In 1997, ENSEARCH began receiving requests from our clients to provide them with traveler Neonatal Nurse Practitioners (NNPs) to cover shifts while we were searching for their permanent staff, or to assist in times of high NICU census, or to offset leave of absence situations. This aspect of our business has grown substantially since then. As a result, on January 01, 2002, we appointed one of our senior consultants to manage,
on an exclusive basis, what we now identify as our Locum Tenens NNP business.

Today, Locum Tenens NNP activity has taken on a life of its own. Gone are the days when a hospital hired LT NNPs solely as a stopgap while searching for permanent staff. Today, many forward-thinking clients accept hiring LT NNPs as a sound business and economic decision. Hiring LT NNPs on a regular basis provides the employer with considerable
flexibility while assuring that the NICU has adequate clinical coverage.

There are a number of critical reasons for this change in thinking. Among them:

• There is a tremendous shortage of NNPs in the United States. NNP schools are diminishing and those that remain are not graduating a sufficient number of new NNPs each year to keep up with demand;
• LBW and VLBW infant births are increasing annually, thus adding to NICU census, which in turn requires additional NNP coverage;
• Most Attending Neonatologists "grew up" with NNPs and accept them as an integral and important part of the medical care team model. Many Neonatologists would not dream of working in a LIII unit that did not staff NNPs;
• Because of flexible scheduling (E.G., 24 and 16 hour shifts), many NNPs have significant time on their hands to work in alternative settings. It is these LT NNPs who are helping to alleviate the shortage of NNPs available for full-time permanent work;
• NNPs welcome the opportunity to learn new things and meet new colleagues in alternative locations. They benefit their home unit by "bringing back" experience they can share;
• Hiring units welcome LT NNPs with significant experience and training from other major tertiary referral centers. The hiring unit has immediate NNP coverage with a minimum investment in orientation and training.

All of the LT NNP candidates we refer are what we call, "Hit The Ground Running" NNPs, meaning they are seasoned Practitioners, usually Masters' prepared, high acuity experienced, NCC certified, fully licensed, proven professionals who can step into a NICU and be immediately
productive after a brief orientation.

Costs to the hiring hospital typically include:

• a competitive hourly rate paid directly to the LT NNP;
• reimbursement to the NNP for licensing fees as well as reasonable travel and lodging expense:
• malpractice insurance coverage; and,
• ENSEARCH recruitment fee based on wages.

ENSEARCH assists in gathering all documentation necessary to credential the NNP by Medical Staffing and maintains detailed scheduling. If you wish to discuss the possibility of appointing LT NNPs for your situation, we encourage you to get in touch with your ENSEARCH representative. Alternatively, you can contact Tim Mattis directly at (707) 795-3800. Email: Tim@ensearch.com