How to Become a Neonatal (NICU) Nurse
Neonatal nursing is a great career path for medical professionals wanting to make a difference in families' lives by caring for newborn infants. A neonatal nurse might address complications of prematurity, acute infection, and congenital defects.
Because neonatal nurses work primarily with some of the most vulnerable patients, they’re required to attain strict credentials by completing nursing degree programs. Prospective nurses can pursue credentials at the associate (ADN), bachelor's (BSN), or master's level (MSN), though many employers require a BSN at a minimum and it's also required to take the NCLEX. Once licensed, neonatal nurses can work in various settings, but primarily in hospitals with units committed to caring for premature babies.
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What Is a Neonatal Nurse?
A neonatal nurse is a registered nurse (RN) with specialized training to work with newborn patients. This type of work usually occurs in a neonatal intensive care unit (NICU), a separate ward in a hospital, where premature or sick babies are given intensive medical care. Neonatal nurses care for healthy premature babies who have not reached full development within the womb and preemies born unwell. Some of the conditions these nurses may encounter include babies exposed to and withdrawing from opiates and narcotics, infections, sepsis, respiratory diseases, or birth defects.
What Do Neonatal Nurses Do?
Neonatal nurses care for premature and fragile neonates, usually in hospitals. While the word “neonatal” itself refers to the first few weeks of a baby’s life, neonatal nurses often care for babies long after, depending on the severity of an infant’s condition and response to treatment. Longer NICU stays may be due to the degree of prematurity, sepsis, profound congenital disabilities, and cardiac issues. Neonates requiring care are admitted to the NICU immediately after birth. In most facilities, neonates who return to the hospital after discharge will go to a pediatric unit if care is required.
The neonatal population is often categorized by levels of acuity and care needs within the NICU, as some neonatal patients have a much greater need for treatment and oversight than others. Roles in these facilities represent some of the most sought-after positions in the field.
The levels of neonatal nursing care and responsibilities include:
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Basic Newborn Care
Level I neonatal nurses care for healthy newborns in a well-baby nursery. They can also care for babies born at 35 to 37 weeks gestation and those that are ill and born at less than 35 weeks until they can be transferred to a NICU unit.
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Special Care
Level II nurses can do everything a Level I nurse does and can also work in special care nurseries that handle premature babies born after 32 weeks gestation who are moderately ill and need immediate care.
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Intensive Care
Level III neonatal nurses work in the NICU with newborns who are very sick with congenital problems or who are extremely premature. These nurses are specially trained to work with these high-risk infants.
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Highest Care
Level IV nurses often work in regional NICUs that are associated with hospitals that specialize in treating genetic conditions and caring for infants born at 22 to 24 weeks gestation with critical health issues.
A typical neonatal nurse’s day might be spent administering medication, feeding neonates, and educating new mothers. As with any nursing career, the neonatal nurse experiences emergencies and must perform life-saving measures.
Where Do Neonatal Nurses Work?
Working as a neonatal nurse can involve practicing in various settings but most commonly in the NICU after delivery — obstetric nurses deliver babies, not NICU nurses. Neonatal nurses working in a NICU may fill the role of staff nurse, nurse manager, or clinical specialist, depending on their education, experience, and interests.
Neonatal nurses working in a NICU may fill the role of staff nurse, nurse manager, or clinical specialist, depending on their education, experience, and interests.
However, not all neonatal nurses work in hospitals. Some neonates may require nursing care that doesn’t warrant a hospital stay. Neonatal nurses can work with these patients within the home and community. A medical professional's ongoing advice and guidance are indispensable to families who find themselves in this situation. Neonatal nurses can serve as experts for at-home care to follow up with any treatment plans for NICU babies after discharge. In other cases, new parents may seek out neonatal nursing care to guide them through the process of early parenthood, even with healthy neonates.
Steps to Become a Neonatal Nurse
There are generally five steps to become and remain a qualified and licensed neonatal nurse:
1
Earn an ASN or BSN degree from a program accredited by the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). Many of these programs can be completed online. A degree program advisor or school's career center can also help find job opportunities within a NICU to start gaining relevant work experience to start building a professional resume.
2
Complete a practicum — supervised clinical experience — as part of the degree. Aspiring neonatal nurses may want to seek out a nursing school that offers clinical practicum placements within a nursery or NICU to train in the specialty.
3
Take and pass the National Council Licensure Examination (NCLEX) to become eligible to apply for state licensure as an RN.
4
5
Complete continuing education credits and contact hours as necessary to keep nursing skills current and licensure active and in good standing.
These steps help students develop the skills and experience needed to practice neonatal nursing. These skills include monitoring a new baby's health, performing tests and evaluating the results, administering special treatments and medications to infants, and educating parents on the care of their child. If interested in career advancement to develop additional skills, nurses can apply for certification as a Critical Care Registered Nurse (CCRN) in neonatal care or enroll in a graduate nursing program to become an advanced practice nurse (APRN) or neonatal nurse practitioner (NNP).
To learn more about nursing requirements and to see a list of accredited online nursing programs by state, explore our guide to becoming a nurse.
What Is the Career Outlook for Neonatal Nurses?
There is a nationwide shortage of nurses that includes NICU nurses. Contributing factors to the demand include advances in life-saving medical technology for neonates and the increased use of fertility treatments, which may contribute to neonatal health complications. The U.S. Bureau of Labor Statistics (BLS) anticipates a steady 9% job growth through 2030 for registered nurses, including neonatal nurses, though the demand and employment may be higher in some parts of the country.
How Much Do Neonatal Nurses Make?
How much a NICU nurse makes depends on the level of education, experience, and location. Neonatal RNs and certified critical care NICU nurses earn a $77,600 annual median salary, and NICU-NPs earn $120,680. There is also a significant difference in salaries between nurses with a BSN versus an MSN.
Some parts of the U.S. may also pay higher than others. For example, RNs and NICU-NPs earn more than the national average in the following states:
RNs
| State | Annual Median Salary |
|---|---|
| California | $125,340 |
| Hawaii | $111,070 |
| Oregon | $99,410 |
| District of Columbia | $95,220 |
| Alaska | $99,110 |
NICU-NPs
| State | Annual Median Salary |
|---|---|
| California | $149,910 |
| New Jersey | $129,240 |
| Washington | $128,980 |
| New York | $128,220 |
| Massachusetts | $128,160 |
It's important to note that even though salaries are higher in some places, so is the cost of living. Cost of living is a measurement that estimates how far a paycheck goes towards living expenses in a specific location. For example, while California pays its nurses well, the cost of living is especially high, and it is in the District of Columbia and New York as well.
Career Advancement
Neonatal nurse jobs can also lead to further career opportunities. Experienced nurses can apply for positions as developmental care specialists, clinical care specialists, or clinical managers. A graduate program is required to achieve a higher level of responsibility as an NNP who may have overlapping duties with doctors to provide direct care to the infants in a NICU. These responsibilities may include writing orders, creating treatment plans and overseeing outcomes, performing minor procedures, and managing medication regimes. With these opportunities in mind, prospective nurses can approach their careers with a mindset of continuous growth and expansion.
NICU nurses can also earn certifications for career advancement, including the CCRN. Candidates must complete one of two options to be eligible to apply to take the CCRN certification exam:
Five-Year Option
2,000 hours of RN or APRN practice in the direct care of acutely/critically ill neonatal patients during the past five years with 144 of those hours completed in the last year before applying.
Two-Year Option
1,750 hours of RN or APRN practice in the direct care of acutely/critically ill neonatal patients during the past two years with 875 of those hours completed in the last year before applying.
The National Certification Corporation also offers certification for neonatal nurses. The eligibility to apply to take the Neonatal Intensive Care Nursing Core Certification (RNC-NIC) exam includes 2,000 hours of RN speciality practice spent providing direct patient care, education, administration, or research in the last two years.
Should I Become a Neonatal Nurse?
Before working in this field, any aspiring neonatal nurse needs to consider the precarious condition of this patient population. Prospective neonatal nurses should consider that a NICU can be a stressful work environment. Different skills may be necessary for neonatal nurses working in the community or in patients' homes. Home and community neonatal nurses provide direct care, but their work may involve more patient parent education than the NICU nurse's work. Resiliency, positive rapport, patience, and interpersonal communication skills will be indispensable for neonatal nurses in a non-hospital setting.
It also helps to consider the personality traits common to many neonatal nurses. O*NET has identified several of these characteristics:
- Adaptability
- Communicative
- Compassionate
- Cooperative
- Conventional
- Ethical
- Investigative
- Service oriented
- Socially perceptive
There are also several other factors to consider when contemplating a neonatal nurse career.
Potential benefits:
Neonatal nursing is a stable and in-demand profession. Due to nursing shortages, hospitals need properly skilled and trained nurses to handle their most vulnerable patients.
It pays well. Some neonatal nurses have the opportunity to earn more than $100,000 a year depending on level of education, experience, and location of the practice.
There's room for career advancement. Continuing education courses, certifications, and graduate degrees can help expand job growth opportunities.
It can be emotionally rewarding. Taking care of newborn babies and nursing them back to health can feel rewarding and satisfying.
Potential drawbacks:
While it can be emotionally rewarding, it can also be emotionally draining. A 2020 survey found that the more distressed a baby is, the more emotionally distressed the nurse is.
Being a neonatal nurse requires a lot of skill. While this is true for any nursing profession, the slightest mistake with a newborn baby can have devastating repercussions.
Parents can be demanding and place pressure on neonatal nurses. It can be difficult to deal with potentially emotionally-charged parents who are anxious and worried about their child.
It can be ethically challenging. Neonatal nurses may be faced with life and death situations that can be distressing and difficult to resolve.
FAQs About Becoming a Neonatal Nurse
What Do You Have to Do to Become a NICU Nurse?
Neonatal nursing requires an ADN at a minimum though earning a BSN may give prospective nurses more employment opportunities and increased income. Nurses may also benefit from certification requiring applicants to have a current nursing license and at least 24 months of experience.
How Long Does It Take To Become a Neonatal (NICU) Nurse?
An ADN degree can take full-time students two years to complete, and a BSN usually takes four. A graduate degree may take an additional two years to complete if you are interested in becoming an APRN or an NNP. Passing the NCLEX-RN is also required to work as a state-licensed neonatal nurse.
Is It Hard to Become a Neonatal Nurse?
Becoming a neonatal nurse takes perseverance and dedication. Any coursework that prepares you to become a healthcare professional is complex and requires intense study. However, if you have a passion for the work and the aptitude, it can be done.
Can I Become a Neonatal Nurse Online?
Yes, you can complete the educational requirements to become a neonatal nurse by earning a nursing degree online from an ACEN- or CCNE-accredited program. Several colleges and universities offer these degree programs though they may require some on-campus work and the completion of a practicum.
Resources for Neonatal Nurses
Several organizations advocate for neonatal nurses and provide resources to aid in career development, education, research, and networking.
| Organization | Benefits |
|---|---|
| Academy of Neonatal Nursing (ANN) | ANN members can attend conferences, subscribe to industry journals, submit articles for publication, access leadership and career development tools, and apply for scholarships to advance education. |
| American Association of Critical-Care Nurses (AACN) | In addition to CCRN certification, AACN hosts scholarships, conferences, and events and develops best-practice guidelines, surveys and reports, webinars, publications, and continuing education activities. |
| Brigham and Women's Hospital | Brigham and Women's Hospital offers a library of tools and resources for neonatal professionals. These include access to academic journals and publications, research tools, and lecture notes. |
| National Association of Neonatal Nurses (NANN) | You can become an NANN member to access professional development tools, industry publications, and the latest education and research information. |
| March of Dimes | The March of Dimes Nursing Programs support nurses by offering up-to-date news and insights regarding premature birth, patient education tools, workshops, scholarships, and information about research grants. |
There are also several neonatal and critical care academic journals available for subscription, though free access to articles may be available through your school,, workplace, or Google Scholar: