What Is a Neonatal Nurse?
What is a neonatal nurse? Our guide explores the job duties, expected salaries, and work settings for this registered nurse specialty.
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9% growth from 2020-2030
Average Annual Salary
Neonatal nurses specialize in the care of preemies and newborns facing specific challenges and older infants with chronic complications due to premature birth. This field can include care of patients up to two years old, according to the National Association of Neonatal Nurses.
According to Payscale data from July 2022, neonatal nurses can expect to earn $71,060, with the Bureau of Labor Statistics (BLS) projecting a job growth of 9% for all registered nurses (RNs) from 2020-2030. For those considering this profession, it takes around four years to become a neonatal nurse.
What Does a Neonatal Nurse Do?
Neonatal nurses care for infants with various medical and surgical conditions. They usually work in the neonatal intensive care unit (NICU) within a hospital, but can work in other healthcare settings as well. These nurses provide daily care for infants, such as feeding, bathing, and changing diapers. However, they also perform comprehensive assessments, such as checking oxygen levels and vital signs and measuring fluid intake and waste output.
Specific job duties depend on the patient care plan and may include providing special feedings (e.g., tube feedings), administering medication, IV fluids, and blood transfusions. NICU nurses may also attend high-risk deliveries and respond to neonatal emergencies in labor and delivery units. They perform screening tests, such as hearing and vision tests, and evaluate results. Other duties include updating parents on the status of the infant, maintaining meticulous patient records, and operating specialized NICU equipment.
An associate degree in nursing (ADN) or a bachelor of science in nursing (BSN) can qualify an RN to work as a neonatal nurse, but some employers prefer the BSN. A certified critical care RN for neonates (CCRN Neonatal) credential is recommended but not mandatory.
A CCRN (Neonatal) designation is a specialty certification for nurses who provide care to newborn patients experiencing acute or critical illnesses. This could include working in the NICU, cardiac care or intensive care units, trauma units, or critical care transport/flights.
Certification eligibility requirements include:
- An unencumbered RN or advanced practice registered nurse (APRN) license
- Two years experience as an RN or an APRN, with 1,750 hours of direct acute or critical care for neonatal patients
- Or five years experience as an RN or an APRN, with a minimum of 2,000 hours caring for acutely or critically ill neonates
Learn more about CCRN (Neonatal) certification here.
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Neonatal nurses provide constant monitoring and care to ill or premature infants. Other key responsibilities include:
- Administering special feedings, such as tube feedings
- Knowledge of specialized NICU equipment (infant ventilators, incubators, radiant warmers, and more)
- Inserting IV lines
- Performing tests
- Managing medications
Neonatal nurses must demonstrate the following:
- Meticulous observation skills
- Empathy and social awareness
- Strong written and oral communication skills
- Ability to multitask
- Ability to work well with others
Where Do Neonatal Nurses Work?
Most neonatal nurses work in the NICU. There are a total of four levels of care for newborns. Level I is for healthy babies, while the other three levels of care involve acutely or critically ill infants.
Other possible job settings for neonatal nurses include cardiac care, trauma units, and critical care transport/flights. Neonatal nurses may work in community or in-home settings to provide education and follow-up care for high-risk babies after discharge.
Level II NICU
This level cares for infants born at 32 weeks gestation and above or full-term babies in need of close observation. This level of care includes close monitoring of vital signs, weight, and fluid status. Level II NICU nurses administer IV fluids and medications.
Level III NICU
Level III NICU includes infants born before 32 weeks' gestation weighing under 1,500 grams, or those at any gestation considered critically ill. Common care at this level includes close observation, mastery of ventilators, and care of infants needing surgery.
Level IV NICU
Level IV NICU nurses care for newborns needing major surgery, such as procedures for congenital heart defects. This is the highest level of care for infants.
Home and community care neonatal nurses assess how infants are doing after discharge (e.g., gaining weight, growth rate, and medical stability). They also educate parents on proper care for infants at home and answer questions.
How to Become a Neonatal Nurse
The minimum requirement to become a neonatal nurse is an ADN, but many employers require a BSN. Certification is also often required. This includes a CCRN (Neonatal) credential or an advanced practice RN (APRN) certification, such as a nurse practitioner, specializing in neonatal nursing care. Neonatal nurses may choose to pursue graduate programs to become APRNs.
Master of science in nursing (MSN) degrees prepare nurses for certification as neonatal nurse practitioners, leading to a higher salary and more career options.
The steps involved in becoming a neonatal nurse include:
- Earn an ADN or BSN from an accredited college or university.
- Pass the NCLEX for RN licensure.
- Gain experience working with neonatal patients.
- Obtain certification or pursue an APRN designation, such as a neonatal nurse practitioner.
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How Much Do Neonatal Nurses Make?
According to Payscale data from July 2022, neonatal nurses make an average base pay of $35.11 per hour. Payscale reports a salary range of $53,000-$101,000, depending on the healthcare setting, experience level, and education.
Frequently Asked Questions about Neonatal Nurses
How long does it take to become a neonatal nurse?
It takes 2-4 years for nurses to complete an accredited program and qualify for RN licensure. After obtaining a license, RNs need two or more years of experience to earn CCRN (Neotatal) certification.
What's the difference between a neonatal nurse and a neonatal nurse practitioner (NNP)?
A neonatal nurse must have a minimum of two years of nursing school education with optional certification. A neonatal nurse practitioner (NNP) needs an advanced practice RN degree, such as an MSN or a doctor of nursing practice. A neonatal nurse practitioner must pass a certification exam after completing graduate school.
Can neonatal nurses prescribe medicine?
Neonatal nurses cannot prescribe medication unless they have an APRN designation, such as a neonatal nurse practitioner (NNP). Nurse practitioners can prescribe medications under the supervision of a medical doctor in most states.
What does a typical day look like for a NICU nurse?
Neonatal nurses feed, bathe, change, and weigh high-risk infants. They administer medications and assess oxygen levels, vital signs, and other assessments, such as measurement of fluid intake and urine output. Depending on the care plan, neonatal nurses may administer and monitor IV fluids and blood products. NICU nurses often attend high-risk deliveries and respond to neonatal emergencies in labor and delivery units.
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