During my time in the pediatric ICU I found myself consistently drawn to the smallest, most immature patients, which led me back to the neonatal unit, and eventually to becoming an NNP. I feel great satisfaction in providing the highest quality, evidence-based care for the most vulnerable patients and their families in the hospital. I also feel a great responsibility to inspire and train the next generation of nurses and NNPs the highest level of evidence-based care.
About Dr. Mary Puchalski, DNP, APN, CNS, NNP-BC: With nearly 30 years of clinical experience, Dr. Puchalski has worked as a staff nurse in all areas of the maternal-child nursing specialty, including mother/baby, labor and delivery, neonatal intensive care, pediatrics, and pediatric intensive care. She currently is a Clinical Assistant Professor and director of the Neonatal Nurse Practitioner (NNP) program at the University of Illinois at Chicago College of Nursing and holds a clinical position as a NNP in Rush University Medical Center’s level IV NICU. She is the coauthor of the N-PASS: Neonatal Pain, Agitation and Sedation Scale, and has published articles in peer-reviewed journals, as well as presents nationally on neonatal topics. The focus of her doctoral work was on evidence-based care for infants with Neonatal Abstinence Syndrome (NAS).
Previous positions held by Dr. Puchalski include Lead of NNP Services at Rush University Medical Center, Perinatal Outreach Educator for Loyola University Chicago’s level III Perinatal Center, and Neonatal-Pediatric Clinical Nurse Specialist (CNS). Professional activities have included memberships in the Illinois Department of Public Health Statewide NAS Committee, National Association of Neonatal Nurse Practitioners (NANNP) Quality Metrics Task Force, Perinatal Nursing Advisory Council for the Chicago Area March of Dimes, Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) Consulting Group, and peer review panel for Advances in Neonatal Care, the official journal of the National Association of Neonatal Nurses (NANN). She is the PowerPoint slide designer for all of the modules published by the S.T.A.B.L.E.® Program of Park City, Utah, an internationally recognized neonatal education company.
Honors received by Dr. Puchalski include the 2014 Procter & Gamble Doctor of Nursing Practice Post Master’s Scholarship though the American Association of Nurse Practitioners (AANP), 2014 March of Dimes Graduate Nursing Scholarship, and membership in Sigma Theta Tau (STTI), the International Honor Society of Nursing. She is also a member of numerous other professional nursing organizations.
Dr. Puchalski received her Bachelor of Science in nursing (BSN) from University of at Illinois Chicago, her master of science (MS) in parent-child nursing from Northern Illinois University (DeKalb, IL), NNP postmaster’s certificate from Rush University (Chicago, IL), and Doctor of Nursing Practice (DNP) from Chatham University (Pittsburgh, PA). She is certified as a Neonatal Intensive Care Nurse and NNP by the National Certification Corporation (NCC), is a regional trainer for the American Academy of Pediatrics’ (AAP) Neonatal Resuscitation Program (NRP), and a lead instructor for the S.T.A.B.L.E.® Program.
[OnlineFNPPrograms.com] Could you please describe your current responsibilities as a Neonatal Nurse Practitioner at Rush University Medical Center? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] The NNP is an advanced practice nurse who specializes in the management of infants up to 2 years of age, with specific expertise in the preterm and ill newborn infant. They primarily work in neonatal intensive care units (NICU) and special care nurseries (SCN). They attend high risk deliveries, perform advanced procedures, and provide daily, individualized management of neonates in the NICU including: advanced physical assessment; evaluation of laboratory and clinical data; writing orders; and performing advanced practice clinical skills and procedures: e.g. neonatal delivery room management, intubation, umbilical catheter placement, lumbar puncture, chest tube insertion, percutaneous arterial line and central line placement. They also provide parent/family support, anticipatory guidance, and education as families are considered integral partners in the care of their infant. All patient management and care is delivered in collaboration with attending neonatologists, the bedside nurse, and other interdisciplinary team members (dieticians, pharmacists, respiratory therapists, physical therapists, speech therapists, discharge planner) within a family-centered care perspective. We also support the pediatric and med-peds residents in the NICU.
[OnlineFNPPrograms.com] You were also the Lead for Neonatal Nurse Practitioner Services at Rush University for over three years. Could you elaborate on this role as well? What responsibilities did you have as the Lead, and how did they differ from your direct clinical work with patients? How did you coordinate patient care and work with nurse practitioners, physicians, registered nurses, and medical assistants?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] As the Lead for the NNP service at Rush University Medical Center I aspired to promote excellence in professional practice. I was responsible for the provision of leadership, guidance, and supervision to the NNP group, ensuring adequate clinical coverage for the NNP group’s services, and evaluation of the quality and effectiveness of care. I acted as a liaison to nursing administration in the NICU and reported to the Director of the Rush Children’s Hospital and indirectly to the Clinical Director of the Neonatal Intensive Care Unit. The position accounted for 0.25 of my 1.0 Full Time Equivalent (FTE); the remainder of the FTE was as a clinical NNP in the NICU.
[OnlineFNPPrograms.com] Prior to your work at Rush University, you were a Neonatal/Pediatric Clinical Nurse Specialist at Elmhurst Memorial Healthcare. Could you describe this role, and also explain the difference between a Neonatal/Pediatric CNS and an NNP, in terms of the daily responsibilities, work setting, and patients served?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] A CNS is an advanced practice nurse who is an expert in the bedside care of the patient–in my case pediatric and neonatal patients. They work with the bedside nurse to enhance their knowledge through education, evaluate competency based on national standards, develop policy and procedures, and evaluate/incorporate evidence-based practice changes. They work closely with nursing leadership in all aspects of their role.
[OnlineFNPPrograms.com] Why did you decide to work in advanced neonatal nursing specifically, and what path did you take to discover that this field of advanced practice nursing was right for you?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] When I was a small child I spent many days in the hospital. I distinctly remember the emotional pain I felt when my parents were required to leave, as well as physical pain from tests and procedures. These experiences engendered a passion to make a difference for other children in their medical care.
I started out in a pre-med program in college, but early on decided that nursing was a better fit for me because it focused on the care of whole patient and family. I have always had a special interest in the care of women and children. I started out my nursing career in a postpartum unit which then led to my interest in caring for infants who presented as ill requiring specialized care. This led me to obtain my master’s degree in parent-child nursing. During my time in the pediatric ICU I found myself consistently drawn to the smallest, most immature patients, which led me back to the neonatal unit, and eventually to becoming an NNP. I feel great satisfaction in providing the highest quality, evidence-based care for the most vulnerable patients and their families in the hospital. I also feel a great responsibility to inspire and train the next generation of nurses and NNPs the highest level of evidence-based care.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working in advanced neonatal nursing? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these challenges?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] The highest reward is the joy parents express when the hold their newborn for the first time … as well as their excitement when their baby is discharged home to them. Of course it is also very satisfying to see infant’s conditions improve through diagnosis and treatment. It is incredibly humbling when you encounter a parent outside of the hospital and they thank you for all you did for their child because you know it took “a village” to accomplish it. Often parents bring their child back to the NICU for a “visit” – seeing that child whom you cared for as a newborn or preterm infant grow and develop is the ultimate reward.
Challenges come in numerous forms, many of which are common to any workplace: differences in individual knowledge, practice/treatment preferences, and personalities. The long workday hours and in-house call requirements of a clinically based NNP can also be challenging, both in balancing one’s personal life and health, as well as professional life and health. Some of these challenges are exacerbated by the aging process.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming neonatal nurse practitioners, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] I encourage all future nurse practitioners, regardless of their chosen specialty, to enter a training program which confers a Doctor of Nursing Practice degree. It is the terminal professional practice degree for a clinically based nurse, preparing them for the highest level of professional nursing practice. In addition to training in one’s specialty, graduates are conferred expertise in health systems leadership, improving patient outcomes through infusion of evidence-based practice, intra-disciplinary collaboration, as well as organizational and economic evaluation of clinical outcomes.
To prepare to become an NNP one must be a registered professional nurse with at least 2 years of full time equivalent practice in the NICU environment. Competency in the American Academy of Pediatrics Neonatal Resuscitation Program, The S.T.A.B.L.E. ® Program, and certification through NCC as a neonatal intensive care nurse are excellent preparatory programs. Membership in the National Association of Neonatal Nurses (NANN) and their local chapter, attendance in the educational activities of these organizations, and reading the journal, Advances in Neonatal Care, also will enhance their professional portfolio. Numerous volunteer activities are available through one’s local chapter of the March of Dimes. Additionally, participation in your organization’s nursing committee demonstrates leadership potential.
[OnlineFNPPrograms.com] You have also had extensive experience in graduate nursing academics, as a Perinatal Outreach Education Coordinator, an Instructor for Rush University’s Neonatal Nurse Practitioner Program, and as a Clinical Assistant Professor at the University of Illinois at Chicago. Could you please elaborate on these three roles, the classes you taught, and how nurse practitioners who are interested in teaching can enter this field?
[Dr. Puchalski, DNP, APN, CNS, NNP-BC] As an Outreach Education Coordinator I provide educational programming and support, and quality improvement activities for the Loyola Perinatal Center network hospitals for perinatal nursing providers. I performed needs assessments with the nursing staff of the network hospitals to identify critical learning needs, designed eduational programs to meet those needs, and provided updates on national and local practice policies and competencies. Some of the programs I supported include AWHONN’s fetal monitoring program, the AAP Neonatal Resuscitation Program (NRP), and the S.T.A.B.L.E. Program. I was also responsible for maintaining relationships with the stakeholders, both within the perinatal center and network hospitals.
As a faculty member and director of the NNP program at the University of Illinois at Chicago, I am responsible for the development, provision, and support of the curriculum preparing registered nurses to obtain a Doctor of Nursing Practice degree and a specialty concentration in advanced practice neonatal nursing as a nurse practitioner. I must ensure that the program meets the criteria established by National Association of Neonatal Nurse Practitioners’ (NANNP) “Education Standards and Curriculum Guidelines for NNP Programs,” the National Organization of Nurse Practitioner Faculties’ (NONPF) “Population-Focused Nurse Practitioner Competencies,” and the American Association of Colleges of Nursing’s (AACN) “Essentials of Doctoral Education for Advanced Nursing Practice.” I must ensure the students complete 600+ hours of clinical practicum experience in the daily management of neonates in a NICU with a certified NNP, as well as an additional 400+ practicum hours in leadership and quality improvement/evidenced-bases practice improvement initiatives . I also advise all students in the NNP specialty and support the development, implementation, and evaluation of their DNP projects in the clinical arena. NNPs interested in a faculty position must obtain a DNP and maintain a clinical practice as a NNP.
Thank you Dr. Puchalski for participating in our APRN career guide interview series!