If you enjoy caring for infants and you like to help others, starting a career as a neonatal nurse may be the right path for you. Neonatal nurses handle many of the same duties as standard nurses, except they specifically work with infants, typically under one month old who is struggling with some type of health condition.
Babies sent to the NICU (Neonatal Intensive Care Unit) are often born prematurely, underweight, or have some type of medical condition, such as respiratory distress disorder, hypoglycemia, sepsis or some other serious infection. Studies show that between 10% and 15% of babies born in the United States require some type of care from the neonatal unit and require 24/7 monitoring.
According to the Bureau of Labor Statistics, the demand for nurses as a whole is expected to increase by 7% over the next ten years. Since neonatal nurses require a high level of skills and experience, the demand for these specialized professionals is even higher. Additionally, since the need for neonatal services is always in demand, job security for a neonatal nurse is very high.
If you’re considering a career as a neonatal nurse, this guide can help. It will explain the role of a neonatal nurse, the steps you need to take to become a NICU nurse and how much you can expect to earn throughout your career.
Responsibilities of a neonatal nurse
Working as a neonatal nurse can be extremely rewarding since you can play a huge role in providing life-saving treatments to infants. However, this career can also be very demanding and emotionally stressful. While survival rates in the NICU units have improved greatly over recent years, you must prepare yourself for the fact that medical treatment will not be enough to save all patients.
The neonatal unit is specifically designed for babies who are born under distress or with a significant health condition. For example, premature babies born under the gestational age of 37 weeks or have a birth weight lower than 5.5 pounds are sent to the NICU unit. This is quite common with multiple births. Also, newborns struggling with drug withdrawals or STDs are often sent to the NICU unit for specialized care. Babies born with various health conditions, such as respiratory distress, seizures, hypoglycemia and life-threatening birth defects are also transferred to the NICU unit.
Neonatal nurses must have a high level of empathy and compassion as they will work with both infants and their parents and guardians. They should also be very nurturing and understand that they will be the primary care provider for infants less than 30 days old. Most nurses in the NICU unit care for between one to four babies at a time depending on their care level.
Additionally, neonatal nurses must be able to work well with very little supervision. They must be detailed-oriented and have the ability to think and make decisions under pressure. Excellent communication and observation skills are also a must for neonatal nurses. First, they often serve as a liaison between the doctors and the parents, so they must be able to communicate all necessary information in both written and oral format. Secondly, since infants are not able to verbally communicate, they must be able to evaluate symptoms through observation.
Most neonatal nurses work in a hospital setting, but they may also work at an outpatient center or private practice or work on a hospice or infant transport team. Nurses often work long shifts that extend 10 to 12 hours or more and should expect to spend the majority of the day on their feet examining and treating patients.
The typical neonatal nurse job description includes tasks, such as:
- Evaluate and oversee patient care in NICU units
- Collaborate with physicians and other medical professionals
- Operate and maintain medical equipment, such as incubators and ventilators
- Extract blood samples
- Connect intravenous lines
- Check infant vitals
- Administer medication as prescribed by a doctor
- Provide patient education to parents and guardians
- Stock medical supplies as necessary
- Maintain and update patient medical records and charts
Neonatal nurses must also handle infant care services, such as changing diapers, bathing, feeding and dressing.
NICU nurses who advance their career to become a Neonatal Nurse Practitioner (NNP) can handle additional duties, such as:
- Conduct neonatal physical exams
- Order and evaluate lab tests
- Make diagnoses with physician collaboration
- Handle the admission and discharge process
- Contact neonatal resuscitation and other life-saving procedures
NPPs must have strong leadership skills and have the ability to oversee neonatal RNS and other support staff. They have a strong partnership with the on-duty physician and are required to alert all necessary parties to any changes in the patient’s condition throughout the day as well as any test results and parent concerns.
Average salary for neonatal nurses
Nurses must have at least an RN license to obtain a job in a NICU unit. According to the Bureau of Labor Statistics (BLS), RN earns a median annual salary of $73,300. However, most hospitals also want their NICU nurses to have clinical experience working with infants. Since a higher level of experience is required, a neonatal registered nurse can expect to earn a slightly higher salary than the average RN nurse.
Naturally, neonatal nurses can expect to earn a higher salary as their education and experience level increases over time. For example, the BLS statistics show that Nurse Practitioners earn a median annual salary of $109,820. These statistics represent more than $36,000 difference per year between the average pay for RNs and Nurse Practitioners. Nurses who work towards earning a certification as a Neonatal Nurse Practitioner can expect to earn an even higher salary.
As with RN, the average neonatal nurse practitioner can expect to earn more than a standard NP due to their specialized training.
Education isn’t the only factor that influences a nurse’s salaries, so does location. In fact, studies show a nearly $30,000 a year difference between the highest paying state (Massachusetts – $105,493) and the lowest paying state (Florida – $73,365)
There are several reasons for this huge discrepancy. First, salaries in specific regions of the country are usually aligned with the cost of living in that area. The cost of living represents the amount of money it costs to sustain a standard quality of living. It typically factors in costs, such as housing and transportation. For example, several states with the highest cost of living rates, such as New York, Massachusetts and Hawaii also offer some of the highest salaries to NICU nurses.
Demand also plays a huge role in salaries. For example, in areas where there is a greater demand for neonatal nurses, you can expect to find higher salaries.
If you want to find a NICU nursing job that offers the highest salary, you may need to be selective about where you live. Here’s a look at the states that pay the highest NICU nursing salaries.
- Massachusetts: $105,493
- Hawaii: $103,986
- Connecticut: $102,931
- Wisconsin: $101,334
- Tennessee: $100,678
- Washington: $100,318
- Minnesota: $100,290
- Rhode Island: $100,070
- Ohio: $99,940
- New York: $99,473
Salaries also vary between locations within the state. You can expect to find higher-paying NICU nursing jobs in larger cities, especially metropolitan areas. These larger areas are likely to have larger NICU units and handle higher levels of care than smaller cities as well as a higher demand to hire a qualified nurse. In fact, many rural hospitals may not even have a neonatal unit.
If you are interested in moving to one of these states to work as a NICU nurse, keep in mind that each state has its own licensing requirement. It’s important to learn about these requirements prior to moving. If possible, you may even want to check out these requirements before entering a nursing school.
Another thing to consider before moving to a new location is the overall cost of living in the area. Until you factor in the cost of housing and transportation, you may find that you will have more money to spend by working in an area with a lower cost of living.
How experience can affect salary as a neonatal nurse
As with any career, experience plays a vital role in neonatal nursing salaries. In fact, experience is crucial and often required when it comes to NICU care. Basically, the more experience your gain working in the NICU unit the more money you can expect to make. What makes neonatal care different is that experience isn’t enough, it’s where you get your experience that really matters.
Neonatal units are broken down into four primary levels of care, including:
- Level I: Neonatal care level I includes caring for healthy newborns. These neonatal nurses often work as a pediatric nurse in the maternity ward of the hospital. Nurses at this level don’t typically require previous experience, but specialized classes in newborn care may be necessary. While these nurses aren’t technically considered NICU nurses, it’s a great place for nurses without experience working with infants to start their careers and to gain clinical experience.
- Level II: NICU unit level II care is for low-risk infants that still require 24/7 monitoring and supervision. Entry-level nurses with neonatal clinical experience and appropriate education can obtain a job at a level I unit upon graduation and RN licensure.
- Level III: NICU unit level III care treats newborns with serious and even critical health conditions. In order to work at this level of care, a neonatal nurse must have the appropriate training as well as several years of clinical experience in a level II care unit.
- Level IV: NICU level IV units treat only the most severe cases. This includes infants with life-threatening illnesses, rare medical conditions, and babies born at less than 32 weeks of gestation or are under 1,500 grams in weight. Neonatal nurses at this level often require extensive training and clinical experience. Licensed Neonatal Nurse Practitioners as well as RNs with many years of experience work in these units.
NICU nurses can advance their careers by obtaining positions in a higher level of care units. Since specialized training and experience is required at each level of care, a neonatal nurse can expect to obtain a higher salary at each level. The demand for higher-level care nurses is also greater since most nurses don’t have the necessary skills and experience. However, only larger hospitals, often found in larger cities, offer level IV NICU care, so moving to one of the cities may be necessary to advance your career.
Experience isn’t the only factor that can help increase your salary potential as a neonatal nurse. Here’s a look at several other factors that may help you earn a higher salary as a NICU nurse.
Go back to school
Education is almost as important as experience, especially considering you are likely to gain more neonatal clinical experience in school. If you currently hold an associate degree, considering enrolling in an RN-to-BSN or RN-to-MSN program. These programs are specifically designed for nurses who have their RN license but didn’t earn their bachelor’s degree. Many of these programs can be completed in as little as two to three years and can have a big impact on your salaries. Additionally, an advanced degree will open up higher-paying jobs to you.
If you have already earned your bachelor’s degree, then you can enroll in a BSN-to-MSN or BSN-to-DNP program to earn your master’s degree or doctorate degree. Both of these graduate-level programs will enable you to become a certified Neonatal Nurse Practitioner and greatly improve your job opportunities and salary. These programs also take an average of two to three years and provide the fastest way to improve your salary.
You can also consider taking continuing education classes pertaining to newly developed treatments, equipment and other medical advances in the neonatal field. Having this extra training may put you above the competition and help you land a higher-paying job in a NICU unit.
Once you have your RN or APRN license you can advance your career by obtaining specialized certification in the neonatal field. The most prestigious certification organization is the Nation Certification Corporation (NCC). This is the same organization the certifies nurse practitioners.
The NCC offers several certifications in the neonatal field, including:
- Neonatal Pediatric Transport (C-NPT)
- Electronic Fetal Monitoring (C-EFM)
- Care of the Extremely Low Birth Weight Neonate (C-ELBW)
- Obstetric and Neonatal Quality and Safety (C-ONQS)
Most of these nursing specialties can be obtained with just an RN license, but two-years of experience and 2,000 clinical hours, with at least part of these hours being in the specific field, may also be required. Nurses must pass each competency exam to gain certification in a specific area.
For example, if you want to be certified as a Neonatal Pediatric Transport, you must have an RN license, of two-years and 2,000 clinical hours providing neonatal clinical care, of which at least some of this experience pertains to pediatric transport.
Gaining a certification can be a great way to advance your career and increase your salary. The most important thing is to provide your employer with the proper documentation as soon as you earn your certification. In some cases, this may instantly increase your salary. In other cases, it may only make you eligible for higher-paying positions when they are available.
Many hospitals and medical facilities manage a career development program for their employers. While each program is different, it might include benefits, such as tuition reimbursement or a mentorship. Make sure you request more information about such programs and make full use of them throughout your employment.
Not only will this step increase your training and experience, but it will show your employer that you are willing to move up the career ladder. Additionally, employers may be more willing to promote employees that they have invested a lot of time and money in over the years.
Keep in mind that some employers have certain requirements attached to its career development program. For example, you may have to agree to work for the employer for a set number of years to be eligible for tuition reimbursement. Be sure to read all the fine print before entering any program.
The right types of networking can also help you find higher-paying neonatal nursing jobs. Be sure to stay in contact with former classmates and professors and alert them to any job opportunities you may want. Also, spend some time networking when you attend special seminars, workshops or training. You never know when the right connection can help you land a high-paying job later in your career.
You should also consider joining one or more professional organizations, such as the National Association of Neonatal Nurses (NANN) or the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). These connections can keep you up-to-date on new discoveries in the neonatal field and also alert you to job opportunities that you may not have otherwise hear about.
Steps to become a neonatal nurse
While the educational track for neonatal nurses is very similar to standard RNs initially, many NICU nurses gain additional education and credentials to advance their careers. At the bare minimum, a neonatal intensive care nurse must have an RN license with experience providing care to infants. However, many hospitals preferred nurses who are certified to provide neonatal care.
If you are considering a career as a neonatal nurse, here’s a look at the typical career path, including advanced education and certification options.
Before you can obtain your RN license, you must first complete an accredited undergraduate program. You have three basic educational paths you can take to meet this requirement, including:
- Nursing school diploma: Nursing diploma programs are typically held in a nursing school or hospital setting. These programs take an average of two years of intense, full-time studies to complete.
- Associate degree: Many community colleges offer associate degree programs in nursing. You can typically earn an Associate of Science in Nursing (ASN) or an Associate Degree in Nursing (AND) degree in two to three years.
- Bachelor’s degree: Universities and colleges typically offer four-year nursing programs that qualify graduates to obtain their RN license. Graduating students earn a Bachelor of Science in Nursing (BSN) degree.
No matter which nursing program you enter, you can expect to take a mixture of medical-related and general education courses along with hands-on clinical experience. While nursing specialties are not available at the undergraduate level, you should consider taking courses, or electives, in pediatric or infant care, if possible. Additionally, try to earn some clinical experience in pediatric or infant care or consider completing an internship program. This added experience will improve your chances of landing a job in a neonatal unit because many hospitals want nurses with infant care experience.
If you are looking for a way to enter the nursing profession as quickly as possible, a nursing diploma or associate degree program may be the best option, since these programs only take two years to complete. However, it’s important to note that many employers today are leaning towards hiring nurses with a BSN degree. In addition, if you want to become a nurse practitioner, you must have a bachelor’s degree to enter a master-level program.
Both in-person and online nursing programs are available. However, most programs require hands-on clinical experience to be completed for graduation. While you may be able to complete your clinical work at a local medical facility, be sure to request more information about this requirement before entering into a program.
Once you have obtained your undergraduate degree in nursing from an accredited university, you can work towards earning your RN (Registered Nurse) license. The first step is to check with the National Council of State Boards of Nursing (NCSBN) to determine the specific licensing requirements for the state where you plan to work. Once all requirements are met, you can apply to take the NCLEX-RN exam.
You must successfully pass this examination in order to earn your RN license. The bulk of the test consists of multiple-choice questions, while some other types of questions, such as fill in the blanks and sequencing are also included. It’s recommended to take the test shortly after graduation, so the information is fresh in your mind. You should also consider taking a test-prep course to help you study.
Many hospitals are looking for NICU nurses with experience working with children and providing infant care. If you were not able to obtain this type of clinical experience during your undergraduate program or through an internship program, you may need to start your career working in a pediatric unit to obtain this experience. However, some low-level NICU units may be willing to hire licensed RNs.
Aspiring neonatal nurses who want to further advance their careers apply to a graduate program. Competition into these graduate programs is very intense, so it’s recommended to apply early and to several schools to secure admission. Earning a graduate degree will allow you to earn a license as an Advanced Practice Registered Nurse (APRN). There are two primary graduate program options, including:
- Master of Science in Nursing (MSN): An MSN program takes an average of two to three years to complete. Students with only an associate degree can consider enrolling in an RN-to-MSN program, otherwise, they will have to complete a bachelor’s degree program before enrolling in graduate school. Students with a bachelor’s degree can enter a BSN-to-MSN program.
- Doctor of Nursing Practices (DNP): Neonatal nurses wishing to advance their careers even further can enter into a doctorate program. Some universities offer BSN-to-DNP programs, which allows students to skip the master-level programs and earn their doctorate degree faster. It typically takes an additional two to four years to complete a doctorate program.
There are no specialty degrees in neonatal nursing available at the graduate level, but students should take the neonatal nurse educational track, such as the neonatal nurse practitioner track offered by many colleges and universities.
At this level of education, you can expect to take advanced courses, such as neonate pathophysiology, neonatal health assessments, pediatric physiology and diagnostic management along with advanced clinical experience and research. It’s crucial at this level to obtain clinical experience working in the NICU unit. Some clinical work may be available online, but all clinical and lab work must be done in-person. However, you may be able to complete this experience at an approved medical facility near you to avoid the need to move.
Neonatal nurse practitioner
Once you have completed a graduate program in nursing, you can pursue your certification as a neonatal nurse practitioner. The first step is to earn your APRN (Advanced Practice Registered Degree) as a nurse practitioner, which requires the passage of the national exam. As soon as you have your APRN license, you can attain your certification as a neonatal nurse practitioner (NNP).
NPP certification is offered through the National Certification Corporation. You must provide proof of your graduate degree and APRN license when applying to sit for the NPP exam. Success passage of the NPP exam will allow you to practice as an NPP.