What is a neonatal nurse?
If you love babies, becoming a neonatal nurse is the career for you! Neonatal nurses assist mothers with the birth of their child and provide post-birth care for the child. They perform neonatal tests throughout pregnancy and traditional nursing duties on newborn babies, including checking vital signs and monitoring patients. These nurses care for newborns who may have a variety of issues, such as being premature, having low birth weight, congenital disabilities, infections, malformations, or heart problems. Neonatal is defined as the first month of life, but neonatal nurses typically care for infants from birth until they are discharged from the hospital. Some can care for infants up to two years old, depending on the circumstances.
Neonatal nurses provide round-the-clock care for infants who experience health issues immediately after birth. They perform tests, evaluate results, and work closely with doctors on providing treatments and care. This type of nurse may educate parents on how to care for the infant. They use and maintain equipment in the course of their daily routines to monitor infants and assist in their care.
Being a neonatal nurse can be unpredictable as each infant they care for has different problems, different levels of illness, and varying needs. Working with infant patients who are often in critical condition and need constant attention can be very emotionally and physically draining. Everything from administering medications to assessing pain levels to handling infants makes the job more difficult for neonatal nurses than other types of nurses, due to the small, delicate lives they care for.
Neonatal nurses may have to deal with life-and-death situations every day and need to suppress their emotions to a large degree to not get overwhelmed. Although the emotional impact can be difficult, these nurses know they are making a huge difference in the lives of infants and their families. Taking care of the smallest and most vulnerable patients is also very rewarding.
Qualifications and eligibility
Neonatal nurses must have strong decision-making skills. They are often presented with difficult and critical situations where they need to be focused and make the right decision quickly. They need to be caring and compassionate. Newborn babies are frail and vulnerable and must be cared for very carefully. These individuals should be good communicators. They often talk with parents, sometimes about difficult situations, and need to be able to communicate clearly and effectively.
A natural interest in caring for newborns is essential for this role. You need to have a desire and passion to care for infants. Kindness and empathy are two qualities that these nurses should have. Sick infants present an extremely stressful time for parents, and nurses must be comforting and kind, even while dealing with a large amount of stress themselves. Neonatal nurses often find themselves in new environments or handling different duties and must be able to quickly and smoothly adapt.
A neonatal ward in a hospital is often a fast-paced environment, and nurses need to be able to stay calm and relaxed. These professionals may work long shifts, including weekends and holidays, and many times are on their feet for long periods. They must be able to handle the physical, emotional, and mental strain of the work schedule and caring for sick newborns every day.
The educational requirements for a neonatal nurse include obtaining an associate degree or bachelor’s in nursing from an accredited program. Most neonatal nursing positions require a bachelor’s degree. Nursing students typically undergo a period of supervised clinical training before obtaining a nursing license. A student who wants to become a licensed RN must pass the National Council Licensure Examination (NCLEX). Individual states may also have other requirements for licensing.
Those interested in becoming advanced practice nurses must obtain a master’s or doctoral degree. An advanced practice nurse assists physicians and nursing staff to provide comprehensive care to infants.
A neonatal nurse typically works in a hospital setting, either in a nursery with less acutely ill or convalescing infants or a neonatal intensive care unit (NICU) for critically ill patients. They usually work with multiple patients at the same time, but the number of patients can vary depending on how sick they are. They work with doctors, nurses, therapists, and other healthcare personnel on a daily basis. Some neonatal nurses work outside the hospital, providing home care or follow-up care for high-risk infants. The work can be physically, emotionally, and mentally taxing.
Typical work hours
Neonatal nurses provide critical care to patients around the clock, which includes nights, weekends, and holidays. They typically work shifts and can rotate from nights to days on a regular basis, which can be demanding on the body. They may work 8, 10, or 12-hour shifts.
Types of neonatal nurses
There are 4 levels of neonatal nurses, each one filling a different role in the care of infants and their mothers. Each level determines what kind of work this nurse does.
- Level I neonatal nurses – typically care for healthy newborns in a hospital nursery. They perform such duties as neonatal resuscitation, well-care for newborns, and care for premature babies at 35 to 37 weeks of gestation and ill newborns who are less than 35 gestational weeks. They run standard tests on newborns like vision and hearing, give shots, bathe, and assist mothers in how to care for their newborns.
- Level II neonatal nurses – can perform all the duties of a level I nurse and are also qualified to provide care to premature infants born at or after 32 weeks who have illnesses that require additional care. They may care for convalescing infants after intensive care or ventilators for those with problems breathing. They are qualified to administer intravenous fluids, specialized feeding, oxygen therapy, medications, and more.
- Level III neonatal nurses – work in the neonatal intensive care unit (NICU). Level III nurses care for very ill newborns and infants born before 32 weeks of gestation who require constant monitoring and care. These are typically very premature infants or those with congenital problems. They utilize incubators, ventilators, and other equipment in caring for sick infants.
- Level IV neonatal nurses – specialize in surgical repair of severe genetic or acquired conditions. Some duties include providing mechanical ventilation, various advanced surgeries, such as open-heart surgeries, and ECMO (Extracorporeal Membrane Oxygenation). They care for infants born at 22 to 24 weeks of gestation with critical health problems.
The earning potential for a neonatal nurse can vary greatly depending on geographic location, education, experience, and acquired skills.
- According to the U.S. Bureau of Labor Statistics, the median annual wage for registered nurses was $77,600 in May 2021. The lowest 10 percent earned less than $59,450, and the highest 10 percent earned more than $120,250. The median annual wages for registered nurses in the top industries in which they worked were:
- Government – $85,970
- Hospitals; state, local, and private – $78,070
- Ambulatory healthcare services – $76,700
- Nursing and residential care facilities – $72,420
- Educational services; state, local, and private – $61,780
- The average neonatal nurse practitioner’s salary in the United States is $131,029 as of July 2022. The annual salary range falls between $120,441 and $141,667. The 5 cities with the highest salaries are:
- San Jose, CA – $91,312
- Santa Clara, CA – $91,312
- Fremont, CA – $91,079
- Daly City, CA – $90,948
- San Francisco, CA – $90,948
- As of Aug 2022, the five states with the highest annual pay are listed as:
- New York – $122,780
- California – $119,353
- Idaho – $118,820
- New Hampshire – $116,155
- Vermont – $113,446
- The bottom three states are:
- Georgia – $85,822
- Louisiana – $82,840
- North Carolina – $78,930
The U.S. Bureau of Labor Statistics predicts that the employment of registered nurses is projected to grow 9% from 2020 to 2030, about as fast as the average for all occupations. An estimated 194,500 openings for registered nurses are projected each year.
There are a wide variety of career options for neonatal nurses. Although you typically start your career working in a well-baby nursery caring for healthy infants, as your career progresses, here are some other opportunities available in neonatal nursing:
- Neonatal nurses – provide specialized care for acutely ill infants or supportive care for convalescent or mildly ill newborns. They typically give out IV medications, monitor infants in incubators or ventilators, and assist in the deliveries of premature infants.
- Neonatal nurse managers – oversee a staff of neonatal nurses, provide work schedules, and ensure the proper resources are available for high-quality patient care.
- Neonatal clinical nurse specialists – an advanced position for neonatal nurses who provide educational programs to teach clinical skills and give support to the nursing staff to maintain a high level of care to patients.
- NICU nurses – work in neonatal intensive care units (NICU), caring for critically ill patients. They often communicate with families and provide emotional support. The role typically requires clinical experience as a neonatal nurse before moving into the NICU setting. NICU nurses work day and night shifts in a hospital setting. They typically hold a BSN degree with specialized training in neonatal and critical care.
- Neonatal developmental care specialists – they provide direct care and assist staff in caring for infants with developmental needs.
- Neonatal nurse practitioners (NNPs) – advanced practice nurses who work with the doctors and neonatal nursing staff to provide comprehensive critical care to the infants in the NICU. A master’s degree or doctorate and national certification are typically required for this role.
- Pediatric surgical nurses – care for children undergoing surgery by monitoring newborns before and after a surgical procedure and assisting surgeons in performing medical procedures.
- Nurse midwife – has a nurse midwife credential and advanced practice registered nurse license. They counsel patients on reproductive health and family planning and educate pregnant women on prenatal health and wellness. As advanced practice nurses, nurse midwives must hold a master’s degree or doctorate.
Steps to becoming a neonatal nurse
1. Get a nursing degree
Although you can become a nurse with an associate’s degree in nursing, most neonatal positions in hospitals prefer a bachelor’s degree from an accredited nursing program. Typical courses include anatomy and physiology, biology, chemistry, psychology, and more. Most colleges will have a nursing program, but if you are looking for alternative options, some of the best schools for nursing include:
- WGU: This program offers an accelerated nursing program for those who don’t currently have a bachelor’s in nursing. There aren’t set log-in times or schedules, so you can complete the work on your own time. Many people will finish their MSN in 18 months or three six-month terms.
- Concordia University: For this program, you’ll need at least 60 college credits to apply, but then, you can earn your nursing degree in just 16 months. There are three start dates per year, and the program is in Dallas.
- West Coast University: Accredited by WASC and CCNE, they have both evening and weekend options so that you can pursue this while still maintaining a job. They’ll help you graduate in nursing in as little as 34 months with your bachelor’s degree.
- Chamberlain University: The nursing program here has multiple start dates and 23 different locations to choose from. With scholarships and grants and no waitlist, this is perfect for those who want to get started now. They also offer a weekend and evening option.
2. Gain clinical experience in a neonatal setting
A Bachelor of Science degree in Nursing includes both coursework and clinical practice. If you are interested in becoming a neonatal nurse, you’ll want to do your clinical training in the neonatal ward of a local hospital.
3. Pass the NCLEX-RN exam
After you’ve earned your degree, you’ll need to get your license and become a registered nurse (RN). Apply to take the National Council Licensure Exam for registered nurses, also called the NCLEX-RN. The NCLEX is managed by the National Council of State Boards of Nursing. You’ll be tested on your knowledge of health promotion and maintenance, psychosocial integrity, physiological integrity, and more. After passing the examination, you will be able to apply for your RN license.
4. Enter a residency program
After obtaining your license and becoming an RN, you can apply for nursing positions. Many hospitals offer residency programs for RNs that typically last between 12 and 24 months. You might be assigned to a specific unit or rotate through several during your residency. Employers in neonatal care are typically looking for 2 years of experience. You should look for a residency in general pediatrics, labor and delivery, maternal-child nursing, or a related specialty to gain the experience needed to work as a neonatal nurse.
5. Get certified
After you’ve met your 2 years of experience requirements, you can get certified by one of many organizations that offer neonatal nursing certifications. Although certification isn’t typically required, it can help you develop your skills and strengthen your resume when applying for NICU positions. Some top certifications include:
- RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC) – Offered by the National Certification Corporation (NCC), this certification shows your experience in providing care to critically ill patients and their families in a NICU environment. You must have a minimum of two years in neonatal care and pass an exam. Certification is good for 3 years.
- Credential in Inpatient Obstetric Nursing (RNC-OB) – Administered by the NCC, the RNC-OB demonstrates your competency and knowledge in obstetrics nursing. The credential is available for licensed registered nurses with a minimum of 2 years of experience and 2000 hours caring for pregnant women during the antepartum, intrapartum, postpartum, and newborn periods. The 3-hour exam consists of 175 multiple-choice questions. Certification is valid for three years.
- Critical Care Registered Nurse (CCRN (Neonatal)) – The American Association of Critical Care Nurses offers this credential to registered critical care nurses with experience in caring for acutely/critically ill neonatal patients in NICUs, cardiac care units, combined ICU/CCUs, medical/surgical ICUs, trauma units, or critical care transport/flight. The requirements include a combination of practice hours on critically ill patients and passing a 3-hour exam.
- Certification in Maternal Newborn Nursing (RNC-MNN) – The RNC-MNN is offered by the NCC and proves your knowledge and competency in providing care to the childbearing family from birth to six weeks within hospital or outpatient settings. Status as an RN, Two years of experience, and passing a 3-hour test consisting of 175 multiple-choice questions are required for certification.
- RNC Certification in Low Risk Neonatal Intensive Care Nursing (RNC-LRN(R)) – The NCC administers this certification exam, which proves your competency in providing care to acutely and chronically ill neonatal patients and their families within level II, chronic care, special care or step-down units. Requirements for certification are you must be an RN, have two years of relevant experience, and pass an exam. Certification is valid for 3 years.
6. Consider an advanced degree
To become a neonatal nurse practitioner, you will need either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). With this advanced education, you can assume many of the responsibilities of a doctor, providing primary care or specialty care in a NICU.
7. Join neonatal nursing associations
Neonatal association websites offer many resources, job opportunities, and more. Some of the top associations are:
- American Academy of Nursing (AAN)
- American Association of Nurse Practitioners (AANP)
- American Nurses Association (ANA)
- Academy of Neonatal Nurses (ANN)
- Association of Women’s Health, Obstetric and Neonatal Nursing (AWHONN)
- National Association of Neonatal Nurses (NANN)
- National Organization of Nurse Practitioner Faculties (NONPF)
- National Perinatal Association (NPA)
- Southern Research Nursing Society (SNRS)
Tips for becoming a neonatal nurse
If you are planning to become a neonatal nurse, there are a few things you can do to get ahead of the game.
- Know what level of NICU you want to work in. Level 1 is typically taking care of healthy babies or those with minimal issues. Level 4 is taking care of the most critically ill infants. The level you want to work out can help determine what types of certifications and jobs you look at.
- Have a passion for taking care of newborns. Not everyone is cut out to work as a neonatal nurse. Make sure you have that interest.
- Match your skills to what a neonatal nurse does and make sure you are right for this type of work. You’ll need compassion, empathy, good communication skills, and excellent decision-making skills.
- Think about what level of education you want to pursue. Most nurses have a bachelor’s degree in nursing. But you might aspire to become a nurse practitioner and want to get your master’s or doctorate in nursing.
- Volunteer at a local hospital. Get a feel for the environment and what these nurses do every day. Talk to them about the job and about any advice they can give you.
- Understand that neonatal nurses work days, nights, weekends, and holidays and that the work can be very stressful and physically, emotionally, and mentally draining. Know what you are signing up for before you put in the work to become an RN.
- Look into which certifications would be a good fit for you and work to meet the prerequisites to attain that certification.
Neonatal nurse interview questions to expect
- A baby was born three weeks early. All vital signs look good, but their sugar levels are extremely low. What would you recommend?
- How will you comfort parents whose baby was just taken away in distress to the NICU?
- Why is it important to think clinically about babies when working in a level 3 NICU?
- The doctor asks you to inform the parents that their baby will not graduate from the NICU today as planned. How will you prepare them for this setback?
- Why is it important to practice proper PPE protocols while working in the NICU?
- How would you describe working with sick infants? How do you keep your emotions under control through the highs and lows of this position?