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; the neonatal period is considered to be the first 28 days of an infant’s life, but neonatal nurses may work with babies for much longer. The care that a neonatal nurse provides depends upon the baby’s gestational age, the method of delivery, and the infant’s overall health. Nursing care ranges from intensive care of critically ill neonates to monitoring infants who are entirely well and who are only occasionally in the nursery when they are 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. These changes have 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. They administer vaccines and medications, assist with diagnostic tests, and operate sophisticated medical equipment such as ventilators, incubators and phototherapy lamps. They also maintain patient records and provide support and education to parents regarding their baby’s unique circumstances and future care requirements.
Most neonatal nurses are registered nurses who work in hospital nurseries or neonatal intensive care units. These nurses have experience and specific training to meet the particular needs of infants. Many neonatal nurses also work as advanced practice registered nurses (APRNs), such as neonatal nurse practitioners (NNPs) and neonatal clinical nurse specialists (CNSs). Advanced practice registered nurses 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 their parents.
Historically, new mothers and their babies stayed in the hospital for a week or more after delivery. Most neonatal nurses worked in hospital nurseries, caring for babies while new mothers recovered. Today, 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 care for healthy babies in level I nurseries that are designed for healthy, full-term newborns and for babies born between 34 and 37 weeks’ gestation – known as late preterm infants – without health complications. However, most neonatal nurses work primarily in neonatal intensive care units (NICUs). Depending on the hospital, a NICU may be defined according to different levels.
- A level II nursery houses premature or sick babies who may need extra time in the hospital for oxygen, medication or special feedings. These babies are expected to recover and go home within a few days or weeks. Level II nurseries are often located in community hospitals and in smaller facilities.
- Level III nurseries are designed for premature and ill babies who need high-tech medical and nursing care, including specialized respiratory support and care of critical illness.
- Level IV nurseries provide care for the most complex conditions; they offer the services of level II and III nurseries, but may also include surgical care and transport of critically ill infants.
Level III and IV NICUs are found in most large metropolitan hospitals or in specialized children’s hospitals. A nurse who works in a NICU can expect irregular hours and shift work (including weekends and holidays) to accommodate the needs of the babies in her care.
Some neonatal nurses may also work in community settings or in home care situations where they care for babies who are transitioning out of the hospital. They may meet with families in their homes and provide education to parents who are getting ready to bring their babies home from the hospital. The work hours in these settings are typically closer to normal business hours.
It is necessary to obtain an undergraduate education before beginning neonatal nursing studies. Community colleges offer associate degrees in nursing, which are usually two-year programs, whereas university-level institutions offer bachelor’s degrees, which are 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 a Doctor of Nursing Practice Degree in Neonatal Nursing. Current standards state that nurses who want to become APRNs need only to complete a master’s degree program; however, the American Association of Colleges of Nursing (AACN) has recommended that students who want to practice advanced nursing achieve a Doctor of Nursing Practice (DNP) degree. The transition to making the DNP a requirement for all students in all programs is still in process. There are many programs available that offer both master’s and doctoral degrees in 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 through 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 and facility requirements. Some facilities may expect 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 then further training after graduation and while working.
Licensing and/or Certification
Following graduation, aspiring RNs must pass the National Council Licensure Examination (NCLEX) to receive a state license. Other state-specific requirements for licensure may include background checks and education verification. Some neonatal nurses are required to gain specialty certification as part of their employment. For example, a hospital that employs neonatal nurses to work in the NICU may require that all nurses have extra certification in neonatal advanced life support training.
Once a neonatal RN has been working for a period of time, she may apply for certification through a national certifying body such as the American Nurses Credentialing Center (ANCC). Being certified means that a nurse has demonstrated expertise in a particular specialty. The certification process usually involves demonstrating that she has worked a certain number of hours within the specialty and then has passed 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 must accrue continuing education credits, which are offered by employers or professional organizations. The number of continuing education credits required in order to maintain licensure varies from state to state.
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 manage various technologies and equipment needed for infant care. Neonatal nurses need to have patience, compassion, and the ability to communicate complex concepts, and they must be able to 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 within their field. Neonatal RNs can opt for a graduate education in an advanced practice specialty. Alternately, they may work in leadership, education of families and other staff, or in research. Advanced practice nurses have the option of moving into management roles such as university educators, healthcare executives or researchers.
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Collectively, RNs in the US have a median annual salary of about $66,640 and can earn anywhere from $45,880 to $98,880 yearly, according to the Bureau of Labor Statistics (BLS) as of May 2014. Salaries tend to be higher on both coasts and in major Midwest cities. Higher educational levels typically translate to higher salaries.
Neonatal nurses who become APRNs will enjoy higher salaries. The BLS reports that nurse practitioners make a median salary of $95,350.
The Bureau of Labor Statistics predicts job growth of 19% for all RNs and growth of 34% for nurse practitioners between 2012 and 2022, which is faster than average. 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 a neonatal 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.