Ask a Nurse: What Steps Do I Take to Become a NICU Nurse?

Alexa Davidson, MSN, RN
Updated September 8, 2023
    Neonatal intensive care unit nurses have a challenging and rewarding career. Learn what it takes to be successful in this nursing specialty.
    Featured ImageCredit: andresr / E+ / Getty Images

    In our Ask a Nurse series, experienced nurses provide an insider look at the nursing profession by answering your questions about nursing careers, degrees, and resources.

    Question: Through life experiences, I have taken a serious interest to be a neonatal intensive care unit (NICU) nurse. What are the steps to start and end up actually working as a NICU nurse? How do I start?

    Let’s break down each of these questions in the answer.

    How to Become a NICU Nurse

    Have you always dreamed of taking care of babies? In the NICU, nurses take care of newborns with various health conditions. Babies go to the NICU if they’re born prematurely or have a condition that needs to be treated before they can go home.

    As a NICU nurse, you’ll develop highly specialized skills as you become an expert in the neonatal population. You may see babies born with conditions such as congenital heart or lung defects, digestive disorders, or infection. You’ll learn to manage various types of equipment like breathing machines and intravenous lines (IVs). Experienced NICU nurses even get to help out in the delivery room during high-risk deliveries!

    If this nursing specialty sounds interesting to you, a career as a NICU nurse might be the right fit. To get started in becoming a NICU nurse, you will need:

    • An associate nursing degree or bachelor of science in nursing (BSN) degree: Many hospitals require a BSN degree for new hires, so check the requirements for your area.
    • An RN license: After completing nursing school, you’ll take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to be a licensed registered nurse.
    • Basic life support certification: To work in a hospital, you will need to be certified in cardiopulmonary resuscitation through an American Heart Association-verified course.
    • Neonatal resuscitation program (NRP) certification: Most NICUs require NRP certification. This training course will prepare you to respond to neonatal emergencies.

    Many NICUs hire new nursing graduates right out of nursing school. New nurses may choose to participate in a new nurse residency program during their first year as a nurse. A residency program allows nurses to further their nursing education and develop skills while beginning to work.

    Nurse orientation for a neonatal intensive care unit will depend on the amount of experience you have. Because nursing students usually have little exposure to the NICU in school, new graduate orientation may take up to six months.

    Experienced nurses transitioning to the NICU will have a shorter orientation, typically 12 weeks or less.

    What Success Looks Like as a NICU Nurse

    Neonatal intensive care nurses have a unique skill set that’s unlike any other nursing specialty. Everything in the NICU is smaller, including the subtle changes patients will show when they’re sick. To be successful in the NICU, you will need to notice every tiny detail and understand how to respond to patient changes.

    Nationwide, NICUs are categorized by level of care, with level 1 NICUs providing basic neonatal care and level 4 providing highly specialized care.

    For instance, nurses in a level 1 NICU may take care of newborns requiring oxygen or feeding tubes. In a level 4 NICU, you may care for patients with surgical needs like extracorporeal membrane oxygenation, heart surgery, tracheostomies, or abdominal surgery.

    No matter which type of NICU you work in, you’ll need to have strong nursing skills and a caring, compassionate attitude. Here are a few skills you’ll need to succeed as a NICU nurse.

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      Attention to Detail

      To be successful in the NICU, strong attention to detail is a must. You’ll want to be organized, focused, and detail oriented. Don’t be afraid to ask questions during a nursing report to clarify details.

      For example, in adults IV flushes are often overlooked, but in the NICU a 1mL flush counts toward the patient’s intake and output.

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      Strong Assessment Skills

      Successful NICU nurses are pros at noticing subtle assessment changes.

      Whether it’s a baby’s breathing pattern or belly size, NICU nurses will spot a patient assessment change. It’s important to have a strong baseline assessment at the beginning of your shift to know what to do with your findings.

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      Family-Centered Care

      In the NICU, the relationships you establish with babies and their parents or guardians make a big impact. Many babies stay in the NICU for an extended amount of time, so it helps to get to know their families and caretakers.

      Parents or guardians in the NICU go through a roller coaster of emotions and challenges, so you should aim to make their experience a little better.

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      The most successful NICU nurses go the extra mile for their patients and love them like their own. If you find yourself singing or talking to a newborn, don’t feel silly. Babies need human interaction, so do what you can to provide a loving environment for the growing baby.

      On the other hand, premature babies may be sensitive to noise, lights, and touch. A successful NICU nurse knows to adjust the environment according to the baby’s needs.

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      Calm Under Pressure

      To be successful in the NICU, it’s important to maintain a calm presence under stress. Over time you’ll become an expert at managing neonatal emergencies, but the way you respond is equally important.

      The NICU can be a high-stress environment even when your patients are stable. You’ll learn to remain focused despite noisy alarms and monitors, beeping IVs, and crying babies.

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      Excellent Communication

      In the NICU, you may collaborate with a team of physicians, neonatal nurse practitioners, respiratory therapists, dietitians, and pharmacists to create a plan of care. To work well in an interdisciplinary care team, you will need strong communication skills.

      You’ll want to establish relationships with all the members of your patient’s care team so you can coordinate the baby’s care. Having good communication with your providers is necessary so you know whom to reach when your patient has a status change.

    In Summary:

    To become a NICU nurse, you should complete the necessary schooling and have the following characteristics:

    • Calm under pressure
    • Attention to detail
    • Care and compassion
    • Strong assessment skills