Neonatal Intensive Care Nurse

What is a Neonatal Intensive Care (NICU) Nurse?

The National Association of Neonatal Nurses (NANN) describes this field of nursing as one focused on the treatment of infants born prematurely, born with congenital defects, and those experiencing critical complications during the first month of life. Such nurses are typically found in the specialized neonatal intensive care units (NICU) of hospitals. Their patients require continuous monitoring and treatment of serious, often life-threatening, conditions. According to NANN, each year approximately 40,000 infants are born in the United States needing specialized care.

NICU Nurses complete additional training beyond what is required to be licensed as a Registered Nurse (RN), and may choose to pursue RNC-NIC certification.

Common Responsibilities for a NICU Nurse:

  • Collaborate with other medical professionals as part of an NICU team
  • Provide comfort and support to newborns
  • Educate patients’ mothers and other family members about newborn care
  • Administer treatment and medication as prescribed by a physician
  • Use advanced equipment and technological monitoring devices

Who Should Consider Becoming a NICU Nurse?

In neonatal intensive care units (NICU), the stakes are high and atmosphere is intense. A typical NICU nurse job description consists of a laundry list of advanced skills, each of which must be executed with little or no margin of error. Clearly, this job is not for everyone. Nursing professionals who are successful in the NICU possess a unique combination of strengths. Emotional stability is crucial for caring for very ill or premature infants and, in a typical NICU, emergencies are routine. To respond to rapidly changing situations, an NICU nurse must always maintain a calm demeanor while quickly gathering and assessing information, following complex protocols, and communicating with other medical professionals. In any area of medicine, nurses are expected to offer compassionate care to their patients. The NICU nurse, however, must also extend this empathy to terrified and overwhelmed new parents.

Excellent communication skills are another must-have for every neonatal nurse practitioner job description. The NICU nurse serves as a central liaison between a baby, a baby’s parents, and a multidisciplinary medical team that includes physicians, therapists, and RNs. In a single conversation, complex information must be explained in plain English, while highly specific and technical information must be communicated accurately in another conversation. Mathematical aptitude is useful for calculating medication dosages, as is comfort with advanced technology. Finally, any neonatal nurse should possess the physical stamina to regularly work 12-hour shifts.


Educational Paths to Becoming an NICU Nurse

Registered Nurses can earn their license after completing either an associate or bachelor’s program, although employers hiring for neonatal intensive care positions may prefer applicants with a Bachelor’s of Science in Nursing, as well as relevant experience working with critically ill infants.

What Education is Needed to Become an NICU Nurse?

Aspiring NICU nurses have two options for breaking into this notoriously competitive field, both of which begin with the RN credential. Currently, students can qualify for the RN with a two-year diploma or associate degree. However, these programs are being phased out in favor of the four-year bachelor of science in nursing (BSN) degree. Specialty certifications in NICU nursing are available to RNs, including the RNC-NIC and the CCRN-Neonatal credentials. Registered nurses may sit for these exams after demonstration of two years of work experience in acute or critical care nursing.

Other nursing professionals may opt for neonatal nurse practitioner (NNP) credentials, which require completion of a master of science in Nursing (MSN) program. Admission to an MSN program is based on a bachelor’s degree — RNs who hold two-year degrees must complete the BSN before applying to an MSN program. Like the certifications mentioned above, MSN programs also require two prior years of clinical experience. The National Association of Neonatal Nurses recommends that future NNPs gain this experience in a level III NICU.

How Long Does It Take to Become an NICU Nurse?

Currently, an aspiring RN may achieve NICU certification in as few as four years, based on a two-year degree and two years of clinical experience. Because the industry is moving away from two-year programs, this time frame is somewhat unrealistic. Instead, consider that a college freshman could expect to reach certification in six years, after completion of the BSN and two years of work. Alternately, the working RN who chooses to move into the specialty need only gain two years of experience in acute care to qualify for a certification exam. Students in pursuit of NNP credentials may earn them in as few as eight years from start to finish: four years of undergraduate study, two years of work experience, and two years of full-time graduate study. The working RN with a two-year degree can take a shortcut here; RN-to-BSN programs can shave a year or so from total time to completion.

Online study is commonly offered in BSN, RN-to-BSN, and MSN programs because much of the course material lends itself well to the distance learning format. Schools that offer this allow online students to arrange for clinical experiences near their homes, rounding out neonatal nurse degree requirements. Online study adds enormous flexibility to a working nurse’s class schedule, and in many cases allows a student to attend school full-time without taking off work. Neonatal nurse practitioner schooling is most often conducted in cohorts, where smaller groups of students progress through the curriculum together. Working in cohorts offers these students unique networking and collaboration opportunities.

What Will I Learn in an Online NICU Nursing Certification Program?

  • Advanced newborn health assessment: Diagnostic data interpretation in newborns and infants. Emphasizes systemic data collection, clinical problem-solving, and diagnostic reasoning. Assessments include physical examination, fetal, perinatal, psychosocial, gestational age, neurobehavioral, and developmental. Differential diagnosis discussion.
  • Neonatal pathophysiology: Theoretical and practical knowledge for the role of advanced practice neonatal nurse in the NICU environment. Resuscitation and stabilization of the neonate. Disease processes, nursing management, and pathophysiology of critically and chronically ill newborns and infants; includes an emphasis on effects on infants’ families.
  • Newborn/infant pharmacology: Pharmacokinetics, pharmacodynamics, and pharmacotherapeutics in the fetus, newborn, and infant. Special focus on drug therapy in this patient population, including advanced nursing management of selected newborn/infant therapeutics. Legal, ethical, and financial issues related to prescribing.
  • Advanced procedures for neonatal nurse practitioners: Essential NICU concepts, skill, and equipment for direct bedside assessment and care. Theoretical basis, indications, and complications for all skills are emphasized. Differentiation between normal and abnormal lab values is emphasized.
  • Developmental physiology: Examination of human genetics, embryologic development, and normal physiologic function of bodily systems. Cell division, gametogenesis, and inheritance patterns are addressed. Emphasis is placed on structural and functional development of fetal systems, as well as long-term clinical implications of alterations in structure and physiologic function. The legal, ethical, and financial implications of long-term care of infants with genetic abnormalities are discussed.

NICU Nurse Certification and Licensing Requirements

Certification is not required to work in NICU settings, however many nurses in these environments choose to obtain RNC-NIC training and credentials offered through the National Certification Corporation (NCC).

Requirements to take the RNC-NIC exam:

  • Current RN license in the United States or Canada
  • One of the following:
    • At least 24 months experience working with critically ill infants as an RN
    • A minimum of 2,000 hours of specialty experience in neonatal health that includes direct patient care, education, administration or research
  • Employment related to the neonatal specialty within the past 24 months

RNC-NIC recertification requirements:

  • $100 NCC maintenance fee
  • Continuing education hours

RNC-NIC certification is awarded for three years, and must be maintained through continuing education. The number of hours required varies, ranging from 10 to 45. Opportunities are offered through multiple sources, including the National Association of Neonatal Nurses, which provides education in four competency areas:

  1. General assessment
  2. Physiology and pathophysiology
  3. Pharmacology
  4. Professional practice

Accreditation

An accredited school’s curriculum and admissions process has been vetted by an impartial body. National accrediting bodies are focused on a specific type of education, such as technical or online. Students who seek schools that offer neonatal nursing programs online would do well to seek out accreditation by the Distance Education and Training Council (DETC) Accrediting Commission. Regional accreditation is geographically-based, and emphasizes academic rigor more than national accrediting bodies do. Generally, regional accreditation carries more weight than national accreditation does, especially when it comes to graduate school admissions. Program-specific, or specialized accreditation, is an especially useful tool for measuring the worth of academic offerings in certain fields. The Commission on Collegiate Nursing Education (CCNE) evaluates and monitors nursing education programs at all levels. Any nursing program that carries this accreditation can be assumed to have met the nursing industry’s standards.

Though the federal government does not involve itself at the accreditation level, the U.S. Department of Education (DOE) does provide oversight of the accreditation process. The DOE also maintains a database of accredited schools. Similarly, the Council for Higher Education Accreditation is an independent association of accredited degree-granting institutions which also offers a database of accredited schools.


Career Outlook

The nursing profession is enjoying tremendous growth in the U.S. due to an aging Baby Boomer population, restructuring of the health insurance industry, rapid strides forward in medical knowledge, and a shift toward preventive care. As shown below, the U.S. Bureau of Labor Statistics (BLS) projects a 16% increase in jobs for RNs through 2024. Advanced practice nurses such as NICU nurses also benefit from the Institute of Medicine’s industry-wide push toward higher education for all nurses. Data provided by the BLS indicates a 17% increase in jobs for these professions.

Source: BLS

Work Environments

In U.S. hospitals, newborn nurseries are categorized by the level of care that they provide. Level I nurseries care for full-term healthy infants, level II for healthy infants born at 32 weeks gestation or later, level III for infants born prior to 32 weeks or critically ill newborns at any gestational age, and level IV for acute care of the most seriously ill infants. The majority of hospital-employed NICU nurses work in level III or level IV nurseries. As the table below demonstrates, graduates of neonatal nursing programs have a number of options. For each of the most common employers, we’ve included a description of the workplace and the median neonatal nurse salary.

Average Hourly Rate for NICU Nurses by Workplace Environment

Environment Description Average Hourly Rate for CNA
General Hospital Acute care facility where patients recover from surgery, disease, or trauma. Generally contains one wing or floor devoted to labor and delivery, postpartum, and newborn care. May be small community hospitals (~75 beds) or large regional hospitals (~1500 beds). $83,085
Community/Home Health Multidimensional healthcare services delivered in the home or in a community-based setting. Skilled care includes wound care, IV therapy, well baby care and assessment, chronic disease monitoring, injections, minor illness, and patient/caregiver education. $65,500
Military Direct care facilities for military service persons and their family members, located on military bases and posts throughout the U.S. and across the globe. $64,205
Physician’s Office/Private Practice Office home where individual or group of physicians see patients for non-acute follow-up. Often adjacent to hospital complex. Physicians, RNs, and CNAs perform routine checkups and assessments. Care delivery may include minor surgical procedures, injections, blood testing, measurement of vital signs, and long-term care plan management. $75,000
School Public or private educational facility. School nurses promote student health, facilitate optimal development, and advance academic achievement. Care delivery includes screening, assessments, referrals, administering medications and vaccinations, first aid for minor injury, care for minor illness, and health education and counseling. $46,715

Source: Payscale

NICU Nurse Salary

The path to NICU certification is not an easy one but completing neonatal nurse schooling pays off. The table below illustrates the average NICU nurse salary in several different scenarios available to graduates of NICU nursing programs. From the staff RN with NICU certification up through the neonatal nurse practitioner salary, professionals in this specialty are well-compensated. For comparison, we have also including top-paying states and the median salaries of careers in adjacent fields.

Source: Payscale

What is an Extracorporeal Membrane Oxygenation Specialist (ECMO)?

Extracorporeal membrane oxygenation (ECMO) is a life support treatment for patients whose heart, lungs, or both are unable to function due to illness, injury, or premature birth. Used only when other methods of treating these organs have failed, the ECMO circuit can support a newborn’s heart and lungs while they heal. Initially, ECMO is placed by a surgeon, after which a dedicated team continually monitors the patient around the clock. The ECMO specialist is a key member of this team, responsible for running the ECMO machine and monitoring its effect on the patient. ECMO specialists are nurses, respiratory therapists, or perfusionists who have undergone specialized training in ECMO procedures. In many cases, NICU nurses who are also ECMO specialists serve as bedside nurses for newborns while they are on the ECMO machine. ECMO training is offered at standalone facilities and universities across the U.S. and usually consists of three to five full days of instruction and hands-on learning.

For more information, read about the different paths to becoming a nurse.