NICU Nursing Introduction

The NICU RN is often the unsung hero of the labor and delivery unit.  When expectant mothers arrive to deliver their newborns, their interaction is first with the L&D nurses, who assist the obstetricians in bringing their little ones into the world.  However, if anything goes awry, the NICU RN step in and care for the sick newborns.

The NICU nurse is an exciting and life-giving area of nursing. NICU nurses are responsible for caring and comforting newborns who have health concerns or need extra care due to prematurity, low birth weight or other conditions. NICU nurses may also be responsible for teaching parents about their child’s condition and how they can help at home. If you’re interested in becoming a NICU nurse, read on to learn more!

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What is a NICU Nurse

The NICU RN cares for critically ill newborns post-delivery.  These babies may be in the NICU for a variety of reasons, from being born premature, to having inadequately developed lungs, to being born to mothers with drug or alcohol addiction.  According to the National Association of Neonatal Nurses, “Neonatal nursing generally encompasses those infants who experience problems shortly after birth, but it also encompasses care for infants who experience long-term problems related to their prematurity or illness after birth. A few neonatal nurses may care for infants up to about 2 years of age. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.”

Neonatal Nurses speak with parents about breastfeeding and infection control, monitor vital signs, assist in procedures like blood transfusions or eye drops for newborns suffering from infections of their eyes. They position infants for feeding time by holding them upright and supporting them in a special chair or propping up on one arm at an angle. The Neonatal Nurse’s job is not limited to these tasks though; they work closely with doctors to ensure that every phase of care is carried out as accurately as possible, which includes helping doctors set up equipment that needs to be used.

What Does a NICU RN Do on a Daily Basis?

The day-to-day job of the NICU RN is dependent on their patient load.  In an ideal world, the NICU would have little to no patients, but this is typically not the case.  The NICU nurse must be prepared for whatever type of issue that may arise.  In addition, the type of care provided depends on the level of NICU the RN is employed.  According to Rocky Mountain Hospital for Children, there are 4 levels of NICU care:

  • Level I: Basic newborn care: these hospitals take care of healthy babies that are born full-term. If a baby requires advanced care, they will stabilize the baby and transfer to the appropriate level of NICU care.
  • Level II: Advanced newborn care: these hospitals are equipped to care for babies born premature, at 32 weeks or greater gestation. They also may care for babies with certain serious health conditions.
  • Level III: Subspecialty newborn care: these hospitals are equipped to care for babies born prior to 32 weeks’ gestation and other critical illnesses. They are equipped to provide respiratory support and often have the availability of pediatric subspecialties as needed.
  • Level IV: Highest level of newborn care: these hospitals are equipped similarly to the level III NICU, but also are prepared with pediatric surgeons and anesthesiologists. They are able to provide surgical intervention for serious congenital conditions.

In all levels of newborn care, the NICU nurse is responsible for providing the safety of their patients.  This includes (but is not limited to) vital signs, patient assessment, feedings, medication administration, ventilator assessment and family education.

Where do Neonatal Nurses Work?

Neonatal nurses, also called neonatal intensive care specialists (NICU), work in primarily in hospitals caring for infants of with less than thirty-six weeks gestation.

In the United States, most neonatal nurses work on medical teams that care exclusively for babies with birth weights 1000 grams or less. They monitor the baby’s nutrition, growth and development and treatment protocols as needed during their stay at hospitals such as NICU’s. These nurses also have expertise in life support systems which include ventilators, cardiopulmonary resuscitation (CPR), and endotracheal intubation tubes. The use of these tools is part of what neonatal nurses do in order to save a baby’s life when it cannot breathe on its own even after getting clear fluid from its lungs or when it does not have a strong enough heartbeat. NICU nurses also work with babies who are suffering from infections or bleeding in their brains, and adjust treatment plans accordingly to meet the baby’s needs

How Do I Become a NICU RN?

Typically, the minimum education requirement for the NICU RN is an ADN degree.  Some hospitals may require a BSN degree, based on the critical nature of the patients involved.  After graduation, it is possible to find NICU critical care internships.  For example, Baylor Health Care System offers paid internships to new nursing graduations.  Their NICU program is 16 weeks, progressing from caring for stable premature babies to advanced care.  Seeking out these opportunities is a quick way to becoming a NICU RN. Learn about similar nursing career options such as Neonatal Nurse Practitioner, Women’s Health Nurse Practitioner or Labor and Deliver Nurse.

Once employed in the NICU profession, there are continuing education opportunities within supervising organizations to help nurses maintain their certification requirements for board recertification by way of successful completion of nationally standardized examinations for renewal certification.

How do I Become a Neonatal Nurse Practitioner?

To become a Neonatal Nurse Practitioner, one must first complete their Bachelor’s degree in Nursing and pass the National Council Licensure Examination (NCLEX-RN) to gain licensure as an RN. After having passed this exam, one can now pursue higher education with an emphasis on either graduate studies in nursing or general graduate studies with the goal of eventually obtaining a Masters of Science degree. Some universities offer online Master’s degrees in these areas of study, and others offer on campus programs. An average course load will often be between six to nine credits per semester. Read about How to Become a Neonatal Nurse Practitioner.

What Skills Are Needed To Be a Neonatal Nurse

The NICU is a high-stress environment, and neonatal nurses must be able to handle stress well. They should also enjoy the fast pace of work while maintaining an awareness of safety for all patients under their care. NICU nurses need good communication skills in order to keep parents informed about how the baby is doing as well as other NICU staff. NICU nurses need patience, compassion and emotional maturity to deal with the deaths of babies under their care.

A neonatal nurse needs to be compassionate. In the NICU there are many cases of premature babies who require treatment immediately after birth. Providing care in these circumstances often puts nurses at high risk for burnout and exhaustion. Nurses need a lot of patience to work with families who have had their lives turned upside down by having an infant in critical condition or experiencing unexpected loss of a baby due to stillbirth or death shortly after birth. Hospitals that deal with care for high-risk pregnancies may see some staff turnover reminiscent in the pediatric unit as well because it is an especially emotional environment which is constantly dealing with deaths, issues that go beyond what other units like emergency doctors experience. 

What is the Job Outlook for a NICU Nurses?

The Bureau of Labor and Statistics notes that between 2014 and 2024, nursing as a whole is expected to grow by 16%.  Unfortunately, there will always be critically ill newborns so we can ascertain that the need for the NICU RN would rise at a similar rate.

Neonatal Nurses Salary

NICU salaries are difficult to determine, as they vary significantly from unit to unit. The size of the hospital, the location of the facility and cost of living in that area all play into how much someone is paid. Compensation also differs for nurse who work part-time vs. full-time hours. In general, salary’s start at about $32.98 per hours for new graduates in rural areas and can go up to over $100k per year in major metropolitan cities with higher cost of living.

NICU nurses may work in a NICU or be “floaters” who move between units. NICUs can vary from very small to large with many different specialties. There are NICUs that specialize in just one topic such as oncology, surgery, neurology and so forth. NICU salaries will depend on the location, NICU size, experience and the NICU specialty.

NICUs in larger teaching hospitals may have higher salaries than NICUs that are part of a small community hospital or private practice. Large NICUs can also offer better benefits such as retirement plans, vacation time, paid sick days and so forth because these nurses spend more hours on-duty. NICUs in teaching hospitals will have higher salaries because they are expected to provide instructors. NICU nurses with more experience also earn a higher salary than those who are just starting out and NICUs that specialize in oncology, surgery or neurology may pay better as well.

According to Payscale, the average neonatal nurses salary is about $32.98 per hour.  This rate can increase if the nurse holds a BSN degree or if they have advanced education as a transport NICU RN. According to Zip Recruiter, state-by-state neonatal nurses salary are as follows:

StateAnnual SalaryMonthly PayWeekly PayHourly Wage
New York$119,052$9,921$2,289$57.24
New Hampshire$115,545$9,629$2,222$55.55
West Virginia$103,437$8,620$1,989$49.73
New Jersey$98,853$8,238$1,901$47.53
Rhode Island$96,866$8,072$1,863$46.57
North Dakota$95,393$7,949$1,834$45.86
South Dakota$92,607$7,717$1,781$44.52
New Mexico$90,506$7,542$1,740$43.51
South Carolina$88,931$7,411$1,710$42.76
North Carolina$75,783$6,315$1,457$36.43

What is the Career Outlook for Neonatal Nurses?

With roughly 2.3 million newborns born in the US each year, and a shortage of qualified staff to take care of them, the neonatal nurses’ prospects are excellent. By 2024, it is estimated that there will be 53% more jobs than qualified applicants for those positions. Some hospitals have resorted to hiring Australian neonatologists because they can’t find American patients willing to work in such high-intensity rotations with 12-hour shifts every day for four weeks at a time!

In addition to all the job openings caused by retirement or people seeking other careers, new healthcare reforms should create an even bigger demand for trained professionals like neonatal nurses as doctors and hospitals try to provide better coverage while delivering higher quality care which

The US Bureau of Labor Statistics says that the job outlook for Neonatal Nurses will continue to be “very good”. They also note, however, that hospital budgets have been cut and so hiring rates may not necessarily increase in accordance with other jobs. In general, it seems like the only way for a Neonatal Nurse to significantly affect their career path is by establishing themselves as a leader in neonatal care. This can be done through volunteering or work-shadowing opportunities.

NICU Resources and Organizations

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Sources: 50 State Boards of Nursing, University Websites, U.S. Department of Education, Bureau of Labor Statistics. Ranking Methodology.