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How to Become a NICU Nurse

April 7, 2021 | Staff Writers

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If you are deeply passionate about children and healthcare, then a career in NICU can be one of the best nursing careers you could ever get into. NICU nurse is short for neonatal intensive care nurse and refers to a nurse practitioner who works in healthcare facilities such as maternity hospitals to provide specialized care to newborns and premature babies in the intensive care units.

Since newborn infants in the ICU are highly delicate and require constant medical attention, there is high demand for NICU nurses. One nurse is usually assigned one to three NICU babies at a time.

NICU nursing jobs demand that nurses are highly observant and attentive to detail, able to note small but significant changes that may occur in an infant in intensive care. This calls for alertness at all times.

Empathy and a good bedside manner are essential as a NICU nurse. They work with parents of sick infants, and most of those parents are going through the trauma of watching their newborn baby struggle for survival. Nurses who work with them need to know how to relate to people in crisis and manage those powerful emotions.

This article explores the process of becoming a neonatal intensive care nurse from the responsibilities of a NICU RN, where to learn NICU nursing, the educational requirements, the best neonatal nursing schools, and the medical and personal skills and abilities needed for a NICU nurse.

What to Consider Before Becoming a NICU Nurse

Before you jump on the bandwagon and take up a career in neonatal nursing, you have to consider several aspects to see if you are a good fit. Some of these include the responsibilities and educational credentials required. You do not want to get into the field and discover too late that you don’t probably like some or all of the NICU job responsibilities that you have to accomplish daily. You also want to be sure that you are up to the task of acquiring both the starting and continuing education credentials.

Job Responsibilities of a NICU Nurse

As a neonatal nurse practitioner, you work with newborns who have various medical ailments such as risky infections, cardiac problems, respiratory complications, premature congenital disabilities, and other malformations that affect their growth, development, and general health.

Neonatal nurses work in neonatal ICUs, labor and delivery sections, and other acute care setups to provide specialized care to preterm infants and full-term newborns right from the time they are born until they leave the children’s hospital. They take care of any infant with complications that arise shortly after birth or those with chronic long-term complications following their birth.

A NICU nurse works closely with other key healthcare professionals like doctors whereby they are expected to report any crucial improvements or drawbacks in the health of the neonate they are assigned to look after.

Where to Learn More About NICU Nursing

Other than the usual education a NICU RN receives from a nursing school, you can learn more about NICU nursing from various sources. Even long before you join any nursing practice school, you can look up more information in this area from any of the following national or international bodies:

You can also learn more about neonatal nursing from state-based bodies such as the Florida Association of Neonatal Nurse Practitioners

The Board of Nursing in your state is also a good reference point for information on NICU nursing.

Interested students can also access more information about NICU nursing from the various nursing schools they check out. This can be done online or in-person. Online checks can be the best since they involve no transport costs and information can be shared via email, calls, or web chatbots. 

Continuing Education Requirements for NICU Nurses

As with most other professions, a NICU RN is expected to maintain certain continuing education units, abbreviated as CEUs, to allow them to continue with nursing practice in their state or beyond. Continuing education differs from state to state and is generally meant to enhance the knowledge and nursing skills required to maintain a proactive and successful career in neonatal intensive care nursing. The CEUs are also meant to ensure that nurses maintain their RN licensure in good condition as per the specific state regulations.

The National Certification Corporation (NCC) and the American Association of Critical Care Nursing are the major certification agencies for NICU nurses. The NCC requires that NICU nurses should earn at least 15 and up to 50 hours of CEUs from recognized and NCC-accredited CEU agencies. One CEU is equal to 10 hours.

Some of the topics needed as CEUs include:

  • Premature Infancy
  • Newborn Screening
  • Evidence-based Care in Pregnancy
  • Ethics for Nurses
  • Pediatric Pain Management
  • Thermoregulation
  • Jaundice
  • Breastfeeding
  • Kangaroo Care
  • Shaken Baby Syndrome
  • Neonatal Respiratory Failure
  • Sudden Infant Death Syndrome and Other Sleep-related Causes of Infant Death

The maintenance period for the NICU nursing certifications is every three years.

Steps to Become a Neonatal Nurse

Becoming a neonatal nurse involves taking predetermined and deliberate steps to ensure you do not skip any of the crucial requirements. Since it is a sensitive career, it is important to follow all the key steps as outlined below. This will help you to offer the best manageable care, avoid vocational mishaps like unexpected infant fatalities, as well as keep you on the right side of both the law and the nursing profession. 

The process to become a neonatal nurse practitioner may take a long time and a lot of financial resources depending on the state you are in and the educational programs you join. 

Educational Paths You Can Take to Become a Neonatal Nurse

  1. Associate’s Degree in Nursing (ADN)
    This is the basic educational requirement for neonatal nursing and licensure as a registered nurse

    Two-year ADN programs are offered in many vocational schools and community colleges in the country. When searching for the best programs, it is important to consider factors such as NCLEX exam and RN licensure, tuition, curriculum, clinical hours, expected job opportunities and salary, unforeseen costs, program length, waitlists, among others.

    The ADN curriculum includes prerequisites and nursing classes with varying requirements and titles, although each school has to meet the state-specific requirements issued by the board of nursing in the state. Some of the prerequisites include Microbiology, Communications, Physiology and Anatomy, Psychology, and Chemistry.

    Nursing classes for ADN programs include:
    • Pharmacology
    • Foundations in Nursing
    • Maternal and Child Nursing Care
    • Behavioral Health
  2. Bachelor of Science in Nursing (BSN) Degree
    You can find a good nursing program for this four-year degree to become a neonatal nurse with greater experience to enable you to command a bigger NICU nurse salary, which comes to upwards of $54,872.

    While an associate’s degree is the basic requirement to become a licensed neonatal nurse, most health care facilities and providers now prefer to hire neonatal nurses with at least a BSN. A nursing student may take an RN-to-BSN program to advance their education to match the current demand.

    Aspiring NICU students also choose between an online or on-campus accelerated direct entry BSN degree and the usual four-year program. 

Necessary Steps to Becoming a Neonatal Nurse

You can consider the process of becoming a neonatal nurse as taking place in different basic steps that you have to follow closely for the best outcome in your career. The following are some of the steps to consider:

  1. Evaluating Yourself
    Even before any concrete action is taken, there is the need to evaluate yourself against the requirements or responsibilities of a neonatal care career to see if you would be a good fit. You can check on your personality to see if you possess the much-needed virtues such as patience, compassion, and alertness. What are your strengths or weaknesses and how may these impact your neonatal nursing career?
  2. Researching About Neonatal Nursing
    The fact that you are already reading this means that you are doing great at your research efforts around the neonatal nursing career. Some of the key aspects to research include the educational requirements, tuition, best neonatal nursing schools, nursing school supplies you would need, expected salary, and the daily realities of NICU nursing.
  3. Acquiring Educational Credentials
    As noted earlier, you can start with an associate’s degree in nursing and then take the NCLEX exam for RN licensure. To raise your chances of getting a better job faster and commanding a higher pay, you can enroll in a suitable RN to BSN program.

    Alternatively, you can study for a bachelor’s nursing degree directly for four years or through an accelerated program. 
  4. Finding Work and Building Experience
    As with other careers, you don’t really become a neonatal nurse until you actually find a job matching your acquired education. This is important because the education acquisition and work period can be totally different, and you stand a better chance of building up your experience by finding internships and employment. Since neonatal nursing is about intensive care, you can find work in a neonatal ICU, children’s hospital, medical evacuation and transport services, community health organization, among others.

Finding work after study is important because you are required to have at least two years of experience working in a neonatal setting before you can take the national certification for NICU nursing through the American Association of Critical Care Nursing, AACN.

How Long it Takes to Become a Neonatal Nurse Practitioner

One of the ultimate goals for a neonatal nursing career is to become a nurse practitioner. This higher position helps you to shift from nursing roles such as clinical nurse specialist and pediatric nurse to more advanced roles like neonatal clinical nurse specialist. 

You can take up a suitable neonatal nurse practitioner program to earn your Master’s of Science in Nursing (MSN) degree to become a neonatal NP. Different universities and colleges offer MSN programs as either traditional two-year programs or accelerated programs that usually take less than two years depending on your availability. 

To obtain the MSN, you must have completed a four-year BSN. This brings the duration for becoming a neonatal nurse practitioner to about six years. This could be longer if your MSN delays due to part-time or work-study arrangements. 

Neonatal Nursing Schools and Careers

This section will explore how much it costs to take a neonatal nursing degree, the best schools for neonatal nursing careers, and the general career outlook for neonatal nurses. 

Cost of Attending a College for a Neonatal Nursing Degree

There is no hard and fast rule on how colleges should price their neonatal nursing degrees. Our specific search for the exact cost of obtaining a neonatal degree did not yield many results. The costs indicated herein are thus generally indicative of how much it takes to complete a degree in nursing in general. It is worth noting that the cost revolves around aspects like tuition, accommodation, transport, nursing school supplies, neonatal nurse certification fees, and meals. As such, the cost of a neonatal nursing degree depends on several factors. These include:

  1. The Type and Status of the College
    Private universities usually charge more for nursing degrees than public universities. This is because public schools receive funding from the government hence can afford to run smoothly even when they charge lower. While a nursing student may pay about $500 per credit at a public university for a BSN, a student in a private university would pay between $1,500 and $2,000 for the same program. Institutions with higher prestige also charge more since there is high competition for the few slots available. 
  2. Location – In-state vs Out-of-state Colleges
    If you opt for an in-state college or program, you end up paying less money than a student doing the same program from outside the state. The price may even double for the non-resident student. Community colleges even charge students resident in their counties lower at about $28,000 while non-residents usually pay more than $63,000.
  3. Type of Degree Program and Learning Mode
    Generally, the more advanced degree programs cost higher than the lower ones. A doctorate in nursing costs more than an MSN, which costs more than a BSN. The higher costs are because colleges have to pay their teaching staff more for their advanced expertise and experience. 

    An associate degree in nursing costs between $6,000 and $40,000 at a public college, and between $30,000 and $100,000 at a private college. 

    A BSN degree costs between $40,000 and $200,000 or even more. 

    If you opt for the traditional learning mode for on-campus studies, you will pay more for your neonatal nursing degree than a student who opts for the online system. Online students get rid of other costs such as transport and expensive school-based accommodation. 

Other than tuition, the other costs to take into consideration are nursing supplies like books, meals, on-campus or off-campus accommodation, transport, and fees for certifications. 

Best Nursing Schools for Neonatal Career Paths

Neonatal nursing as a specialty field falls within pediatric nurse programs where aspiring neonatal nurses can find an associate’s degree in nursing, bachelor of science in nursing, Master’s of science in nursing, and post Master’s certificate courses. Most of these programs have the assumption that you are already highly educated with at least two years of neonatal nursing experience.

The following are some of the best nursing schools for neonatal nursing career pathways:

  1. University of Pennsylvania School of Nursing in Philadelphia

    Annual Tuition Fees: $41,134

    This is a private research institution that the US and World Report ranked number one in 2019 in the category of the best pediatric nursing programs. The same organization named the university’s school of nursing as the third-best graduate school for nursing. It also ranked as the eighth-best national university in the same year.

    It has both BSN and MSN programs for RNs with over two years of experience working in the neonatal intensive care unit. An ASN option is also available. 
  2. Vanderbilt University School of Nursing in Nashville

    Annual Tuition Fees: $45,610

    This is a private research university that ranked fourth in the category of the best pediatric nursing schools in 2019. Its School of Nursing came in at number eight nationally.

    Aspiring neonatal nurses can take either an MSN or doctoral degree. There are both online classes and distance learning options that students can attend over the weekend.
  3. University of Arizona College of Nursing in Tempe

    Annual Tuition Fees: $11,769 for in-state students, $34,967 for out-of-state students

    The institution offers a part-time or full-time BSN to DNP program that combines class training with clinical experience in Phoenix healthcare facilities.

    The school also offers an RNP (Registered Nurse Practitioner) program.
  4. Emory University Nell Hodgson Woodruff School of Nursing in Atlanta

    Annual Tuition Fees: $46,314

    The school’s neonatal nurse practitioner program is one of its kind for its hybridity. It combines personal classes, online studies, and 700 hours of direct neonatal patient care.

    There are three categories including BSN, Accelerated BSN, and MSN.
  5. University of Cincinnati Nursing School in Ohio

    Aspiring neonatal nurses can take associate, bachelor’s, master’s, post master’s certificate, and doctoral programs. 

What a Typical Neonatal Nursing Career Looks Like

Once students complete suitable online RN programs and other educational requirements to become a neonatal nursing practitioner, there are no barriers to how much their career can progress as they gather more clinical experience working with neonatal patients. 

A neonatal nursing career involves working in fast-paced hospitals or intensive care units to offer specialized health care to newborn babies, usually up to 28 days old. This career offers opportunities for a fulfilling life as nurses get to serve critically ill babies to facilitate their release from the hospital. Once this is achieved, most nurses that are passionate about newborns are overwhelmed with joy as much as the infant’s parents that they have been comforting and dealing with throughout the hospital stay. 

Since neonatal nursing is part of pediatric nursing, neonatal nurses work together with other professionals like pediatric nurses, doctors, nurse educators, and pediatric emergency room nurses. 

Maintaining a stable and successful neonatal nursing career calls for constantly enhancing one’s experience and education in areas such as neonatal resuscitation and pediatric pain management. 

Neonatal nurses may also obtain postgraduate degrees to become a nurse practitioner with the ability to work as a clinical nurse specialist, neonatal nurse educator, or lactation consultant. 

Skills and Abilities Needed to Become a NICU Nurse

NICU nursing careers require a combination of both personal and medical skills and abilities if you are to perform your duties and responsibilities as a NICU nurse for the best outcomes in neonatal patients. Newborn infants with ailments are delicate and require special skills to best care for them during the period they are in the intensive care unit. Fortunately, most of the nursing career skills that apply to all other types of nurses also apply to neonatal nursing. 

Skills Needed to Become a Neonatal Nurse

We will break the skills and abilities requirements for NICU nurses into two categories as follows:

  1. Medical Skills and Abilities
    As a given, aspiring neonatal nurses first have to complete among other options, a two-year nursing degree to become a registered nurse. One can then further their studies to become an advanced practice nurse with special clinical training as a pediatric nurse, neonatal ICU nurse, or clinical nurse specialist.

    Some of the medical skills and abilities neonatal nurses acquire include:
    • Patient Care
    • Infection Control
    • Telemetry
    • Patient Assessment
    • Proper usage of medical equipment
    • Kangaroo Care
    • Lactation or Breastfeeding Consultancy
    • Neonatal Resuscitation
    • Basic Life Support
    • Advanced Cardiovascular Life Support
    • Maternal-Child Nursing
    • Labor and Delivery Nursing.
  2. Personal Skills and Abilities
    These are largely inherent skills and abilities that each neonatal nurse should possess. However, some can be acquired along the education path or during actual clinical work. They include but are not limited to the following:
    • Empathy/Kindness
    • Critical Thinking
    • Leadership
    • Alertness and Attention to Detail
    • Communication and Listening Skills
    • Physical Endurance.

What Neonatal Nurses Do on a Daily Basis

From a broad perspective, neonatal nurses take care of neonates with various medical complications to help them stabilize and recover from problems such as dangerous infections, congenital disabilities, and cardiac or other morphological malformations. This care lasts between the recognized 28 days or one-month neonatal period to the time the child is discharged from the hospital. 

On a daily basis, neonatal nurses may do the following tasks:

  • Offer comfort, personal care, and medical support to newborn babies with critical health complications
  • Change diapers, feed, and clothe newborns
  • Collaborate with other healthcare workers like doctors, nursing assistants, and surgeons that comprise the larger pediatric or neonatal care team
  • Administering medication and treatments as prescribed by the attending physicians
  • Comforting and educating parents and families of newborn patients about proper infant care for the period after the child is discharged from the hospital
  • Using appropriate medical equipment and technological devices like the cardiorespiratory monitor to check the progress of newborn infants
  • Minimize the number of interruptions or disruptions in the NICU by holding back other healthcare professionals and family members to follow the strictly allowed schedules
  • Ensuring proper infection control and environment sterility by among other measures, frequently scrubbing their arms and hands between the elbows and fingertips with antiseptic and antimicrobial soap

You may also be tasked as a charge nurse to record patient’s medical details, supervise other nurses, oversee admission, transfer, and discharge of neonatal patients, and coordinate everyday administrative duties in the NICU. 

How to Know if You Can Be a Good NICU Nurse

Before you start your neonatal career, you should assess yourself to see if you are cut out to be a good NICU nurse. This calls for deep and honest consideration of your strengths and weaknesses. Any nursing practice is labor-intensive and thus requires people who can withstand long working hours in fast-paced settings where things could go wrong, and fatalities can occur whether or not the right medical procedures were offered in good time. 

You have to be dynamic and learn to accept that when you succeed, life has been saved, and if you unfortunately fail a life is lost. Not every patient will or can survive, but a NICU nurse needs to be able to accept that and continue caring for all of them. 

If you are at a loss whether a NICU nursing career is the best for you, you can seek the services of a certified career counselor to guide you through the process of self-assessment. 

Generally, the main reason you would think you can be a good NICU nurse is that you are honestly passionate about children. 

You should also check to ascertain that you can withstand traumatizing health situations without excessively breaking down, as this would further upset parents and family members and limit your ability to effectively perform your duties and responsibilities. 

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