Meet a Neonatal Nurse
Ever wondered about the journey to becoming a neonatal nurse? This resource provides firsthand insights into the path of neonatal nurse schooling and licensure from an experienced neonatal nurse.
In hospital maternity wards, while many babies arrive healthy and depart a few days after birth, some newborns encounter challenges adapting to life outside the womb, such as anemia, breathing difficulties, and jaundice.
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Neonatal nurses play a vital role in tending to these newborns, ensuring their well-being and nurturing their health. The National Association of Neonatal Nurses defines this profession as a specialized field that involves caring for newborns facing various issues like prematurity, birth defects, infections, heart malformations, and surgical complications.
Like other nurses, neonatal nurses require the appropriate degree and nursing license. Yet, they may also pursue certification in neonatal nursing as a specialty. This article provides valuable insights on how to become a neonatal nurse and what this career entails. For further details on career and salary prospects for NICU nurses, consult this resource.
A Conversation with a Neonatal Nurse
Q: What inspired you to pursue neonatal care? At which point in your nursing career did you decide this was your path?
My interest in neonatal care ignited during my maternity clinical experience in nursing school. I shadowed a NICU nurse caring for a baby in a level II NICU at a small community hospital. While in nursing school, I worked as a nursing assistant on an adult oncology floor. Upon applying for nursing positions, current hospital staff had priority. I decided to apply to both the ER, leveraging my EMS background, and NICU due to my positive clinical experience. Fortunately, a spot was open in the NICU, and I’m grateful for how things worked out.
Q: How does the relationship between neonatal nurses and labor and delivery nurses function?
The dynamic between neonatal nurses and labor and delivery (L&D) nurses can differ between hospitals. In some cases, NICU nurses work alongside L&D nurses during high-risk deliveries, respond to newborn emergencies in L&D, or assist L&D nurses in monitoring the baby’s transition. In other settings, roles might be filled by NPs, medical residents, fellows, or hospitalists. In rural hospitals, an L&D nurse might care for a sick newborn until transfer to a NICU. It varies.
Q: What are the notable challenges and rewards of NICU work?
Starting in the NICU presents the challenge of not knowing what you don’t know. Nursing school only covers neonatal nursing superficially, if at all. NICU care is distinct, and its specificity can’t be learned elsewhere. I suggest purchasing and familiarizing yourself with a neonatal certification preparation book before starting orientation. This way, you’ll have some familiarity with neonatal terminology.
Q: Could you walk us through a typical day for you?
Currently, I work in a level IV cardiac NICU. A typical day with a critical one-to-one patient might unfold as follows:
7:00-8:00: Receive report from the night shift, verify continuous infusions, assess orders, perform safety checks, check breastmilk/formula fridge, prepare for rounds, disinfect surfaces, grab coffee.
8:00-9:00: Initial care time. Thorough assessment of the infant, checking neurological, cardiovascular, respiratory, GI, GU, and skin status. Pain assessment. Evaluation of IV and PICC sites. What’s the condition of the dressing and site? Is the line unclamped? Surgical incision site assessment. Suctioning of ETT and naso/oropharyngeal areas. Feeding, warming, and scanning breastmilk. Administering medications via IV, gastric tube, duodenal tube, or nebulization. Diaper change. Repositioning the infant and developmental care (managing sensory stimuli).
9:00: Medical rounds involving neonatology, pediatric cardiology, mid-level providers, nutrition, pharmacy, charge nurse, and the family. Discussing plans and goals for the day.
9:30: Implement changes discussed during rounds, coordinate with technicians for imaging/tests.
10:00: Charting! Continuous monitoring of the infant (vitals, pain/sedation, airway suctioning). Providing emotional support to the family.
11:00, 14:00, 17:00 (or as needed): Repeat care times, assessment, diaper change, repositioning, feeding.
Throughout the day: Continuous monitoring of the infant, charting, medication administration, updating the mid-level provider and family.
Q: What surprising aspect of this role might nursing students benefit from knowing?
Babies are more resilient than we realize.
Q: Any advice for aspiring nurses considering a career in the NICU?
Begin by joining professional organizations, benefiting from student discounts to learn about the NICU. The National Association of Neonatal Nurses (NANN) and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) are recommended. They offer journals that can be read electronically, helping you delve into the field.
Some hospitals hire new graduate nurses directly into the NICU. Don’t hesitate to apply, even if you lack experience.
If feasible, balance nursing school with non-nursing roles at your target hospital, like nursing assistant, patient transport, or unit clerk. These positions offer flexible schedules and introduce you to the hospital environment, values, policies, and culture, facilitating a smoother transition into nursing.
What a Neonatal Nurse Does
In hospital maternity wards, newborns fall into one of four neonatal care levels: well newborn (I), special care nursery (II), neonatal intensive care unit (NICU, III), and regional NICU (IV). Neonatal nurses specialize in caring for infants in the latter three levels requiring specialized attention. These intensive care units demand round-the-clock care from nurses, often working with demanding equipment like incubators, blood pressure monitors, respirators, and ventilators. Neonatal nurses care for babies, provide guidance to mothers, and offer support to families.
Newborns don’t adhere to schedules, necessitating continuous NICU coverage, including nights and weekends. Shifts usually last 12 hours, though 8- or 10-hour shifts are also common.
How to Become a Neonatal Nurse
Aspiring neonatal nurses can follow diverse educational paths:
Neonatal nurses need proper licensure. They can acquire registered nurse (RN) licensure through either an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN). ADN programs typically last two years full-time, while a BSN takes around four years.
Upon graduation, candidates take the NCLEX-RN exam and apply for RN licensure. With experience, they might consider specialized certification in
neonatal care. While not obligatory, certification can boost job prospects. Two well-regarded certifications are RNC Certification for Neonatal Intensive Care Nursing and Critical Care Registered Nursing (Neonatal) certification.
Advanced degrees, such as a master of science in nursing (MSN), can lead to becoming a neonatal nurse practitioner. An MSN typically takes two years and prepares graduates to work as nurse practitioners, who assume more responsibilities than RNs. They can independently meet with patients and, in many states, prescribe medication without physician oversight. An MSN also facilitates specialization, such as neonatal care.
Salary of a Neonatal Nurse
Registered nurses, as per the Bureau of Labor Statistics (BLS), earn a median annual salary of about $73,300. With over 3 million RNs in the U.S. in 2019, the BLS projects a 7% job increase from 2019-2029.
While specific figures for neonatal nurses aren’t provided by the BLS, PayScale estimates their average salary at around $70,600, spanning from $49,000-$106,000.
Salaries are influenced by location. California, Hawaii, Washington, D.C., Massachusetts, and Oregon boast the highest RN salaries, ranging from $93,000-$113,000 according to the BLS.
Advanced practice nurses, like neonatal nurse practitioners, tend to earn higher salaries. Nurse practitioners, along with other advanced practice nurses, earn a median annual salary of around $115,800. The BLS projects a 45% growth in advanced practice nursing jobs from 2019-2029, making it one of the fastest-growing professions in the U.S.
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