the same. The reaction to this influx of PAs into the NICU is mixed but the bottom line is the babies need to be cared for and is a result of the necessity to meet the staffing demands.


What about you, our reader, what changes are you seeing? 

  • Are you seeing this trend entering your unit(s)
  • Is it just PAs or are you also seeing Hospitalists?
  • If so, how is that working out…and what are your thoughts?
  • Have you seen (or heard) a pay discrepancy between NNPs and PAs?
  • If you are a PA in the NICU, we’d love your input too! 
    • How was the learning curve?