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

The neonatal intensive care unit (NICU) relies on a multidisciplinary team of advanced practice providers (APPs), including neonatal nurse practitioners (NNPs) and physician assistants. With the Accreditation Council for Graduate Medical Education residency rotation reductions taking effect in July 2025, the demand for NNPs to fill clinical coverage gaps will increase. Anticipated changes in federal reimbursement and Medicaid services and National Institutes of Health pose financial challenges for Children's Hospitals.

This review examines the current state of the NICU APP workforce with special emphasis on NNPs, including historical trends, educational requirements, and the impact of regulatory changes. Data were gathered from surveys completed by national professional organizations, published literature in PubMed, and expert communication.

Despite their critical role and increased demand, APPs including NNPs face challenges, such as burnout, staffing deficits, reimbursement, and a decline in the number of NNP graduates by 20% since 2022. Neonatal nurse practitioner recruitment is hindered by the lengthy onboarding process and high costs. The integration of physician assistants, hospitalists, and non-NNPs as possible solutions to fill the NNP shortage gap presents challenges, such as lack of training opportunities and managing patients outside their scope of practice.

Addressing workforce shortage requires strategies, including tuition-supported programs, recruiting registered nurses to become NNPs, developing mentorship programs, and increasing NNP preceptors. Further research is needed to evaluate the effectiveness of these strategies and to explore additional solutions for sustaining the NNP workforce.