Sandra Bellini

State of the state: NNP program update 2013.

Findings from a spring 2013 survey of neonatal nurse practitioner (NNP) program directors are presented and concerning trends identified. Implications of these findings, in combination with other external factors influencing the supply/demand ratio on the stability of the NNP workforce nationwide, are explored. Present and future NNP workforce demands in relation to the educational programs available to prepare nurses for NNP practice are examined. Finally, discussion focuses on the politics and pragmatics of sustaining the NNP role for posterity.

Heparinized Saline vs Normal Saline for Maintenance of Intravenous Access in Neonates: An Evidence-based Practice Change

PURPOSE: To design, implement, and to evaluate the outcomes of an evidence-based practice change regarding the use of heparin in intravenous (IV) locks to improve patient safety. Phase I of the project examined dwell time, hours of patency, gestational age at birth and at time of IV lock insertion, birthweight and weight at time of insertion, and reason for discontinuation for IV access devices prior to and following the practice change from heparinized saline (HS) to normal saline (NS) flush. Phase II of the project was to determine the effect of the educational program on staff knowledge of the use of heparinized saline vs normal saline flushes. SUBJECTS: The setting was an 18 bed level III NICU located in the northeastern United States. A sample of 70 infants with IV locks were included in the study; HS (n = 34) and NS (n = 36) respectively. Infants with IVs that were converted to IV locks were excluded. Only professional NICU staff (n = 40) were recruited for the educational offering. DESIGN: A comparative descriptive design with two components was utilized. METHODS: A retrospective and prospective chart review was used to compare the outcomes of neonates with IV locks flushed with heparin and normal saline flush and evaluated the outcomes. A pretest/posttest design was used to analyze the change of the NICU staffs knowledge concerning heparin flush before and after an educational offering. MAIN OUTCOME MEASURES: IV lock patency after practice change to NS flush and the change of the NICU staffs knowledge concerning heparin flush after an educational offering. PRINCIPAL RESULTS: There was a statistically significant difference in IV catheter patency with NS flushed catheters averaging 13 hours longer than HS flushed catheters (p = 0.02). Also a statistically significant increase in mean scores was noted for the NICU staff posttest after the educational offering (p = .0001). There was a 20% increase in knowledge scores. CONCLUSIONS: Findings from this project support the current literature base suggesting that the use of heparin is unnecessary for the maintenance of IV access devices. Unnecessary exposure of neonates to heparin increases risk to patient safety and should therefore be avoided. Future research should examine the use of heparin in central lines in neonates. Findings additionally support educating staff prior to practice changes.

The Doctor of Nursing Practice Graduate as Faculty Member

This article focuses on the emerging role of the Doctor of Nursing Practice (DNP) graduate as faculty member. Discussion includes historical composition of faculties. Re-evaluation of Boyers model of scholarship in relation to faculty roles is examined. Discussion includes barriers facing current DNP faculty as well as the potential advantages that DNP graduates may make toward school of nursing faculties. Discussion concludes with considerations for the future of the discipline as demographics and traditional values shift over time.

What Parents Need to Know About Vitamin K Administration at Birth

Prophylactic treatment of newborns with intramuscular vitamin K has been the standard of care for many years in the United States. However, instances of parental refusal of routine prophylaxis are currently on the rise. Refusal of routine prophylaxis can have serious long-term neurodevelopmental consequences for some newborns, who may subsequently develop vitamin K deficiency-associated hemorrhagic disease of the newborn (HDN).

Flushing of intravenous locks in neonates: no evidence that heparin improves patency compared with saline

Commentary on: ArntsIJHeijnenJAWilbersHT. Effectiveness of heparin solution versus normal saline in maintaining patency of intravenous locks in neonates: a double blind randomized controlled study. J Adv Nurs 2011;67:2677–85.

A Primer on Updates to the Neonatal Resuscitation Program

In October 2015, the American Heart Association and the American Academy of Pediatrics released advanced notification of substantive changes to appear in the seventh edition of the Neonatal Resuscitation Program (NRP) scheduled for release in the spring of 2016. The expectation is that all NRP providers will be educated in the seventh edition of the NRP during 2016, with the national implementation target date set as January 2017. This column presents a brief discussion and summary of changes to the NRP.

Retinopathy of prematurity: improving outcomes through evidence-based practice.

This article presents an overview of retinopathy of prematurity, including pathophysiology, developmental classifications and potential prevention and treatment strategies. Readers may earn two CNE contact hours for this learning activity by completing the post-test and participant feedback form at http://JournalsCNE.awhonn.org.