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What is a Neonatal Nurse?

What is a Neonatal Nurse?

While some people may think that all nurses are the same, that’s not the whole truth. Yes, every nurse does have the same foundation regarding medical practice and how to treat and care for patients. However, there are many nurses who decide to specialize in a specific field of nursing. These nurses put in the extra time and effort to acquire the skills they need to be experts in a specific area of nursing – for example, neonatal nursing.


What is a Neonatal Nurse?

Neonatal nurses play a vital role when it comes to the health of newborn babies. Some newborn babies are not born healthy and suffer from a number of complications such as cardiac malformations, birth defects, surgical problems, infections, and premature births; this is where neonatal nurses come in. They ensure that newborns facing complications always receive the high-quality care they need. Neonatal nurses must not only be knowledgeable in their field, but also be mentally and emotionally strong to be able to deal with the ups and downs of their jobs. At times the job may be emotionally taxing, as well as physically exhausting. As a neonatal nurse, you may find yourself working evenings, weekends, and overnight shifts in the NICU (neonatal intensive care unit).

Before becoming a practicing neonatal nurse in the intensive care unit, you will need to complete several requirements regarding education, training, and certification. To become a neonatal nurse, you must not only have an active registered nurse license, but you must also go through a master’s program and become an advanced practice registered nurse (APRN).


What does a neonatal nurse do?

Neonatal nurse practitioners assist in the delivery and treatment of newborn infants. Supervised by a neonatologist, neonatal NPs work in acute and nonacute settings and should be ready to address any health issues that arise from complications such as HIV infections, drug addictions, premature births, genetic disorders, and others.

Newborn infants may be treated by registered nurses in a majority of Level I nurseries. They attend to births and treat newborns if possible. NNPs (neonatal nurse practitioners) go through more extensive training than their RN counterparts and are better equipped to deal with complex health issues. They may also receive more responsibilities such as prescribing medications, planning treatment, and diagnosing when needed, depending on the rules nd regulations set by their state.

Neonatal nurse practitioners strive to decrease the mortality rates of newborns. Depending on the newborn infant’s specific condition, duties will vary between neonatal nurses and neonatal nurse practitioners. The following are the four levels of neonatal care:

  • Level I: Every healthcare facility with inpatient maternity care will have a Level I neonatal nursery. As the basic form of nursery, it is home to generally healthy newborns. Neonatal nurse practitioners in Level I nurseries can provide feeding, bathing, resuscitation, postnatal care, health evaluations, measuring, and weighing.
  • Level II: Newborns who are suffering from moderate health complications are taken to Level II nurseries. These nurseries may also include newborn infants coming from a Level III nursery and are in the process of healing. Infants in Level II nurseries will generally recover fairly rapidly.
  • Level III: Newborn infants who are either premature or are in need of surgery and find themselves in critical condition will be taken to Level III nurseries, which is considered a subspecialty neonatal intensive care unit.
  • Level IV: Newborn infants born in extreme critical condition will be taken to Level IV nurseries. Known as regional neonatal intensive care units, Level IV nurseries monitor newborns 24-hours a day. Infants in these nurseries may need complex surgery.

Neonatal nurse practitioners can expect to be responsible for the following duties across a number of healthcare settings:

  • Manage ventilators
  • Create treatment plans
  • Prescribe medications
  • Order and perform diagnostic and lab tests
  • Start and maintain IV lines
  • Give treatment guidance to parents
  • Evaluate vital signs
  • Draw blood
  • Monitor specialized equipment (incubators, ventilators, etc.)
  • Perform neonatal resuscitation


Why is a Neonatal Nurse so important?

Newborn infants need special care when faced with health complications. Healthy newborns can grow into healthy adults, and everything must be done to secure the health of babies. Without neonatal nurses caring for newborns, the mortality rate of newborns may increase significantly, not to mention any health complications faced later in life due to poor care at the time of birth. Neonatal nurses make sure that newborn infants receive the treatment they need to grow into healthy adults.


How to Become a Neonatal Nurse?

Before becoming an advanced practice registered nurse, prospective neonatal nurses must go through basic training. Prospective neonatal nurses have two options: obtain an associate’s or a bachelor’s degree in nursing. From there, they must pass their NCLEX-RN license exam. Once they become registered nurses, they must have two years of experience and practice. Afterwards, they can apply to graduate programs and obtain a graduate degree (like a Master of Science in Nursing) and become an advanced practice registered nurse.

Nurses in a graduate program will gain experience in pediatric pharmacology, transitions to advanced nursing, and neonatal health assessment. They gain hands-on experience, work alongside other practical nurses in facilities designated for neonatal care, and complete a thesis.


Neonatal Nurse Education Requirements and Training

Nurses looking to become neonatal nurse practitioners must go through and complete a graduate program as well as become an advanced practice registered nurse. Entry-level nurse practitioner positions are commonly available for nurses who graduated with a master’s degree. While a doctorate degree may be the highest degree in the field, it is not necessary to start working as a neonatal nurse. One of the concentrations in master’s programs is neonatal nursing; others include anesthesiology, gerontology, and midwifery.

The following explains what you can expect from a master’s program with a concentration in neonatal nursing. Keep in mind that the information may differ, depending on the school.


What are the admission requirements for a Master’s in Nursing program?

In order to be admitted to a nursing practitioner master’s program, you will have to complete several educational requirements and submit extensive documentation. Whether it’s in nursing or not, you must have a bachelor’s degree before applying to a master’s program. Depending on the school, you may only be allowed to apply if you have a bachelor’s in nursing, while other school may not care what you graduated in as long as you have a bachelor’s degree and meet every other requirement.

To apply to a nursing practitioner master’s program, you must:

  • Write a personal statement that shows you have clear goals and understanding of the role you will have as a nurse practitioner
  • Submit between 2 and 3 letters of recommendation from supervisors
  • Provide a complete resume showing your years of experience
  • Have an unencumbered, up-to-date RN license

Depending on the school, you may see additional requirements such as proof of malpractice insurance, a background check, and specific course prerequisites. Generally, nurse practitioner master’s programs won’t require GRE test scores. Some common prerequisites you may be asked to complete include a health assessment class and a class in statistics, both three credit hour classes.

The following are some sample courses you may have to complete in master’s program with a concentration in neonatal nursing:

  • Role of the Advanced Practice Nurse: Students will examine the historical, social, political, philosophical, and economic influences that affect advanced practice neonatal nurses. Students will explore this role from a variety of angles such as educators, researchers, clinicians, consultants, and administrators. Students will become knowledgeable team members of an advanced healthcare team.
  • Research for Advanced Nursing Practice: Students taking this course will develop the proficiency of a neonatal intensive care unit nurse. They will learn to utilize and evaluate research in their decision-making process. They will also identify researchable problems within clinical practice. Usually separated into two sequential courses, this course will help students explore measurement and data collection techniques, enhance their critical thinking skills, and examine theoretical reasoning.
  • Advanced Newborn/Infant Pharmacology: Students will learn how to apply advanced pharmacotherapeutic principles when it comes to high-risk newborn infants. They will learn how to safely administer medications to newborns in the neonatal intensive care unit. The course covers concepts such as pharmacodynamics and pharmacokinetics as it concerns neonatal physiology.
  • Clinical Decision-Making for Neonatal Nurse Practitioners: Students will learn a number of valuable skills such as assessment, diagnosis, and management of a variety of healthcare needs (primary, prenatal, postpartum, etc.). They will learn about the maintenance needs of pregnant mothers (both regular and high-risk types) and neonates, health promotion, and prevention of illness and injury.
  • Care of the High-Risk Neonate: Focusing on the care of high-risk deliveries in regard to maternal and neonatal care, students will develop a greater understanding of interventions used by advanced practice neonatal intensive care unit nurses when it comes to caring for newborn infants and their families. Students will research findings and study the practical application of theories.


How long does a master’s program in nursing take to complete?

As with any degree, time to completion will depend on the specific course requirements of the program you’re a part of and your type of enrollment. Full-time students will generally take about two years to graduate from their Master’s program, while students who attend part-time will generally take anywhere between three and five years to graduate from their program.

To complete a neonatal nursing practitioner program, you will generally have to complete between 54-65 credits of nursing core courses, clinical experience courses, and neonatal-focused classes. The good news is that if you decide to specialize in any area – whether it’d be neonatal nursing, anesthesiology, or gerontology – you won’t take any extra time as your specialization courses are built into your course curriculum through electives.

Certain factors may affect your graduation timeline. For example, many programs require their students to have between one to two years of work experience in the neonatal intensive care unit. Those who don’t meet these requirements may face some delays in their graduation timelines and may be barred from participating in clinical courses until these prerequisites are met. On the flip side, those who have previous graduate education experience may graduate sooner than their peers by transferring their credits where allowed.


What type of clinical training and certification do I have to complete?

The National Association of Neonatal Nurses has set the following educational and curriculum guidelines for neonatal nurse practitioner programs: each student must complete a clinical component, which has to be a minimum of 600 clock hours, working in either a delivery room, a pediatric intensive care unit (ICU), or a neonatal intensive care unit (NICU). The guidelines suggest that most of the clinical components take part in Level III and Level IV neonatal intensive care units. Observational experience does not count as part of this requirement.

Before practicing, neonatal nurses must obtain their certification once they complete their master’s program. Obtaining the certification from the National Certification Corporation (NCC) is a popular choice among graduates However, each state has their own list of approved certifications, so check with your state board of nursing before taking the exam to see if your state accepts NCC certification.


Are master’s in nursing programs available online?

Sometimes studying on-campus can be hard, especially for busy adults and working professionals. Fortunately, there is an increasing number of neonatal nurse practitioner programs available online, allowing busy adults who can’t go to school full time achieve their dreams at their own pace. Like their on-campus counterparts, online programs offer both part-time and full-time options, so you can set your own pace.

The program options and formats differ between schools, so make sure you research each school to find the one that best fits your criteria. Some programs offer synchronous and asynchronous classes, while some schools may require students to visit campus and other approved facilities from time to time. Clinical hours are still required, and online students will generally go to a nearby healthcare facility that’s been approved by the program to complete their required hours.


The NNP Career Outlook

According to the U.S. Bureau of Labor Statistics, advanced practice registered nurses (APRNs), of which neonatal nurses are a part of, should expect a career growth rate of 31% between 2016 and 2026. Areas that are underserved, such as remote areas and inner cities, could expect an even higher growth rate. According to PayScale, neonatal nurse practitioners should expect an average annual salary of around $97,000.

Neonatal nurses are not always confined to a NICU. In some cases, NNP’s will be part of on flight and/or ground transport teams as they treat newborns on their way to facilities better equipped to care for their medical needs. Serving as part of a critical care transport team can be done from time to time or may be a primary duty for some neonatal nurses. Flight nurses are not restricted to treating newborns; they may also treat older children.

Some neonatal nurses can look at developmental care as an area where they can advance their careers. Neonatal nurses who not only want to contribute their skills to their career but also their ideas can aim to become part of a parent advisory committee or developmental care committee. These groups are usually available at major healthcare facilities.

Neonatal nurses can complete a master’s program and become advanced practice registered nurses and execute their role as neonatal nurse practitioners. Nurses who go through this process usually receive training at the doctoral level.

According to the National Association of Neonatal Nurses, survival rates for low birth-weight babies has increased tenfold in just 15 years. This miraculous change in the neonatal ward is thanks to effective medical breakthroughs.

These advances come in many forms, including the use of high technology. MedStar Georgetown University Hospital, one of the oldest academic teaching hospitals in the nation, uses the following high-tech therapies to treat their newborn infants:

  • Bedside patent ductus arteriosus ligation
  • High frequency oscillator ventilation
  • Extracorporeal membrane oxygenation (ECMO)

Some neonatal care units have started applying old-fashioned practices such as physical contact, nurturing, and baby cuddlers. Newborns who suffer from neonatal abstinence syndrome may be treated with massages.


Salary and Employment

Among neonatal nurses with RN credentials, the ones with the highest earning power make an annual salary of about $92,000. Neonatal nurses in the median range earn about $58,500 a year and the ones who earn the lowest make about $40,000 a year, according to PayScale.

Based on a report by the National Association of Neonatal Nurses (NANN), there are around 40,000 infants born with low weight annually. Due to the use of high technology and medical advances, the survival rate has increased tenfold over the past 15 years. To keep this rate going up, lowering the mortality rates of newborn babies, neonatal nurses are in high demand.


How to increase your neonatal nurse salary

Neonatal nurses are registered nurses who focus on the care and treatment of newborns and infants. These sub-specialty nurses can progress through their careers in three different levels:

  • Level 1: Caring for newborn infants who are healthy and will have short hospital stays.
  • Level 2: Caring for newborns and infants who either were born prematurely or are ill.
  • Level 3: Caring for babies in the Neonatal Intensive Care Unit (NICU), where they will need specialized care and equipment. Complex surgical procedures are sometimes needed.


Top 3 Neonatal Nursing Specialties

Although neonatal nursing is in itself a sub-specialty, neonatal nurses can plan to move into any of the following related specialties:

  • Neonatal Transporters: These neonatal specialists focus on providing heart-lung bypass services for infants in critical condition. They can be part of ECMO, the extracorporeal membrane oxygenation team.
  • Neonatal Nurse Practitioners (NNPs): Serving as advanced practice nurses, NNPs work in the Neonatal Intensive Care Unit (NICU) and provide comprehensive treatment to critically ill infants. Having completed a master’s program and extensive training, NNPs are highly skilled and will often train others when needed.
  • Developmental Care Specialists: Neonatal nurses with a specialty in developmental care not only work with infants but may also be involved in research aimed to improve the treatment of newborns and infants. They study the developmental care of premature born babies and those who are ill, as well as provide aid to other members of their team when necessary.


Neonatal Nurse Resources


Neonatal Nurse FAQs

What are some of the responsibilities and duties of neonatal nurses?

Specific duties and responsibilities will vary by setting and location. However, as a neonatal nurse you should be ready to do any of the following:

  • Holding new babies to provide comfort
  • Administering medications
  • Resuscitating newborns
  • Delivering babies
  • Transporting babies to their mothers
  • Changing diapers

What is the work environment like for neonatal nurses?

Neonatal nurses have several settings to choose from when it comes to work. You can find neonatal nurses in:

  • Private clinics
  • ICU’s
  • Women’s clinics
  • Maternity wards
  • Home (as healthcare nurses)

What are some jobs related to neonatal nursing?

If you’re interested in delving into a neonatal nursing specialty or a related field, you can try becoming a transitional care nursery nurse, labor and delivery staff nurse, neonatal nurse practitioner (NNP), travel NICU nurse, or a neonatal ICU nurse.

How much do neonatal nurses earn a year?

Experience and training affect much of your salary, as well as any specialties. For example, neonatal nurses without a master’s degree can expect to earn about $40,00 a year at the start of their careers. Neonatal Nurse Practitioners (NNPs) on the other hand can expect to start earning $90,000 a year at the start of their careers. Geographical location and workplace setting also affects this figure.

What are the top paying states for neonatal nurse practitioners?

The state with the highest paying salary for NNPs is California ($126,770 annual mean wage), followed by Alaska ($125,140), Hawaii ($122,580), Massachusetts ($120,140), and Connecticut ($118,500).


Helpful Organizations, Societies & Agencies

The following organizations and agencies offer several resources for people wanting to enter the neonatal nursing field and registered nurses currently working as neonatal nurses. They each offer unique help, so click on each one to see how they can help your career move forward.


Neonatal Nurse Scholarship

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List of Neonatal Nurse Programs

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Ready for a fulfilling career in the world of healthcare? Then what are you waiting for? Enroll today in a Neonatal Nurse program near you and start making a difference in your life and the world around you.

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