How to Become a NICU Nurse in 2023

How to Become a NICU Nurse in 2023

A wealth of people who adores newborn babies chooses to dedicate their careers to working with infants. Nurses can take advantage of a multitude of pathways to work with newborn infants. They can work as a labor nurse, pediatric nurse, neonatal intensive care unit nurse, and delivery nurse.

A neonatal nurse practitioner performs fulfilling and important work for newborn infants who are chronically ill and need intensive care after birth, for instance, neonatal resuscitation. Becoming a neonatal intensive care unit nurse (NICU) entails acquiring the correct national certification, nursing degree, and license. 

In this guide, we’ll help you prepare for the career path of becoming a neonatal nurse in addition to salary and career expectations for the profession. 

Responsibilities of a NICU Nurse

According to the National Association of Neonatal Nurses (NANN), about 40,000 infants in the US are born with unhealthy birth weights every year, potentially predisposing them to a multitude of health challenges immediately after birth or during delivery. A NICU nurse is a registered nurse who cares for the needs of premature and newborn infants who require intensive care, whereas a neonatal nurse is a registered nurse who is trained to provide neonatal care regardless of their condition. 

A NICU nurse has a nursing degree such as a doctoral, diploma, baccalaureate, or master’s and works under the supervision of a physician. In contrast, an advanced practice nurse such as a neonatal clinical nurse specialist (CNS) typically plays the role of a researcher, educator, consultant, charge nurse, or administrator and is a registered nurse. 

The two main responsibilities of neonatal nursing are as follows. 

1. Advanced and Basic Infant Care Procedures

A neonatal clinical nurse specialist is expected to be adept at performing fundamental nursing procedures such as monitoring premature infants, taking vital signs, accurate charting, the ability to terminate and begin an intravenous line (IV), and cardiopulmonary resuscitation for newborn babies. 

2. Interpersonal Skills

As part of the health care team, NICU nurses are responsible for coordinating all the medical treatments and procedures that encompass patient care, for instance, performing tests, administering medications, and inserting intravenous lines. A NICU RN assists physicians during treatments and communicates regularly with other team members during the entire shift. 

Other responsibilities of NICU nursing include: 

  • Delivering round-the-clock to adversely ill premature infants and newborn babies.
  • Caring for the fundamental needs of an infant includes changing diapers and feeding. Additionally, a neonatal intensive care nurse provides other levels of care.
  • Adjusting and using specialized medical equipment.
  • Evaluating the effectiveness of treatment and coming up with nursing plans.
  • Comforting anxious family members and comforting ill newborn infants.
  • Providing support to family members and educating them on how to provide home-based neonatal care for their infant. 

Let’s discuss the distinct levels of neonatal care and the type of work that each level entails. 

1. Level I NICUs (Basic Care for a Newborn Baby)

A registered nurse specializes in providing postnatal care for newborn infants. In these facilities, a neonatal nurse helps to maintain the stability of physiologically sound newborn infants at a gestation period of 35 to 37 weeks. They help stabilize newborn infants who are born at less than 35 weeks gestation and sick until they can be transferred to a health care facility that can deliver an adequate amount of neonatal patient care.

2. Level II NICUs (Advanced Neonatal Nursing)

At this level of neonatal intensive care, a registered nurse caters to critically ill newborn infants who may require feeding support, special medication, or breathing support. A level II NICU advanced practice nurse typically works in a smaller healthcare facility known as a special care nursery. 

3. Level III NICUs (Sub-specialty Care for Newborn Babies)

A registered nurse working at a NICU nursing unit deals with premature infants born before the 32nd week of the gestation period and newborns suffering from adverse afflictions at any gestational age. Usually, a level III neonatal intensive care unit nurse provides patient care that encompasses the entire realm of respiratory support systems, advanced imaging technologies, and pediatric sub-specialties. 

4. Level IV (Regional) NICUs (The Highest Level of Neonatal Care)

These facilities deliver care for newborn infants who are as young as 22 to 24 weeks of gestational age. A level IV neonatal intensive care unit nurse delivers mechanical ventilation that includes high-frequency ventilation and a broad range of surgical procedures such as open-heart surgery that is required to rectify congenital heart defects. Some level IV NICU facilities provide ECMO, an acronym for extracorporeal membrane oxygenation. 

Qualities of a Successful NICU Nurse

A pediatric nurse who works in the neonatal intensive care unit of a hospital must possess certain nursing skills to thrive in their career by efficiently caring for newborn infants with medically complex or acute health conditions. 


A neonatal intensive care unit nurse must have the inherent traits of being compassionate and caring towards a tiny, helpless newborn baby. They must have almost motherly instincts to care for chronically ill newborns that typically are unable to be in direct contact with their mothers due to precarious conditions. A NICU nurse must fill in the gap of this motherly role by combining genuine love and sympathy for the infant with emergency-quality medical skills. 


A NICU RN serves as the mediator between the parents of the infant and the doctors. Therefore, they must possess incredible communication skills. A NICU nurse must be able to concisely explain complex terminology and situations to parents, including the procedures performed on newborns under the delegation of the doctors. 

A registered nurse needs to express the loved ones’ concerns to the doctors involved and instruct them on how to care for their newborn baby. Additionally, the nurse must communicate with patience, realizing that stressed-out parents might require information to be repeated. 


As is the case with other nursing careers, the work of a NICU nurse is emotionally draining, as NICU nursing brings them face-to-face with a myriad of heartbreaking situations in the form of suffering and emergencies. Constantly seeing a helpless infant in peril and their distressed loved ones can take a toll on a NICU nurse, emotionally and mentally. 

They must have the emotional and mental stability to deal with the stress by remaining upbeat, strong, and emotionally detached while displaying genuine concern. This emotional stability allows a nurse attending to a neonatal patient to remain focused on the essential medical challenges of their job and offer support to families. 

Critical Thinking

A NICU nurse must have critical thinking skills to quickly assess a situation involving a newborn baby. As part of their daily life in the medical field, they must respond immediately to deteriorating situations. 

Nurses must maintain vigilance and be keen on detail to provide the best neonatal care. Catering to a plethora of newborns in the intensive care unit must be well-organized and prioritize each neonatal patient accordingly to prevent a bad situation from worsening. 

Manual Dexterity

An infant is tiny, which means a NICU nurse must have nimble fingers to perform the necessary procedures such as neonatal resuscitation on their patients. Additionally, newborns are most susceptible to injury, so they must be handled with care even when a baby is moving erratically. Excellent hand dexterity makes it easier to provide neonatal care to an infant and allows a neonatal nurse practitioner to work more efficiently.

The types of problems that a NICU clinical nurse specialist encounters are:


Although a nursing career comes with stress, the pressure that comes with caring for newborn infants with health issues and communicating with their loved ones adds to the stress. Rushing a newborn baby from the delivery room to the neonatal intensive care unit and then offering intensive care is a significantly stressful scenario that can repeatedly occur during a NICU nurse’s shift. 

A neonatal nurse must control their emotional responses to stress to maintain a high level of professionalism and make rational decisions when dealing with other medical staff and the loved ones of patients. Parents of chronically ill newborn infants are usually desperate and demanding, which means a neonatal nurse must learn to handle such challenging situations.

Physical Demands

There’s no denying that these coincide with the emotional stress that comes with NICU nursing. A neonatal registered nurse is on their feet or most of their shift as they manage the concurrent care for many newborn infants. They work 12-hour days and usually rotate overnight, day, and night shifts, given that an infant requires neonatal care around the clock. 

In addition to transporting newborns from delivery rooms to the neonatal intensive care unit, a NICU nurse frequently moves equipment between rooms within the unit. Adding to the gruesome demands, some NICU nurses take classes, squeezing them in their work schedules to progress to nursing management. 

Nurse Burnout

The effects of stress and nurse burnout in a neonatal intensive care unit, low morale, mental exhaustion, and increasing levels of absenteeism can have a detrimental impact on the quality of care that a neonatal NP provides. Due to the nature of this highly specialized form of health care, a neonatal pediatric nurse can experience significant levels of physical and psychological stress. 

Burnout is a symptom of workplace stress that manifests as depersonalization, reduced sense of personal accomplishment, mental and emotional exhaustion. Emotional support, self-care, and job satisfaction are the key ingredients to curbing burnout in a neonatal nurse practitioner. Therefore, the implications concerning nursing practice and burnout in the NICU are clear. It’s the responsibility of the administrative leaders and individual nurses to take the necessary measures to keep burnout at bay. Preventing this occurrence in the NICU can usher in greater recruitment sales, staff retention, and optimal neonatal care. 

Steps to Becoming a Neonatal Nurse

Lets’ delve into the necessary steps to becoming a neonatal nurse practitioner. 

1. Education

Neonatal nursing entails following the same educational pathways as any registered nurse. A neonatal NP can enroll in a nursing program and pursue a bachelor of science in nursing (BSN) or an associate degree in nursing (ADN). Pursuing either nursing degree prepares aspiring NICUs to qualify for an RN license. 

Nonetheless, one nursing program differs from another in focus and length, among other aspects. A BSN usually lasts four years, whereas an ADN takes years to complete on a full-time basis. Furthermore, an ADN nursing program comprises fewer general education courses, which means that students channel most of their coursework to basic nursing skills. 

Contrarily, a BSN nursing program typically has more general education courses in the social sciences and humanities in addition to the core nursing coursework. The curriculum usually involves more writing, paving the way for students to polish up on their communication skills. The last two years of a BSN program center on nursing theory, ethics, and techniques. Students also gain practical experience by participating in laboratory and clinical courses. 

Additionally, a nursing program may offer specialization courses within BSN programs, allowing interested learners to delve into neonatal nursing. After graduation, a NICU nurse interested in a neonatal nursing career usually starts as a pediatric nurse, working their way up. 

Nonetheless, a wealth of hospitals and other medical facilities offer a new graduate residency in neonatal nursing. It allows new graduates to gain paid experience and further education on caring for critically ill newborn infants. 

To practice, a registered nurse candidate must acquire a state license. Applying for licensure involves completing your education and passing the NCLEX RN exam that assesses fundamental nursing skills such as infection and safety control, psychosocial integrity, health care maintenance and improvement, and physiological adaptation. 

2. National Certification and Training

After earning a license, a nurse can pursue certification to become a neonatal NP. The National Certification Corporation offers an RNC certificate for Neonatal Intensive Care Nursing (RNC NIC). 

Interested individuals must possess 24 months of work experience as a registered nurse, active RN licensure, and the minimum passing score to qualify for the credential. The certification rules regard at least 2,000 hours in administration, research, direct patient care, and education to fulfill the experience requirement. 

Furthermore, the American Association of Critical Care Nursing (AACCN) grants a CCRN specialty in neonatal care. To be eligible for this credential, an applicant must have 1750 to 2000 hours of direct neonatal care of critically ill patients. The certificate also requires sitting a proctored exam that evaluates the knowledge of neonatal intensive care. 

Neonatal Nursing Schools and Careers

Here are the top colleges that offer the best programs in neonatal nursing. 

University of Pennsylvania 

As a private research university, this institution is one of the top pediatric nurse practitioner programs in the US. The University of Pennsylvania’s School of Nursing was also the 8th best national university in 2019. A registered nurse with two years of experience under their belt in neonatal intensive care can enroll in a nurse practitioner program to earn a master’s degree in the field. The one-year advanced program offers courses in developmental physiology, high-risk neonatal care and theory, and pediatric pharmacology. 

Vanderbilt University

Located in Nashville, this university is one of the best pediatric nursing schools. It offers a neonatal nursing practitioner program that leads to a post-master’s certificate. An applicant must have at least two years of experience in high-risk newborn infants and an MSN. Graduates from this program qualify for employment in an immediate care nursery, neonatal intensive care nursery, and a newborn nursery. Furthermore, the program is offered in a distance-learning format through online courses. 

Arizona State University 

Situated in Tempe, it offers a DNP and BSN program for any aspiring nurse practitioner. The program represents the perfect combination of practical experience in medical institutions and classroom coursework. It’s also offered on a part-time or full-time basis. Learners receive simulated clinical training via the Arizona State University Simulation and Learning Resources Facility (SLR). 

Other Top Neonatal Schools are:

Duke University

It offers graduate programs in pediatric nursing. 

East Carolina University

The institution has a neonatal nurse practitioner program that prepares a graduate to take on nursing education roles. 

Northeastern University 

A neonatal nursing student can gain experience in the field at medical facilities such as the Children’s Hospital, the Women and Infant’s Hospital, and the Medical Center located in Boston. 

University of California

Located in San Francisco, this university has one of the best programs that any aspiring pediatric nurse practitioner will find appealing. 

University of Florida

It offers most of its neonatal nursing courses virtually. However, learners must commute to the campus for the required clinical hours. 

The Top Employing States for NICU Nurses

Employment trends and compensation differ due to various factors such as specialization and location. According to the BLS, the states with the greatest concentration of NICU nurses and other RNs are Rhode Island, Delaware, South Dakota, Mississippi, and West Virginia. 

The average salaries for these states fall ranges from $84,000 to $103,000, with RNs in Delaware and Rhode Island earning the highest. California ranks as the highest-paying state for career, with a licensed nursing practitioner earning an average of $113,240 per year. 

Other high-paying areas include Oregon, the District of Columbia, and Massachusetts, where the average earnings vary from $92,960 to $104,060. The high-paying metropolitan areas for RNs are located in the Santa Clara, San Jose, and Sunnyvale jurisdictions of California. Santa Clara ranks at the top, with average salaries soaring to $140,740. 

Neonatal Nurse Salary

The salary of an entry-level position in this field has a national median average that reaches $50,243 annually. Nonetheless, this figure isn’t constant as neonatal nurse salaries will differ according to the years of experience, location, and state. 

With the years of experience (1 to 4 years) that a neonatal nurse earns in this field, they can expect an annual salary of $53,387. A NICU nurse with 5 to 9 years of expertise can expect at least $60,000 per year. NICUs with decades of experience can expect a generous compensation of $74,865 yearly. In the US, the median average salary for a neonatal nurse is $60,967 annually. 

When it comes to the cities, the highest-paying hourly wages are Illinois with $26.17 to $50.52 and Texas with $25.42 to $40.04. 

NICU Nurse Job Growth

The BLS projects career growth in the nursing industry in its entirety. The number of RNs
Including NICUs) is expected to grow by 7% by 2029. It’s a rate that surpasses the growth rate of other professions. The job outlook is incredible, with the increase factor being based on the characteristics of the field and the demand. 

Given that the baby boom population is rising, there’s an increasing need for neonatal care for premature infants and newborn babies. The aid of aspiring neonatal nurses is always welcomed in these critical cases of babies and their loved ones that need to be in the loop of what to expect. 

Upon completing a neonatal nurse practitioner program in an accredited nursing school and passing a neonatal nurse interview, a registered nurse can be gainfully employed in various nursing care environments such as women’s clinics, conventional hospitals, private medical institutions, and maternity wards. 

Where Does a NICU Nurse Work?

A NICU RN can find work in a public or private-owned hospital. Although rarely, a NICU nurse can work in a home health care environment or as part of an emergency medical team. We’ve rounded up a few of the most common locations that you’ll find a pediatric nurse practitioner. 

  • Community Health Organizations 
  • Home Health Services
  • Hospitals
  • Medical Transport Services and Evacuation
  • A Neonatal Intensive Care Unit

The Highest-Paying Industries for a NICU RN

The healthcare sector plays a major role in determining employment salaries and hourly rates for a neonatal nurse practitioner. The highest paying industries for a NICU RN range from home healthcare services, outpatient care centers, general surgical and medical institutions, and nursing care facilities to physicians’ offices. 

The best-paying RN industries vary considerably. According to the BLS, a licensed nurse practitioner working for business support services takes home an average of $106,670 per year. Nonetheless, the industry only employs 650 registered nurses. 

It’s worth noting that is figure is for LPs in general, which means the average earnings for a neonatal nurse surpass that of a registered nurse. Other top-paying industries are medicine manufacturing, the federal government, and pharmaceutical. 

NICU-Related Salaries and Jobs 

Labor and Delivery Nurse: $51,000 to $92,000

It entails working with a team of midwives, physicians, and other medical professionals and assisting families throughout the entire delivery process. A labor and delivery nurse provides patient care during problematic and normal pregnancies, providing guidance, hands-on clinical care for newborns, and a wealth of information. 

Flight Nurse Specialist: $53,000 to $98,000

Also known as a transport nurse, a flight nurse is an RN trained to deliver medical care as their transport a patient such as an infant, in an aircraft or helicopter. They are usually relied upon to help transport an injured or chronically ill patient to a trauma center. 

Occupational Health Nurse: $74,211

It refers to a licensed nurse practitioner who provides safety and health services and programs to community groups and medical workers. The nursing practice entails the restoration and promotion of health, including that of newborn infants, protection from environmental and work-related hazards, and the prevention of injuries and illnesses. An occupational health nurse is an RN who combines the knowledge of business and health and blends it into health care expertise. 

Nursery Nurse: $13,000 to $86,000

As a registered nurse, a nursery nurse delivers medical care for newly born infants. Although they usually work in hospital nurseries, they also provide outpatient care at private residences. 

Pediatric Operating Room Nurse: $53,000 to $102,000

An OR nurse is an individual who works with patients being prepared for surgery and their families as part of the interdisciplinary care team. An OR RN evaluates patients before planning and implementing the necessary steps during and post-surgery. 

In NICU nursing, an OR pediatric RN helps in general surgical procedures for premature infants, newborn babies, and adolescents below the age of 18. They might handle a boatload of tasks such as intervening if complications arise during surgery and handing surgeons the tools they need during procedures. A registered nurse provides patient care during, after, and before surgeries. 

Clinical Nurse Specialist (CNS): $91,301

It prepares graduates from nursing schools to become professional clinicians who provide population-level care and direct patient care. A CNS is a registered nurse who is certified in their preferred specialty, for instance, pediatrics nursing. Earning a specialty certificate depicts an advanced level of knowledge in addition to expert clinical skills in a niche field of nursing, such as NICU nursing. 

A clinical nurse specialist implements the changes that boost outcomes for entire categories of patients, such as newborn babies, in certain health care environments. A specialist also serves as a consultant for nursing staff in an organization and usually works in managerial or executive positions, working with a team to come up with procedures and policies. 

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