How to Become a NICU Nurse (Neonatal Nurse)

by NurseJournal Staff
• 4 min read
Reviewed by Theresa Granger, Ph.D., MN, NP-C

Learn what NICU nurses do, what is required to become one, and about the career outlook for the profession with this step-by-step guide on how to become a neonatal nurse.

How to Become a NICU Nurse (Neonatal Nurse)

Many people who adore babies choose to dedicate their careers to working with infants. Nurses can take advantage of several pathways to work with babies; they can work as labor and delivery nurses, pediatric nurses, and neonatal intensive care nurses. Neonatal nurses perform important and fulfilling work caring for critically ill infants in need of extra attention after birth.

In order to become a neonatal intensive care unit (NICU) nurse, individuals need to obtain the correct degree, licensure, and specialty certification. This guide can help you prepare for the career path; it goes over the steps it takes to become a neonatal nurse, in addition to career and salary expectations for the profession.

Keep in mind, this page limits its focus to neonatal intensive care nurses with registered nursing (RN) licensure. Nurse practitioners may also focus on neonatal care, although RNs need an advanced degree and additional certification in order to become a neonatal nurse practitioner.

What is a Neonatal Nurse?

Neonatal nurses work with infants born with critical health problems, giving them the specialized care they need to lead healthy lives. Infants might be born prematurely, or with congenital disorders or infections. According to the National Association of Neonatal Nurses (NANN), about 40,000 infants are born with below-healthy birth weights each year in the United States, thus potentially predisposing them to a number of health challenges during delivery or immediately after birth.

Although "neonatal" technically refers to infants up to one month old, neonatal nurses might work with young children up to two years old. If you want to learn more about the neonatal nursing profession as a whole, this guide will serve as a useful resource.

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What Do NICU Nurses Do?

Neonatal nurses perform a wide variety of tasks. They may assist with birthing, and they measure and weigh infants after they are born. The bulk of their profession involves caring for infants immediately after birth.

Neonatal nurses ensure an infant’s bodily functions are performing as expected, including proper breathing, blood circulation, digestion, and regulating bodily fluids. NICU nurses perform tests to evaluate any problems, operate equipment that helps with a baby’s vital functions, monitor infant health, and administer treatment and medication as prescribed by doctors.

As part of their duties, neonatal nurses document and report on the infant’s progress. They also educate parents on how to care for their infants, teaching parents how to breastfeed and take care of their child’s conditions at home.

Where Do Neonatal Nurses Work?

Neonatal nurses work in neonatal intensive care units (NICU) and maternity wards at hospitals, birthing centers, and clinics. They may carry out their duties in delivery rooms and nurseries. In the United States, these nurses fall into four categories: Level I (well newborn nursery), Level II (special care nursery), Level III (NICU), and Level IV (regional NICU).

These nurseries have special equipment, like ventilators, blood pressure monitors, oxygen hoods, and incubators that help infants gain enough oxygen and maintain fluid balance. These work environments are often stressful, as infants who need extra medical care also need constant attention. This means neonatal nurses must stay on high alert and work well under pressure.

Steps to Become a Neonatal Nurse


Neonatal nurses can follow the same educational pathways as any registered nurse (RN). They can either pursue an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN). Both degrees prepare students to take the NCLEX-RN, and graduates of both programs qualify for RN licensure.

However, the programs differ in length and focus, among other features. An ADN lasts two years for full-time students, while a BSN traditionally takes four years to complete. ADN programs require fewer general education courses, and instead students dedicate most of their coursework to foundational nursing skills.

In contrast, BSN programs include more general education courses in the humanities and social sciences in addition to the core nursing courses. A BSN curriculum typically involves more writing, giving students a chance to hone their communication skills.

The last two years of a BSN program focus on nursing techniques, theory, and ethics. Learners also gain hands-on practice by participating in clinical and laboratory courses. Some schools also offer specialization courses within BSN programs, so interested students can begin learning about neonatal nursing.

After graduation, nurses interested in a neonatal nursing career often start out in a general pediatrics unit and work their way up. However, many hospitals offer a new graduate nursing residency in neonatal nursing, which allows a new graduate to gain paid work experience and additional education on how to care for critically ill infants.

In order to practice, RN candidates must obtain state licensure. In order to apply for licensure, RN candidates must complete their education and pass the NCLEX-RN. The exam evaluates basic nursing skills, including health promotion and maintenance, safety and infection control, physiological adaptation, and psychosocial integrity.

Training and Certification

After they earn licensure, nurses can pursue several different certifications in neonatal care.

The National Certification Corporation offers an RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC). Interested individuals must possess an active RN license, 24 months of specialty experience as an RN, and a passing score on a qualifying exam to obtain the credential. The certification rules consider a minimum of 2,000 hours in direct patient care, education, administration, or research to count toward the experience requirement.

The American Association of Critical-Care Nurses also grants a CCRN (Neonatal) specialty certification. To qualify for this credential, applicants must possess 1,750-2,000 hours in direct care of acutely or critically ill neonatal patients. This certification also requires a proctored exam evaluating test-takers' knowledge of neonatal care.

NICU Nurse (Neonatal Nurse) Salary and Job Growth

The Bureau of Labor Statistics (BLS) projects above average growth for the nursing industry as a whole; the number of RNs is projected to increase by 7% from 2019 to 2029. RNs make a lucrative median annual salary of $73,300, according to BLS data.

PayScale data shows that neonatal nurses earn a similar average salary of about $101,727. You can learn more about the salary outlook for NICU nurses with this resource.

Top Employing States for RNs (Including NICU Nurses)

Salary and employment trends vary by several factors, including location and specialization (if applicable). BLS data shows that the states with the highest concentration for RNs, including NICU nurses, are South Dakota, West Virginia, Mississippi, Rhode Island, and Delaware. Average salary figures for these states, as reported by ZipRecruiter, range from $84,000-$103,000, with nurses in Rhode Island and Delaware earning the highest rates.

California ranks as the top-paying state for the profession, with RNs earning average salaries of $113,240, according to the BLS. Other top-paying regions include Hawaii, the District of Columbia, Massachusetts, and Oregon, where the mean earnings range from $92,960-$104,060. The top-paying metro areas for RNs are all located in California; the San Jose/Sunnyvale/Santa Clara region ranks highest, with average earnings reaching $140,740.

Top Paying Industries for RNs (Including NICU Nurses)

Industry can also play a significant role in determining nursing employment rates and salaries. The top-employing industries for RNs include general medical and surgical hospitals, physicians' offices, home healthcare services, nursing care facilities, and outpatient care centers.

The top-paying industries for RNs differ significantly. BLS figures show that nurses working for business support services earn the highest average salaries of $92,200. However, the industry only employs 650 RNs. It should be noted that this figure is for RNs in general, and the average salary for neonatal nurses is higher than the average salaries for RNs.

Other top-paying industries include the federal government, and pharmaceutical and medicine manufacturing.

Reviewed By:

Theresa Granger

Theresa Granger, Ph.D., MN, NP-C

With over two decades of teaching and clinical practice as a family nurse practitioner, Dr. Granger is an expert in nursing education and clinical practice at all levels of education (associate, baccalaureate, and graduate). She has published and lectured extensively on nursing education and clinical practice-related content. Her expertise ranges from student advising and mentoring to curricular and content design (both on ground and online) to teaching and formal course delivery. Dr. Granger is one of the founding faculty members of the University of Southern California’s first ever fully online graduate family nurse practitioner program. is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

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