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What Is a Neonatal Nurse?

April 8, 2021 | Staff Writers

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A neonatal nurse is a specialized pediatric nurse that taking care of babies within the first few weeks of their lives. Most of these babies will have minor issues that clear up with time. Others will have an array of health issues, including being born prematurely or with other congenital issues, that require specialized care. 

This profession is over a century old, making it essential to the hospital environment and public health. As level of experience and education has a direct correlation with the patient’s length of stay and infant mortality rates. There are numerous subspecialties and specializations within this branch, including NICU, neonatal intensive care unit, nursing and being a neonatal nurse educator. 

Apart from being a fulfilling nursing career path, it’s also one of the fastest growing. According to the CDC,  about 10 percent of newborn infants born in the U.S. are preterm and approximately 1.4 percent of premies are extremely underweight, weighing less than 5.5 pounds. These and other reasons have raised the need from you neonatal nurses who have the emotional, mental, and physical skills to handle this demanding profession.

Benefits of a career in neonatal nursing

Sign-on benefits and bonus incentives

On average, neonatal nurses with a bachelor’s in nursing along with their RN certification can earn between $70,000 and $80,000 per year. For those who have a master’s degree or higher, their salary can be at least 30 percent higher plus added financial incentives. Some institutions offer a flat signing bonus that’s tacked onto the annual salary earnings after a certain tenure. Other benefits and incentives depend on experience and location. 

A number of cities have stronger needs for neonatal nurses than others and may offer a more lucrative incentive beyond the signing bonus. In an effort to attract certain nurses with desired specializations and experience, they could offer profit-sharing bonuses. The way it works is that these bonuses depend on being more efficient when it comes to billing and coding rules. Nurses may receive a percentage of those receipts during quarterly or yearly. 

These receipts could be for the organization as a whole or for the employees services rendered. They may be controversial to some, as they think it creates a rushed environment prone to making more mistakes, but that’s not the case. The objective is to reward nurses for their improved productivity, because unofficially, employees need to generate enough billing to cover two to three times their salary. 

In cases where the nurse provides more benefit to the institution without sacrificing patient care, some organizations believe that their advanced level of care warrants a share of that effort. 

Not all hospitals offer this kind of a bonus structure, so it’s important to look at your research, gather data, discuss your contract, and negotiate.

Long-term benefits of neonatal nursing

Caring for those little human beings during the first days of their lives has expected and uniquely satisfying benefits.

  • It’s a little less demanding: Being an active nurse, you’re going to be on your feet during your entire shift or sometimes two shifts. Neonatal nursing has its own type of stress, but one of its benefits is that you’ll spend less time and energy moving your patients around. Newborn babies are much lighter than adults, so there is less physicality required.
  • Job stability and security: The job outlook for neonatal nursing professionals is overwhelmingly positive, because hospitals will always need these types of professionals. With the different specializations and training available, there are a lot of potential paths open, so there will always be a place for neonatal nurses.
  • Better able to cope with stress: You’re always dealing with patients that can’t fully express themselves. This means you need to have a level of mental acuity and agility that will help you to take action when complications occur. The skills, training, and practice you develop will help you to not only handle the more stressful parts of the job, but it can help you to be more proactive about spotting patient warning signs.
  • Job satisfaction: As an aspiring neonatal nurse, your goal is to provide the best care possible. There’s a special type of satisfaction that comes with knowing that you helped a critically ill baby become healthy enough to start their new life.
  • Quick decision-making: These babies are more vulnerable to infection and disease. Because their immune system needs a little more time to develop, neonatal nurses need to be able to make quick decisions when any issues arise so that they don’t become critical. 
  • Great manual dexterity: Newborn infants are naturally wriggly and prone to erratic movements, which can be inconvenient when trying to administer treatment. This means that neonatal nurses’ fingers become both gentle and nimble because the last thing they want to do is inflict injury.
  • Teaching parent specialized caregiving skills: As babies get strong enough to eat or breathe without assistance, these nurses are the ones who have to advise parents about administering basic care of their child. This can include giving them the medicine, special feeding needs, or any other therapies. Neonatal nurses play a significant part in empowering parents to give newborns the care they need to thrive. 

As a result of all of these experiences, these nurses have become a part of the parents core caregiving team. They’re the ones many lean on to handle the overwhelming fear and worry that can come with handling a fragile newborn. The benefits of neonatal nursing go far beyond salaries and bonuses, because these professionals are the baby’s first line of nurture.

How to become a neonatal nurse

Neonatal nursing education requirements

The educational component of neonatal nursing requires an RN license as well as an associate degree in nursing as the bare minimum. However, a bachelor’s is now becoming the minimum requirement. To earn a BSN, there are a few pathways:

  • Traditional four-year degree: This is for students who have a high school degree but no college experience in health care.
  • LPN to BSN: An LPN, licensed practical nurse, is one who deals with basic patient care and comfort under the supervision of a managing nurse. The LPN-to-BSN bridge provides registered nursing license qualifications as well as a bachelor’s degree within two or three years.
  • RN to BSN: Active RN’s can fulfil their BSN requirement within a few years through this bridge program.
  • Accelerated programs: Accelerated programs, also known as direct entry, are for individuals with a non-nursing bachelor’s degree who want to enter the nursing field in the shortest time possible. They need to fulfill specific course prerequisites before going through this program.

Along with the coursework, students need about 700 or more clinical hours to gain practical experience and achieve the minimum licensing requirements. There are also several universities that offer online and hybrid bridge programs.

Apart from all of these technical requirements, becoming a neonatal nurse first requires someone who loves to nurture and care for infants. They must also have a natural curiosity about understanding the behaviors of patients who have no other ways of communicating but with little sounds and erratic movements. This requires a lot of patience and compassion even when times are stressful. These skills can’t be taught in any course.

Continuing nursing education requirements

Continuing nursing education, CNE, are for nursing professionals, while CEUs, continuing education units, are continuing education units, where one CEU equals 10 educational course hours. These

not only cover educational courses but certain qualified activities, also called contact hours. Continuing education isn’t required in some states, but may be as  little as five hours every year or as much as 500 practice hours or more within two years. State licensing boards may require nurses to take mandatory topics as part of their CEU requirements.

Not all CNE and CEUs are created equally, however. For all continuing education units to count, they must be offered by an approved provider. Taking a nursing CEU course at a college or university counts, but CNE courses provided by the American Nurses Credentialing Center, ANCC, are the best choice. The ANCC is the organization that dictates nursing board standards, so they provide courses about the latest technologies within the neonatal field. Another great benefits that their course credits can also boost earning potential.

Some of the continuing education courses for neonatal nurses include:

  • Neonatal Transportation: Understanding the practical, psychological, and social impact of moving babies to and from different units or geographically locations relative to the parents
  • Newborn hearing and screening program: Establishing a procedure to detect early hearing loss and quicker intervention to support parents of children with hearing impairments
  • A seminar for diagnosing and classifying neonatal seizures

Neonatal nursing certifications

In addition to continuing education, there are a few certifications that neonatal nurses can work toward as they progress in their career. Some of these are basic certifications for all neonatal nurses, while others are valuable depending on their specialization.

  • Neonatal resuscitation program: This course is the most basic certification, and it dictates key skills all neonatal nursing professionals need to have.
  • Low-risk neonatal nursing: Licensed RNs in the U.S. and Canada with at least 2 years of experience in the specialization of their choice can take this competency-based core exam.
  • Electronic fetal monitoring certification (C-EFM): Depending on the specialization, nurses can learn how to read and monitor fetal health through the EFM.
  • Neonatal pediatric transport: This certification covers transport core knowledge as well as knowledge about how to handle clinical issues that arise during transportation, such as cardiovascular and electrolyte imbalances.

Typical career path of a neonatal nurse

The road through a neonatal nursing career starts with schooling. While some aspiring neonatal  nurses can begin as LPNs, which can count towards their practical hours, becoming a registered nurse provides a higher level of care. From there, RNs with a bachelor’s in nursing are in a better position to accelerate their path to becoming a trained and trusted specialist.

Why neonatal nurses need an MSN

Getting a masters in nursing, MSN, is an education commitment the pays off in a number of ways. As an MSN-trained neonatal nurse, you are able to work autonomously and can easily collaborate with other necessary professionals, such as neonatologists and pharmacologists, to ensure the best care for your patients. You’ll have the skills to deal with acute and non-acute settings as well as the ability to implement advanced care practices and programs. 

You will have an expanding list of duties that include interpreting diagnostics and lab tests in addition to creating personalized care plans, participating in newborn baby transport and monitoring their well-being with more cutting-edge equipment. There are several specialization routes MSN-educated neonatal nurses can take, including becoming a nurse practitioner or a NICU nurse.

Depending on your focus, you can earn close to or more than $100,000 a year.

Difference between a neonatal nurse and a NICU nurse

While some may use these titles interchangeably, there is a big difference between a neonatal nurse and a NICU RNs. Neonatal nurses care for babies from birth to a month of life. NICU nurses are practitioners trained to focus on babies who are critically ill and may require special or longer-term care, before they can safely go home. They’re also trained on more technologically advanced techniques on how to help patients handle the stresses and challenges of having a sick child. There are four level of NICU specialists:

  • Level I nurses deal with full-term newborns that are healthy and won’t need as much care.
  • Level II nurses deal with the babies that were born prematurely or are sick enough to need constant attention for a longer period of time.
  • Level III nurses are for seriously ill newborns with critical health issues that require constant monitoring and management from a qualified NICU nurse.
  • Level IV nurses are required to have experience with the previous three levels before qualifying for the fourth one. These nurses deal with infants born before 32 weeks, weighing less than 5 pounds, and need life support or other advanced diagnostics.

Non-traditional neonatal nursing paths

With a master’s degree and plenty of clinical experience, there are plenty of non-traditional jobs for neonatal nurse practitioners and specialists. These are unique positions that can be short- or long-term and can provide travel options and flexibility.

  • Product manager: As a neonatal nurse, you’ve worked with numerous critical neonatal care devices and technology. If you have an entrepreneurial spark, there are numerous companies out there that need product managers who can use their experience to make a medical product better.
  • Telemedicine: In 2019, researchers estimated that the telemedicine sector was worth about $41 billion. This is one of the most versatile Tech sectors, because it involves home health monitoring and consulting. As each sub-sector finds its way in this burgeoning industry, neonatal nursing professionals can be a significant part, especially as a way of calming parent fears when it comes to caring for an ill child. 
  • Tech start-up consultant: Whether it’s about creating the next great diagnostic tool for newborns or software for medical professionals, medical tech startups need subject matter experts that can help them improve their offerings. Nurses are in a great position to assess a new company’s products or services due to their experience directly with patients and can provide insight as it relates to certain policies and procedures.
  • Clinical editor: For neonatal nurses who have worked in the clinical research space, being a clinical editor won’t be a stretch. Editors are responsible for coming up with proprietary content and for appraising the content on a site or in a database. They ensure that scholarly journals and publishers are putting forward accurate information.
  • Continuing education writer: CE writers create educational modules and generate class material for continuing education programs. They can work from home offices, making it a really flexible option. Compensation can be hourly or based on a percentage of sales.
  • Foreign service health practitioner: Neonatal nurses who pass the necessary security clearance can work for the U.S. Department of State to provide care around the world. Many countries need help, especially when it comes to newborns. Any qualified nursing professional with a desire to travel and isn’t afraid to work in harsh or hostile environments can take advantage of this unique opportunity.

High-demand neonatal nursing careers

As more nurses approach retirement, there are some high-demand opportunities available for nurses who want to grow in the profession.

  • Nursing educator: Nurse Educators co-create continuing education courses and programs for specific institutions. They also take a look at hospital standards and practices to find gaps and work to improve overall care guidelines. Average salary ranges from $80,000 to $90,000 per year.
  • Nurse practitioner: A Neonatal Nurse Practitioner, NNP, works closely with all parties, including neonatologist doctors, parents, and hospital technicians to ensure the best care for newborns. They communicate diagnoses, recommend and prescribe treatments, and interact with parents and other family members. The average base salary for this specialization is approximately $105,000 per year plus bonuses and profit sharing.
  • Clinical nurse specialist: NICU/Neonatal clinical nurse specialist, CNS, is a diverse role that’s dedicated to improving patient care and safety. A CNS interacts with other medical professionals as well as parents to provide the best care for neonates. These nurses touch on all aspects of care, including evidence based practice, to improve patient outcome. Average salary for a NICU/Neonatal CNS is $124,000 per year.

What to look for in a neonatal nursing program

There are any number of neonatal nursing programs around, and many lists ranking their own versions of the best programs. While many are considered great, here are a few features some of the top programs have in common:

Actively practicing faculty

As technology and medicine are continuously changing and interacting, the best schools realize that they need faculty that are still active in their fields. While retired professionals work fine for other degrees, active neonatal medical professionals are more than familiar with updated practices, certification program requirements, and changes to policies and procedures, for example. It keeps classes fresher and more exciting as well as more relevant. Plus, these active faculty have more relevant and current stories and anecdotes to draw from.

Local contacts for clinical hands-on practice 

Many of the top schools have relationships with local hospitals or medical facilities to make it easier for students to fulfill the necessary practical hours. For some of the larger schools, they may have their own full-scale medical campus. In some cases, schools will work with students in their local area to find suitable facilities for them to fulfill their hours. Either way, they make sure that students have numerous options to fulfill their hands-on practice requirements.

Both online and offline courses 

Gone are the days when higher education was only about sitting in a classroom. Many schools offer online options for their advanced neonatal programs. Some may also offer hybrid programs, where students take most of their classes online but must periodically visit the campus to fulfill lab requirements. As busy working professionals, nurses need to be able to take classes while balancing work shifts and personal obligations so having an online learning environment provides flexibility and makes it more likely that they will follow through with their studies.

An academic advisor/mentor

The classes are laid out and that’s pretty straightforward, but there are times when things get complicated. Whether it’s changes to your schedule at work or at home, having a trusted advisor to help you navigate those challenges can help students stay accountable and focused. Additionally, when something serious comes up, it helps to have another head to figure things out, so that you don’t lose momentum. 

Choosing the right program

The commitment needed for nurses to embark upon a neonatal specialization requires some reflection to make sure the program you like is right for you. Here are a few things to consider. 

  • Proper accreditation ensures that your school conforms to either the Accreditation Commission for Education in Nursing, ACEN, or the Commission on Collegiate Nursing Education, CCNE. Accredited institutions conform to rigorous education standards and some jobs will require that nurses attend schools with either of these credentials.
  • Remember that tuition costs can be a few hundred dollars per credit or more. Many programs require 40 to 50 credits for completion of a master’s, which turns out to be close to $50,000. Some are fortunate to have employers pay some or all of their tuition costs, but there are those who have to rely on financial aid to help them. On top of that, additional expenses such as course materials, lab fees, and transportation have to factor into the expenses. When choosing the right program for you, make sure to account for all expenses.
  • Part-time, full-time, or accelerated programs can take about three or four years to finish. Remember to factor in your clinical hours to get a better estimate to completion. 
  • Hands-on clinical partnerships or affiliations with nearby hospitals or clinics makes the process of getting your practical much easier. This streamlines the process, so make sure you ask your school if it has those relationships in place.

Top neonatal nursing schools

Here are some of the best institutions for pursuing your neonatal nursing degree and specialization.

Penn Nursing at the University of Pennsylvania offers a neonatal nursing program that prepares students to be leaders in intensive care nurseries and home care settings. They boast that graduates have a high pass rate for the nurse practitioner exam and students get personalized attention. To make fulfilling clinical hours easier, nurses can go to Penn Medicine and the Child Hospital of Pennsylvania.

Vanderbilt School of Nursing has a neonatal nursing program that requires at least two years of experience with levels III newborns. This neonatal nurse practitioner program puts Vanderbilt in the top 10 schools for MSN and DNP programs. It uses a developmental approach to in-depth curriculum content. This is a distance-only neonatal NP program, and the placement office ensures that students find the right experience to fulfill the requirements to get them ready for the career as a neonatal intensive care nurse practitioner.

Arizona State University has an 84-credit neonatal nurse practitioner doctorate, DNP, program. Nurses learn advanced theory and practice as they apply evidence-based practice to create a supportive framework for neonates and their families. The school does its best to arrange clinical hours in the students area, but if that’s not possible students are required to complete their hours in Phoenix.

East Carolina University is one of the top universities for Clinical Nurse Specialist degrees. Nurses take the skills they learn at ECU to lead, collaborate, and apply the advanced practice nursing principles for improving patient care. This school’s 43-semester CNS program prepares nurses to be consultants, educators, and researchers in their neonatal specialization. One of the biggest benefits of pursuing this degree at ECU is that students get matched with a faculty mentor and advisor who helps them to tackle challenges and stay focused.

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