how to become a neonatal nurse

newborn baby being cared for in hospital

You've been thinking about becoming a nurse for a long time now. You know this fulfilling career could bring benefits to both your life and the lives of the patients with whom you'll work every day. As you get closer to making the move into nursing, you're starting to consider which nursing specialty best suits you.

Working as a NICU (neonatal intensive care unit) nurse or specializing in neonatal sounds appealing to you. But you know the neonatal nurse job description isn't all baby rattles and cooing infants. You want to get a better idea of what this role is all about before you make any choices.

So to help you make your decision, we gathered some critical information to help you decide if neonatal nursing is the right choice for you.

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What is a neonatal nurse?

Simply put, these nurses specialize in working with newborn babies. Neonatal nurses care for infants who are born with issues such as premature birth, birth defects, infections or cardiac issues, according to the National Association of Neonatal Nurses (NANN). The term "neonatal" refers to the first month of an infant's life, but neonatal nurses may treat ailing newborns until they are discharged from the hospital, even if that takes several months.

Most neonatal nurses work in a typical hospital environment—usually in the neonatal intensive care unit (NICU) or maternity ward. However, not all neonatal nurses work in such intense settings. Some care for healthy babies in mother-baby nurseries, and others work in clinics or home healthcare to provide follow-up care for infants.

A neonatal nurse will have a variety of job duties throughout the day. They may do anything from resuscitating infants and administering medication to helping a new mom get started breastfeeding. Despite what the job title implies, neonatal nurses should expect to work with infants' families just as much as the infants themselves. Neonatal nurses "will help integrate parents into the critical care that you provide," according to NANN.

The neonatal nurse job description

A neonatal nurse working in a NICU could expect to start the day with responsibilities that more or less resemble what you'd see with other nursing specialties—dividing patient loads, relaying important patient information, reviewing notes and checking in with all patients and their families. This provides neonatal nurses an opportunity to identify any signs of trouble, answer questions and educate families about they can expect next.

Obviously these patients can't just say how they're feeling or what's bothering them, so neonatal nurses will need an in-depth knowledge of common neonatal ailments and the risks unique to this patient population. Additionally they'll need to be excellent, empathetic communicators—the nature of this work means they may have to relay bad or seemingly scary news to new parents and help them process what it means.

What are the benefits of being a neonatal nurse?

Caring for sick babies and offering support to their families can definitely be rewarding. But a neonatal nursing career offers benefits beyond the fulfilling job of patient care. The Bureau of Labor Statistics reports that registered nurses earned a 2018 median annual salary of $71,730.¹

Neonatal nurses also have the potential for career advancement within this specialization. As your knowledge, experience and educational attainment level grows, you may be eligible for job titles such as developmental care specialist, clinical care specialist or nurse manager, according to NANN. These advanced roles will allow you to support staff and direct educational programs that will improve patient care across the board.

Neonatal nurse education and training

Your first step to becoming a neonatal nurse is to become a registered nurse by obtaining an Associate's degree or Bachelor's degree in Nursing and passing the NCLEX-RN exam. It should be noted that some employers may prefer neonatal nurses who've earned a Bachelor's degree—particularly if you're planning to work at a large hospital.

Once you've obtained you degree and licensure, things get less linear. You may be able to find a neonatal nursing role straight out of school, but there's also a good chance you'll need to first build experience if you're looking for a NICU position. Your best bet is to get established as a nurse at a facility with a NICU and build experience in infant care—pediatrics and well-newborn nurseries are good options if possible. This valuable experience will show employers that you have the hands-on skills you need to care for infants, which makes for a smoother transition to the NICU.

What is it like to work as a neonatal nurse?

You're probably wondering how the work of a neonatal nurse compares to other types of nursing specialties. While all registered nursing jobs have a fair amount of common ground—administering medication, charting important information and answering questions all can be expected—there are a few nuances worth noting.

A NICU registered nurse will most likely be in a hospital environment where the stakes for the patient are likely to be higher. With higher-risk patients typically comes a smaller nurse to patient ratio—NICU patients just need additional care. That said, a neonatal nurse working in a mother and baby center that doesn't facilitate high risk pregnancies can probably expect to have a larger number of patients under their supervision each shift.

Another big difference from other types of nursing is the literal size of your patients—medications obviously need to be scaled down and require precision to ensure they're safely administered. Given that many NICU patients are severely premature, a big focus is placed on feeding patients and ensuring they reach developmental goals. You can also expect to work closely with labor and delivery nurses to facilitate the transition from the delivery room to the NICU.

Perhaps one of the most challenging aspects of NICU nursing is managing the emotions that come with it—the highs of seeing an almost impossibly tiny premature baby overcome the odds will contrast with the lows of a family knowing their newborn might not be coming home. It takes a steady presence and good self-care habits to manage this fact.

What qualities make for a good neonatal nurse?

You can probably guess that neonatal nurses must have a love for infants and their parents. But what other skills matter in a neonatal or NICU nurse? We analyzed more than 25,000 neonatal nursing job postings to uncover the other important skills employers are seeking:²

Specialized neonatal nursing skills

Advanced cardiac life support (ACLS)
Treatment planning
Neonatal resuscitation
Patient evaluation
Patient / family education
Neonatology

Transferable neonatal nursing skills

Planning
Teamwork
Communication skills
Research
Critical thinking
Computer literacy

Are you destined to become a neonatal nurse?

If you're compassionate and willing to go the extra mile to acquire the necessary experience and education, a rewarding career treating newborns and supporting their families could be the perfect fit for you.

Neonatal nursing is not for the faint of heart, but for the right person—it's a nursing career that puts you in contact with the patients you love most. If you're ready to get started on your journey toward becoming a neonatal nurse, check out our article, "How to Become a Registered Nurse: Your 4-Step Guide."

¹Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, [accessed December, 2019] www.bls.gov/ooh/. Information represents national, averaged data for the occupations listed and includes workers at all levels of education and experience. This data does not represent starting salaries. Employment conditions in your area may vary.
²Burning-Glass.com (analysis of 27,152 neonatal nursing job postings, Oct. 01, 2018 - Sep. 30, 2019.)

EDITOR'S NOTE: This article was originally published in 2015. It has since been updated to include information relevant to 2020.