by Kelly Field, Public Relations

Nurse practitioners, from left, Cathleen Hughes, Robin Bissinger and Carolyn Meeks, consult with neonatologist, Dilip Purohit, second from left, on a newborn patient.

Until recently, newborns in MUSC’s neonatal care unit were treated primarily by neonatologists and the residents and fellows they supervised.

Then, a few years ago, new residency protocols were introduced, and residents became restricted in the amount of time they could spend in the neonatal intensive care unit (NNICU). With neonatal services expanding even as fellowships dwindled, neonatologists were left shorthanded, eager for competent assistance.

Enter the nurse practitioner, the certified advanced practice nursing professional who has expanded nursing and unburdened overworked doctors nationwide.

“We needed to find qualified people to work with us and to provide top quality care,” said Dilip Purohit, M.D., director of the Division of Neonatology, and one of the doctors who supervises the neonatal nurse practitioners (NNP). “And the NNPs did it.”

Autonomous, yet cooperative; specialized, yet diverse, nurse practitioners are difficult to classify.

Though working under the supervision of doctors, they often carry their own case load; though specializing in family, general, neonatal, pediatric, adult or geriatric care, they may undertake functions as varied as direct care, administration, and education. They may work in clinics, overseeing outpatients, or they may work in hospitals, collaborating with specialists.

MUSC’s neonatal nurse practitioners fall under this latter category.

“We carry a case load of critically ill babies,” explained Robin Bissinger, coordinator of the neonatal nurse practitioner program. “What distinguishes us from other nurse practitioners is our focus on critical care.”

Though relatively new, the MUSC Nurse Practitioner Master's Program is among the most distinguished in the nation, according to Bissinger. All of the 15 faculty have master's degrees, several are published, and all participate in the graduate program for NNPs offered by the College of Nursing.

Cheryl Carlson, Linda L. Bellig, and Bissinger have all been featured national speakers on a variety of neonatal nursing subjects, and this April both Bissinger and Bellig will travel to England to present papers at an international neonatal nursing conference in England—Bissinger on the cost-effectiveness of nurse practitioners, Bellig on the ethics of resuscitation of the very low birth weight infant.

Both women believe that it is this publication precedent that enabled their program to recruit five new staff members this year, among them the president of the 12,000 member National Association of Neonatal Nurses.

“We’ve worked hard to make the program here as dynamic and attractive as possible,” Bissinger said. “I think a lot of people have been drawn here because they see publication and research as good possibilities.”

In the expanding job market, the typical number of faculty recruited by a college is only one a year. MUSC has consistently attracted more than three.

And though many would describe the treatment provided by nurse practitioners as equivalent or at least comparable to the treatment previously provided by interns and residents (a 1997 survey conducted at the University of Missouri Hospital, department of surgery, rated nurse practitioners there as friendly, knowledgeable and efficient), its cost is much less.

In fact, after only one and a half years, Bissinger’s research showed that MUSC’s neonatal care program was saving $14,000 per infant compared to the costs incurred under the old system.

Though practitioners have yet to account for decrease, most of it coming in diminished hospital stays, shortened ventilation times of patients, and slightly less lab and X-ray work, Bissinger and Bellig attribute it to the greater experience of nurse practitioners.

“By the time they even enter the program, most practitioners have worked for at least one or two years,” she said. “They have that intuitive sense of babies that is gained through experience.”

Bellig added that nurse practitioners are also generally better acquainted with the multi-disciplinary network available to them.

“They have experience working in conjunction with many other practitioners--nutritionalists, respiratory therapists, pharmacologists--and know the sources available for consultation.”

And because neonatal nurse practitioners work so intimately with their patients, they often develop strong relationships with the parents as well. Those who do not initially understand the NNP role learn to appreciate the 24-hour availability and familiarity it affords; those with reservations come to trust the caretakers who have continuous responsibility for their child.

“Once exposed to the role they are generally very accepting,” said Bissinger, adding that “The Division of Neonatology under Purohit’s supervision has worked hard to help the NNP’s develop a collaborative practice.”

In the future, both women expect the role of the nurse practitioner to continue to expand.

Currently, there are plans to train NNPs to treat ECMO (extra corporeal membrane oxygination), the most acute cases.

“We’re starting to be seen more as leaders and experts,” said Bissinger. “The NNP’s are becoming leaders and experts in their field here at MUSC. Nationally, they are seen as a dynamic and professional team.”

“They are the way medicine is going all over the country,” Purohit said. “It’s the wave of the future.”