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NEONATAL NURSE

Career Overview

How Long Does Becoming a Neonatal Nurse Take

2 years

Average salary: Neonatal Nurse

$101,727 /Year

PART ONE

Neonatal Nurse Career Guide

While all nurses are special, those who choose to work in the Neonatal Intensive Care Unit (NICU) possess unparallelled mental fortitude, gentle touch and compassion. Neonatal Nurses care for the most vulnerable patients in the hospital, compromised infants, while providing needed counsel and education to rattled parents. The labor is uniquely demanding, but the rewards are plentiful for those who stick with it. 

PART TWO

Overview

Neonatal Nurses focus on caring for newborn babies with health problems. This can range from general sickness, to premature birth to even various birth defects.  Babies under these conditions have to be looked after until they are healthy enough to go home with their parents. This process can last weeks or even months, depending on the severity of their condition. 

 

The importance of this labor cannot be understated. The National Association of Neonatal Nurses (NANN) estimates that around 40,000 low-weight babies are born in America, each year. Neonatal Nurses have had a direct impact on improving infancy survival rates, which have improved tenfold compared to fifteen years ago. 

PART THREE

Tasks and Responsibilities:

NICU units typically provide three to four levels of care: 

  1. Basic infant care, found in most hospitals

  2. Advanced care for sick or premature babies

  3. Neonatal care for highly-compromised infants in critical condition 

  4. Intense care for infants with deadly and serious birth defects (only found in certain destination centers, university medical facilities and children’s hospitals) 

Though neonatal nurses most commonly deal with Level III cases, your work may cover all three levels of care. Depending on the situation, you may even have to care for children up to two years of age.  As a result, neonatal nurses have to take on a wide variety of responsibilities and tasks: 

 

  • Providing care as soon as babies are born. 

  • Feeding them, changing their diapers and monitoring infant condition closely

  • Applying medications, when necessary

  • Recording an infant’s medical history, shown symptoms and made diagnoses

  • Pacifying crying babies

  • Measuring and weighing newborn babies

  • Educating patient families on how to breastfeed, the infant’s current condition and the treatment plan

  • Giving counsel to parents and family members who are distressed or upset

The extent of your rights and responsibilities depends on your state’s Scope of Practice laws. To get clarity on this, contact your local State Board of Nursing or visit their website for more information.

PART FOUR

Nature of Work

Between basic infant care and complex treatments for compromised patients, a typical shift is both demanding and varied. Because the NICU is open 24/7, the hours are also very long. Shifts can last 12 hours and can even extend to the evening or weekend. 

 

The work also demands a lot of out of nurses professionally and emotionally. Clear communication and empathy are key in educating and comforting patient families. Nurses must also have the composure to stay level headed amidst a hectic and ever-changing work environment. Finally, they need the delicate touch to deal with extremely sensitive and compromised infants. The smallest mistakes can have dire consequences. 

 

On the other hand, the workload is manageable in some aspects. It depends on how many babies are born at a time, but neonatal nurses typically only care for one to two patients at a time. For truly serious cases, NICUs might put together teams that tackle one or two cases at a time. Since babies also rest most of the time, NICUs can expect just three to four hours of hands-on care, in between hours of condition monitoring.

PART FIVE

Neonatal Nurse Salary

Because of the complexity and specialized nature of the work, Neonatal Nurses have notably higher salaries compared to other RNs. For comparison, the BLS in 2020 listed the average Registered Nursing salary at $75,330 per year. Meanwhile, it is reported that the US salary for Neonatal Nurses sits at $101,727 per year. Like with most healthcare professions, actual income is highly dependent on a number of factors. Years of experience, geographical location and additional certifications are just a couple of these variables. 

At the time of writing, ZipRecruiter lists the following as the highest-paying states for Neonatal Nurses:

  • West Virginia: $103,437

  • Wyoming: $106,169

  • Vermont: $109,375

  • New Hampshire: $115,545

  • New York: $119,052

Because of their value to their organizations, Neonatal Nurses tend to enjoy a host of professional benefits. This includes overtime pay, paid leave and other benefits. Your perks will differ depending on the hospital or facility, but you can expect generous, substantial packages no matter where you work. 

PART SIX

Outlook

According to the Atlantic, around 700,000 nurses are projected to leave the workforce by 2024. As a result, the demand for new nurses will be very high, for the foreseeable future. The BLS currently projects a 9% annual employment growth rate for Registered Nurses, from 2020 to 2030. While this is average across all occupations, this translates to 194,500 annual job openings within this time. Demand for Neonatal Nurses will be even higher than average. Because of how specialized their qualifications are, finding NICU replacements will be especially difficult. Expect employers to do their best to retain key talent in these positions. 

How to Become a Neonatal Nurse 

You cannot become a NICU Nurse on a whim. There are certain qualifications and steps you need to take, before you can start. This section will go over everything you need to do to become a Neonatal Nurse. 

Step 1: Become a Registered Nurse

To become an RN, you first need to complete an accredited BSN or ADN nursing program. Once you graduate, you must take and pass the NCLEX-RN. At minimum, this would take 4 years. 

Step 2: Acquire experience

For your next step, you have to complete two years of relevant neonatal nursing experience. In particular, you want experience in the following areas:

 

  • Labor and Delivery Nursing

  • Well Baby Nursing

  • Maternal-Child Nursing

  • Pediatric Nursing

Step 3: Additional certifications

You can start applying for work in the NICU once you get enough experience. However, taking up additional certification programs will provide additional training and make you more appealing to employers. You will also qualify for higher positions within the NICU, in time.

Listed below are some of the available Neonatal Nursing Certifications, and the organizations that provide them. 

  • RNC Certification in Low Risk Neonatal Intensive Care Nursing (RNC-LRN(R)) - National Certification Corporation

  • Critical Care Neonatal Nursing (CCRN Neonatal) - American Association of Critical Care Nursing 

  • RNC Certification for Neonatal Intensive Nursing Care (RNC-NIC) - National Certification Corporation 

  • Care of the Extremely Low Birth Weight Neonate Subspeciality (C-ELBW) - National Certification Corporation 

  • Neonatal Neuro-Intensive Care (C-NNIC) - National Certification Corporation

 

Best Neonatal Nursing Programs

Neonatal Nurses have a number of high quality, accredited programs available to them. Listed below are the institutions that stand out, with regards to success rate, program quality and reputation: 

1. University of Pennsylvania 

Private schools will always be the most expensive and University of Pennsylvania’s $80,110 tuition is no exception. If you can shoulder those costs, you get to experience one of the best nursing programs in the entire country. Aspiring Neonatal Nurses in particular will get the opportunity to work at the Children’s Hospital of Philadelphia. The BSN program’s focus on contributing to the community is also perfect for nurses with humanitarian wishes. It will take you around four years to complete. 

2. University of Colorado Denver

Students of the University of Colorado’s esteemed BSN program will study in the Aurora campus, rather than the main building in Denver. Luckily, there is also a good chance you will get to work at the highly-regarded Children’s Hospital Colorado. Gaining experience at one of the best children’s hospitals in the country will undoubtedly be valuable in the future. For the BSN program, students can pick from a traditional four-year course and a two year program that requires two years of prerequisite courses. In-state students only have to pay $21,560, while those outside Colorado must hand over $38,400 annually. 

3. Georgetown University

As an institution, Georgetown University ranks among the top research universities in the nation. Being a private school, its tuition of $57,928 is pricey, yet worth it for the quality of their four-year BSN program. Of particular interest are the direct entry option for non-nursing students with bachelor’s degrees. Students also get experience immediately, as they can start their rotations as early as year one. Aspiring Neonatal Nursing students get to fulfill their clinical hour requirements in world-class facilities like the Children’s National Hospital. 

4. University of California Los Angeles
UCLA’s programs consistently rank among the best in the nation, and its 4-year BSN offering is no exception. Students get to rack up significant and relevant clinical experience in world-class facilities such as the Children’s Hospital of Los Angeles. Whether you are a Neonatal Nurse or you want to focus on a different specialization, this is one of the best options for nurses who want to work in California. Helping matters is the $13,249 in-state annual tuition, which is by far the least expensive rates covered thus far. The Out-of-State tuition, however, is considerably more expensive at $43,003.

5.  University of Massachusetts Boston 

UMB is one of the best possible choices, if you live in Massachusetts. Its location next to the JFK Library and Presidential Museum is ideal, and provides you with instant access to valuable learning materials. Additionally, its in-state tuition of $14,741 is very affordable, though the out-of-state fee of $35,203 is still reasonable. The direct entry program takes around two and a half years to finish, while the traditional route is four years long. As for clinical rotations, students may get the chance to work at the esteemed Boston Children’s Hospital.

6. Ohio State University

Located in Columbus, Ohio, OSU is one of the top public universities in America. With a cheap In-state tuition of $11,518 and a top quality, four year BSN offering, the application process can be extremely competitive. Those who make it get to enjoy a world class curriculum and the chance to gain experience in institutions like Columbus' Nationwide Children's Hospital. Even the out-of-state fee of $33,502 is reasonable, relatively speaking. 

7. Xavier University 

Xavier University is a relatively small Jesuit school, located in Cincinnati, Ohio. While the application process is quite competitive, 98% of all graduates from their healthcare programs land roles in just six months. While you complete your clinical rotations, you may end up working in the esteemed Cincinnati Children’s Hospital. The tuition of $42,460 is still quite steep, but the quality of the program speaks for itself. 

8. University of Washington 

This Seattle-based institution is easily among the best universities in the state of Washington. Though it is more renowned for its research programs, the four-year BSN course is still an incredible offering with high NCLEX-RN passing rates. While you fill out your 1,000 hours of clinical rotations, you might get the opportunity to work at Seattle Children’s Hospital, which is one of the best in the region. Washington natives can enjoy a $16,104 in-state tuition, while out-of-state students must pay $53,208 annually. 

9. University of Pittsburgh
Pitt might be one of the oldest institutions listed, having been founded in 1787. Compared to other schools, its nursing curriculum is uniquely holistic. Along with the expected classes, nursing students have to take up courses in Dietrich School of Arts and Sciences. On the other hand, BSN students can acquire clinical exposure in their first year, and start their clinical rotations as early as year two. You could opt to fulfill your required hours in UMPC Children’s, which is run by the university itself. The annual state tuition sits at $24,298 and students outside Pennsylvania must pay a costly $43,634.

10. University of Houston

The University of Houston is easily one of the bigger universities, with an attendance of roughly 46,000. Its size does not dilute its quality however, as its BSN program is both top quality and affordable. Texas natives only need to pay $10,203.40 in annual tuition, while out-of-state fees still sit at a reasonable $20,363.40. If you still cannot cover these costs, you can avail of the school’s numerous financial aid and scholarship programs. During this four year course, nurses will complete two years in Houston and the final two at the Katy instructional site. If you want to become a neonatal nurse, you can complete some of your clinical hours in the Texas Children’s Hospital. 

Continuing Education

Though Neonatal Nurses do not have specific continuing education requirements, NICU-related additional certifications do. You also have to stay on top of your regular RN CEUs. 

For your RN certification, certification requirements vary from state-to-state. As an example, here are the prerequisites for 5 different states:

  • California: 30 contact hours every two years

  • Georgia: 24 contact hours every two years or 4 different alternatives

  • Mississippi: No CE Required 

  • Ohio: 24 contact hours every two years

  • Minnesota: 24 contact hours every two years 

For more specific information, refer to your area’s State Board of Nursing. 

As for your advanced certifications, you can look up their CEU prerequisites on the organization’s official websites. Just as an example, CCRN has its own set of requirements that you must complete within the three-year renewal period: 

  • 100 CERPs (a particular form of CE)

    • Minimum 60 CERPs in Category A

    • 10 CERPs each in B and C

    • 20 CERPs in a category of your choice 

  • Clinical Practice Hours as an RN

    • 432 hours of direct care of acutely/critically ill neonatal patients. 144 of those must be acquired within 12 months of the scheduled renewal. 

 

Neonatal Nurse vs Neonatal Nurse Practitioner

Both Neonatal Nurses and NPs fulfill similar roles and responsibilities within the NICU. Where they differ is in scope of practice. Neonatal Nurses can only operate with supervision from physicians, while NPs can operate independently in certain states. NPs also have the authority to diagnose patients, create treatment plans and prescribe medications, which RNs cannot do. For more information, refer to our Neonatal Nurse Practitioner Guide. 

Further Reading