Health care costs are, however, high and some resources are scarce. As a result, ethical issues and conflicts develop. Patients, their families and the health care community tend to have divergent views. They likewise often have conflicting beliefs on health and illness and views on what is right or wrong. The nurse's experience of ethical dilemmas and moral distress are proportionate to of the patient and/or the family. The nurse, the patient or surrogate decision-maker and family struggle to discover what can be done to prevent, improve or cure a particular medical condition according to a common belief of what "ought" to be. Supports can come from sources, such as ethics consultants and committees, nurse ethicists, pastoral care providers and institutional review boards. As a consequence, the Joint Commission for Accreditation of Healthcare Organizations requires agencies seeking accreditation to come up with a mechanism to address ethical issues in patient care of these kinds. Ethics committees and ethics consultants fulfill this requirement. Institutional or medical ethics committees in many hospitals have been educating, providing case consultations, and making recommendations since the 80s. Many such committees have been involved in policy development, such as through a nurse ethicist or nursing ethics committee assisting practitioners in handling these ethical issues. Nursing and medical schools have also recognized the importance of knowledge and skills for future practitioners and incorporated the introduction and development of these knowledge and skills in their curricula (Kopala). Technological advances in the last decade have substantially decreased neonatal mortality rate, yet 19,000 newborns continue to die in the U.S. each year (Engler 2004). The registered or advanced practice neonatal nurse practitioner is often involved with the patient's family decisions in difficult or end-of-life times, such as withdrawing mechanical ventilation and the likelihood of the infant's death. Her support is most crucial at times like these. She can and should take advantage of the opportunity to form a relationship of trust with the family, which is vital to the optimal care she provides. Central to this care is her recognition of the importance of the loss of the infant. From this awareness, she can develop or initiate additional interventions in this time of grief, such as organized telephone follow-ups and forming support groups for the grieving family (Engler).

Schools or institutions establish their own requirements for neonatal nurse practitioners (Jones 2004). Most of them assess the nurse's ability to administer medications, do math calculations, start and maintain intravenous lines, conduct cardiopulmonary resuscitation, and perform corollary skills. These skills include suctioning, gavage feedings, and ventilator care. Some hospitals or medical centers hire NNPs after graduation from an accredited school and after passing the state board of nursing exams for licensure. The type and length of nursing experience also vary from one institution to another. In the current shortage of NNPs, the scarcity of qualified nurses is a deciding factor...

For their part, individual states or certifying bodies impose continuing education requirements on NNPs. There are no schools actually specializing in neonatal nursing. A nurse who aspires to be an NNP must obtain a master's degree in neonatal nursing, but the most common way is to work at any of the three nursery levels. A Nursing graduate should first acquire experience as a registered nurse in a NICU and then go to graduate school to become an NNP or clinical nurse specialist in order to qualify to work as an NNP (Jones).
The current shortage in nurses virtually insures nursing applicants of jobs in neonatal nursing (Jones 2004). The general downsizing conducted a few years ago reduced the volume of nursing pursing advanced practice education. This drove aspirants to positions in neonatal nursing. The average NNPs is also middle-aged and, thus, likely to move to less stressful nursing areas and positions. Most nurse practitioners with no experience receive a starting annual salary of between $30,000 and $40,000. Experienced NNPs receive higher salaries. A full-time nurse receives a percentage of health care benefits remitted by her employer. She gets two weeks vacation, a life insurance, a retirement plan, and tuition reimbursements for continuing education. An NNP can also aspire for advancement. Most hospitals offer more employment opportunities to NNPs with a master's or doctoral education. An NNP or clinical nurse specialist can expect higher job availability, responsibility and compensation. High-risk clinics for neonatal intensive care or home follow-up care also employ NNPs (Jones).

With almost 40,000 low-birth-weight babies born in the U.S. every year, there is clearly a growing market for NNPs (Jones 2004). The Workforce Report of the American Nurses Association and the Association of Nurse Executives in 1998 projected the shortage of acute care neonatal nurses to continue into the next decade. Neonatal nurse practitioners are privileged to work with newborns and experience the marvel of birth each day. It may not be as pleasant for NNPs working at NICUs because of occasional deaths of seriously ill or premature infants. But, on the whole, neonatal nursing is said to be one of the most rewarding nursing specialties available to qualified and willing nurses today (Jones).

Bibliography

1. Creech, R. (2005). Neonatal Nurse Practitioner Program. Leaders in Medicine: United Health Systems of Eastern Carolina. http://www.uhseast.com/body-cfm?id=329

2. Engler, A.J. (2004). Neonatal Staff and Advanced Practice Nurses' Perceptions of Bereavement/End-of-Life Care of Families of Critically Il and/or Dying Infants. Critical Care Nurse: American Association of Critical-Care Nurses

3. Jones, J. (2004). Neonatal Nursing: the First Six Weeks. Critical Care Nurse: American Association of Critical-Care Nurses

4. Kopala, B. (2005). Ethical Dilemma and Moral Distress: Proposed New NANDA Diagnoses. International Journal of Nursing Terminologies and Classifications: Nursecom, Inc.

5. Nursing (2002). Spotlight on Neonatal Nursing.…