Submitted by Andrew Steger on Wed, 07/14/2021 - 00:40
neonatal patient in NICU

How to Become a Neonatal Nurse

If you enjoy newborn infants, you might consider a career in nursing with a focus on newborn care. There are many different options for this specialty, including labor and delivery, pediatrics, or becoming a neonatal intensive care unit (NICU) nurse.

Neonatal nurses perform the important work of caring for critically ill newborns. As a neonatal nurse, you may work under stressful conditions that require you to be alert and agile and to make decisions quickly. Newborn babies can develop complications fast and without warning.

If you’re embarking on this career path, you likely have many questions, such as the amount of time required for education and licensing requirements. Understanding what to expect and your educational options, such as online accelerated BSN programs, will get you on the right path so you can start your career.



What is required of a neonatal nurse?

Newborns can’t fully communicate what they feel; therefore, the job of the neonatal nurse is to stay in tune with the patient’s needs while monitoring health status closely. Additionally, a neonatal nurse provides support to parents as they manage stress and plan for the future.

The neonatal nurse may also provide ongoing education, such as helping parents understand the diagnosis and required care as well as how to manage any specialized medical needs after discharge.

What is expected on a daily basis?

Neonatal nurses typically work in NICUs as well as hospitals and maternity wards. In the United States, hospital nurseries are rated on four different levels: level I (babies who are well), level II (special care nursing), level III (NICU) and level IV (regional NICU).

Breaking it down further according to the American Academy of Pediatrics, level I facilities provide basic care to low risk babies, level II facilities are reserved for moderately ill newborns with problems that are expected to resolve quickly, level III facilities are designated based on clinical experience (e.g. complexity of care, large patient volume), and level IV facilities include the capabilities of a level III facility while focusing resources on extremely complex care.

Working in the NICU, you will be trained to operate the specialized equipment required to care for infants, such as oxygen hoods, incubators and ventilators, to ensure that infants are getting what they need to thrive. Nurses monitor breathing, circulation, digestion and the regulation of body fluids. You will perform tests to spot any changes to the child’s health, prioritize interventions and report those changes to the medical provider.

Patients in the NICU require around the clock care and advanced planning for the time period following hospital discharge, which often includes at-home nursing care. NICU nurses can expect to work rotating shifts including nights and weekends. During their time caring for patients, they will also be instrumental in caring for the whole family and providing education in the areas of breastfeeding, infant nutrition, infection prevention and developmental milestones.

NICU nurses may eventually transition into roles that include care coordination and home care to support children and their families as they navigate the complex health systems. NICU nurses also promote healthy child development and support the management of chronic illnesses that may result from premature birth. It is important for NICU nurses to implement self-care practices and seek the support of colleagues who understand the stresses involved in caring for young, sick patients. Despite NICU stresses, job satisfaction can be extremely high if you feel called to care for the smallest and most vulnerable patients.

Neonatal registered nurses vs. neonatal nurse practitioners

Launching a career as a neonatal nurse requires you to become a registered nurse with hands-on clinical experience and expertise in the area of neonatal nursing. Many nurses seek to expand their expertise and career opportunities by becoming a neonatal nurse practitioner (NNP), but what’s the difference? Here are a few differences to note.

Neonatal RN. Becoming a neonatal RN requires you to obtain RN licensure, which can be accomplished via an associate degree in nursing (ADN), bachelor of science in nursing (BSN) or direct entry master’s program. Passing the National Council Licensure Examination is also a requirement. RNs earn around $73,000 annually. Neonatal RNs assess the infant’s physical wellness to monitor for changes and prioritize interventions, collaborate with the family and interdisciplinary team to promote quality of life andare instrumental in education and discharge planning.

NNP (Neonatal Nurse Practitioner). An advanced degree in nursing is required to become an NNP. This may include a master’s degree in nursing, which takes approximately two to three years post-RN, or a doctorate in nursing practice, which takes approximately three to four years post-RN. Most programs require at least two years’ experience working in a NICU prior to entering the program. NNPs earn around $115,800 annually on average. Neonatal nurse practitioners have advanced training in assessment, diagnostic reasoning and advanced intervention skills that allow them to make diagnoses and determine and refine the treatment plan.

If you’re headed down this career path, you might be interested in learning more details about the requirements for each path and the specific licenses required for your state. Understanding these requirements can help you decide on the best option to meet your specific career goals.

Required education

If you want to become a neonatal nurse, you will need to complete a program of study and meet the required licensing requirements that are outlined in state-specific application processes and regulations. The first step is earning an ADN, BSN or master’s degree from an accredited nursing program. Additionally, consider the following:

  • Complete the NCLEX exam. This exam is conducted by the National Council of State Boards of Nursing. It’s a national standardized test that is designed to certify your preparation to practice as a registered nurse. The exam includes multiple-choice questions and alternate item formats. Expect the exam process to take roughly six hours.

  • Receive an RN license in your state. Every state has a regulatory board that is responsible for overseeing licensing requirements. All states currently require nursing graduates to complete the NCLEX-RN to receive approval to practice nursing as a licensed RN. States may have additional requirements, so check with the state board where you intend to practice regarding rules and regulations. This may include education requirements for renewal, application fees and transfer procedures.

  • Gain relevant work experience. Apply to work in a neonatal intensive care unit upon graduation from a nursing program and receipt of your license. Some of these units will require you to obtain practice hours working in a pediatric practice first, but there are some units that will hire you as a new graduate RN.

Once you obtain the required education, you may decide to pursue advanced education, such as earning a master’s or doctoral degree in nursing and relevant certifications.

Specialty education and certifications

You can become a neonatal nurse through either in-person or online programs, allowing you the flexibility to earn the degree while maintaining professional and personal commitments. Many programs are 100% online with the exception of your clinical practicum experience(s), which are typically arranged in your local area. Additionally, some programs require a residency. Education and certifications will vary based on the career path you select. A couple options include:

  • NICU RN: As a NICU nurse, you need to earn your RN and then can continue your education to complete RNC or CCRN certification.

  • Neonatal NP: You can also become a neonatal nurse practitioner which requires you to earn an RN license and complete graduate education (MSN or DNP) and then take the NP certification exam.

Continuing education requirements depend on the regulations in your state and the mandates set forth by your certification organization. Regardless of your selection, you’ll need to stay up to date on continuing education requirements to maintain licensure and any certifications.

Job outlook and earning potential for neonatal nurses

Neonatal nurses earn an average of $73,880 annually, but there are multiple factors that can influence earning potential, including where you live, how much experience you have and your level of education.

Regardless, the overall demand for neonatal nurses is increasing and the Bureau of Labor statistics anticipates a 7% growth between 2019 and 2029. Growth is estimated to add about 175,900 job opportunities each year. This growth is the result of new jobs being added due to increased demand and also due to existing neonatal nurses retiring or moving on to other areas of interest. Job growth is consistent across the U.S.; however, some areas are experiencing faster growth than normal for nursing. For example, California is ranked among the top-paying states for this specialty. Other top-paying areas include Hawaii, Oregon, the District of Columbia and Massachusetts.

Is neonatal nursing the right specialty for you?

If you aren’t sure whether neonatal nursing is the right area of specialty for you, consider registering for a distance ABSN program to become a registered nurse for employment in a NICU. This will give you experience to determine whether it’s a good fit, and also to complete the hours required for many master’s degree programs and specialty certifications.

Hands-on experience will allow you to fully understand the parts of this job that can’t be taught, such as working under unique stresses, delivering compassion and communicating clearly in a high-pressure environment. Additionally, you can be certain that regardless of where you decide to live or work in the future, there will be demand in this specialty.



The content published on our blog is reviewed by credentialed healthcare professionals to give you the most up-to-date and professionally accurate information. This particular article was professionally reviewed by Colleen Sanders, RN, FNP-BC on July 13, 2021.



Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Registered Nurses. (visited July 04, 2021).

Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. (visited July 26, 2021).

PayScale. Average Neonatal Nurse (RN) Hourly Pay (visited July 26, 2021).

NurseJournal. How to Become a NICU Nurse (Neonatal Nurse) (visited July 26, 2021).