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Is a Career in Neonatal Nursing Right for You?

What Is Neonatal Nursing?

Neonatal nursing is a subspecialty of nursing that works with newborn infants born with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and surgical problems. The neonatal period is defined as the first month of life; however, these newborns are often sick for months. Neonatal nursing generally encompasses care for those infants who experience problems shortly after birth, but it also encompasses care for infants who experience long-term problems related to their prematurity or illness after birth. A few neonatal nurses may care for infants up to about 2 years of age. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.

Approximately 40,000 low-birth-weight infants are born annually in the United States. Because of significant medical advances and the efforts of physicians and nurses who provide for very vulnerable babies, survival rates are 10 times better now than they were 15 years ago.

What Can I Expect as a Neonatal Nurse?

You can expect to make a difference in the lives of infants and their families. In fact, you'll likely hear from the infants and families you've helped treat throughout their lives. In many ways, you are the voice of the smallest and sickest patients who don't have one of their own.

You can expect to work in a hospital setting, either in a level II nursery with less acutely ill or convalescing infants or a level III nursery with the most critically ill patients. You can expect to work with as many as four infants at a time, though that ratio varies depending on how ill patients are. Neonatal critical care is provided around the clock and on weekends and holidays, so you can expect to regularly work 12-hour shifts, though some nurseries offer 8- and 10-hour shifts or other flexible options.

In some cases, you won't be working in a hospital. Instead, you'll be in the community, providing home care or follow-up for high-risk infants.

Salaries vary regionally, and advanced practice nurses are compensated at a higher level. Additional compensation is given for work on nights and weekends. For specific information in a particular geographic region, contact the hospitals where you are interested in working. For information on wages by occupation and region, refer to www.bls.gov/bls/blswage.htm.

Career Options

As your career progresses, there are a variety of opportunities available in neonatal nursing.

Staff nurses may provide highly technical care for acutely ill infants or supportive care for convalescent or mildly ill newborns. On an average day you may assist a new mom with breastfeeding her infant, care for a very ill full-term infant who is on a ventilator and receiving numerous IV medications, or attend the delivery of a very small and premature infant.

Nurse managers provide leadership for the staffing and administration of the NICU, ensuring that the environment and resources needed for high-quality patient care are available.

Clinical nurse specialists are advanced practice nurses who provide educational programs and support to both nursing staff and ancillary staff so that they provide care that is up to date and based on the best available evidence. Clinical nurse specialists may provide direct patient care at the bedside and give support to staff who are learning clinical skills.

Developmental care specialists are nurses who have studied the developmental care of sick and preterm infants. They provide direct care and assist their colleagues in meeting the developmental needs of these special babies.

Neonatal nurse practitioners (NNPs) are advanced practice nurses who work with the physicians and nursing staff to provide comprehensive critical care to the infants in the NICU. This role requires additional schooling in a master's or doctoral program, as well as a national certification. In this role you share your expertise with a multidisciplinary team as you take on the medical management for a group of critically ill infants.

Certification

After working with neonates for a time, many neonatal nurses choose to take a national certification test to validate their knowledge. You may choose to be part of a neonatal transport team or participate on an extracorporeal membrane oxygenation (ECMO) team that provides heart-lung bypass for critically ill infants. You may develop leadership skills as a charge nurse or stabilization nurse in moderate- or high-risk deliveries.

Preparing to Be a Neonatal Nurse

There are a number of steps you will take to prepare to be a neonatal nurse.

Undergraduate Education

Basic nursing education can be achieved through three routes. Enrollment in an accredited school of nursing is encouraged.

  1. An associate degree can be obtained in 2–3 years at a junior or community college.
  2. A diploma degree can be obtained through a hospital-based school of nursing. However, diploma programs are being phased out in most areas of the country.
  3. The baccalaureate degree (BSN), which provides the most career flexibility, is earned through a college or university and generally takes 4 years to obtain.

If you have a degree in another field, you may be eligible for an accelerated program where you can obtain a bachelor of science in nursing (BSN) or master of science in nursing (MSN) in 1-2 years.

Graduate Education

If you plan to pursue work in advanced practice nursing, you will need a master's or doctoral degree.

If you're interested in working as an advanced practice nurse, in the near future a doctor of nursing practice (DNP) will be required. Entrance into this practice-focused doctoral program requires a bachelor's degree.

In addition, some nurses who have a master's degree choose to pursue a PhD, a research-focused doctorate.

Postgraduate Preparation

When you become a registered nurse, you will want to work in a hospital with a NICU. Some NICUs require prior experience in infant care, such as work in pediatrics or in a well-newborn nursery, though most will hire new graduate nurses with a strong interest in neonatal intensive care and have orientation programs that teach you how to care for sick infants. A variety of educational programs provide introductory information about neonatal care.

If you plan to go on to become an NNP, you should practice in a level III NICU as a staff nurse before applying to graduate school. These units provide the most highly skilled care to the sickest of infants.

Sources of Information

In addition to NANN, visit the following resources to learn more information about neonatology or nursing education in general.

How Does NANN Help Neonatal Nurses?

Founded in 1984, NANN represents the community of neonatal nurses that provides evidence-based care to high-risk neonatal patients. With more than 7,000 members, NANN is recognized as the expert voice that influences standards of practice through advocacy, education, networking, collaboration, and leadership.

NANN is the only national nonprofit association created by neonatal nurses for neonatal nurses. The National Association of Neonatal Nurse Practitioners (NANNP), a division of NANN, gives NNPs a distinct voice within NANN to address career development and educational needs and provides representation to address advanced neonatal practice issues in the larger nursing community.

As a professional nursing association, NANN supports its members through a number of valuable membership benefits, including access to an online peer network, opportunities to participate in NANN's annual conference, and a subscription to Advances in Neonatal Care, a bimonthly peer-reviewed professional journal. Learn more about NANN's extensive member benefits.

NANN Student Membership

Are you a nursing student looking for a career in neonatal nursing? NANN student membership is an affordable way to connect with practicing neonatal nurses, including potential employers, and increase your knowledge in neonatal nursing. Student membership is open to students who are interested in neonatal nursing and are currently enrolled in an entry-level nursing program that leads to eligibility for the NCLEX examination upon graduation. Learn more about NANN membership.

National Student Nurses' Association (NSNA) members can join NANN at a special discounted student rate of $45 (verification of NSNA membership status is required). Indicate your NSNA membership when completing your registration form or mention it when registering via phone 800.451.3795.