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What is a Neonatal Nurse?

A neonatal nurse is a specialized medical professional who takes care of newborn infants less than 28 days old, suffering health problems or dealing with prematurity. Neonatal nurseries are divided into four levels:

  • Level 1 provides care for healthy newborns. This level cares for healthy newborn infants when they are not sharing a room with their mother.
  • Level II is set up to provide special care for the sick newborn. Here, the nurses provide special therapy to help the infant get ready for discharge.

  • Level III is the Neonatal Intensive Care Unit or NICU. Here, the infants need extensive technology (breathing or feeding tubes).
  • Level IV offers higher care levels with 24-hour neonatologists and surgeons.

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Steps to Become a Licensed Neonatal Nurse

You will have to go to community college or a four-year university and earn your LPN, then your BSN before you enter this nursing specialty.

In community college, neonatal nurses earn an Associate of Science in Nursing (ASN); in a four-year university, you’ll earn your Bachelor of Science in Nursing (BSN). If you transfer from community college to a four-year university, this may be easier for you.

At both levels, you’ll study nursing in the classroom, then take part in clinicals (clinical practice sessions, which are similar to internships).

  • Step 1: Education

  • Step 2: Your Clinical or Working in NICU

  • Step 3: Get Your Certification

  • Step 4: Earn Your Graduate Degree

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Step 1: Education

Find a community college or four-year university that offers a major in nursing. You will take your general education classes, such as English, math, biology, and sociology. Once you have completed your general education courses, you’ll begin your core courses, which deal directly with nursing.

Your college or university may require its nursing students to maintain a specific GPA; if your grades fall below this GPA, you are at risk of losing your spot in the nursing program. If you find that any courses are giving you problems, request tutoring so you can become comfortable with the material.

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Step 2: Your Clinical or Working in NICU

Participate fully in your clinical. You may rotate from specialty to specialty, even if you already know you want to be a neonatal nurse. Pay attention to everything your clinical supervisor shows you so you can learn it. Your time in each clinical rotation won’t last very long, so learning quickly will be key to understanding your job role.

If you can, find a position working in NICU. You may already be working in a hospital, so request some time in NICU, so you can get additional experience. Find out if you should have prior experience in maternity or general nursing.

Step 3: Get Your Certification

Apply for certification through the American Nurse Credentialing Center (ANCC). To become a licensed RN, you will have to take and pass the National Council Licensure Exam or NCLEX. This certification tells you and your employer that you have the knowledge you need to work in this specialty.

Once you have your certification, you’ll have to take continuing education (CE) classes so you can renew your certification as required by your state. Professional nursing organizations can direct you to the resources that enable you to obtain your CE credit hours. Keep in mind that hospitals with a NICU prefer their NICU nurses who have their BSN and certification.

Step 4: Earn Your Graduate Degree

You may choose to advance your education to the graduate level. The expanded opportunities for learning will enable you to provide even more specialized care to the infants you see. A graduate degree in nursing also means that, when the time is right, you will be able to advance to a higher nursing level. You may even become the director of the NICU nurses.

What Does a Neonatal Nurse Do?

As a licensed RN, the neonatal nurse provides specialized care at one of several levels, to newborn infants needing more care than a healthy newborn would need.

The neonatal nurse works with medical professionals who, themselves, are trained and educated to work with sick or premature newborns. They may care for up to four newborns, actively monitoring their conditions minute to minute.

Their shifts are usually longer than those of other neonatal nurses—they may work at night, over the holidays and on weekends, as needed. The nurse will regularly monitor their charges’ vitals, give IV fluids and medications, give regular feedings and, overall, give comfort to the newborns in their care.

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Even though neonatal nurse practitioners are working with premature or sick infants, they experience a lower degree of physical stress than fellow neonatal nurses who are working in other specialties. In addition to their work within the nursery, the neonatal nurse will have to update the infant’s parents about their conditions, progress, improvement, or setbacks. Even though these babies are struggling with illness or prematurity, the overall mood is joyful.

Needed Skills to Acquire

Neonatal nursing is highly specialized, requiring working with the smallest and most fragile infants. Neonatal nurses in this specialization need to have several specific skills that will equip them to work every day with these infants:

  • Interest in newborns
  • Empathy and understanding for baby’s parents and family members
  • Ability to work effectively as a member of a multidisciplinary team
  • Good understanding of psychological and physiological needs of newborns
  • Competence to work in a technical practice area

The six Cs that a neonatal nurse should have include:

  • Commitment
  • Care
  • Courage
  • Compassion
  • Communication
  • Competence

Neonatal nurse practitioners should have a caring, tender, and competent bedside manner. They are expected to handle the tiny limbs of a newborn, insert IVs, and give injections. They may also have to insert gastro-nasal tubes so the babies can take in nutrition if they can’t yet nurse or bottle-feed. Bedside manner also pertains to the parents; they are often anxiously awaiting news and updates about their newest family members. And, given that an illness or prematurity were not anticipated, they are even more worried.

All of these require that the nurse have a soft, tender touch. They should also have steady hands so they can find veins and insert tubes on the first try.

Alternative Education and Career Paths

Neonatal nurse practitioners possess highly specialized knowledge and skills. Therefore, a formal education in nursing is required. Whether you choose begin your nursing career by earning an ASN or a BSN, your education will be mandatory. There are no alternatives or shortcuts to becoming a neonatal nurse.

In addition, you will be required to undergo supervised clinical experience (the clinical), then sit for your licensure exam. This is the NCLEX, for registered nurses. If you live in a state that requires additional testing or requirements, you’ll have to meet those requirements and show documentation of having done so.

You may need to obtain either your master’s or doctoral degree to become an advanced practice nurse, which is what the neonatal nurse is.

In investigating the different nursing programs in your area, you may have found that the clinical experience is mandatory. Again, this is something that you cannot bypass. The experience and education are specialized enough that you must complete a clinical. You will receive experienced leadership during your clinical. You will also become a part of a specialized network, which will benefit you during your job searches. You want your employer to know that you have the knowledge and experience to do your work in the NICU.

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Neonatal Nurse Careers and Salary

Where Might You Work?

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After you graduate from your nursing program and earn your certificate or licensure, you’ll work in a hospital. The population of newborn babies you’ll be working with are those sick enough to be taken to the Neonatal Intensive Care Unit (NICU).

The NICU is its own hospital department; the infants who are brought here are either premature, suffering from birth defects, recovering from surgery, or dealing with a complication. If one of these babies comes back to NICU after discharge, you may take care of them off and on until they are two years old. Expect to be certified within neonatal intensive care (RNC-NIC) or neonatal (CCRN).

In the NICU, you’ll be under the supervision of a neonatologist, monitor the infant’s vital signs, ensure that all equipment works correctly, and keep parents up-to-date on their baby’s progress. You may hook critically ill infants up to life-saving technology and give them comfort when they are in pain.

NICU and PICU (pediatric intensive care unit) are similar, but NICU takes care of sick infants only. If this is your passion, then seek out the information you need.

Potential Career Paths

While you will work solely in the NICU, your daily activities will vary. Your patient load will be low, allowing you to give each infant the care and attention they need. The parents of your tiny patients will also need your care. While they are happy they are now parents, they are also scared and worried for their little ones. It will be up to you to educate them and help calm them down.

Advanced Practice Clinician Neonatal
Your main responsibility will be to deliver and coordinate primary care to premature or critically ill newborn babies. You will be under the direct supervision of neonatologists. You will provide clinical and administrative assistance to the programs within the Neonatal Services Department. These include staff education, transport and outreach education.

At your level, you will be required to complete a neonatal nurse practitioner program and obtain your certificate from the National Certification Corporation (NCC) or the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N). This is required.

Registered Nurse (RN)—ICU-Neonatal ICU
This position is open only to new graduate neonatal nurses and experienced neonatal nurses. You will work in a Level IV neonate Intensive Care Unit, which includes a step-down unit. In your work, you will work with a diverse patient population (infants with cardiac, multi-system dysfunction, prematurity, and cardiac problems).

If you are a new graduate nurse, you will be enrolled automatically into a Nurse Residency Program. You will work within the hospital’s Clinic Nursing Professional Practice Model (this includes accountability for planning, implementing, evaluating and communicating all phases of nursing care for patients assigned to you).

Registered Nurse (7p-7a) Neonatal ICU
Your job responsibilities include applying nursing judgment through a complete and systematic approach. You will apply assessment, planning, implementation, and evaluation/reassessment. You will collaborate with patient care team members on the patient care plan.

You will prioritize your tasks and adjust priorities as needed. Maintain an orderly efficient and timely flow of patients. Spot and report errors or unusual occurrences, then initiate action when needed. Record accurate, complete, and timely entries into the patient’s medical record, addressing all steps of the nursing process. You’ll communicate actively with healthcare team members, patient, and patient family.

RN Fellowship—Registered Nurse—NICU
As an associate of a hospital, you will be providing direct nursing care, using established procedures, policies, and protocols.

You will implement and monitor patient care plans; monitor, record, and communicate the conditions of your patients as appropriate; make notes and carry out physician and nursing orders; serve as the primary coordinator of all disciplines to establish well-coordinated patient care; assess and coordinate the patient’s discharge planning needs with all members of the healthcare team.

RN—Neonatal Intensive Care Unit
In your daily duties, you will: Assess, diagnose, plan, implement, and evaluate patent care to achieve patient goals and reach desired outcomes; create a learning environment for patents and families, nursing, and other members of the healthcare team, including students; effectively advocate for ethical and holistic care, promoting autonomy, rights, dignity, and the values and beliefs of those you serve; engage in ongoing professional development; align practice with safety and quality; be accountable for safety, and identify, and correct problems; lead and coordinate teams, delegate, coordinate care, and collaborate with others as equal members of the inter-professional care team to integrate nursing knowledge.

Registered Nurse Extern—Neonatal Intensive Care Unit
As a student nurse extern (SNE), you will help out with general unit workflow and help in performing patient care activities as an experienced registered nurse observes and guides your decisions and actions. You should have a passion for NICU nursing; this position helps to prepare you for the NICU Nurse Residency Program once you graduate.

Inside this Level IV NICU, the medical and nursing staff provide care for those infants who are the most critically ill. You will observe neonates receiving extremely specialized care. These infants may be extremely premature; they may have neurologic, respiratory, cardiac, renal/urologic, gastrointestinal, metabolic, or skeletal illnesses.

Neonatal Nurse Salaries

Occupation Entry-Level Mid-Career Late-Career
Neonatal Intensive Care Unit (NICU) Nurse $48,000 $68,000 $103,000
Neonatal Nurse (RN) $49,000 $73,000 $107,000
Neonatal Nurse Practitioner (NP) $99,000 $107,000 $125,000
Pediatrics Nurse Practitioner (NP) $86,000 $91,000 $99,000

**Salary info provided by PayScale

Career Outlook

The employment of registered neonatal nurses is predicted to grow 15% between 2016 and 2026. This projection is much faster than it is for the averages for all occupations. With the needs of the Baby Boomer generation for healthcare, as well as on preventive care, increasing, neonatal nurses as well as other medical professionals will be busy for decades into the future.

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Looking at neonatal nurse practitioners specifically, employment is expected to grow by 31% between 2014 and 2024. Advanced nursing practices in the neonatal specialty allow RNs to provide specialized care to premature or ill newborn infants.

The job outlook for neonatal nurse practitioners is also good. As more children of Baby Boomers start having babies, this specialty will be in high demand.

Not every infant is born on time. Nor are they born without serious defects or illnesses. This means that, now that later generations are becoming parents, their babies may need specialized healthcare. Another factor leading to the increase in jobs for registered and specialized neonatal nurses: retirement of current registered and neonatal nurses. As older, more experienced neonatal nurses near retirement and leave their positions, hospitals need to hire new neonatal nurses to replace them.

Advancing From Here

There may come a time when you want to do something else in your nursing career. While you may have thoroughly enjoyed your work, maybe it’s time to become a Nurse Educator. If you are passionate about your career and helping others, you can pass this on to new nursing students.

Return to school and earn your MSN. Neonatal nurses with an advanced education are highly valued in the NICU. Earning your MSN means that you are placing yourself for career advancement. If you have natural leadership skills, you’ll find it easier to advance your nursing career. However, you need an entire range of attributes, including ethical conduct and professionalism.

When you see opportunities opening up in your community, volunteer. Even if they are unpaid, you will benefit. Develop a network of nursing professionals and professionals outside your career. Attend nursing conferences and join professional organizations. Then you’ll have all the qualifications you’ll need to grab any opportunity that comes your way.

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Frequently Asked Questions

What kind of salary growth can neonatal nurses expect?

A neonatal nurse salary can potentially increase over $30,000 throughout their careers.

What is the job outlook for neonatal nurse practitioners?

According to the Bureau of Labor Statistics, jobs for neonatal nurses are expected to increase by 45% by 2030. 

How much do neonatal nurse practitioners make?

Neonatal Nurse Practitioners make an average salary of about $118,000 per year according to the Bureau of Labor Statistics.

Where do neonatal nurse practitioners work?

Neonatal nurses works in private or public hospitals, physicians' offices, home healthcare services, and nursing care facilities. Other neonatal nurses work in outpatient clinics and schools.

What will your workday be like as a neonatal nurse?

Most neonatal nurses work between 8 and 12 hour a day. Many neonatal nurses work weekends and holidays as well. Many neonatal nurses work more than 40 hours a week.

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