How to Become a Neonatal Nurse: A Guide to NICU Nursing

The neonatal period refers to the first 28 days of a newborn’s life, and neonatal/NICU (Neonatal Intensive Care Unit) nurses play a critical role in ensuring the well-being of these fragile infants during this time. As registered nurses with additional certifications, these specialized healthcare professionals provide care and support to infants requiring intensive medical attention due to various health conditions, complications, or prematurity. 

There is a growing demand for neonatal nurses: career website Zippia predicts 12 percent job growth until 2028, and salaries have been rising steadily since 2008. It’s a good time to enter the field for aspiring nurses passionate about working with newborns.

Understanding the Role: Neonatal/NICU Nurses

Neonatal/NICU nurses fit into the healthcare system at its earliest stage in a patient’s life – just after birth. Their crucial role has many responsibilities related to the care of this vulnerable population. 

  • Medical care and monitoring: Neonatal nurses monitor the vital signs—heart rate, respiratory rate, blood pressure, and temperature—of premature or critically ill newborns. They also administer medications, treatments, and interventions as prescribed by doctors.
  • Ventilator and respiratory support: Many premature infants have underdeveloped lungs. Neonatal nurses operate and manage various respiratory support devices, including ventilators, CPAP (Continuous Positive Airway Pressure) machines, and oxygen therapy that assist them in breathing.
  • Feeding and nutrition: Premature or sick infants often have underdeveloped sucking reflexes which cause difficulty breastfeeding or bottle feeding. Neonatal nurses provide specialized feeding methods, such as tube feeding or IV nutrition, to ensure that the infants receive adequate nutrition for growth and development.
  • Infection prevention and control: Neonatal nurses implement infection prevention and control measures to minimize the risk of infection spreading. Neonatal units are particularly susceptible to infections due to the vulnerability of newborns’ immune systems. 
  • Family support and education: Neonatal nurses provide emotional support and educate the infant’s families. They explain medical conditions, treatment plans, and progress of their babies to families, and offer guidance on how to care for their infants both within the hospital and after discharge.
  • Collaboration with multidisciplinary team: Multiple specialists evaluate and care for infants in the NICU. Neonatal nurses work closely with a multidisciplinary team, including neonatologists, pediatricians, respiratory therapists, occupational therapists, and other healthcare professionals to provide excellent care. 
  • Advocacy and communication: Neonatal nurses advocate for their tiny patients, addressing their needs and concerns. They also keep the medical team informed of the infants’ progress, changes in condition, and any concerns.
  • Emotional support: It’s emotionally challenging for both families and healthcare providers to deal with critically ill or premature infants. Neonatal nurses emotionally support not only the families but also help each other cope with the stress and emotional demands of the job.
  • Emergency response: Advanced certifications and training teach neonatal nurses how to respond swiftly and effectively in emergency situations, such as when an infant’s condition suddenly deteriorates. Their quick thinking and actions can often make a critical difference in saving a newborn’s life.

Neonatal/NICU nurses play a pivotal role in caring and recovering newborns requiring intensive medical attention. Their specialized knowledge, skills, and compassion significantly improve the outcomes and quality of life for these vulnerable infants and their families.

What Does a Neonatal Nurse Do?

No two days are the same in a neonatal unit; neonatal nurses must always expect the unexpected. While some daily tasks remain the same, a sudden change in an infant’s condition could require quick thinking. In general, these professionals:

  • Monitor vital signs
  • Administer medication and treatments
  • Respiratory support
  • Feed and provide nutrition
  • Follow protocols to prevent infection
  • Assess developmental needs
  • Support families
  • Document patient care
  • Collaborate with other medical professionals
  • Respond to emergencies

Neonatal nurses have the expertise and dedication to contribute significantly to improving outcomes for these vulnerable infants and their families. Their job can be physically and emotionally demanding. Maintaining calm and objectivity when caring for an infant in distress is hard, and many neonatal nurses must learn to balance grief and empathy with their clinical skills.

How to Become a Neonatal/NICU Nurse

Becoming a neonatal/NICU nurse involves a combination of education, training, and practical experience. Here’s a general pathway to becoming a neonatal nurse:

First, aspiring neonatal nurses need to meet educational prerequisites. Start with a high school diploma or equivalent. Some nursing programs require specific science and math courses as prerequisites, so those interested in this path should get help from a guidance counselor when choosing courses during their junior and senior year.

Next is obtaining an advanced degree. This could be an associate degree in nursing (ADN), a two-year program community colleges offer. Or, enroll in a four-year bachelor of science in nursing (BSN) degree, which is increasingly preferred by many healthcare institutions, and may offer better career opportunities as it provides a more comprehensive education.

After completing a nursing program, nurses must pass the NCLEX-RN (National Council Licensure Examination for Registered Nurses) to become licensed registered nurses (RNs). 

Without clinical experience, it’s difficult to specialize. Many hospitals require nurses to have some experience before entering neonatal nursing. Typically, this ranges from one to two years of experience in nursing. Apply to work in pediatric nursing, maternity nursing, or general medical-surgical nursing to build a strong foundation of skills and knowledge. 

While gaining experience, pursue certifications such as Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS), which are often required or preferred for neonatal nursing roles. Find other NICU nurse programs in the next section. 

Once certified, with some experience, nurses can start applying for neonatal nursing positions in hospitals, neonatal intensive care units, pediatric units, and other healthcare settings. But obtaining a neonatal/NICU nurse role is only the beginning; staying current in this constantly changing field is important. Most nurses participate in continuing education programs, workshops, seminars, and conferences 

Joining professional organizations such as the National Association of Neonatal Nurses (NANN) connects nurses with their peers and gives them access to resources for learning and staying informed about industry trends.

The specific pathway to neonatal nursing may vary based on an individual’s location, educational institution, and circumstances. Researching and planning ahead before committing to a path can help nurses make informed decisions about their education and career path as neonatal nurses.

Diving Deeper: Neonatal Nurse Certification Requirements

Obtaining an advanced neonatal/NICU nursing certification signals to patients and employers that a nurse is serious about the field and providing quality care to infants. Many hospitals and clinics require certification because they know it means a nurse can give a standardized level of care. Neonatal nurse certification requirements typically include an active nursing license in good standing and a nursing degree. 

Offered by the Neonatal Intensive Care Nursing Certification Corporation (NNCC), the Neonatal Intensive Care Nursing (RNC-NIC) certification validates the certificate holder’s specialized knowledge and skills. It builds confidence in the nurses’ understanding of evidence-based practices in neonatal care. They also offer the Certified Neonatal Nurse Practitioner (NNP-BC) Certification, with similar benefits. This certification enables nurses to work as neonatal nurse practitioners who provide comprehensive care to critically ill newborns. It also enhances a nurse’s diagnostic, treatment, and management abilities in complex neonatal cases.

The American Nurses Credentialing Center (ANCC) offers the Pediatric Nursing Certification PED-BC™, which more generally certifies nurses to work in the pediatric specialty.

It’s not uncommon for critically ill patients to move between hospitals and treatment facilities. The Certification in Neonatal Pediatric Transport (C-NPT), offered by the Board of Certification for Neonatal/Pediatric Transport (BCNPT), teaches nurses the skills they need to transport critically ill neonates between hospitals, gives them the competency to handle emergencies during transport, and demonstrates expertise in ensuring patient stability during transfers.

Part of a neonatal nurse’s role is educating parents about how best to care for their infant. The Certified Breastfeeding Specialist (CBS) Certification, offered by the Lactation Education Accreditation and Approval Review Committee (LEAARC) teaches nurses how they can provide specialized assistance to mothers and infants with breastfeeding challenges and lactation management.

For those nurses interested in advancing their careers and becoming neonatal nurse practitioners (NNPs), they’ll have to pursue a master’s or doctoral program in neonatal nursing. These programs provide advanced education and clinical training specific to neonatal care.

In the NICU environment, certified nurses enhance patient safety, contribute to positive outcomes, and increase the overall quality of care provided to critically ill newborns and their families. They also open doors to advance in their career and occupy leadership roles in neonatal nursing.

What Makes a Good Neonatal Nurse?

A good neonatal nurse possesses a balance of clinical skills and soft skills. They must balance the clinical competency to accurately assess and treat their patients with the compassion and empathy to explain a diagnosis to their parents. And on top of that, they’ll need to work effectively in a high-stress environment. 

Above all else, a solid nursing knowledge and clinical skills foundation is essential. This includes understanding neonatal physiology, assessment techniques, medical interventions, and the use of specialized equipment. Neonatal nurses must combine this clinical competency with a high attention to detail, Neonatal patients are highly sensitive and fragile, so even the smallest changes in vital signs, symptoms, and overall condition could be impactful.

Using their critical thinking skills, neonatal nurses can quickly recognize potential complications and devise appropriate interventions. In the NICU, unexpected challenges can arise and call for a quick assessment, the ability to analyze information and make a sound decision. Good neonatal nurses devise creative solutions to address complex issues.

Part of making fast assessments and pivoting is adaptability. Neonatal nursing involves dealing with complex and often unpredictable situations. Being adaptable and thinking on their feet is crucial for providing the best care in rapidly changing circumstances.

But, as they do this, neonatal nurses cannot lose sight of the patient’s families. Often, parents are worried and scared. NICU nurses must bring compassion and an understanding of families’ emotional challenges when they have a baby in the NICU, giving them support with genuine kindness.

Effective communication skills, whether it’s explaining a test to a worried mother or conveying information to a pediatrician, are vital for building trust and supporting teamwork. Neonatal nursing is a team effort. Working collaboratively with doctors, therapists, fellow nurses, and other healthcare professionals is essential for comprehensive care.

The emotional demands of neonatal nursing can overwhelm nurses. Resilience allows nurses to bounce back from difficult situations, manage stress, and continue to provide high-quality care. Neonatal nurses need patience, both with themselves and their charges, to handle complex medical conditions that may not always have the hoped-for outcome. 

There will be times when a neonatal nurse feels trapped, or caught in the middle. Neonatal nurses can face ethical dilemmas related to end-of-life care, parental wishes, and other complex issues. Upholding ethical principles is essential in these situations, as is managing their own mental health. 

Being a neonatal nurse means filling a role that demands both technical skill and the ability to connect with patients on a deeply human level. 

The Realities: How Hard Is It to Be a Neonatal Nurse?

The nature of the work of a neonatal nurse involves caring for extremely vulnerable patients and supporting families who are experiencing high levels of stress and uncertainty. A recent study published in the Journal of Neonatal Nursing found that many NICU nurses suffer from burnout and many reported struggling with emotional exhaustion.  

Neonatal nurses often witness the suffering and vulnerability of critically ill newborns, and must hold space for their parent’s grief. Patients can spend months in the NICU, which leads to building relationships with patients and families and a deep emotional connection, making the loss particularly challenging. The fear of losing a patient or witnessing a baby’s pain can affect nurses’ mental health.

Neonatal nurses may encounter ethical dilemmas regarding end-of-life decisions, resuscitation, and other complex medical choices. These situations require careful consideration, communication, and respect for beliefs that may differ from the nurses’ belief system. While essential, consistently providing empathetic and compassionate care can exhaust NICU nurses, especially when dealing with challenging cases.

Delivering difficult news to families or discussing treatment options, especially when the information is distressing or complex, requires tact and kindness. Neonatal nurses must strike a delicate balance between providing hope to families and being realistic about the prognosis and potential outcomes for critically ill infants. These challenges can make being a neonatal nurse quite hard, and yes, these nurses have the opportunity to make a big impact in the lives of many.

Compensation: How Much Do Neonatal Nurses Make?

According to career website Zippia (2023), Neonatal nurses make an average of $71,497 nationwide. Salaries can range from $41,000 a year to $122,000, depending on the part of the country where the nurse practices. The highest-paid neonatal nurses are in Washington, where the average salary is $155,826, and the lowest in Arkansas at $101,936, according to ZipRecruiter (2023).

Neonatal nurses with more certifications and advanced degrees can expect a higher salary. Most nurses receive health insurance, dental, and reimbursement for continuing education. With experience and more education, many nurses can grow their careers and move into supervisory roles. 

Neonatal/NICU Nurses Can Make a Real Difference

Neonatal nurses fill a critically important role in the healthcare system. Their dedication and compassion have an impact. While there will be tough days, there are also days when they get to watch a healthy baby go home with their family. It is a worthwhile and rewarding career path.

Kristen Lewis

Kristen Lewis


Kristen Lewis is a graduate student pursuing an M.A. in Speech-Language Pathology at West Chester University of Pennsylvania. A former educator, Kristen now uses her experience and passion for healthcare to inform readers.