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Optimizing clinical care and training in the neonatal intensive care unit: the relationship between front line providers and physician trainees

Journal of Perinatology volume 43, pages 1513–1519 (2023)Cite this article

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Abstract

Changes in neonatal intensive care unit (NICU) coverage models, restrictions in trainee work hours, and alterations to the training requirements of pediatric house staff have led to a rapid increase in utilization of front-line providers (FLPs) in the NICU. FLP describes a provider who cares for neonates and infants in the delivery room, nursery, and NICU, and includes nurse practitioners, physician assistants, and/or hospitalists. The increasing presence and responsibility of FLPs in the NICU have fundamentally changed the way patient care is provided as well as the learning environment for trainees. With these changes has come confusion over role clarity with resulting periodic conflict. While staffing changes have addressed a critical clinical gap, they have also highlighted areas for improvement amongst the teams of NICU providers. This paper describes the current landscape and summarizes improvement opportunities with a dynamic neonatal interprofessional provider team.

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Data availability

Data from the ONTPD survey which are referenced in this article are available at: https://collaborate.aap.org/SONPM/_layouts/15/WopiFrame.aspx?sourcedoc=%7B62FB95B2-38A3-4155-B67B-40DAD51D9B8B%7D&file=2022%20ONTPD%20Annual%20Report.pdf&action=default.

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Author information

Authors and Affiliations

  1. University of Colorado, Aurora, CO, USA

    Nicolle Fernández Dyess

  2. Nationwide Children’s Hospital, Columbus, OH, USA

    Erin Keels

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Patrick Myers & Tonia Branche

  4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Heather French

  5. Baylor College of Medicine, Houston, TX, USA

    Kristina Reber

  6. Albert Einstein College of Medicine, Bronx, NY, USA

    Mariam Susan LaTuga

  7. Yale University School of Medicine, New Haven, CT, USA

    Lindsay C. Johnston

  8. Stanford University School of Medicine, Palo Alto, CA, USA

    John Feister & Melissa Scala

  9. University of California, San Diego, CA, USA

    Krishelle Marc-Aurele

  10. Duke University School of Medicine, Durham, NC, USA

    Aaron Adams

  11. Stanford University/Lucile Packard Children’s Hospital, Palo Alto CA, USA

    Kristine Boyle

  12. Boston Children’s Hospital, Boston, MA, USA

    Oludare A. Odumade

Authors
  1. Nicolle Fernández Dyess
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  2. Erin Keels
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  3. Patrick Myers
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  4. Heather French
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  5. Kristina Reber
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  6. Mariam Susan LaTuga
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  7. Lindsay C. Johnston
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  8. Melissa Scala
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Consortia

The Frontline Provider Interprofessional Writing Group (FLIP)

  • Nicolle Fernández Dyess
  • , Erin Keels
  • , Patrick Myers
  • , Heather French
  • , Kristina Reber
  • , Mariam Susan LaTuga
  • , Lindsay C. Johnston
  • , Melissa Scala
  • , Krishelle Marc-Aurele
  • , Tonia Branche
  • , Aaron Adams
  • , John Feister
  • , Kristine Boyle
  •  & Oludare A. Odumade

Contributions

MS conceptualized this project and convened the interprofessional working group. NFD, ELK, PM, KM-A, MSL, LCJ, KR, and MS drafted the initial manuscript. All authors critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Melissa Scala.

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Dyess, N.F., Keels, E., Myers, P. et al. Optimizing clinical care and training in the neonatal intensive care unit: the relationship between front line providers and physician trainees. J Perinatol 43, 1513–1519 (2023). https://doi.org/10.1038/s41372-023-01749-7

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