how to become a neonatal nurse

How to Become a Neonatal Nurse Specialist or Practitioner

Working with newborn babies—many who are critically ill—can be a challenge. Are you up for it?

One of the most demanding—and rewarding—careers in the growing healthcare field is neonatal nursing. This nursing specialty focuses on the care of newborn infants with health problems in the first days or weeks after birth. Neonatal nurses are trained to work with babies with physical defects, infection, cardiac irregularities, and other problems that may require the infant to spend time in the neonatal intensive care unit (NICU).

What Does a Neonatal Nurse Do?

A neonatal nurse works with newborn babies as well as their parents, helping them care for their child. They help new parents hold, bathe, and feed their baby, and often act as a bridge between the parent and the specialists working with the infant. Neonatal nurses typically work in hospitals or clinics, but can also work in a community setting, providing at-home follow-up care for high-risk babies and their families once the babies leave the hospital.

"The job involves a lot of observation to determine if behavior is normal or not normal," says Beth Morgan, a neonatal-certified registered nurse with 15 years of experience in the NICU. "They watch carefully for circulation issues and blood oxygenation and check vital signs frequently. They also learn to give (the babies) a lot of contact with the mothers right away."

Many babies are born prematurely or have developed other illnesses. For this type of seriously ill infant, round-the-clock care is given exclusively in the NICU. Neonatal nurses who work as part of the NICU team are often called "NICU nurses."

The job of a neonatal nurse, whether working in the NICU or elsewhere, requires good intuition and attention to subtle changes in babies' behaviors. Joan Rikli, director of NICU and pediatric services for Helen DeVos Children's Hospital, in Grand Rapids, Michigan, and also president of the National Association of Neonatal Nurses (NANN), says that "some infants are too little to even cry, so you have to understand subtle signs of potential problems."

The job can be challenging, but also incredibly rewarding. "We can save babies, and they can become almost a part of the family," says Rikli, who has been a nurse for more than 40 years and has worked extensively in the NICU. "I get cards and letters and visits all the time. You get invited to their children's graduations."

Is a Neonatal Nurse and an NICU Nurse the Same Thing?

It is often assumed that neonatal nurses and NICU nurses are virtually interchangeable, but the roles are not always the same. The job title "neonatal nurse" describes nurses that work with critically ill infants. "NICU nurses" are neonatal nurses who work specifically in the neonatal intensive care unit. In other words, NICU nurses are neonatal nurses, but not all neonatal nurses work in the NICU.

Babies born premature or with certain birth defects are considered Level II care babies, who require constant monitoring. Infants with the most serious health concerns—usually those born at less than 32 weeks' gestation, as well as babies born with critical illnesses—require Level III care.

The babies who require this type of elevated care are the ones who end up in the neonatal intensive care unit being cared for by NICU nurses. They must be placed on ventilators, are tube-fed, and are usually isolated to prevent potential infections.

How Can I Become a Neonatal Nurse?

There are two levels of neonatal nursing practice you can pursue. To work as a neonatal nurse, you must be licensed as a registered nurse (RN). To work as a neonatal nurse practitioner, a more advanced role with more professional responsibilities, you must be licensed as a nurse practitioner (NP) or clinical nurse specialist (CNS), both of whom are considered advanced practice registered nurses (APRNs).

What Education, Licensing, and Certifications Do I Need?

To become a neonatal nurse, you must earn at least a two-year Associate Degree in Nursing (ADN), although a four-year Bachelor of Science in Nursing (BSN) degree is becoming more commonly required. You must also be licensed as an RN. Neonatal nurses must also be certified in neonatal resuscitation as well as earn specific NICU certificates if they're working in the NICU. You may also be required to have a minimum number of years of clinical experience in a hospital setting.

To become a neonatal nurse practitioner, you will need at least two years of clinical experience in a neonatal intensive care unit before pursuing an advanced degree. Currently, NNPs need at least a Master of Science in Nursing (MSN) degree, although The National Organization of Nurse Practitioner Faculties in 2018 made the decision to move all entry-level nurse practitioner education to the Doctor of Nursing Practice (DNP) degree by 2025. You must also earn state certification as a neonatal nurse practitioner in the state in which you wish to practice.

Neonatal Nurse

Degree you'll need:
At least an Associate Degree in Nursing (ADN), although a Bachelor of Science in Nursing (BSN) is most often required

Licensing required:
Registered nurse (RN)

Neonatal Nurse Practitioner

Degree you'll need:
At least a Master of Science in Nursing (MSN)

Licensing required:
Advanced practice registered nursing (APRN) license, such as nurse practitioner (NP) or clinical nurse specialist (CNS)

How Much Can I Make?

The BLS doesn't provide figures for neonatal nurses or neonatal nurse practitioners specifically. It does, however, track salaries for registered nurses and nurse practitioners, which are the licenses required for neonatal nurses and neonatal nurse practitioners, respectively. The mean (average) annual salary for RNs is $77,460 and the mean annual salary for nurse practitioners is $111,840, according to the BLS.

$77,460

Mean Annual Salary for RNs

According to U.S. Bureau of Labor Statistics (BLS) 2019

Morgan says that salary levels will always vary by region and experience. When she started as an RN in Wichita, Kansas, in 2004, for instance, she was earning a salary at the low end of the RN average at the time. Later, when she moved to the larger city of Houston, where demand for neonatal nurses is higher, she was making significantly more in the NICU. Once she completes her studies to earn a master's and becomes a neonatal nurse practitioner, she said she can expect another significant salary increase.

Neonatal Nurse Specialist Career Outlook

As with most nursing careers, the demand for neonatal nurses and neonatal nurse practitioners is expected to increase significantly over the next 10 years, says Morgan; even in rural or suburban areas.

"Everyone's still having babies," Morgan notes, "and about 10% of them will always need extra care."

The job is not only in demand, but also an enjoyable one.

"(Neonatal nurses) develop a wonderful rapport with each family," says Joan E. Edwards, a tenured professor at Texas Woman's University in Houston and director of its Center for Global Nursing. "It's not just a science, it's also an art. There's a lot of caring behind what we do."

How to Stay Informed in this Field

Fortunately for future neonatal nursing students, there are several associations, blogs, podcasts and other social media feeds to keep you on top of the latest developments in the field.

Academy of Neonatal Nursing—Provides access to peer-reviewed publications, national conferences, online resources, and other educational offerings.
AWHONN Insights—This podcast from the Association of Women's Health, Obstetric, and Neonatal Nursing features advice from leading experts in the field.
NANNcast—The National Association of Neonatal Nurses hosts a monthly podcast in which members can present advice, tips, and expertise to better inform neonatal nurses, industry partners, and families of NICU patients.

"It's best to join one of these groups before graduation," Edwards suggests, so you can take full advantage of the networking information and opportunities the sites can offer. Most offer a range of podcasts and online blogs about neonatal nursing experiences.

The Facebook pages of neonatal associations are also good resources for gathering quick tips and information about neonatal nursing, Morgan says. Also, some hospitals have Facebook and LinkedIn pages where prospective neonatal nurses and NNPs can gather to discuss their latest experiences in the field. "NICU students should put questions out there on Facebook," Morgan says, "such as 'Are there any NICU nursing tips to share?' You'll get hundreds of people replying."

Is Neonatal Nursing the Right Specialty for You?

Most people who try to pursue a neonatal nursing career find out pretty quickly if they're suited for the demands.

"There are emotional and spiritual aspects to the job" that may not come naturally to some nursing students, Morgan notes. Morgan's mother is a retired neonatal nurse, so she has been steeped in the care of newborns from an early age.

Many times, neonatal nurses work with new parents during a time of crisis and worry. "They are often scared or in panic mode," Morgan says. "Some are recovering from drugs. (As a nurse,) you can go from crying and grieving to joyful in the same hour. It's not a skill you just walk in with. There are a lot of wonderful things and sad things that can happen, and then a miracle can occur—they stay with you."

"It's so miraculous when a you see a baby take its first breath," says Edwards. "It's very special to work in that environment."