CANNP Newsletter January 2015.pub

CANNP News
Carolinas Association of Neonatal Nurse Practitioners
President’s Message:
Happy New Year! Most of us made New
Year’s resolutions, or at least thought
about goals, for the coming year. I
encourage you to challenge yourself
personally and professionally to go that
extra mile this year!
This may seem like a silly comparison, but I
recently had my middle school age church
youth group do an activity where they had
to log their activities for a week and then
evaluate what they saw. Some of our
activities are required (work or school) and
are not negotiable. The youth found that
they were spending more time doing things
that were not required, and maybe a waste
of time, than they thought. We should
reflect on how we use our time as well.
When I look back on certain experiences, I
sometimes find that they have provided me
with much more in terms of growth and
networking than I would have imagined.
Volunteer activities in particular can be
especially enriching. I am usually the one
who gains the most.
My youth group went to DC last spring and
participated in an “Outreach Run.” We
prepped on homelessness—watched a video
by the Homeless Coalition, had a speaker,
packed goodie bags, etc. On the morning
we did run, the youth were initially
apprehensive and shy, but they blossomed
and took on this new challenge. We prayed
with, were prayed for, talked, hugged, and
listened. Some of us were even entertained
by a rapper named Zeus. The youth talked
about what they saw, how they felt and
what they can do, during our worship
service that night and shared what meant
Judy Philbrook, NNP-BC
the most to them in our church’s
newsletter. We all came back with many
memories and changed attitudes. This was
truly rewarding for me—to plan, lead,
experience and see the growth!
My position on the CANNP Board is also
rewarding in this way. This organization
offers something unique that is not
offered in many other states. We have a
dedicated neonatal nurse practitioner
organization that is here to hear us, teach
us, keep us up-to-date on state and
national requirements and allow us to
network with our colleagues who work
nearby. Our annual conference is an
excellent opportunity to do all of the
above!
I encourage you to give this some thought
and ask what you can do this year to step
outside your comfort zone. Consider how
you spend your time and look at taking on
a leadership role, teaching, mentoring, or
volunteering in a professional activity.
Strive for growth and balance. A
willingness to learn, participate and think
outside the box can take you a long way
and provide opportunities that you may
not initially think possible.
Volume 15 Issue 1
February 2015
Special points of
interest:

2015 Conference

Officer Reports

Educational Feature

NANNP Update
Inside this issue:
Officer Reports
2
2015 Conference
Highlights
3
Educational Offering
4-5
NANNP Update
6-7
Please take a look at this Newsletter—
there is valuable information about our
Practice Site Updates
annual conference, as well as an
educational feature and an update from
Membership
NANNP. I also encourage you to renew
your membership and help us maintain and Application
grow this organization.
8
9
Officer Updates
Secretary’s Report:
Kathy Connelly
Minutes from the last annual
business meeting will be displayed
outside of the conference room at
the 2015 Conference.
Treasurer’s Report:
Judy Philbrook
Current Balance: $16,924
Membership:
Member-At-Large Report:
Sharon Rush
Please email practice site updates to
srush@capefearvalley.com by May 31,
2015 for the next newsletter.
I would also love to see members
volunteer to write an article for this
newsletter.
Website:
Remember to visit the website....
Conference information, updates and
newsletters can be found there! The
website address is cannp.org.
CANNP had 45 members in 2014.
It is time to renew your
membership! This can be done by:
1) PayPal on the website (you do
not need to print and mail the
application)
2) Completing the membership
application form enclosed in this
newsletter (or you may obtain
one from our website) and
mailing it to:
CANNP
c/o Judy Philbrook
*Reminder*
Please bring a door prize/gift
basket from your NNP team to
the conference.
Board of
Nursing Info
6474 Summerchase Dr
Fayetteville, NC 28311
Membership applications must be
received by or at the annual
conference.
Please encourage all members of
your team to join or rejoin and be
active in this worthwhile
organization.
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For questions about advanced
practice legislative changes, please
follow one of the following links to
the Board of Nursing in your state:
http://www.ncbon.com/
http://www.llr.state.sc.us/POL/Nurs
ing/
CANNP News
Conference Highlights 2015
The 2015 conference “Babies are Our
Business” will be held at the Great
Wolf Lodge in Charlotte, NC on April 16
and 17th.
Please see the side column for the
conference agenda.
Members of the conference planning
committee are:
Joanna Fetcher NNP-BC
Paula Issinghoff NNP-BC
Reagan Oglesbee NNP-BC
Carol Snyder NNP-BC
Cheryl Smith NNP-BC
Renee Starcevich NNP-BC
The committee has worked hard to
ensure a wonderful conference. Join us
in Charlotte for a great conference, a
chance to network with colleagues from
North and South Carolina, continuing
education credits and perhaps some
shopping or sight seeing.
Brochures should be mailed in the next
week. If you do not receive one, please
check the website for conference
information.
Carolinas Association of Neonatal Nurse Practitioners
April 16 and 17, 2015
Thursday April 16, 2015
8:15-9:15
Update in Neonatal Neurology
Carolyn Hart, MD
9:15-10:15
Antibiotic Stewardship
John “Brock” Harris, Pharm D
10:15 – 10:45
Break
10:45-11:45
The Premature Infant:A Nutritional Emergency
Suzanne Smith MSRD, LDN, IBCLC
11:45 - 1:15
Lunch/CANNP Meeting
1:15 - 2:15
The Golden Hour
Phyllis Waddell, RN, BSN
2:15-2:30
2:30-3:30
3:45-5:45
Break
Competency Maintenance: What You Don't Know Can
Hurt You
Lee Shirland, MS, NNP-BC
Optional Skills Lab
Friday April 17, 2015
8:00-9:00
HFOV with the Neonate
Chris Surike, RRT-NPS
9:00 –10:00
NNP Mentoring Program
Amy Jnah (ECU) DNP, NNP-BC
10:00-10:30
Break
10:30-11:30
Nursing Research in the NICU
D Newberry DNP, NNP-BC
11:30- 12:30
Putting Together Prenatal and
Neonatal Genetic Testing
Erin Steed, MS, CGC
12:30-1:30
Lunch
1:30 - 2:30
Gut Microbiome and Its Effect on Disease
Chris Magryta, MD
2:30-3:30
Newborn Screening for Complex
Congenital Heart Disease
Matthew B. Brothers, MD
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CANNP News
Educational Feature: A Case Study
Susan Nalls, MSN, NNP-BC
Background:
A male infant born at 36 weeks
gestation demonstrates persistent poor
feeding as he approaches 40 weeks post
conceptual age. Nipple feeding issues
started with infant having difficulty
with coordination which is often seen
with preterm infants, but feeding
difficulties progressively worsened as
the baby approached term. He had an
uncoordinated suck during feeds.
Within a few suck bursts, he
experiences intermittent stridor,
increased work of breathing, and
pooling of oral secretions. Respiratory
compromise progressed to include
occasional obstructive apnea as well.
The infant was also noted to have noisy
respirations and a crowing cry when he
was active or agitated.
However, for a subset of infants,
laryngomalacia can be a serious
condition because this partial
obstruction can cause respiratory
compromise and failure to thrive due
to poor coordination between
breathing and feeding.
Symptoms of laryngomalacia

Stridor

Crowing cry

Difficult oral feeding

Poor weight gains

Choking while feeding

Pooling of oral secretions

Coughing during feeds

Apnea

Retractions with feeds
History:

Cyanosis
Pregnancy was complicated by IUGR.
Fetal ultrasound had a question of
possible skeletal dysplasia as well.

Emesis or spits

Aspiration
Karyotype was normal. Viral studies
were negative.
Diagnosis: Laryngomalacia
Laryngomalacia (LM) is the softening of
the tissues of the larynx above the
vocal cords. This floppy tissue falls into
the airway on inspiration and causes a
partial obstruction.
Laryngomalacia is the most common
cause for noisy breathing in infancy. It
is most often seen in mild forms and
does not compromise the infant.
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It is common for infants with mild
laryngomalacia to have intermittent
noisy respirations. Infants with
moderate to severe laryngomalacia
experience noisy respirations and
intermittent stridor. Respiratory
symptoms become worse with
agitation, crying, and feedings.
These symptoms are often apparent
within the first weeks of life thru
the first year. It is common for the
noisy respirations to get worse over
time before they begin to improve.
In the premature infant, noisy
respirations and stridor can evolve
as the infant advances on oral
feedings at which time it becomes
more difficult to coordinate sucking
with respirations during feeds.
Diagnosis is made through review of
the infants history, physical exam
and consulting the pediatric ENT
for an airway evaluation and
endoscopy. Endoscopy can identify
abnormalities in the structures
above the larynx including
laryngomalacia while also being
valuable to diagnosis any involvement
in the lower airway too.
Treatment is usually conservative
and supportive. Symptoms will often
increase or get worse over the first
few months after diagnosis, usually
between 4-8 months of age. Most
infants outgrow the noisy breathing
within their first year.
Laryngomalacia can be complicated
by gastrointestinal reflux which
causes inflammation and irritation
above the vocal cords and worsen
noisy breathing. If reflux is also
diagnosed, treatment may include a
change in feeds or adding a
medication to control symptoms.
Nipple feedings and breastfeeding
may proceed with care to monitor
the baby’s airway. The term infant
will often pace himself during the
feed, but the preterm infant will
Educational Feature (cont)
need assistance to control the pace of feeds. Infants
often protect their airways during feeding best in
the upright supine position or side lying position.
Most infants outgrow laryngomalacia with supportive
measures.
The case infant with laryngomalacia required
gastrostomy placement due to ineffective or poor
oral feeding.
In rare cases, infants may require surgical
intervention to correct airway malformations.
Surgery options are supraglottoplasty in which
excess tissue on the epiglottis is removed and
support structures are tightened, and tracheostomy.
It is common for
the noisy
respirations to get
worse over time
before they begin
to improve.
Reference:
http://www.cincinnatichildrens.org/health/l/laryngo
malacia-infantile/
Panel A: Flexible laryngoscopy of laryngomalacia during inspiration. Note
collapse of the epiglottis. Panel B: Flexible laryngoscopy of laryngomalacia
during expiration. Note the omega-shaped epiglottis.
2014 Up to Date: Graphic 79457 Version 1
Courtesy of Glenn C Isaacson, MD, FAAP, FACS.
Page 5
CANNP News
NANNP Update from Susan Meier
Chair, National Association of Neonatal Nurse Practitioners
The National Association of Neonatal Nurse Practitioners (NANNP) and the Carolinas Association
of Neonatal Nurse Practitioners share a commitment to support the professional development of
NNPs through education and research, and by providing a forum to exchange ideas and best
practices. Additionally, we share a commitment to advocate for the neonatal nursing profession as
a whole. It is in this spirit of shared purpose that I am pleased to update you on NANNP’s
contributions and accomplishments in 2014. I hope you and your members will find the attached
summary helpful in maintaining awareness of the national organization’s efforts last year and our
focus for 2015.
The National Association of Neonatal Nurse Practitioners
(NANNP) had a very productive 2014 in each of the
organization’s focus areas of education, research, advocacy,
and membership.
As a member of the planning committee for the 2014 Hot
Topics in Neonatology conference, NANNP added its
perspective and voice to the ongoing discussion of physician
and nurse practitioner collaboration in the NICU.
Education
NANNP’s education publications and products released in
2014 reflect NANNP’s unique role and influence in setting
national standards for neonatal nurse practitioner (NNP)
education and practice. They include:
Research
With support from Ikaria and in collaboration with the
National Certification Corporation (NCC), NANNP designed
and conducted its second NNP Workforce Survey, which
helps it maintain a pulse on characteristics of the current
NNP workforce. The results and analysis are complete and
publication is in process. Expect the executive summary
within the next month and the full report to members late
spring.
Education Standards and Curriculum Guidelines for
Neonatal Nurse Practitioner Programs (revised)
NNP Competencies and Orientation Toolkit, 2nd Edition,
endorsed by NONPF
Pharmacology Webinar Series
Resource Guide for Neonatal Cardiac Care with
Companion Figure (new online format for ease of access) NANNP served as a co-provider of the Neonatal Faculty
and Clinical Leadership Forum at the Neonatal Advanced
Practice Nursing Forum in 2014 and is privileged to do so
again in 2015, to offer its perspective on strengths,
weaknesses, opportunities and threats relative to
neonatal APRN practice and education.
The NANNP Leadership Summit at NANN’s annual
education conference in September featured a day of
programming focused on the interests of NNPs. Key
member discussions focused on two areas. First, how to
measure and demonstrate the value of an NNP as one
approach to helping stem the practice of filling NNP
roles with PAs, hospitalists, etc., due to the shortage of
NNPs. Second, how do NNPs control their scope of
practice and adapt to full scope of practice requirements
that include primary care for children up to age two?
NANNP is using the feedback of these discussions to
inform 2015 initiatives in the areas of quality, retention
and recruitment and NANNP’s position on scope of
practice.
Page 6
Additionally, APRNs were well represented at NANN’s
Research Summit in April with 9 presentations of original
work, and NANN’s small research grants included an award
to an NNP (Ann Phalen).
Advocacy
NANNP added clarity to the discussion of NNP scope
through two publications:
The Future of Neonatal Advanced Practice
Registered Nurse Practice (White Paper)
Advanced Practice Registered Nurse: Role,
Preparation, and Scope of Practice (Position
Statement), endorsed by the American
Association of Pediatrics, Perinatal Section.
Through its ongoing collaboration with select nursing,
physician and certification organizations such as AAP
Perinatal Section and COFN, AANP, NONPF, NCC, and
NAPNAP, NANNP helps to further the profession and
interests of the neonatal APRN. NANNP was present at
the AANP conference in Nashville (June), the NONPF
meeting (April) and the Consensus Meeting (May). NANNP
has been asked to participate in the NONPF/AACN
meeting to revise the National Task Force guidelines on NP
educational programs. This work will begin in February
2015.
In Memorium
Membership
Membership in NANNP reached an all-time high in 2014,
which is an important indication of the value NNPs place
on the work NANNP does to be a strong advocate for
the profession and a resource for their effective
ongoing practice and personal development. With a
generous grant from Abbott, we have been able to offer
new graduate NNPs free membership for their first
year in the organization. The 2014 NANNP Business
meeting was recorded and is available for viewing on the
members-only page of the NANNP website.
In 2015, NANNP will continue to address the
professional and educational needs of NNPs through our
programs and collaboration. Three areas of specific
concentration for 2015 and beyond are:
Mentoring: With the help of a generous grant
from MedImmune, we are developing a toolkit
that will provide practical approaches and
advice for mentoring novice NNPs to help
them transition from expert RN to expert
NNP more effectively and efficiently.
Quality Metrics: We have initiated foundational
work to develop standards for measuring the
quality and impact of the NNP role.
NNP Workforce: In recognition of a likely
shortage of experienced NNPs due to the
large numbers of NNPs who are nearing
retirement, we are evaluating tactics to help
attract and encourage promising neonatal
nurses to continue their professional
development by becoming neonatal nurse
practitioners.
NANNP is excited about the year ahead and looks
forward to pursuing additional collaborative
opportunities.
Joan Lucas
July 08, 1946 - January 02, 2015
Joan started her nursing career at Cape Fear Valley
Medical Center in July 1991. She had initially
received a BA in Zoology from Drew University in NJ
and then worked 5 years at Duke University Medical
Center as a research tech in the neurosciences lab
with a neurologist studying phenylalanine hydroxylase
(the enzyme missing in PKU). She had 4 children (all
boys!) and then returned to school to study nursing.
Joan received her ADN from Sampson Community
College in 1991.
She received her BSN from UNC-CH in 1994. She
then attended Georgetown University’s certificate
program in 1995 and worked as a NNP with the
Neonatal Advanced Practice Service (NAPS) until
her retirement in January 2014. Joan took on many
projects while working as a NNP. Her PI projects
included tracking early surfactant use and
pneumothorax incidence. She taught at the Skills lab
a couple times (at the 2013 CANNP Conference and
for the NAPS) and was the chair of the policy and
procedure review committee. Joan was also part of
the Golden Hour Committee.
Joan was an avid Carolina and Yankees fan, who
immensely enjoyed gardening, quilting and caring for
her grandchildren. She maintained contact with the
Cape Fear medical team after her retirement—even
attending Journal Club—and social gatherings. She
will be missed.
Page 7
Practice Site Updates
Sharon Rush, MSN, NNP-BC
First I would like to start by encouraging all of you out
there to share updates from your practice sites with all of
us. Anybody may submit an update for publication in a future
issue of the newsletter, and updates may be submitted at
anytime throughout the year.
Cape Fear Valley Health System
We would like to welcome the newest member to our team
Donna Parker NNP. Donna graduated from the NNP program
at ECU in December. She is currently busy studying for her
NCC certification exam. We would like to wish her the very
best of luck.
WakeMed Health & Hospitals
This upcoming year is starting to be an EPIC year! We went
live with EPIC on Feb. 1st (your prayers are appreciated
during this transition—we were still doing paper charts)!
While we are working through all the kinks during this Go
Live phase, we are excited to join the other EPIC teams. We
are pleased to be opening up a new 6 bed Special Care
Nursery at our new facility at WakeMed North in May. With
the addition of WakeMed North we have hired 6 new
practitioners and 1 neonatologist. Our new practitioners are:
Holly Wells, Alix Lavenburg and Lauree Kruyer, joining us
from Rex, Sarah Garro from Womens, Kristen Harbaugh
from Vidant, Elizabeth Beauvais Carmac from UNC, and our
neonatologist is Steve Demeo who is just finishing his
fellowship at Duke. Amy Jnah from ECU School of Nursing
also joined us as a per diem NNP. Congratulations to Nancy
White PNP on her new position as Director for Mid-Level
Providers-Women & Children. Tracey Robertson DNP & Desi
Newberry DNP have joined the faculty at ECU’s School of
Nursing. Ginger Rhodes-Ryan has been extremely busy as
our Research Coordinator with 10 research studies. Our
updated NICU with 27 single rooms has been extremely
popular with our parents and we hope to have enough funding
in the distant near future to complete the rest of the
renovations. We would love to have you all come visit us and
would be proud to give you a tour.
Page 8
Duke University Medical Center
Duke is going to have one eventful year! In addition to the
ever-continuing research studies, NPs now go on transport
with the Duke Life Flight team. With the increasing
demand of Duke’s transport team, we have trained several
practitioners on transport techniques. Some of the NP’s
include Kitty Hill, Shannon Lawrence, Melissa Long, Laura
Lumsden, Sarah Mears, Mari Porter, and more to come.
We are continuing to give DevelopMe workshops led by
Laura Lumsden and Cathy Simmons, which look at how to
improve developmental care in our three units. We had
two NPs recognized as Friends of Nursing for their
continual work with the nursing staff and in the units,
Claudia Herbert and Laura Lumsden. With the
implementation of EPIC (or Maestro Care, as we call it at
Duke) we have found several areas in which we could
reduce costs and improve our clinical practice. Through
these money saving techniques, we will be able to provide
more effective clinical management. This next year, we
will be adding our only male NP of the group, Dave Tallon.
We are super excited to see him join! Through all of these
changes, we have two practitioners, Keirsten LeBar and
Stephanie Blake, in the process of obtaining their DNPs.
We look forward to the coming changes this next year and
we can’t wait to hear everyone else’s news from their
home hospitals.
Membership Application
CANNP celebrates its 24th anniversary in 2015! The Association provides a communication
network for exchange of ideas regarding Neonatal Nurse Practitioner practice. Our goal is to
facilitate professional development through education and research. Your affiliation helps to
expand membership services. By joining or renewing your membership in 2015 you will be taking
an active role in supporting CANNP goals. Please print clearly or type the following information:
Name
Address
City ___________________ State _____________ Zip code __________
Phone
Work __________ ____ Home
_________
Email ________________________________________
Employer
Fee:
$35.00
______Renewal
______ NNP
______ New Member
______ Student
I agree to allow my name to be released for mailing lists for conferences:
Yes ______________
No ______________
Please enclose check payable to:
CANNP
c/o Judy Philbrook
6474 Summerchase Dr
Fayetteville, NC 28311
Volume 15 Issue 1
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