Neonatal nursing is a branch of healthcare that focuses on providing care for infants who were born prematurely, or are suffering from health problems such as birth defects, infections, or heart deformities. Neonatal nurses are registered nurses who specialize in working with these young, vulnerable patients. Many neonatal nurses work in Neonatal Intensive Care Units (NICU), providing highly specialized medical care to at risk newborns. This guide offers details of the profession, including the needed education, skills and credentials, an interview with someone who has worked in a neonatal unit, and what students can expect in terms of salary and job growth after graduating from a neonatal nursing program.
What Does a Neonatal Nurse Do?
Neonatal nurses work primarily with infants less than one month old, though they might work with children up to toddlerhood. Many of their patients are transferred to the NICU due to premature birth or significant medical conditions. Neonatal nurses are highly trained in the finer points of caring for infants, including special procedures for intravenous infusions, blood draws, and oxygen administration.
Did You Know?
A small bump in education could translate to a serious bump in pay for neonatal nurses. According to Payscale, neonatal nurses made a median salary of $59,598, while neonatal nurse practitioners earned $92,259.
Neonatal Nurse Salaries
Salary Guide
The work of a neonatal nurse is very valuable; indeed, infants in precarious medical situations depend on their expertise for survival. Though rewards go far beyond money, financial incentive is still a consideration for those who are intending to pursue this career. While the Bureau of Labor Statistics does not report data specifically on neonatal nurse incomes, it does provide information for general nursing occupations. As of May 2014, the median annual income for registered nurses was $66,640, while those in the 90th percentile earned $98,880 annually. Individuals who earn certifications or an advanced degree can potentially earn even more.
In addition to their level of training and experience, neonatal nurses might find varying salaries based on geographical location. The list below highlights the top five states where nurses earned the highest incomes in 2014:
- California
- Hawaii
- Massachusetts
- Alaska
- Oregon
Steps to Becoming a Neonatal Nurse
- Diploma programs offered by hospital-based schools
- Associate degrees offered by community colleges
- Bachelor's degrees at a four-year colleges or universities
Neonatal Nursing Degrees by Level
Working as a neonatal nurse offers many rewards, especially the satisfaction of helping defenseless infants become healthy and strong. In order to reach this point, students must first earn a registered nursing credential. Three routes exist, including diplomas, associate degrees, and bachelor's degrees in nursing.
The nursing diploma is usually offered in a hospital setting and can take one to two years to complete. Those considering this option should be aware that the competition for nursing positions has led many employers to seek out applicants who have earned a higher level of education. Many nursing associations are calling for nursing diplomas to be phased out as a path to becoming a registered nurse.
Below is an overview of the associate, bachelor's, and master's degrees in nursing, the skills and knowledge gained during the pursuit of the degree, the curricula a student may expect to undertake, and the potential career advantages each degree level offers.
Associate Degree in Nursing
The associate degree in nursing typically takes two years to complete and includes a blend of classroom instruction and clinical training. After finishing their degree and becoming licensed, graduates can move directly into work as a registered nurse. Once obtaining a nursing position, they can begin training for a neonatal unit, maternity floor, or other opportunities leading to work as a neonatal nurse.
This degree level typically includes general education courses forming a firm foundation for more advanced nursing courses. Classes focus on the basic knowledge and skills an individual will need to step into the role of registered nurse. The table below illustrates a few common courses from associate degree programs around the country.
Introduction to Nursing Practice
Focuses on the basics of nursing practice, caring for anyone from the neonate to the geriatric; includes basic assessment and practical skills.
Skills & Knowledge Gained
-
Ability to conduct assessments and identify problems in patients of varying ages -
Development of practical skills forming the basis of nursing
Maternal Newborn Nursing
Studies focus on the maternal newborn population, including working with mothers and families, newborns (including those with health issues), and the transition from hospital to home.
Skills & Knowledge Gained
-
Foundational understanding of working with mothers and infants -
Understanding of maternal health and risk factors, neonatal health issues, and family security
Pediatric Nursing
Focuses on caring for young children, including assessments, common health problems, dysfunctional health patterns, basic interventions, and outreach for parents, siblings, and other family members.
Skills & Knowledge Gained
-
Familiarity with most common health issues in young children and how to solve them -
Awareness of when potential interventions may be needed for more serious issues -
Ability to communicate with families of injured or sick children
Basics of Pharmacology
Studies highlight pharmaceutical use in hospital settings, including proper dosages, common drugs, potential interactions and adverse effects, and administration routes.
Skills & Knowledge Gained
-
Ability to identify and use common pharmaceuticals in hospital settings -
Understanding of dosages and proper drugs for specific illnesses, injuries, and body weights -
Awareness of adverse effects or possible drug interactions
Bachelor of Science in Nursing
A bachelor's degree builds on associate level coursework, providing more in-depth classes and a greater focus on advanced skills and knowledge. The bachelor's degree also forms a solid stepping-stone for those who want to eventually earn a master's degree.
In addition to general education courses, bachelor's level nursing programs prepare students for the rigors of working in a variety of healthcare settings, including hospitals, private practices, and community clinics. Those who plan to work as neonatal nurses can tailor their courses to include electives focused on pediatric and infant care.
The course descriptions below describe actual classes offered by Bachelor of Science in nursing programs across the country, giving potential students an idea of what to expect during their education.
Introductions to Research
Focuses on research methods used in professional healthcare settings, evidence-based practice, theoretical and conceptual grounding of research, research design, and how to integrate findings into clinical work.
Skills & Knowledge Gained
-
Development of research skills, including assessment and how to create and track research projects -
Ability to implement research findings into clinical practice
Foundations of Genetics and Genomics
Covers genes and the human genome, including the environmental influences that might change them. Specific studies of ethical, legal, moral, and social implications in health care are also provided.
Skills & Knowledge Gained
-
Foundational understanding of genetics and the human genome -
Application of knowledge in the assessment and study of infants in NICU -
Understanding of ethical or moral issues arising due to genomic or genetic manipulation
Maternal Fetal Nursing
Focuses on the health of mothers during childbearing years, as well as family-centered nursing care before, during and after pregnancy; includes the health potential of newborns, handling basic health issues, and conducting assessments.
Skills & Knowledge Gained
-
Knowledge of maternal health and how it affects the neonate -
Ability to identify potential health factors requiring NICU admission -
Understanding of family-centered approach to healthcare for benefit of mother and child
Leadership and Management in Nursing
Focuses on critical decision-making, working closely with other leaders in healthcare settings, prioritizing and delegating, communication skills, and becoming valuable members of a professional nursing team.
Skills & Knowledge Gained
-
Understanding of what it takes to be a great nursing manager and leader -
Ability to implement skills and knowledge appropriately -
Development of confidence to be leaders in their field
Master's Degree in Nursing
Master's degrees in nursing are popular options for those seeking opportunities for advancement and higher earning potential. Programs typically take two to three years to complete, depending upon how much time a student is able to devote to their studies. Most graduate degree level students are working full-time, making online programs a popular option.
Below is a brief list of courses students may encounter during a master's program in nursing. These classes are typically offered in traditional settings, online platforms, or hybrid programs.
Advanced Neonatal Health Assessment
Focus on how to perform an accurate gestational age and health assessment, including pertinent data to collect, identification of potential diagnostic tests necessary, and taking parental health histories.
Skills & Knowledge Gained
-
Understanding of what constitutes serious health issues for newborns -
Ability to assess findings that deviate from normal
Neonatal Physiology
An in-depth view of human genetics, development and developing body systems, with studies from the embryonic stage to the neonate. Environmental and genetic factors are examined, including their corresponding outcomes.
Skills & Knowledge Gained
-
Understanding of factors leading to neonate problems, including environmental, maternal, or genetic influences -
Knowledge of long-term effects of such factors
Advanced Neonatal Pharmaceuticals
Discussion of the various drugs and pharmaceutical interventions suitable for neonates and small children, including varied reactions to certain drugs, correct drug choices, and routes of administration.
Skills & Knowledge Gained
-
Knowledge of how certain drugs affect neonates -
Ability to choose correct drugs and properly administer them
Essential Components of the NICU
A study of the practical applications of nursing knowledge in NICUs, including essential nursery skills, resuscitation, assessment, and laboratory analysis.
Skills & Knowledge Gained
-
Development of basic NICU skills, including procedures commonly used for neonates and those with perilous health problems -
Ability to apply practical knowledge in clinical practice
Doctorate Degree in Nursing
There are four doctoral options for those interested in neonatal nursing. These include:
-
Doctor of Nursing Practice (DNP)
This is a practical degree offering nurses the opportunity to hone their skills to provide better care for NICU patients.
-
Doctor of Nursing Philosophy (PhD)
This degree is rooted in research, allowing students to gain the skills and knowledge necessary to move into positions at research universities and hospitals.
-
Doctor of Nursing (DN)
This degree is ideal for those who want to focus on a very specific point of nursing, such as specialist skills in neonatal care.
-
Doctor of Nursing Science (DNSc)
This degree has a strong focus on investigative and research skills, and is designed for those who want to work with or lead research teams.
Students who have already earned a master's degree and have several years of experience working in a neonatal unit may decide to pursue a doctoral program. Those who want to work as hands-on neonatal nurses can earn the DNP or the DN with an emphasis on neonatal care, preparing them to work in the best NICU units in the country.
Graduates of doctoral programs in nursing will have strong skills and deeply rooted knowledge, honed over years of experience and educational study. Some of the most common skills students can expect to master during a doctoral program are highlighted below.
Understanding of illness trajectory
Students learn to assess research and translate findings into action. Understanding the course of illness in an individual and in various populations allows nurses to be better prepared to administer proper treatments and assessments.
Collaborative skills
The leadership and management skills of a doctoral graduate are finely tuned, giving them the excellent skills to work effectively with those in the highest levels of research and administration.
Leadership
Students who graduate from either a DNP or PhD program will possess a deep knowledge of research and the methods behind it, allowing them to work with research teams focused on new techniques, medications, and practices that benefit children in NICUs.
Ability to implement healthcare changes
An advanced education in nursing enables graduates to spot issues in the healthcare system at both micro and macro levels. Not only will graduates know how to identify these issues, they will also have the skills and knowledge needed to implement change.
Expertise with neonatal tools and technology
Doctoral graduates possess a deeper understanding of how to use tools specific to the neonatal unit and typically have an awareness of emerging technologies gaining a foothold in the hospital community. These skills will allow them to teach others how to incorporate advances as they become available.
Neonatal Nursing Online Schools
When choosing a neonatal nursing program, it is very important to narrow down the field with intelligent, clear criteria that ensures a beneficial educational experience. Online schools offer the same high-quality education as brick-and-mortar institutions, but should be held to the same standards as their traditional counterparts. The following points are very important when seeking out any neonatal nursing program, but especially when choosing from online opportunities.
Faculty with Experience Specific to Neonatal Nursing
When learning something new, it pays to learn from the best. It is vitally important to ensure nursing faculty members are highly trained in specific neonatal issues and have extensive experience in the NICU. Look for faculty with past or current experience helping neonates, those who have penned in-depth research papers on neonatal issues, and those who are well known in the field for their contributions to the advancement of neonatal research or practice. These highly trained individuals not only provide a fantastic learning experience, they can also be great assets for networking upon graduation.
Licensure Preparation Courses
A nurse must be licensed in order to practice, and many schools offer great courses that prepare students for questions they will likely encounter on the NCLEX-RN examination. Courses should provide in-depth preparation for the licensure test and highlight any additional state-specific requirements. Students should seek out schools that incorporate NCLEX-RN prep into the curriculum or offer supplemental courses that review necessary points of taking this particular examination.
NCLEX-RN Examination Passage Rates
When a student attends a nursing program, they should graduate with the knowledge and skills necessary to pass the licensing examination and become a registered nurse. Not all schools are created equal, and some may have much higher examination passage rates than others. Information about the passage rates of a particular school can be found either on their website or by calling the admissions office. The higher the passage rate, the more likely it is that the program has suitably prepared its students.
Concentrations in Neonatal Nursing Care
Most nursing programs provide a variety of electives within the nursing field, allowing students to concentrate their knowledge in a particular area. Potential students should review the course catalog to ensure the portfolio of electives available include neonatal topics. While associate and bachelor's level degrees may only offer electives in neonatal nursing, master's and doctoral programs should have a spectrum of electives available in this area. Students should strive to find the school best matched to their goals, and that includes a strong emphasis on neonatal courses.
Components of a Successful Career as
a Neonatal Nurse
Skills
Neonatal nurses should have excellent time management, as they might be working with more than one infant at a time. They should be able to communicate clearly with their colleagues, and be able to provide health updates to parents and family members who may not understand medical terminology. Other top skills include attention to detail, sound judgment and decision-making capabilities, critical thinking, and the ability to teach parents how to best care for newborns facing medical issues.
Credentials
Professionals looking to enhance their knowledge and skill sets have numerous credential programs available to them, including those offered by the National Certification Corporation. A few of the top neonatal certifications are listed below:
- Neonatal Intensive Care
- Neonatal Nurse Practitioner
- Low Risk Neonatal Nursing
- Maternal Newborn Nursing
- Electronic Fetal Monitoring
- Neonatal Pediatric Transport
- Inpatient Obstetric Nursing
- Women's Health Care Nurse Practitioner
In order to gain certification, applicants must pass an examination and complete a set number of continuing education credits.
Tools and Technology
Neonatal nurses are expected to be agile users of common tools needed in the NICU, including tiny versions of typical instruments. They should also be proficient in the specific technologies used in the field. A list of the most common tools and technologies is given below:
| Medical Instruments | Blood pressure cuffs, oxygen administration devices, intravenous catheters, fetal monitoring units, infant feeding supplies |
| Medical Software | IDX Systems; Misys Healthcare Systems, Siemens, and Epic programs; Microsoft Office Suite |
Suzanne Lefever, MS, RN, CRNP, is an associate professor of nursing at Cedarville University. She also has extensive experience in the NICU unit. We asked her to share her story of becoming a neonatal nurse, and what the profession has taught her.
What led to your decision to become a neonatal nurse?
During my student OB rotation, my clinical instructor was very passionate about that area of nursing and her passion was contagious. I was interested in critical care, pediatrics, and obstetrics, and the NICU was a way to combine all those interests.
What educational path did you take to become a neonatal nurse?
My educational path began with a BSN (Bachelor of Science in Nursing) from Goshen College. There was a woman that had mentored me in high school and as a diploma prepared nurse, she was adamant about the need to go to college and obtain a bachelor's level education. She was definitely before her time in realizing the trend of further education in the nursing profession. I worked as a registered nurse for about seven years (six in the NICU), before attending Georgetown University Medical Center for my neonatal nurse practitioner certification. I completed my masters of nursing at SUNY Stonybrook. I worked as an NNP for ten years and then transitioned into academia as a faculty member of the BSN program at Cedarville University.
What were some of your favorite courses and why?
I definitely enjoyed my science classes, particularly anatomy and physiology, and understanding the way the body is created and functions, and what goes wrong with diseases. The clinical courses in nursing are the real highlight, and also being able to focus on a particular area such as medical surgical nursing, intensive care, psychiatric, and pediatrics. There is something to take away from each area, even if it isn't of real interest. As BSN nurses, we are taught to see the big picture, care for patients holistically, and think critically.
What did your day-to-day work as a neonatal nurse entail?
The day-to-day work depends on the level of NICU the nurse is stations. Level One is well baby, while those in Level Four require life sustaining measures, long term care, surgery, and advanced technology. The more premature a baby is or the more critically ill, the higher level of advanced care will be required. Most people think about neonatal nursing from the perspective of critically ill neonates.
The working day begins with reports from nurses on the previous shift. Report includes the history, current condition, changes, needs, and family involvement, as an example. The nurse then assesses the neonate, including hands on care, listening to heart and lungs, and performs a complete physical assessment. This establishes a baseline to know the neonates condition and identify any problems, new or ongoing. As the shift continues, the nurse performs procedures such as starting an IV, giving medications, drawing blood samples, adjusting oxygen levels, and feeding the baby.
Any changes or needs are reported to the doctor or nurse practitioner, and everyone works together as a team. Parents come and go and the nurse is key in educating them, communicating with them, and always facilitating their role as the parent. It also means preparing them for taking the baby home while being realistic about the baby's condition.
In addition to caring for the babies assigned to them, the nurse may assume other responsibilities, such as attending deliveries to care for a newborn immediately after birth in the case of potential problems. Some nurses also function as transport nurses, traveling to other hospitals to stabilize and transport a sick baby back to their hospital's NICU for more advanced care. The shift ends the way it began, by documenting changes in the medical record, and giving report to the next nurse assigned to the baby.
Do you have any advice for students interested in becoming a neonatal nurse?
I would encourage all future nurses to get their bachelors degree, at a minimum. As students go through nursing school, they often wonder why they have to learn so many different things when they only want to be a neonatal nurse. Any degree leading to the registered nurse license is considered a generalist degree, meaning students receive a well-rounded knowledge base of multiple issues across the entire life span. They are prepared to assume a role focused on health promotion or acute care for critically ill and everything in between.
Nurses wanting to specialize in any specific setting, such as neonatal care, will want to seek out any additional opportunities in that specialty while in school. These may include volunteering, applying for a summer externship after the clinical rotations have started, or requesting assignment in the specialty area during the final clinical before graduation. New nurses starting in a NICU will receive an extensive orientation with ongoing, on-the-job education and training.
Job Growth Projections
Those who plan to work as a neonatal nurse can expect robust job growth in the coming years. The BLS reports employment growth of 19 percent for registered nurses and 31 percent for advanced practice nurses from 2012 to 2022. For neonatal nurses, an increased number of mothers having children at an advanced age could spur much of the expansion. Other factors include an increased use of fertility treatments resulting in multiple births and the advancement of technology making it more likely that premature infants will survive.
Though neonatal nurses are needed in hospitals all across the United States, some parts are showing more demand than others. The following areas are expected to offer the highest rates of employment expansion from 2012 to 2022.
Related Careers in Healthcare
There are numerous occupations in the field of healthcare that could be appealing to those with an eye toward neonatal nursing. These related occupations allow individuals to help people, be engaged members of the medical profession, and potentially work with infants and their families.
Licensed practical vocational nurse
Salary
$42,490
Education and Training:
Post-secondary non-degree award
Nurse practitioner
Salary
$95,350
Education and Training:
Master's degree
Nurse midwife
Salary
$96,970
Education and Training:
Master's degree
Registered nurse
Salary
$66,640
Education and Training:
Associate degree
Diagnostic medical sonographer
Salary
$67,530
Education and Training:
Associate degree
Physician assistant
Salary
$95,820
Education and Training:
Master's degree
EMT/paramedic
Salary
$31,700
Education and Training:
Post-secondary non-degree award
Physical therapist
Salary
$82,390
Education and Training:
Doctorate
How Much Do Other Nurses Earn?
Neonatal nursing is only one of several occupations involved in the care of mothers and newborns. The following related careers could be of interest to those who wish to enter the healthcare field, but not necessarily as a neonatal nurse.
Neonatal Nurse and Related Job Salaries
Additional Resources
- How to Become a Licensed Practical Nurse
- How to Become a Nurse Practitioner
- How to Become a Pediatric Nurse
- How to Become a Registered Nurse
- How to Become a School Nurse
- How to Become a Travel Nurse
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