NICU Nursing Careers
The very first neonatal intensive care unit (NICU) in the U.S. was formed at Yale-New Haven Hospital in 1960. Prior to that, sick or premature newborn infants were cared for by nurses in nurseries or pediatric areas. Today, however, NICUs can be found at practically any general care hospital, and NICU nursing has grown into a profession that requires a specific set of knowledge and sophisticated skills.
Most NICU nurses work as staff RNs. They are responsible for total nursing care of infants who may be diagnosed with congenital defects, delivery complications, or most often, prematurity. They formulate nursing care plans; and assess, plan, implement and evaluate the effectiveness of treatments in these plans. On a daily basis they administer medications, perform complex procedures, work with complicated technology, and consult with an interdisciplinary healthcare team to coordinate all aspects of a patient’s care. In the midst of all these tasks, they comfort their patients, and educate and reassure families.
With the evolution of the NICU specialty, careers for advanced practice registered nurses (APRNs) have proliferated. Neonatal nurse practitioners (NPs) work in conjunction with a multidisciplinary team to assess, diagnose, initiate medical treatment orders, and perform procedures. They may also conduct research, act as consultants and educate other nurses and health professionals. Neonatal clinical nurse specialists (CNSs) may also provide some direct patient care; but more often they act as consultants, educators, researchers or administrators. Their primary role is to evaluate and improve nursing care and fine-tune NICU-specific hospital policies and procedures.
NICU nurses may work in one of two types of NICUs. Level II NICUs are designed for less critically ill infants, who may require breathing assistance, help with feedings, or special medication. These units are usually found in community hospitals. Level III NICUs are located in large medical centers and general-care children’s hospitals, and house infants who need the most high-tech and sophisticated care. RNs who work as staff nurses in Level II NICUs may care for up to three or four patients at a time; whereas in Level III NICUs the nurse-to-patient ratio is usually 1:1 or 1:2. Regardless of the NICU level, crying infants, noisy machines, and the presence of doctors, specialists, therapists, ancillary staff, administrators, and family members make for a somewhat noisy and busy working environment.
Most NICU staff RNs work shifts that are 12 hours in duration, although some may work eight-hour shifts. They may be required to work days, evenings, nights or a combination of all three. Working weekends, holidays and overtime also comes with the NICU territory. APRNs work primarily during the day, but their presence and expertise may be required at any time.
A college degree is required to be an RN. While it is possible to work as a staff NICU RN with a two-year associate’s degree from a community college, employers prefer nurses with four-year bachelor’s degrees to work in this highly specialized environment.
APRNs are educated in graduate programs that take two or three years. Most of these programs result in a master’s degree, but according to the American Association of Colleges of Nursing, many are changing to Doctorate of Nursing Practice (DNP) programs and a DNP may eventually be the standard terminal degree for all APRNs.
Before working in a NICU, most nurses need some prior experience and training in a general pediatrics area or another ICU setting. The mastery of basic nursing skills is essential to adapting to the fast pace and complexity of a NICU. Training for NICU nurses is provided on the job, with six to eight weeks as a typical training duration. Some NICUs may hire new nursing graduates (especially those with bachelor’s degrees) and in that case, training may take three months or so. All new NICU RNs are trained by nurses with solid NICU experience.
APRNs are trained in graduate school, but employer-specific training is usually necessary for several weeks under the guidance of another APRN or a nursing supervisor.
Licensing and/or Certification
After successful completion of a nursing educational program, nurses need to pass the state-administered NCLEX examination to get their registered nursing license. An RN license is necessary before starting work and it is also a prerequisite for entry into an APRN program.
Staff NICU nurses have certification options through several organizations including the American Nurses Credentialing Center. Eligibility for certification is possible after a few years of NICU experience and successful completion of an exam. APRNs have mandatory certification requirements for employment eligibility.
Necessary Skills and Qualities
NICU nurses must be skilled observers of infant behaviors and know how illnesses affect patients and families. They must also posses the following qualities and skills.
- Be fast analytical thinkers in order to make appropriate treatment decisions and deal effectively with emergencies.
- Have well-developed stress management skills as NICU work is demanding and can be rough on the psyche—especially when a nurse has to deal with a poor prognosis, a patient’s death or cases of neglect and abuse.
- Be flexible because a nurse’s patient caseload may change from day to day.
- Be skilled communicators and educators, particularly when teaching families how to care for an ill infant.
- Pay attention to detail—precise documentation is a large part of NICU nursing, and sometimes adding special touches to a care regimen can bring great comfort to patients and their families.
Opportunities for Advancement
With some experience behind them, NICU staff nurses may become charge nurses or supervisors. With additional education they may move on to specialty nursing roles within the NICU such as discharge planners or advanced practice nursing careers.
APRNs may choose to subspecialize in a particular type of neonatal care such as cardiology, respiratory illnesses or prematurity. They may take their NICU experience with them and go into education, research, consulting or healthcare administration.
The median yearly salary of U.S. RNs was about $65,000 in 2010. The salary range can be anywhere from $44,190 to over $95,130. APRNs are compensated at the higher end of that range, and staff NICU RNs tend to make a little more than nurses in non-specialized care. Staff nurses with bachelor’s degrees are usually compensated more than nurses without this degree.
According to the U.S. Department of Labor, the registered nursing profession will experience a 26% growth until at least the year 2020. This is due in part to a large number of nurses who are expected to retire. NICU nursing careers at all levels will be readily available due to the fact that NICUs across the U.S. are expanding to meet the need for care of infants who have better chances of survival than in previous years.