Neonatal Intensive Care Unit (NICU) Nursing

Neonatal Nursing is the specialty of caring for the tiniest of patients and their families. Leading patients and families down an often long and circuitous route to a successful homecoming is the ultimate goal of all NICU nurses.

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Neonatal Intensive Care Unit (NICU) Nursing

Overview

Care in the Neonatal Intensive Care Unit (NICU) is extremely specialized and runs the gamut from the stable neonate to the extremely ill infant. NICU nurses are intensive care nurses of the smallest patients. Their work environment usually consists of high intensity care coupled with technical details associated with the most critically ill patients.

NICU nurses provide twenty-four hour skilled care of the medically fragile newborn (from birth to approximately age 30 days) in an intensive care environment. As the age of viability has decreased over the years, there are more and more low birth weight and premature infants being born and requiring intensive care.

Reasons for NICU Admission (not all-inclusive)

  • Congenital cardiac abnormalities
  • Post-open heart surgery
  • Hypoglycemia
  • Gastroschisis
  • Diaphragmatic hernia
  • Fetal alcohol syndrome
  • Drug addicted babies
  • Mechanical ventilation
  • Meconium aspiration
  • Meningitis
  • Respiratory distress
  • Chromosomal abnormalities

Qualities

As in other pediatric specialties, nurses are caring for the infant as well as the parents and family unit. Nurses who work in the NICU must enjoy the education aspect of nursing care since rarely do parents know what happens in a NICU prior to their child's birth. It is imperative that the nurse can easily relate and gear the education to the parent's education and socioeconomic status as well what information they can process at this time. Infants being cared for in the NICU can have a very stormy course with many highs and lows. It is often necessary for the nurse to understand palliative care as well as the usual course of the more common diagnoses.

Work Environment

There is much disparity in thelevels of care that NICUs provide ranging from Level 1 to Level IV.

Level I

Level I facilities (well newborn nurseries) provide a basic level of care to neonates who are low risk.

Level II

Care in a specialty-level facility (level II) should be reserved for stable or moderately ill newborn infants who are born at or more than 32 weeks' gestation or who weigh at or more than 1500 g at birth with problems that are expected to resolve rapidly and who would not be anticipated to need subspecialty-level services on an urgent basis.

Level III

Infants requiring Level III services may require mechanical ventilation and surgery.

Level IV

Infants who are at the lowest age of viability and at the highest level of care are included in Level IV care. Evidence suggests that infants who are born at Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day. Level IV facilities would also include the capability for surgical repair of complex conditions such as congenital cardiac malformations that require cardiopulmonary bypass with or without extracorporeal membrane oxygenation.

Professional Organizations / Associations

National Association of Neonatal Nurses (NANN)

Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN)

Academy of Neonatal Nursing

Education

  • Graduate from an accredited RN (Registered Nurse) program (Diploma, ADN, BSN, MSN, DNP)
  • Successfully pass the NCLEX-RN examination
  • Current, unencumbered U.S. license as an RN

The RN will require experience as a neonatal nurse. This can be obtained in the following areas (not all-inclusive):

  • OB
  • Well baby nursery
  • Maternal-child care
  • Pediatrics

Neonatal/NICU RNs interested in advancing their careers can consider becoming an Advanced Practice Registered Nurse (APRN) and receive education as a Neonatal Nurse Practitioner (NNP).

There are Master of Science in Nursing (MSN) and post-Master's certificate programs available as well as Doctor of Nursing Practice (DNP) programs. Some programs offer the Bachelor of Science in Nursing (BSN) to Doctor of Nursing Practice (DNP) educational opportunity. The type of program availability may include full-time, part-time, online, and/or hybrid.

Neonatal Nurse Practitioner Programs (not all-inclusive)

University of Texas Arlington (MSN)

Rush University Neonatal Nurse Practitioner (NNP) Doctor of Nursing Practice (DNP): online

The Ohio State University (BSN-DNP)

Emory University Nell Hodgson Woodruff School of Nursing Neonatal Nurse Practitioner (MSN or DNP): online

Duke University (MSN and Post-Graduate Certificate): distance-based

Certifications

National Certification Corporation (NCC)

The NCC provides certification examinations for the eligible RN and Neonatal Nurse Practitioner (NNP):

1 - RNC Certification in Low Risk Neonatal Intensive Care Nursing (RNC-LRN{R}) - eligibility (not all-inclusive)

  • Current/active/unencumbered RN license in U.S. or Canada
  • 24 months of specialty experience; minimum 2000 hours
  • Specialty experience: direct patient care, education, administration or research
  • Employment in specialty in the last 24 months

2 - RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC) - eligibility (not all-inclusive)

  • Current/active/unencumbered RN license in U.S. or Canada
  • 24 months of specialty RN experience as U.S. or Canadian RN; minimum 2000 hours
  • Specialty experience: direct patient care, education, administration or research
  • Employment in the specialty sometime in the last 24 months

3 - Neonatal Nurse Practitioner (NNP-BC) - eligibility (not all-inclusive)

  • Current/active/unencumbered U.S. RN or Advanced Practice Registered Nurse (APRN) license
  • Graduated from accredited graduate Nurse Practitioner (NP) program (MSN, DNP, or post-master's that meets NCC approval The program can be a master's DNP or post-master's. Certificate-prepared applicants are not accepted
  • Applicant must be within 8 years of NP graduation to sit for the exam

4 - Neonatal Neuro-Intensive Care (C-NNIC) - eligibility (not all-inclusive)

  • Current/active/unencumbered in U.S. or Canada as a physician (MD/DO), RN, APRN, or respiratory therapist
  • No practice experience is required; recommended that applicant have at least one year of experience caring for neurologically at risk or compromised neonates

American Association of Critical-Care Nurses (AACN)

The AACN provides certification examinations for the eligible RN and APRN. The CCRN® is for the RN who provides acute/critical neonatal care in any work environment (NICU, trauma, flight, etc.). The ACCNS-N® (Neonatal) is for the Clinical Nurse Specialist (CNS).

1 - CCRN® (Neonatal) eligibility (not all-inclusive)

2 yr option:

  • Current/active/unencumbered U.S. RN or APRN license
  • RN or APRN complete 1,750 hours direct care of acutely/critically ill neonatal patients during the previous 2 years
  • 875 of those hours accrued in the most recent year preceding application OR

5 yr option:

  • Current/active/unencumbered U.S. RN or APRN license
  • Practice as an RN or APRN for at least 5 years
  • Minimum 2,000 hours direct care of acutely/critically ill neonatal patients
  • 144 of those hours accrued in the most recent year preceding application

2 - ACCNS-N® (Neonatal) eligibility (not all-inclusive)

  • Current/active/unencumbered U.S. RN or APRN license
  • Graduate from an accredited neonatal CNS program

3 - CCRN-K™ (Neonatal)

This certification is for nurses who do not provide direct patient care but who directly influence the care of the acutely ill neonate. This includes:

  • clinical educators
  • managers and supervisors
  • academic faculty members

eligibility (not all-inclusive)

  • Current/active/unencumbered U.S. RN or APRN license
  • 1,040 hours during the previous two years
  • 260 of those hours accrued in the most recent year preceding application

Additional Certifications

The following are highly recommended for all neonatal RNs and APRNs (not all-inclusive):

  • Basic Life Support (BLS)
  • Pediatric Advanced Life Support (PALS)
  • Neonatal Resuscitation Program (NRP)
  • The S.T.A.B.L.E. Program (post-resuscitation/pre-transport stabilization care of sick infants)

Salary (2020)

According to ZipRecruiter, the average annual pay for a NICU Nurse in the U.S. is $99,711 per year.

According to salary.com, the average NNP salary in the U.S. is $125,135 and falls between $115,021 and $135,291.

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Specializes in Med-Surg, NICU.

Great post!

NICU is the end-goal for me. I am fortunate in that I am in the NICU often for postpartum mothers. It is a very extreme specialty, and most of the nurses that get a job stay in the NICU for the long haul.

My heart is with the babies.

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Specializes in General Surgery, NICU.

Thank you for this informative article and NICU resources! I am helping out a bit in our Level IV NICU and want to transfer and become a NICU nurse.

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Specializes in NICU.

Looks great!

I (in my humble opinion) would add the following:

-Academic centers are an excellent way to get started in a NICU career and they generally overwhelming take new grad nurses. They like them because they are "fresh" and have no "bad habits" that they pick up from the adult world in regards to getting used to adult medicine norms. If you apply for a job, make sure they have a decently long orientation (at least 12 weeks, better to have longer; I had 20 weeks). You will feel like you're in school again because you are learning entirely new norms. It's okay to feel dumb; we all do at times, but especially as a new grad.

-STABLE and NRP are good certifications that you can get while trying to make yourself competitive for job applications, although they are challenging as a student nurse. I took NRP as a senior nursing student and then took STABLE as a new grad while in orientation.

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