Neonatal nursing is a branch of healthcare that focuses on providing care for infants who were born prematurely, or are suffering from health problems such as birth defects, infections, or heart deformities. Neonatal nurses are registered nurses who specialize in working with these young, vulnerable patients. Many neonatal nurses work in Neonatal Intensive Care Units (NICU), providing highly specialized medical care to at risk newborns. This guide offers details of the profession, including the needed education, skills and credentials, an interview with someone who has worked in a neonatal unit, and what students can expect in terms of salary and job growth after graduating from a neonatal nursing program.
Neonatal nurses work primarily with infants less than one month old, though they might work with children up to toddlerhood. Many of their patients are transferred to the NICU due to premature birth or significant medical conditions. Neonatal nurses are highly trained in the finer points of caring for infants, including special procedures for intravenous infusions, blood draws, and oxygen administration.
Neonatal nurses are responsible for a wide variety of tasks, from changing of diapers to administering medications. During each shift in the NICU, they are responsible for one to four babies, each presenting varying needs and challenges. Many work with the same infants until they are discharged, but some may provide home-based care. Those with advanced certifications work as part of surgical teams or assist in high-risk labor and delivery situations.
Though the neonatal period is technically defined as the first month of life, the National Association of Neonatal Nurses (NANN) states that the duties of a neonatal nurse have evolved to include work with children beyond that age. Some neonatal advanced practice registered nurses may care for full term babies with medical issues, sometimes working with a child beyond their second birthday.
A small bump in education could translate to a serious bump in pay for neonatal nurses. According to Payscale, neonatal nurses made a median salary of $59,598, while neonatal nurse practitioners earned $92,259.
The work of a neonatal nurse is very valuable; indeed, infants in precarious medical situations depend on their expertise for survival. Though rewards go far beyond money, financial incentive is still a consideration for those who are intending to pursue this career. While the Bureau of Labor Statistics does not report data specifically on neonatal nurse incomes, it does provide information for general nursing occupations. As of May 2014, the median annual income for registered nurses was $66,640, while those in the 90th percentile earned $98,880 annually. Individuals who earn certifications or an advanced degree can potentially earn even more.
In addition to their level of training and experience, neonatal nurses might find varying salaries based on geographical location. The list below highlights the top five states where nurses earned the highest incomes in 2014:
Before students can become neonatal nurses, they must first become a registered nurse. There are three paths to becoming an RN:
NANN reports that many diploma programs are being phased out, and that bachelor’s degrees offer the greatest potential for quickly finding a job and having career mobility. This level of education also allows students to pursue a graduate degree, a necessary step in being qualified for advanced positions.
Licensure is required for all registered nurses, regardless of specialty. This mandate extends to all 50 states, the District of Columbia, and U.S. territories. Aspiring nurses must complete an accredited nursing program and then sit for the National Council Licensure Exam for Registered Nurses (NCLEX-RN) before beginning work as a registered nurse.
In order to sign up for the test, graduates need to obtain an Authorization to Test (ATT) through the Board of Nursing. Candidates who do not pass the test can take it again in 45 days. Some states have additional requirements for licensure which can be found on the National Council of State Boards of Nursing website.
A number of NICUs require nurses to gain experience working with children or infants prior to being hired. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) notes that some nursing schools offer internship opportunities for students to build this experience prior to graduation. Other opportunities include working in pediatrics or a hospital’s nursery before applying, or undertaking an on-the-job training program offered by select NICUs.
Though an optional step, many neonatal nurses complete certifications to hone their skills and demonstrate competence. While the American Nurses Credentialing Council offers a pediatric nursing certification, the National Certification Corporation (NCC) administers most neonatal credentials.
The NCC offers numerous certifications for neonatal nurses, including those in intensive care, pediatric transport, and low risk neonatal nursing. Continuing education credits may also be required to maintain certification.
Though only a registered nursing license is required to work as a neonatal nurse, those looking to better their chances for advancement can become a neonatal advanced practice nurse by undertaking a master’s degree. Many students choose to complete this program via online learning, allowing them to continue gaining work experience while pursuing their degree.
Working as a neonatal nurse offers many rewards, especially the satisfaction of helping defenseless infants become healthy and strong. In order to reach this point, students must first earn a registered nursing credential. Three routes exist, including diplomas, associate degrees, and bachelor’s degrees in nursing.
The nursing diploma is usually offered in a hospital setting and can take one to two years to complete. Those considering this option should be aware that the competition for nursing positions has led many employers to seek out applicants who have earned a higher level of education. Many nursing associations are calling for nursing diplomas to be phased out as a path to becoming a registered nurse.
Below is an overview of the associate, bachelor’s, and master’s degrees in nursing, the skills and knowledge gained during the pursuit of the degree, the curricula a student may expect to undertake, and the potential career advantages each degree level offers.
The associate degree in nursing typically takes two years to complete and includes a blend of classroom instruction and clinical training. After finishing their degree and becoming licensed, graduates can move directly into work as a registered nurse. Once obtaining a nursing position, they can begin training for a neonatal unit, maternity floor, or other opportunities leading to work as a neonatal nurse.
This degree level typically includes general education courses forming a firm foundation for more advanced nursing courses. Classes focus on the basic knowledge and skills an individual will need to step into the role of registered nurse. The table below illustrates a few common courses from associate degree programs around the country.
Focuses on the basics of nursing practice, caring for anyone from the neonate to the geriatric; includes basic assessment and practical skills.
Studies focus on the maternal newborn population, including working with mothers and families, newborns (including those with health issues), and the transition from hospital to home.
Focuses on caring for young children, including assessments, common health problems, dysfunctional health patterns, basic interventions, and outreach for parents, siblings, and other family members.
Studies highlight pharmaceutical use in hospital settings, including proper dosages, common drugs, potential interactions and adverse effects, and administration routes.
A bachelor’s degree builds on associate level coursework, providing more in-depth classes and a greater focus on advanced skills and knowledge. The bachelor’s degree also forms a solid stepping-stone for those who want to eventually earn a master’s degree.
In addition to general education courses, bachelor’s level nursing programs prepare students for the rigors of working in a variety of healthcare settings, including hospitals, private practices, and community clinics. Those who plan to work as neonatal nurses can tailor their courses to include electives focused on pediatric and infant care.
The course descriptions below describe actual classes offered by Bachelor of Science in nursing programs across the country, giving potential students an idea of what to expect during their education.
Focuses on research methods used in professional healthcare settings, evidence-based practice, theoretical and conceptual grounding of research, research design, and how to integrate findings into clinical work.
Covers genes and the human genome, including the environmental influences that might change them. Specific studies of ethical, legal, moral, and social implications in health care are also provided.
Focuses on the health of mothers during childbearing years, as well as family-centered nursing care before, during and after pregnancy; includes the health potential of newborns, handling basic health issues, and conducting assessments.
Focuses on critical decision-making, working closely with other leaders in healthcare settings, prioritizing and delegating, communication skills, and becoming valuable members of a professional nursing team.
Master’s degrees in nursing are popular options for those seeking opportunities for advancement and higher earning potential. Programs typically take two to three years to complete, depending upon how much time a student is able to devote to their studies. Most graduate degree level students are working full-time, making online programs a popular option.
Below is a brief list of courses students may encounter during a master’s program in nursing. These classes are typically offered in traditional settings, online platforms, or hybrid programs.
Focus on how to perform an accurate gestational age and health assessment, including pertinent data to collect, identification of potential diagnostic tests necessary, and taking parental health histories.
An in-depth view of human genetics, development and developing body systems, with studies from the embryonic stage to the neonate. Environmental and genetic factors are examined, including their corresponding outcomes.
Discussion of the various drugs and pharmaceutical interventions suitable for neonates and small children, including varied reactions to certain drugs, correct drug choices, and routes of administration.
A study of the practical applications of nursing knowledge in NICUs, including essential nursery skills, resuscitation, assessment, and laboratory analysis.
There are four doctoral options for those interested in neonatal nursing. These include:
This is a practical degree offering nurses the opportunity to hone their skills to provide better care for NICU patients.
This degree is rooted in research, allowing students to gain the skills and knowledge necessary to move into positions at research universities and hospitals.
This degree is ideal for those who want to focus on a very specific point of nursing, such as specialist skills in neonatal care.
This degree has a strong focus on investigative and research skills, and is designed for those who want to work with or lead research teams.
Students who have already earned a master’s degree and have several years of experience working in a neonatal unit may decide to pursue a doctoral program. Those who want to work as hands-on neonatal nurses can earn the DNP or the DN with an emphasis on neonatal care, preparing them to work in the best NICU units in the country.
Graduates of doctoral programs in nursing will have strong skills and deeply rooted knowledge, honed over years of experience and educational study. Some of the most common skills students can expect to master during a doctoral program are highlighted below.
Students learn to assess research and translate findings into action. Understanding the course of illness in an individual and in various populations allows nurses to be better prepared to administer proper treatments and assessments.
The leadership and management skills of a doctoral graduate are finely tuned, giving them the excellent skills to work effectively with those in the highest levels of research and administration.
Students who graduate from either a DNP or PhD program will possess a deep knowledge of research and the methods behind it, allowing them to work with research teams focused on new techniques, medications, and practices that benefit children in NICUs.
An advanced education in nursing enables graduates to spot issues in the healthcare system at both micro and macro levels. Not only will graduates know how to identify these issues, they will also have the skills and knowledge needed to implement change.
Doctoral graduates possess a deeper understanding of how to use tools specific to the neonatal unit and typically have an awareness of emerging technologies gaining a foothold in the hospital community. These skills will allow them to teach others how to incorporate advances as they become available.
When choosing a neonatal nursing program, it is very important to narrow down the field with intelligent, clear criteria that ensures a beneficial educational experience. Online schools offer the same high-quality education as brick-and-mortar institutions, but should be held to the same standards as their traditional counterparts. The following points are very important when seeking out any neonatal nursing program, but especially when choosing from online opportunities.
When learning something new, it pays to learn from the best. It is vitally important to ensure nursing faculty members are highly trained in specific neonatal issues and have extensive experience in the NICU. Look for faculty with past or current experience helping neonates, those who have penned in-depth research papers on neonatal issues, and those who are well known in the field for their contributions to the advancement of neonatal research or practice. These highly trained individuals not only provide a fantastic learning experience, they can also be great assets for networking upon graduation.
A nurse must be licensed in order to practice, and many schools offer great courses that prepare students for questions they will likely encounter on the NCLEX-RN examination. Courses should provide in-depth preparation for the licensure test and highlight any additional state-specific requirements. Students should seek out schools that incorporate NCLEX-RN prep into the curriculum or offer supplemental courses that review necessary points of taking this particular examination.
When a student attends a nursing program, they should graduate with the knowledge and skills necessary to pass the licensing examination and become a registered nurse. Not all schools are created equal, and some may have much higher examination passage rates than others. Information about the passage rates of a particular school can be found either on their website or by calling the admissions office. The higher the passage rate, the more likely it is that the program has suitably prepared its students.
Most nursing programs provide a variety of electives within the nursing field, allowing students to concentrate their knowledge in a particular area. Potential students should review the course catalog to ensure the portfolio of electives available include neonatal topics. While associate and bachelor’s level degrees may only offer electives in neonatal nursing, master’s and doctoral programs should have a spectrum of electives available in this area. Students should strive to find the school best matched to their goals, and that includes a strong emphasis on neonatal courses.
Neonatal nurses should have excellent time management, as they might be working with more than one infant at a time. They should be able to communicate clearly with their colleagues, and be able to provide health updates to parents and family members who may not understand medical terminology. Other top skills include attention to detail, sound judgment and decision-making capabilities, critical thinking, and the ability to teach parents how to best care for newborns facing medical issues.
Professionals looking to enhance their knowledge and skill sets have numerous credential programs available to them, including those offered by the National Certification Corporation. A few of the top neonatal certifications are listed below:
In order to gain certification, applicants must pass an examination and complete a set number of continuing education credits.
Suzanne Lefever, MS, RN, CRNP, is an associate professor of nursing at Cedarville University. She also has extensive experience in the NICU unit. We asked her to share her story of becoming a neonatal nurse, and what the profession has taught her.
During my student OB rotation, my clinical instructor was very passionate about that area of nursing and her passion was contagious. I was interested in critical care, pediatrics, and obstetrics, and the NICU was a way to combine all those interests.
My educational path began with a BSN (Bachelor of Science in Nursing) from Goshen College. There was a woman that had mentored me in high school and as a diploma prepared nurse, she was adamant about the need to go to college and obtain a bachelor’s level education. She was definitely before her time in realizing the trend of further education in the nursing profession. I worked as a registered nurse for about seven years (six in the NICU), before attending Georgetown University Medical Center for my neonatal nurse practitioner certification. I completed my masters of nursing at SUNY Stonybrook. I worked as an NNP for ten years and then transitioned into academia as a faculty member of the BSN program at Cedarville University.
I definitely enjoyed my science classes, particularly anatomy and physiology, and understanding the way the body is created and functions, and what goes wrong with diseases. The clinical courses in nursing are the real highlight, and also being able to focus on a particular area such as medical surgical nursing, intensive care, psychiatric, and pediatrics. There is something to take away from each area, even if it isn’t of real interest. As BSN nurses, we are taught to see the big picture, care for patients holistically, and think critically.
The day-to-day work depends on the level of NICU the nurse is stations. Level One is well baby, while those in Level Four require life sustaining measures, long term care, surgery, and advanced technology. The more premature a baby is or the more critically ill, the higher level of advanced care will be required. Most people think about neonatal nursing from the perspective of critically ill neonates.
The working day begins with reports from nurses on the previous shift. Report includes the history, current condition, changes, needs, and family involvement, as an example. The nurse then assesses the neonate, including hands on care, listening to heart and lungs, and performs a complete physical assessment. This establishes a baseline to know the neonates condition and identify any problems, new or ongoing. As the shift continues, the nurse performs procedures such as starting an IV, giving medications, drawing blood samples, adjusting oxygen levels, and feeding the baby.
Any changes or needs are reported to the doctor or nurse practitioner, and everyone works together as a team. Parents come and go and the nurse is key in educating them, communicating with them, and always facilitating their role as the parent. It also means preparing them for taking the baby home while being realistic about the baby's condition.
In addition to caring for the babies assigned to them, the nurse may assume other responsibilities, such as attending deliveries to care for a newborn immediately after birth in the case of potential problems. Some nurses also function as transport nurses, traveling to other hospitals to stabilize and transport a sick baby back to their hospital's NICU for more advanced care. The shift ends the way it began, by documenting changes in the medical record, and giving report to the next nurse assigned to the baby.
I would encourage all future nurses to get their bachelors degree, at a minimum. As students go through nursing school, they often wonder why they have to learn so many different things when they only want to be a neonatal nurse. Any degree leading to the registered nurse license is considered a generalist degree, meaning students receive a well-rounded knowledge base of multiple issues across the entire life span. They are prepared to assume a role focused on health promotion or acute care for critically ill and everything in between.
Nurses wanting to specialize in any specific setting, such as neonatal care, will want to seek out any additional opportunities in that specialty while in school. These may include volunteering, applying for a summer externship after the clinical rotations have started, or requesting assignment in the specialty area during the final clinical before graduation. New nurses starting in a NICU will receive an extensive orientation with ongoing, on-the-job education and training.
Those who plan to work as a neonatal nurse can expect robust job growth in the coming years. The BLS reports employment growth of 19 percent for registered nurses and 31 percent for advanced practice nurses from 2012 to 2022. For neonatal nurses, an increased number of mothers having children at an advanced age could spur much of the expansion. Other factors include an increased use of fertility treatments resulting in multiple births and the advancement of technology making it more likely that premature infants will survive.
Though neonatal nurses are needed in hospitals all across the United States, some parts are showing more demand than others. The following areas are expected to offer the highest rates of employment expansion from 2012 to 2022.
There are numerous occupations in the field of healthcare that could be appealing to those with an eye toward neonatal nursing. These related occupations allow individuals to help people, be engaged members of the medical profession, and potentially work with infants and their families.
Neonatal nursing is only one of several occupations involved in the care of mothers and newborns. The following related careers could be of interest to those who wish to enter the healthcare field, but not necessarily as a neonatal nurse.
Students interested in neonatal nursing schools can start with the following search tool. This will help them begin the journey of reviewing a variety of schools before narrowing down the list through in-depth research.