NICU Nursing Careers
The very first neonatal intensive care unit (NICU) in the United States was formed at Yale-New Haven Hospital in 1960. Prior to its opening, sick or premature newborn infants received care from 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 registered nurses. They are responsible for total 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 of these tasks, they comfort the infants they care for and provide education and reassurance to families.
With the evolution of the NICU specialty, careers for advanced practice registered nurses (APRNs) have proliferated. Neonatal nurse practitioners (NNPs) 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 they are more likely to act as consultants, educators, researchers, or administrators. Their primary role is to evaluate and improve nursing care and to fine-tune NICU-specific hospital policies and procedures.
Neonatal nurses may work in different NICUs that provide varying degrees of care. The designated level assigned to a NICU is based on the type of care provided and the extent of technology available.
- Level II NICUs are designed for less critically ill infants who may require breathing assistance, support with feedings, or special medication. These units are usually found in community hospitals and in smaller healthcare facilities and are typically referred to as special care nurseries.
- Level III NICUs are located in large medical centers and general-care children’s hospitals. They house infants who need advanced care, including respiratory support, diagnostic and imaging studies, and access to medical specialists.
- Level IV NICUs provide the most sophisticated care for ill or premature infants; these facilities are often referred to as regional NICUs because infants from other healthcare centers may be transferred to these facilities for the care they provide, such as advanced life support and surgery.
Nurses who work in Level II NICUs may care for up to three or four patients at a time, whereas in Level III or Level IV NICUs, the nurse-to-patient ratio is usually 1:1 or 1:2. Crying infants, medical equipment, and the presence of doctors, specialists, therapists, ancillary staff, administrators, and family members make for a somewhat noisy and busy working environment regardless of the NICU level.
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 is also expected as part of the job, as the facility is open 24 hours a day, every day of the week. Advanced practice registered nurses work primarily during the day, but their presence and expertise may be required at any time.
To become an RN, it is necessary to complete a college degree. While it is possible to work as a staff NICU RN with a two-year associate’s degree from a community college, employers prefer to hire nurses with four-year bachelor’s degrees to work in this highly specialized environment.
Advanced practice nurses 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.
To learn more about undergraduate- and graduate-level degrees, visit our nursing degree guide.
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 for 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 these cases, training may take three months or more. All new NICU RNs are trained by other nurses who already have solid NICU experience.
For APRNs, training is acquired in graduate school, but employer-specific training is usually necessary for several weeks under the guidance of another APRN or from a nursing supervisor.
Licensing and/or Certification
After successful completion of a nursing educational program, a nurse needs to pass the National Council Licensure Examination (NCLEX) to get a 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. A NICU nurse may achieve certification in several areas related to neonatal care, including certification in pediatric or perinatal nursing. Advanced practice nurses have mandatory certification requirements that they must achieve before they can work in their professions; for example, an NNP must be certified as a neonatal nurse practitioner, while a neonatal CNS would most likely need certification as a pediatric critical care clinical nurse specialist for employment eligibility.
Necessary Skills and Qualities
Neonatal nurses must be skilled observers of infant behaviors and must know how illnesses affect patients and their families. These nurses must also posses the following qualities and skills:
- Quick thinking in order to make appropriate treatment decisions and to deal effectively with emergencies.
- Well-developed stress management skills, as NICU work can be emotionally demanding – especially when a nurse has to manage a poor prognosis, a patient’s death, or cases of neglect and abuse.
- Flexibility, because a nurse’s patient caseload may change from day to day.
- Solid skills in communication and education, particularly when teaching families how to care for an ill infant.
- 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 case management nurses.
Advanced practice nurses may choose to specialize in a particular type of neonatal care such as cardiology, respiratory care, or prematurity. They may take their NICU experience with them to pursue a position in education, research, consulting, or healthcare administration.
If you would like to gain the necessary education to become a NICU nurse, we highly recommend that you check out our free School Finder Tool located HERE.
The median annual salary of RNs in the United States was about $66,640 in 2014, according to the Bureau of Labor Statistics. The lowest 10% of salaries hover near $45,880, while the top 10% of wage earners made around $98,880 per year. Advanced practice nurses are compensated at the higher end of that range, though 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 19% growth from 2012-2022. This is due in part to a large number of nurses who are expected to retire. Neonatal nursing careers at all levels will be readily available, as NICUs across the country are expanding their services to meet the complex needs for care of ill and premature babies and to continue to improve these infants’ chances of survival.