Pursuing a Career as a Neonatal Nurse: Everything You Need to Know

Nurses who choose to work in the neonatal intensive care unit (NICU) have a tough job. As in any intensive-care unit, patients have serious medical conditions, such as cardiac and other organ malformations, congenital disabilities, and infections. But because the patients are neonates, they can also suffer many complications related to premature birth, and their condition is especially fragile.

On any given day, a NICU nurse may have to place an IV line or a breathing tube into a critically ill patient no larger than an outstretched adult hand or change dressings on a newborn who has been placed in a medically-induced coma.

When you become a NICU nurse, you’ll work with some of the sickest newborns and infants. Most will eventually be discharged in the arms of happy parents. Some will not. It’s not a job for everyone, but if you think you’re up to the challenge, keep reading.

In this article, we’ll cover:

• What is a NICU nurse?
• What makes NICU nurses special
• What NICU nurses do
• The education needed to become a NICU nurse
• Advancement opportunities for NICU nurses
• The average neonatal nurse salary
• Is becoming a NICU nurse the right career for me?

What is a NICU nurse?

An NICU nurse’s specialty is defined not by what they do, but by who their patients are. When you become a NICU nurse, you’ll work primarily with patients who are admitted at birth or soon after birth. Many babies in the NICU are newborns, though it’s not unusual for patients to be monitored and treated in the neonatal unit for weeks or even months before discharge. That means that you may have patients as young as a few hours old and patients who are a few months old. When a long-term NICU resident reaches their first birthday, they are usually transferred to the pediatric intensive care unit (PICU). As a result, it’s unusual for NICU nurses to care for patients who are more than twelve months old.

Premature babies make up the majority of the NICU patient population, so most NICU nurses spend their time caring for preemies. Depending on the level of the NICU (more on that below), premature babies may simply need to be monitored as they learn to eat, grow, and breathe—as is the case with most preemies born at 33 weeks or later. Or, if they were born at the edge of viability or very sick, they may require complex medical interventions just to survive from day to day. Given that, the day-to-day duties of NICU nurses can look very different from one hospital to the next.

What makes NICU nurses special

Like many hospital departments that treat critically ill patients, neonatal intensive care units are open 24 hours a day, seven days a week. Most NICU nurses work 12-hour shifts; chances are their shift schedules include some nights and weekends.

It’s a demanding specialty for other reasons. The busiest NICUs at large private and public hospitals in metro areas can have hundreds of patients housed in large, loud, open spaces. In ideal conditions, NICU nurses work with only a few babies at a time—and nurses caring for the sickest infants and the smallest preemies may only have one patient to care for during a shift.

When you become a NICU nurse, babies will be your primary patients, but those babies will have families. You’ll be responsible for caring for those families as well as for their children. Neonates cannot talk, advocate for themselves, or approve procedures, so NICU nurses must work closely with moms, dads, and other caregivers to provide comfort and essential information. Many neonatal nurses (especially those who work with babies who spend months in the NICU) form lifelong bonds with families.

It takes more than just medical skills to work in this environment. The neonatal intensive care unit can be fast-paced and stressful on some days, while other days, it’s all about waiting (because time is often the best healer for premature birth). The most successful NICU nurses are the ones who can handle both extremes, who can compartmentalize their feelings, and who don’t bring too much of their work home with them. Babies will have their bad days, and the worst of those days will involve saying goodbye to patients far too soon. Be sure you can deal with that before you choose this career.

What NICU nurses do

• NICU nurses provide care for premature, sick, or critically ill newborns and infants
• They monitor their patients, administer medicines as necessary, treat wounds, record progress, and confer with doctors and specialists
• They also feed babies, hold them, interact with them, and calm them when they’re in distress
• As a baby’s discharge day approaches, NICU nurses may spend time with parents or other caregivers, teaching them how to care for their babies at home

NICU nurses have different duties depending on what level of neonatal care they work in:

• Nurses in Level 1 NICUs care for relatively healthy babies—usually those born a little bit early (35 to 37 weeks) and healthy. They may help stabilize babies who are born at less than 34 weeks or born sick, so they can be transferred to a hospital with a higher-level NICU.
• Nurses in Level II NICUs (sometimes called special-care nurseries) care for ill newborns and smaller preemies who need breathing support, feeding support, and specialty medications and treatments.
• Nurses in Level III NICUs care for preemies born at less than 32 weeks and babies born with severe health issues. There are specialists in Level III NICUs, along with much more advanced breathing support systems.
• Nurses in Level IV NICUs care for the sickest and smallest babies. Babies who require specialty surgeries, high-frequency ventilation, extracorporeal membrane oxygenation, pediatric anesthesiology, or other specialty care are admitted to advanced care NICUs.

Education needed to become a NICU nurse

To become a NICU RN, you need to earn a bachelor of science in nursing (BSN). While there are nurses with associate’s degrees in nursing who work in the NICU, most hospitals prefer to hire RNs with a bachelor’s degree in nursing plus some minimum number of years of clinical experience. Most BSN programs take four years to complete on a full-time basis, though nurses who have already completed an ADN can apply to RN-to-BSN programs that take less time.

There are no specific neonatal nursing programs at the undergraduate level, but some of the best undergraduate nursing degree programs can be found at:

• University of Massachusetts – Amherst
• University of Pennsylvania
• Johns Hopkins University
• University of California – Irvine
• Duke University
• University of North Carolina at Chapel Hill

Once you’ve graduated from a bachelor’s degree program and have passed the NCLEX-PN exam, you’ll be eligible to apply for your nursing license from your state board of nursing.

Certifications to become a NICU nurse

Certification isn’t necessary to begin working in the NICU, but experience is. Many nurses begin their careers in pediatric nursing, maternal-child nursing, or in labor and delivery nursing.

That said, you can increase your chances of finding work in and out of the NICU by getting the following certifications:

• Basic Life Support (BLS)
• Advanced Cardiovascular Life Support (ACLS)
• Neonatal Resuscitation Program (NRP)

You’ll need two or more years of clinical experience working with neonatal patients before you can get one of the following specialty-specific certifications:

• The critical care neonatal nursing certification via the American Association of Critical Care Nursing
• The RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC) via the National Certification Corporation

Other certifications for NICU nurses include the neonatal pediatric transport certification, the Neonatal/Pediatric Respiratory Care Specialty (NPS) certification, and the low-risk neonatal care certification.

Advancement opportunities for NICU nurses

After becoming a NICU nurse, you may want to become a neonatal nurse practitioner (NNP). To qualify for an NNP master’s degree program, you’ll need at least two years (550 to 1,000 hours) of experience working in a Level II, III, or IV NICU. Look for two-year MSN or three-year DNP programs that offer students the opportunity to specialize in neonatal nursing.

Three of the top schools for neonatal nursing master’s degree candidates are the University of Pennsylvania, Vanderbilt University, and Arizona State University at Tucson. Once you have earned your MSN (or DNP), you can get your Neonatal Nurse Practitioner Core Certification.

The average neonatal nurse salary

According to PayScale, the average neonatal nurse annual income is about $63,000 per year. That doesn’t mean you’ll necessarily earn that much when you become a NICU nurse. You may earn more or less depending on how much nursing experience you have, whether you’re an RN or an NNP, and the state where you work. PayScale gives a salary range for NICU nurses between $44,000 and $100,000. Nurses in Los Angeles, CA and Houston, TX, earn the highest salaries, while NICU nurses in San Antonio, TX, and Orlando, FL, earn the least. Chances are that you will make more money working in a Level IV NICU at a large, well-known hospital than in a Level II NICU at a small community hospital.

Is becoming a NICU nurse the right career for me?

As noted above, this career has its challenges. Babies can be a joy to work with, and the gratitude expressed by families when their discharge dates approach is priceless. But babies in the neonatal intensive care unit can develop complications quickly and without any warning, so NICU nurses have to be 100 percent alert and responsive for the entirety of their long shifts.

When you become a NICU nurse, you’ll also need to have a bottomless supply of compassion. The parents of the babies in your care will be scared, stressed, and sad—and those emotions may emerge in all kinds of ways. In other words, they may not always be at their best, and you need to be able to convey important information in ways they can understand in their worst moments.

In NICU nursing, you may end up dealing with complicated ethical issues. When a family and their healthcare team has to make the decision whether to let go of a critically ill baby who is no longer responding to treatment, you may end up disagreeing with a family’s assessment… or a doctor’s. It won’t be your decision, but a family may look to you for support at that moment or ask for your advice.

Ultimately, to thrive as a registered nurse in the NICU, you need to be able to handle stress and pressure without succumbing to it. This is definitely one of the most emotionally taxing nursing specialties, and you won’t survive in it if you don’t prioritize self-care. If you have what it takes, though, the rewards of your work will outweigh the tough stuff. Many families who’ve come out on the other side of the NICU journey will stop by on holidays or their babies’ discharge anniversaries to say hello or to drop off treats, and there’s nothing quite like seeing how much those babies have grown thanks, in part, to your care.

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