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New Workforce Challenges for Neonatal Nurse Practitioners and Other Neonatal Advanced Practice Providers.

Jacqueline Hoffman1, Colleen R Moss, Michele K Savin

  • 1Author Affiliations: Department of Pediatrics, Division of Neonatology, Oregon Health & Science University, Portland, Oregon (Dr Hoffman); Vanderbilt University School of Nursing and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Moss); Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Savin); and Department of Pediatrics, UC Davis Children's Hospital, Sacramento, California (Dr Lakshminrusimha).

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses
|December 31, 2025
PubMed
Summary

The neonatal intensive care unit (NICU) faces a growing shortage of neonatal nurse practitioners (NNPs) due to increased demand and declining graduates. Strategies like tuition support and enhanced training are crucial for sustaining the NNP workforce.

Keywords:
advanced practice providersclinical coverage gapscompensationlack or demand or shortagepediatric hospitalistsphysician assistantsresidents

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Area of Science:

  • Healthcare Workforce Analysis
  • Neonatal Care
  • Advanced Practice Providers

Background:

  • Neonatal intensive care units (NICUs) depend on advanced practice providers (APPs), including neonatal nurse practitioners (NNPs) and physician assistants.
  • Upcoming residency changes in 2025 will increase NNP demand, while financial challenges loom from federal reimbursement and NIH changes.
  • Children's Hospitals face financial challenges due to anticipated changes in federal reimbursement and Medicaid services.

Purpose of the Study:

  • To review the current state of the NICU APP workforce, focusing on NNPs.
  • To analyze historical trends, educational needs, and the impact of regulatory shifts on NNPs.
  • To identify challenges and potential solutions for the NNP workforce shortage.

Main Methods:

  • A comprehensive review of the NICU APP workforce, with a focus on NNPs.
  • Data collection through national professional organization surveys, PubMed literature review, and expert consultations.
  • Examination of historical trends, educational requirements, and regulatory impacts.

Main Results:

  • NNPs face burnout, staffing shortages, reimbursement issues, and a 20% decline in graduates since 2022.
  • Recruitment challenges include lengthy onboarding and high costs, hindering NNP acquisition.
  • Integrating physician assistants and other non-NNPs presents training and scope-of-practice management issues.

Conclusions:

  • Strategies to address the NNP shortage include tuition support, recruiting registered nurses, mentorship programs, and increasing preceptors.
  • Further research is essential to assess the efficacy of proposed strategies and explore new solutions.
  • Sustaining the NNP workforce requires a multi-faceted approach involving education, recruitment, and retention initiatives.