How to Become a Neonatal Nurse
The first few weeks of an infant's life are a time of changes, transitions and challenges unique to this stage of existence. Neonatal nurses are the experts who care for newborns in a nursery setting throughout the first 28 days of their lives. The care that neonatal nurses provide depends upon the baby’s gestational age, method of delivery and overall health, and ranges from intensive care of critically ill neonates to care for infants who are entirely well and only occasionally in the nursery when not sharing a room with Mom and Dad.
Over the past 50 years, advances in medical technology have made it possible for more ill and premature babies to survive and thrive. This has expanded the range of responsibilities for neonatal nurses and the spectrum of care they provide. Neonatal nurses formulate, implement and evaluate care plans for these tiny patients for as long as they require. They administer vaccines, medications and diagnostic tests and operate sophisticated medical equipment such as ventilators, incubators and phototherapy lamps. They also maintain patient records, and support and educate parents about their baby’s unique circumstances and future care requirements. These professionals work as part of a neonatal care team whose membership varies depending upon the needs of the infant.
Most neonatal nurses are staff RNs in hospital neonatal intensive care units, but many also work as advanced practice nurses (APRNs) such as neonatal nurse practitioners (NNPs) and neonatal clinical nurse specialists (CNSs). APRNs have specialized knowledge and may provide direct care to patients, educate staff or conduct research. Regardless of their level of practice, most neonatal nurses believe that there are few undertakings more rewarding than nursing sick infants to wellness and seeing them leave the hospital with parents well prepared for their care.
Back in the days when new mothers and their babies stayed in the hospital for a week or more, most neonatal nurses worked in hospital nurseries—caring for babies while new mothers recovered. Now, with very brief hospital stays and the availability of rooming-in options, the nursing care of healthy babies falls largely to maternity nurses. A small percentage of neonatal nurses do care for healthy babies in level I nurseries that are designed for healthy, full term newborns and late preterm infants without health complications. However, most neonatal nurses of all practice levels work primarily in neonatal intensive care units (NICUs).
Depending on the hospital, NICUs may be defined as level II nurseries, which house premature or sick babies who may need extra time in the hospital for oxygen, medication or special feedings, or level III nurseries, which are designed for the most premature and/or ill babies who need high-tech medical and nursing care. Level II nurseries are typically located in community hospitals, whereas level III NICUs are found in most large metropolitan hospitals or specialized children’s hospitals. Irregular hours and shiftwork (including weekends and holidays) go hand-in-hand with working in a NICU environment.
Some neonatal nurses may work in community settings or in home care where they care for babies transitioning out of the hospital. Working hours are more regular in these settings.
It’s necessary to obtain an undergraduate education before beginning neonatal nursing studies. Community/junior colleges offer associate degrees in nursing (two-year programs) whereas four-year institutions offer bachelor’s degrees (four-year programs). None of these programs offer nursing specialty tracks, but some may have optional neonatal nursing electives available.
Aspiring neonatal advanced practice nurses must complete either a master’s degree or Doctor of Nursing Practice Degree in Neonatal Nursing. These graduate programs are typically two to three years in length.
Nursing training starts during school in skills labs and real-world clinical settings. After graduation, training is provided by the employer, both in classes and in the NICU through a mentorship or preceptor program. This formal training may take six weeks to three months, depending on a nurse’s prior experience. Some facilities may require new nursing graduates to have a year or two of general nursing or maternal nursing experience before working in a NICU. Advanced practice nurses receive intensive training in graduate school and subsequently receive on-the-job training.
Licensing and/or Certification
Following graduation, aspiring RNs must pass the NCLEX examination to receive a state license. Other state-specific requirements for licensure may include background checks and education verification.
Once a neonatal RN has been working for a period of time, she or he may apply for certification through a national certifying body such as the American Nurses Credentialing Center. Being certified means a nurse has demonstrated expertise in a particular specialty, and the process usually involves passing an examination. In most cases, advanced practice nurses must be certified before they begin working.
To maintain licensure and/or certification, nurses must verify active experience and accrue continuing education credits, which are offered by employers or professional organizations.
Necessary Skills and Qualities
Neonatal nurses must have well-honed critical thinking skills to keep up with the rapidly changing health status of a typical NICU patient. Attention to detail is crucial in order to simultaneously manage multiple high technologies. Neonatal nurses need to have patience, compassion and the ability to communicate complex concepts and teach infant care skills to parents from all backgrounds. They have to maintain emotional objectivity when faced with ethically charged situations such as neglect or a patient’s death. Neonatal nurses must also be able to work effectively with a large interdisciplinary healthcare team.
Opportunities for Advancement
Because care of NICU babies involves a great amount of varied and specialized knowledge, neonatal nurses have ample opportunities to branch out. NICU RNs can opt for a graduate education in an advanced practice specialty, or work in leadership, education of families and other staff, or research. APRNs have the option of moving into non-bedside care roles such as university educators, healthcare executives or researchers.
Collectively, RNs in the US have a median annual salary of about $65,000 and make anywhere from $44,190 to $95,130 according to the Bureau of Labor Statistics. Salaries tend to be higher on both coasts and major Midwest cities. Higher educational levels typically translate to higher salaries.
Jobs for all RNs are predicted to grow by about 26% until at least 2020. According to the Centers for Disease Control and Prevention, one out of every eight babies born in the US is affected by prematurity, so there is no shortage of work for neonatal nurses. Employers more often prefer an RN with a bachelor’s degree, experience and certification.
Because of advances in research and technology, the neonatal nursing profession is in particular need of NNPs and CNSs. These professionals have a high level of expertise and an ability to contribute valuable knowledge and services to the neonatology specialty.