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Shawn Dunlap ’81 had a couple other careers in mind before landing on nursing and then he spent a few years as a nurse before finding his niche. But even after 26 years in pediatric nursing, Dunlap never expected he would be stepping into the pediatrician’s traditional role of performing circumcisions.

However, that’s exactly what Dunlap and his colleagues at Mayo Health Clinic System-Franciscan Healthcare in La Crosse, Wisconsin, have been doing since December 2013.

The rather radical change in standard operating procedures came when Dennis Costakos, a neonatologist at the hospital, thought outside the box to find a more efficient method of delivering neonatal-pediatric services. Dunlap explained that Costakos’ plan was to have pediatricians only see patients in the clinic with neonatal nurse practitioners and a neonatologist handling hospital duties.

“The neonatal nurse practitioners manage the newborn nursery and attend deliveries as well as help manage a neonatal intensive care unit. This is a very unique role here; there are no pediatricians on the floor,” Dunlap said. The neonatal nurse practitioner has a 24-hour shift with one always on duty whereas pediatricians were often on call, he said.

“Patient satisfaction went way up because there was always a provider on staff. There’s always a provider in the hospital to resuscitate a baby in an unfortunate situation,” he said.

STEPPING INTO NEW TERRITORY

But if the pediatrician isn’t working the birth and newborn floor, who is going to circumcise all those male babies? The hospital has about 1,000 births a year.

Costakos supposed that surely somewhere else neonatal nurse practitioners were performing circumcisions. But a review of peer-reviewed medical literature found no articles citing the use of neonatal nurse practitioners for this high-volume surgery. So, what’s the next option? YouTube videos, of course. The next step was then watching pediatricians perform circumcisions.

Finally, nurse practitioners performed 10 observed-but independent circumcisions to become hospital credentialed for the procedure.

The neonatal nurse practitioner staff kept records on the first 200 circumcisions and applied to the International Review Board at Mayo Clinic for a research project.

The findings were “very positive,” Dunlap said. According to the study, “No baby had sufficient bleeding to warrant a urologist consult or penile suture” and Dunlap said urology didn’t report any follow-up visits either.

THE STUDY SAYS …

The study conclusion: “Having an NNP perform the circumcision is safe and results in a two to nine times reduction in professional salary expenses compared to other specialists doing the procedure.” That’s because the hourly compensation for a neonatal nurse practitioner is $53.74 compared to $94.41 for a pediatrician and $248 for a urologist in 2015, when the study was done.

If the entire U.S. applied this model for the 1.1 million newborn circumcisions, the cost savings would be $10 million annually, according to the study.

Dunlap, Costakos and five other team members presented their study at the 2016 gathering of the American Academy of Pediatricians in San Francisco. The poster presentation was titled “Neonatal Nurse Practitioners as Surgeons,” a title, that while attention-grabbing, didn’t set well with some doctors, Dunlap said. The academy is almost exclusively made up of pediatricians, he said. Only recently did it start accepting nurse practitioners.

“It was a feather in our cap to be able to make a presentation at this conference,” said Dunlap, adding a follow-up study is planned.

DISCOVERING NEONATALOGY

Dunlap stepped into neonatology after working as a critical care nurse, a camp nurse and a traveling nurse in his first years. His introduction to neonatology came in 1985, when he was working with the open-heart unit at Gundersen Lutheran in La Crosse. Two of the three surgeons left and Dunlap was left with little work.

The hospital also had several pediatric nurses take maternity leave so Dunlap received a six month assignment and discovered “this is a cool world.

“If you’re a nurse, you want to take care of people and help them through something tough in their life. When you have a premature baby, that’s a pretty big stress. It’s very rewarding to take someone and walk them through a stressful time in their life. At the end, you hand them a healthy product and send them home. Plus, you meet lots of nice people.”

In 1991 Dunlap married and became the director of pediatrics at Arnot Ogden Medical Center in Elmira, New York, an upstate hospital.

“It was during that period of time in administration that I realized that I missed my clinical time working with babies and their families so I went back to school to become a neonatal nurse practitioner,” he said.

BACK TO SCHOOL

In 1993 Dunlap moved back to his home state and entered the neonatal nurse practitioner program at State, which was the second school in America to offer the program. It was a 12-month certificate program offered in partnership with the University of South ��ֱ���� School of Medicine. Sioux Valley Hospital (now Sanford) was the partner in Sioux Falls.

The College of Nursing provided the organizational structure. Neonatologists and neonatal nurse practitioners from the NICU at Sioux Valley Hospital taught the clinical and theory content. Content related to nursing research and nursing roles was taught by Lois Tschetter, who coordinated the program from 1985 to 1993.

Dunlap notes that 1994 was the last year for the certificate program. Then a master’s degree was required. Now a doctorate is required.

He regrets not getting his master’s degree, which would have allowed him to teach.

DAUGHTERS ALSO PURSUE HEALTH CARE

He does not regret ditching his first two career aims—horticulture and broadcast journalism. The 1976 Brookings High School graduate recalled visiting his sister, Marla Dunlap, in the Twin Cities in the 1970s while she was doing clinical rotations as a nursing student and seeing ex-medics working as nurses.

“I remember meeting these guys that were Vietnam veterans and thought they were cool,” said Dunlap, who entered the nursing program as a sophomore. Forty years later, Dunlap was back on campus in fall 2018 for the White Coat Ceremony for his youngest daughter, Morgan. The Dunlaps’ middle daughter will graduate this spring with a doctorate in physical therapy from Wisconsin-Eau Claire.

Their oldest daughter, Erin, graduated from State in 2016 with a biology degree and became a physician assistant in La Crosse. Erin married Sept. 8, 2018, and died Nov. 8, 2018, from a massive pulmonary embolism.

Dunlap’s wife, Michelle, is an exercise physiologist in cardiac rehab at Gundersen Medical Center.

He said, “I am very pleased that my daughters have chosen health care as a career. There are always people getting ill or needing assistance and usually there is a job that gives one many options of where to live and or travel.”