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Exploring the Neonatal Nursing Specialty


Whether you're a nursing student, new graduate, or experienced nurse, choosing the right specialty can provide you job satisfaction and a sense of fulfillment. One nursing specialty that can be particularly rewarding is neonatal nursing. Before deciding on this specialization, you'll want to know how to become a neonatal nurse and what to expect.

What is neonatal nursing?

When considering neonatal nursing or any specialty, it's helpful to know more about the patients served and the nature of the work. Infants in their first 28 days of life are known as neonates. "The neonatal period is the most vulnerable time for a child's survival," said Rachael Zastrow, NNP-BC, APNP, CPNP-PC, and President of the National Association of Neonatal Nurses. Many diagnoses are seen in neonates, such as prematurity, birth defects, surgical problems, cardiac anomalies, and infection. "These infants are often sick for months and spend time in the neonatal intensive care unit (NICU)," she said. Neonatal nurses care for infants who experience problems right after birth and those with long-term, complex medical issues related to prematurity or diagnosis. "NICU nurses also care for their patient's families to help them navigate this tumultuous time," Zastrow said. NICU nurses may occasionally see their patients after hospital discharge in a NICU developmental follow-up clinic or when providing home health care needs, she said.

What does a neonatal nurse do?

There's a common misconception that NICU nurses only hold and feed babies. "This couldn't be further from the truth," Zastrow said.

"NICU nurses are heroes, providing a voice for our smallest, sickest patients who don't have a voice of their own," Zastrow said.

NICU nurses provide round-the clock, safe, and developmentally appropriate care to premature and severely ill newborns and infants, she said. The work consists of:

  • Medication administration
  • Monitoring IV fluids
  • Protecting airways and central lines
  • Giving blood products
  • Providing nutrition
  • Traveling with patients for procedures outside of the NICU, such as MRI or interventional radiology appointments
  • Charting -- and lots of it

In addition to their assigned patients, NICU nurses also attend high-risk deliveries and cesarean sections. They also admit patients transported in from lower-level NICUs. Neonatal nursing care extends to infants' families and caregivers, as it's a challenging time for them too. "NICU nurses not only care for the infants but must also provide a caring and safe environment for the families," Zastrow said.

How do you become a neonatal nurse?

To become a neonatal nurse, you must first obtain your RN license from the state where you intend to practice. The next step is finding a job opening. Zastrow said that in the past, it was difficult to get into NICU nursing unless you had prior experience or knew someone who could refer you. Because of the nursing shortage, it's now common for NICUs to hire new grads fresh out of nursing school. Orientation for a new NICU nurse typically lasts four to six months. "Training may be extended as needed, based on competencies," she said. Former NICU nurse Cheri DiStefano, BSN, RN, current manager in Enterprise Client Success at's parent company, Relias, said, "If you're aspiring to become a neonatal or NICU nurse, my advice is to make connections with people who work in a NICU who can become advocates for you to also work there." Seeking opportunities to work in a NICU in a nonnursing capacity may also open doors for you. "NICUs need assistance at the front desk or need volunteer cuddlers for low-acuity babies," DiStefano said.

Skills needed for neonatal nursing

The skill set needed for neonatal nursing is the same required of any nurse working in an intensive care environment, said Zastrow. These skills should include the ability to:

  • Think critically
  • Adapt to new tasks in a fast-paced environment
  • Maintain focus
  • Make split-second decisions
  • Remain calm in stressful working conditions
  • Provide care and compassion to families
  • Work collaboratively with multidisciplinary teams
  • Communicate clearly
  • Work long shifts, holidays, and nights

Demand and salary for neonatal nurses

Like all nurses, neonatal nurses are in demand. The Bureau of Labor Statistics (BLS) projects 6% job growth for all registered nurses from 2021 to 2031. "According to PayScale data from July 2022, neonatal nurses can expect to earn $71,060," Zastrow said. The 2022 Nurse Salary Research Report tallied the median RN salary at $78,000, combining all specialties and levels of experience. Should you choose to pursue advance practice and become a neonatal nurse practitioner (NNP), the outlook is also favorable. BLS projects 40% job growth for nurse practitioners, nurse anesthetists, and nurse midwives from 2021 to 2031. The median pay for nurse practitioners was $120,680 in May 2021, according to BLS. That aligns with's 2022 Nurse Salary Research Report as well, which found that all APRNs had a median salary of $120,000.

The challenges of neonatal nursing

Neonatal nurses find that caring for neonates and their families is rewarding but challenging. One of the biggest tasks is the amount of knowledge you need to provide expert care, DiStefano said. Two examples are bloodwork and vital signs for neonates -- they are different from adult and pediatric patients. Further, most ICUs are segmented by body system or specialty area such as neuro ICU, cardio-thoracic ICU, and surgical ICU, for example. "This means NICU nurses need to be experts in all body systems in a high acuity setting as they pertain to neonates," DiStefano said. NICU nursing can also impact you emotionally, with a range of highs and lows -- sometimes in the same shift.

"To be great in this role, you need to care about your patients and their families," DiStefano said. "However, the empathy and tenderness which make a great nurse also open you up to deep sorrow when a patient cannot be saved or when a poor outcome occurs."

The joys of neonatal nursing

Working as an NNP is "the most amazing job in the world," Zastrow said. "I'm blessed every day I work to be one of the first people to welcome tiny humans into the world. I can save lives and bring joy to families. I watch babies on the brink of death turn the corner and thrive." Of course, she also supports families in death. Even though the job is hard, DiStefano said, "It is one of the most rewarding roles in the world." Prepare for your nursing certification examination with our self-paced certification review online modules and comprehensive Focused CE courses.