The field of advanced neonatal nursing is so very rewarding. When you take care of a premature baby, weighing only 500 grams in the beginning, the family goes through so many ups and downs. You establish a trusting relationship with the parents and they look to you to take care of their most precious possession.
About Marla Conley: Marla Conley is a Neonatal Nurse Practitioner at Kosair Children’s Hospital Neonatal Specialists. Prior to this role, Ms. Conley was a Neonatal Nurse Practitioner at New York Methodist Hospital and a Nursing Educator at Frankfort Regional Medical Center.
Ms. Conley received her BSN from Eastern Kentucky University in 1989. She holds two master’s degrees: an MSN in Nursing Education from McKendree University in 2009, and an MSN in Neonatal Nurse Practitioner from the University of South Alabama in 2011. Ms. Conley is certified as a Neonatal Nurse Practitioner by the National Certification Corporation. She is an active educator of the nursing community as a Neonatal Resuscitation Program Instructor for the American Academy of Pediatrics and a STABLE Program Instructor for the March of Dimes. She has also taught nationwide on PICC (peripherally inserted central catheter) insertion for adults and neonates, and has presented nationally on the topic of vascular access.
[OnlineFNPPrograms.com] Could you please describe your current responsibilities as a Neonatal Nurse Practitioner at Kosair Children’s Hospital? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Marla Conley, MSN, NNP-BC] My responsibilities as a Neonatal Nurse Practitioner include assessment, planning care and management for premature and sick neonates. Each day, my responsibility includes assessing each baby, reviewing the history, and interpreting laboratory and radiographic results. I then use this data to make a plan for each baby. I attend high risk deliveries and provide care for the newborns. I perform procedures such as intubations, chest tube placements, umbilical line placements, PICC line placements, frenotomies and circumcisions. I admit and discharge those babies ready to go home.
The types of medical conditions and challenges my patient population experiences are typically related to prematurity. We care for all gestations from point of viability to term newborns who experience disorders such as birth defects, respiratory distress, sepsis, hypoglycemia and opiate withdrawal, etc. My role in managing the care of babies includes collaborating with my neonatology team to make a plan for each baby specific to his or her condition. A plan for an extremely premature baby will include a problem list that addresses every system including neurological, respiratory, cardiac, gastrointestinal, musculoskeletal etc.
Nutrition will play a key role in a premature baby’s short and long term plan. Each day, I will do a nutritional assessment, which includes interpreting lab values, conducting growth assessments, and calculating calories needed for this baby to grow considering environmental challenges and physiologic challenges that come with prematurity. I will attempt each day to provide this baby with nutrition, via TPN and lipids and/or milk feedings that mimic in utero nourishment to the best of my ability. I will address each problem every day and attempt to advance my babies toward stabilization. I manage their respiratory system by ventilator adjustments based on their assessment, intubations or extubations, X-ray interpretations and changes in oxygen delivery as needed. Many premature babies need cardiac or hemodynamic interventions, and I assess for changes each day and make decisions based on their needs.
Term newborns have their own different kinds of problems. With today’s advanced obstetrical care, we often know what we are dealing with and are prepared along with the parents when babies are born. But that is not always the case. Many times there are surprises right after delivery and sometimes the mothers have not received any prenatal care. It is my job to identify and formally diagnose problems and disorders, and to discuss with the parents and make a plan.
I often consult and collaborate with other specialties such as pediatric cardiology, neurology, neurosurgery, infectious disease, pediatric surgery team, etc. Our team at Kosair Children’s Hospital includes neonatologists and nurse practitioners. We also have pharmacists who are specially trained in neonatology who assist us, speech pathologists that assess and treat feeding/mechanical problems, and nutritionists specially trained in neonatology as well as physical therapy and occupational therapy. We also have discharge planners that work closely with us and with the families in preparation for discharge needs. We work together and meet once a week to discuss the overall plans. I firmly believe these disciplines are invaluable to the overall care and improved outcomes of our premature and sick neonates.
In my facility, we strive to include the parents in the care and planning of their child’s medical management. We make contact with them at least once a day to update them, to allow for questions, and to discuss the plan for their child that day. We encourage their participation in daily hands-on care as well. Many of our rooms are private and the parents are encouraged to stay with their baby or babies.
[OnlineFNPPrograms.com] You were also an NNP at New York Methodist Hospital, caring for sick and premature neonates in a Level III NICU. Could you describe how this role differed from your current role at Kosair Children’s Hospital? How are Neonatal Intensive Care Units structured at hospitals and medical centers, and what role do NNPs play in general as part of a larger team of medical caregivers?
[Marla Conley, MSN, NNP-BC] At New York Methodist Hospital I was the first NNP they hired. That was one of the things that attracted me to the position. I worked alongside the wonderful neonatologists to define the role of the NNP. I attended C-sections and high-risk deliveries. New York Methodist was a teaching institution, so I also got to work closely with residents. Everyday I learned something from them and they learned something from me. New York Methodist is a level lll NICU, but babies needing surgery were transferred to other hospitals in NY. At Kosair, surgeries are performed there, so that was different for me and I learned that I loved taking care of post surgery babies. The group at Kosair has an outpatient clinic that is staffed solely by the NNP. We function as independent practitioners in our high-risk clinic. We follow up on our high-risk infants after discharge (those babies who go home on oxygen, heart monitors, medication, or those who need close growth follow up). The role of the NNP will vary greatly based on what services the NICU offers and doesn’t offer. The role will also vary depending on the “culture” of the hospital and unit. Some institutions are very pro-nurse practitioner and allow for a very autonomous practice. Other places may be different.
If I learned anything from working at different NICUs and with many different neonatologists from all over the world, it is that there are many ways to effectively and safely achieve the same goal in neonatal care. I feel my experience with and exposure to different cultures and ways of managing babies has made me a much better NNP with open ideas.
[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?
[Marla Conley, MSN, NNP-BC] I had been a staff nurse for several years working in adult critical care. When I started to have babies of my own, I wanted 8 hour shifts as opposed to the 12 hour shifts I was currently working. The only unit in the hospital that still had 8 hour shifts was the NICU. I had never been in the NICU or even heard of the NICU and had NO experience whatsoever with babies. But I gave it a try. The first few months were horrible for me. I could not believe I had to stick needles in their little heads for IVs. I cried all the way home (and I had an hour drive) most days for months. At one point, I thought to myself, ”I am not cut out for this.” But it took the first baby, who was born so little and sick, finally getting better and getting to go home as a fat and healthy baby with excited parents, for me to see the rewards. After that, I was hooked and knew I was right where I needed to be. I discovered I loved doing procedures, I learned to do PICCs and wanted more responsibility and knowledge. I wanted to learn WHY things were being done and became very interested in the medical management of the babies. That is when I decided to go back to school for my NNP!
[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?
[Marla Conley, MSN, NNP-BC] The field of advanced neonatal nursing is so very rewarding. When you take care of a premature baby, weighing only 500 grams in the beginning, the family goes through so many ups and downs during their stay in the NICU. You establish a trusting relationship with the parents and they look to you to take care of their most precious possession. You rejoice with them on the good days and cry with them on the bad. But in the end, when I see these babies going home healthy, I feel so good about the fact I played a role in the success. That is an awesome feeling. Even when the outcomes are not what any of us may have wanted (because sometimes they are not), I still get satisfaction knowing and hoping that I, in some way, made the experience better.
As far as challenges, I see the culture that is widely publicized in nursing literature of this profession “eating their young”–i.e. the problematic culture of bullying within the nursing profession. This is an unfortunate phenomenon, and can pose problems for today’s new nurses as well as new practitioner students. Even experienced practitioners in a new role or new job may experience this. Hopefully today with this issue being brought to the forefront it can be eradicated. I believe and continue to have faith that the nursing profession with the help of advanced nursing degrees, can be the gold standard for professionalism, one that supports each other and takes pride in team work realizing that our potential camaraderie could be our greatest asset in propelling this profession forward! The medical field is ever changing. It is imperative that nurse practitioners read the current literature and stay current on practices. Often one may work with others who resist change or different ways of practice. As a neonatal nurse practitioner, you must be willing to work as a team, but at the same time be open to change based on literature or other ideas if it is in the best interest of your patients and team.
[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?
[Marla Conley, MSN, NNP-BC] For those interested in becoming a NNP and currently working in a NICU, I would recommend taking a deeper interest in how the babies are managed in your NICU. Talk with your NNP/neonatologist about why they are ordering what they order if you don’t understand. Look at your babies’ lab work, X-rays etc. Understand the day to day management. Talk to your pharmacists and nutritionists if possible. Learn why this antibiotic or formula concoction was started and not another. Learn as much as possible, the information is right in front of you. If you have a baby with a certain defect or condition, go read about it that day, it will make more sense to you and you will remember it better. The NNP boards is all about management: fluids and electrolytes. Understand why total fluids were or were not advanced for your baby that day. Understand who gets higher fluids and who is fluid restricted. Understand why certain tests were ordered. Pay attention and ask questions! The more you understand, the better NICU nurse you will be as well!
[OnlineFNPPrograms.com] In what ways have you seen neonatal care evolve during your years in the field? On a related note, how has the NNP role changed over the years, based on your observations? What are some of the biggest challenges still facing neonates and their families?
[Marla Conley, MSN, NNP-BC] As I mentioned earlier, the field of medicine is ever changing. The world of neonatology changes as well, maybe at a slower pace since we do not perform as many studies and trials on babies and pregnant women as we do other adults. However, I have seen great advancements and many changes just in my career. For example: the way we manage oxygen delivery has changed dramatically in the delivery room and for premature babies. We are now successfully managing infants born at 23 and 24 weeks gestation whereas just a few years ago, these infants were considered non viable! Prematurity continues to be a challenge for families and for our healthcare system. Prematurity comes with a host of co morbidities that range from mild to devastating, life-long effects. We as practitioners must know these conditions and discuss these possibilities with families as part of our care. Neonatal Abstinence Syndrome (NAS), a syndrome that fetuses can develop when a pregnant woman takes drugs such as codeine, oxycodone, methadone, or heroin, is one of today’s major challenges for many neonates and families. Most neonatal practitioners manage this on a daily basis as it may take up a large percentage of a NICU’s census.
NAS is a healthcare crisis that is unfortunately getting worse in some parts of the country, not better. We as providers have made great improvements in caring for these babies and families and decreasing their length of stay in the NICU. It is a healthcare issue that will continue to get much focus for years to come. This will continue to be a large part of our practice. The nurse practitioner must be knowledgeable about this issue and learn appropriate, non judgmental management for the whole family unit.
As a profession, nurse practitioners are utilized more and more in clinical setting as well as outpatient settings. Their autonomy is growing. Neonatal nurse practitioners are employed primarily in the clinical setting as the scope of practice includes infants only. For this reason, neonatal nurse practitioners may not be as marketable as other practitioners. This needs to be considered before committing to neonatology as one’s track.
For those considering a neonatal nurse practitioner career, you must realize it is very demanding and often comes with long hours, working weekends and holidays. To be honest, the times I have questioned my decision, was because of time missed with family and my children due to my schedule. As I said, I love my profession, but it comes with a demanding schedule as most jobs do in the medical profession. That being said, it also can be very flexible. Some institutions work varying shifts that may allow more days off, or shorter shifts, more days etc.
I will say it again, I love my job as a neonatal nurse practitioner. I have never regretted my career decision. I get to learn and use my brain every minute of every workday. I feel rewarded and challenged. The field of neonatology is special. The professionals I currently work with and have worked with in the past are the most caring and sensitive men and women I have every encountered; not to mention the most intelligent group of professionals ever! I am so very proud to be in a profession with members who devote themselves to our tiniest and most vulnerable patients!
Thank you Ms. Conley for participating in our APRN career guide interview series!