The Steps to Becoming a Neonatal Nurse

Have you ever thought about a career as a Neonatal Nurse? Do you love babies and the medical field? If so, consider caring for ill or premature babies and watching them grow and blossom with your nurturing.

Neonatal Nurse Requirements

What is the education needed to be a Neonatal Nurse? A series of steps is necessary to complete all the requirements. Let’s look at the various requirements and types of classes necessary to accomplish this educational goal.

Fulfilling the following training and degree requirements will lead to this exciting career:

  • Obtain a nursing degree from an accredited school.
  • Earn either an Associate Degree of Science in Nursing (ASN) or a Baccalaureate of Science in Nursing (BSN).
  • Pass the state board of nursing licensing exam known as NCLEX-RN.
  • Attain licensure in your state.
  • Renew your license according to state regulations, every two or four years.
  • Acquire several years of nursing experience, usually two to three years, within a Neonatal unit, if possible.
  • Consider attending specialized graduate training for Clinical Nurse Specialist or Neonatal Nurse Practitioner.
  • Obtain highly specialized certifications for this position.

All nursing programs provide courses in Anatomy and Physiology, Behavioral Sciences, Chemistry, Microbiology, Nursing Concepts, Nutrition, and Psychology. Liberal arts courses are added for Associate and Baccalaureate degree students.

The nursing courses required will cover advanced topics such as the Physiology of the Newborn and Pathophysiology or the study of changes caused by disease or injury. Neonatal Pharmacology, which concerns medication for infants, is an important component as well. Classes on specialized equipment and procedures used on infants are a must.

Supervised clinical experience helps to engage the nurse in applying coursework by assessing newborns, rendering diagnoses, executing procedures and giving medications. These hands-on experiences are completed in various departments including maternity, pediatrics, psychiatry and surgery primarily in larger hospitals.

Working with newborns who require specialized services in the intensive care unit requires nurses to have specific knowledge and skills sets. The National Association of Neonatal Nurses recommends at least two years of experience in the Neonatal Intensive Care Unit or NICU.

Registered Nurses who are dedicated to the specialized care of these newborns and their families might consider enrolling in graduate courses to become a Clinical Nurse Specialist (CNS) or a Neonatal Nurse Practitioner (NNP).

A Clinical Nurse Specialist (CNS) is a Registered Nurse with advanced graduate education and practice from a specialized training program. The focus of the CNS role is to improve and integrate care for the patient, nurse and system. His/her responsibility is to assist in the navigation of a complex healthcare system through all phases of illness and wellness.

On the other hand, a Neonatal Nurse Practitioner is a Registered Nurse who has completed the necessary steps to becoming a Neonatal Nurse. Trained to evaluate newborns and carry out the specialized medical interventions to ensure their growth and well being, these highly-trained professionals are a great asset to pediatric physicians.

Due to the nature of the work with ill or pre-mature newborns during their first 28 days of life, nursing professionals must be certified in neonatal resuscitation or practices of neonatal intensive care nursing.

Becoming a Neonatal Nurse requires almost as much education as becoming a physician. Advanced degrees and continuing education are necessary due to the unique specialization of providing care to premature, small or sick newborns.

As a Nurse Practitioner concentrating on babies who need technological measures to help them survive, these professionals may hold a national certification as evidence of knowledge and skills in this specialized area.

To be eligible for the Neonatal Nurse Practitioner examination, you must currently hold licensure as an RN in the United State or Canada. In addition, you must have successfully completed a NP program with a graduate degree in the discipline; the latter includes a Masters or Post-Masters degree.

The exam is available in two formats: paper and pencil at specific testing sites or computerized testing. Passing this examination gives a NP the credential as a Neonatal Nurse Practitioner (NNP-BC).

After receiving at least two years of hands-on experience, the nurse is entitled to various other certifications. Tests based upon a number of specializations are available as follows:

  • Critical Care Registered Nurse (CCRN)
  • Neonatal Intensive Care Unit Nurse (NICU)
  • Neonatal Pediatric Transport Nurse (NPT)
  • Low Risk Neonatal Nurse (LRN)

Nurses who were born or educated in foreign countries must secure a visa to work in the United States. To do so, they must participate in a screening procedure that reviews their education and licensure to be sure it is comparable to that provided to a nurse in this country.

Foreign born or educated nurses must demonstrate proficiency in verbal and written English and must afford proof of having passed either the National Council Licensure Examination for Registered Nurses (NCLEX-RN) or the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Examination.

Job Description

Most healthcare professions are experiencing growth. With so many technological advances in all areas, it is not surprising that the demand for this profession will increase, especially since the number of multiple births has risen. These newborns often need critical care to mature before they are ready to go home.

In addition, the more education, certifications and experience a Registered Nurse has, the more opportunities that become available. Becoming a Neonatal Nurse may mean working in the intensive care unit of a large hospital then advancing to a Clinical Nurse Specialist or a Neonatal Nurse Practitioner.

It may also result in teaching, researching or carrying out system development and improvement. Higher education options such as a Doctorate of Nursing Practice (DNP) or a Doctor of Philosophy in Nursing Science (PhD) are terminal degrees that are further options.

A Neonatal Registered Nurse cares for newborn babies in the nursery and the neonatal intensive care unit. Some children are healthy newborns while others are very ill. The nurse’s responsibilities include such tasks and interventions as the following:

  • Administering medications
  • Utilizing specialized equipment such as incubators and ventilators
  • Educating parents about babies’ medical conditions
  • Giving support to parents
  • Recording newborns’ medical histories and treatments
  • Providing specified feedings, oxygen and intravenous therapies
  • Assessing and implementing babies’ care
  • Evaluating treatment plans
  • Assisting attending physicians
  • Delivering other levels of care, as needed

The work of these nurses is divided into three levels depending on the intensity and duration of services that may be needed. An explanation of the levels follows:

Level I is the nursery for healthy newborns. Since mothers with healthy babies now keep the infants in the same room and have a short stay in the hospital, the work of a nurse is simply to care for the mother and child according to their short-term needs.

Level II babies are those that require continual attention to mature before going home. They are the premature or ill babies who need oxygen, intravenous and concentrated feedings

Level III is the neonatal intensive care unit (NICU) where newborns that are critically ill receive constant direct care. These infants usually cannot be cared for in any other department of the hospital. High levels of technology are utilized in their treatment plans. Educating and supporting the parents is a critical role at this level.

Where Do Neonatal Nurses Work?

Neonatal Nurses work primarily in hospitals and in the Neonatal Intensive Care Units (NICU). They may also work in clinics or educate parents and family members. Some may even be employed as researchers or consultants. Their important role necessitates teamwork with doctors, medical staff, parents and other specialists.

Employment consists of a full time 40-hour or more work week. Because they play such a vital role in the care of newborns, they may work holidays, nights or weekends as well.


Salary ranges vary according to geographic areas. The national average salary is $63,000 according to For Neonatal Nurse Practitioners, the average salary is $74,000 according to the same source. Metropolitan area facilities offer the highest salaries.

Of course, the amount of education and experience determines salary levels. Data indicates that pay ranges vary from $49,296 for those with less than one year of experience to $111,831 for those with more than twenty years of work experience in the specialized field.

Unlimited opportunities exist for those who wish to dedicate their knowledge, skills and support to newborns starting life with a healthy start or to those with a critically challenged beginning. As a Neonatal Nurse, you will care for all new human life regardless of the newborns’ state of health.

If this career path is your calling, prepare for a dynamic career full of joy and sorrow. Be ready to celebrate new life with many new parents, but plan to extend emotional encouragement to those whose babies are fighting for their lives.

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