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by
Melissa Mills, BSN (Columnist)
One in every 10 infants born in the United States is preterm, meaning they are born before 37 weeks gestation. Many of these babies have birth defects, low birth weight, and other conditions requiring special care from neonatal intensive care unit (NICU) nurses.
NICU nurses are specialized pediatric practitioners who provide critical care to ill newborns requiring advanced medical and nursing treatment. They also provide education and support to family members during one of the scariest times of their lives.
NICU Nurse Job Description
NICU nurses provide around-the-clock primary care for newborn infants requiring medical and surgical interventions such as bathing, feeding, and diapering. However, they also perform advanced assessments and procedures for premature infants who are often critically ill and require tube feedings, medications, IV fluids, blood transfusions, and mechanical ventilation.
Nurses in the NICU may provide one-on-one care for the most critically ill infants, or they may be assigned three to four infants, often called "feeder-growers,” who are past the critically ill phase of care but still require monitoring as they learn to breathe, eat, and grow independently before going home with their parents.
These highly-skilled nurses often gain clinical experience on adult medical-surgical units or general pediatric units before transferring to the NICU. However, some healthcare facilities offer internships in neonatal nursing care for new graduates with active RN licensure so they can gain experience with this specialized patient population.
NICU Nurse Responsibilities
Most of the time, neonatal nurses work in hospitals with special care nurseries. However, these clinical nurse specialists are also needed to provide patient care in critical care transport, trauma, and cardiac care units.
There are four levels of care for all newborns:
- Level I nurseries provide standard patient care to healthy babies in hospitals. The newborns are usually discharged within a few days after birth.
- Level II nurseries provide hands-on care for premature babies at 32 weeks gestation or above and full-term infants who need close observation.
- Level III nurseries give specialized care for babies born before 32 weeks gestation and those with low birth weight who are critically ill.
- Level IV nurseries are NICU units that provide patient care to the most critically ill newborns needing surgery and other advanced nursing and medical treatment. These units are often found in specialized pediatric hospitals and academic institutions that employ advanced healthcare professionals in many specialties.
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Because NICU nursing care can be delivered at various levels, the type of nursing responsibilities and duties can also vary. A higher level of NICU nursing care might also require additional education requirements and credentials for the nurses working there.
Typical NICU nursing care duties across the spectrum of units include the following:
- Perform comprehensive patient care, including assessments and vital sign monitoring
- Draw blood and perform other specialized procedures
- Collaborate with the healthcare team, including nurses, physicians, and neonatal nurse practitioners
- Administer medications, IV fluids, oxygen therapy, and specialized feeding techniques such as tube feedings
- Work with specialized medical equipment such as incubators, ventilators, IV pumps, and specialized oxygen delivery systems
- Provide pre-and post-surgical care for infants
- Provide hands-on patient care for newborns, including diapering, feeding, bathing, and dressing
- Educate parents and family members about the newborn's condition and any post-hospital care they may need
NICU Salary Expectations
According to the Bureau of Labor Statistics (BLS), RNs make an average annual salary of $77,600. However, BLS doesn't provide data specifically on NICU nurse salaries.
Payscale, a company that allows NICU nurses to self-report annual earnings, reports that the average NICU nurse salary in March 2023 was just over $75,000, and the 90th percentile of earnings was $119,000.
NICU nurse salaries vary based on the level of the NICU unit in which the nurse works and other factors, including:
- Years of nursing experience
- Level of education, licensure, and certification
- Geographical area of the U.S.
- Type, level, and location of the healthcare facility
How to Become a NICU Nurse
NICU nurses are registered nurses (RNs) with at least an ADN or associate's degree in nursing. In addition, many healthcare facilities require a BSN or bachelor's degree to work in this highly advanced and specialized nursing practice field.
Nurses who enjoy this nursing field can obtain an advanced nursing degree to provide a higher level of medical care and oversight for these patients. Examples of APRNs who work in the NICU include those with a master's degree in nursing (MSN), neonatal nurse practitioners, and those with a doctor of nursing practice (DNP).
Nurses can specialize in their NICU nursing career in other ways too. For example, they often obtain certifications or go into nursing leadership positions. Nursing leadership job titles include charge nurse, nurse manager, or director of nursing.
Related: 10 Best Master of Science in Nursing (MSN) Programs in 2023
Does this nursing specialty sound like the job for you? If you're interested in a NICU nursing career, follow the steps below to get on the NICU nurse career pathway.
- Attend an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN) nursing program.
- Pass the NCLEX-RN exam and obtain your RN license.
- Gain nursing experience on a general nursing unit working with adults or pediatric patients or apply to a NICU internship program to gain NICU nursing experience.
- Apply to and work at any level of special care nursery to gain clinical nursing experience.
- Become a member of the National Association of Neonatal Nurses or other organizations to stay current on all new hands-on care treatment modalities for this specialty.
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Consider specialized neonatal nurse certifications such as:
- Critical Care Registered Nurse (CCRN) granted by the American Association of Critical Care Nurses
- RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC) granted by the National Certification Corporation
NICU nurses make a meaningful difference in the lives of vulnerable infants and their families during a crucial and challenging time. Contributing to advancing neonatal care can be highly rewarding for those drawn to this specialized field.
