The Neonatal Nurse

Neonatal nurses work with infants who have born with conditions that require substantial medical care. Often they are premature; they may have been born with some body systems not yet fully developed. Some babies receive neonatal intensive care because they have been born with cardiac defects, other birth defects, or multi-system genetic disorders. Various medical issues may arise or be discovered at the time of birth. In recent years, too, neonatal wards have been seeing a lot of infants born drug-dependent.

Neonatal nurses need confidence as well as skill.

Neonatal nurses typically work in neonatal intensive care units, or NICUs. Although neonatal means newborn, neonatal nurses may work with infants beyond what is generally considered the newborn phase. Most often it is until the baby first leaves the hospital. In rare instances, a neonatal nurse may work with infants up to age two.

Levels of Neonatal Care

There are different levels of NICU for babies born at different gestational ages and birth weights and with varying levels of acuity. Higher levels are needed for babies who need more than brief assistance with breathing. Being born at a weight of three pounds puts a baby into a high risk category (though much smaller babies now routinely survive.

Newborns go to a special care unit where there is moderate risk for complications. Special care is sometimes referred to as a Level II NICU. Level II nurseries are not designed to provided artificial ventilation for the long-term.

Level III is a true neonatal intensive care unit. Artificial ventilation is provided for more extended time periods. Pediatric surgeons and medical sub-specialists are available to manage more serious medical needs. These are high-volume units – it makes a difference in outcomes!

Level IV, or regional neonatal intensive care unit, is higher yet. NICUs with this designation manage complex cases; the institution is able to perform complex surgeries on neonates.

MedStar Georgetown University Hospital, a Level IV facility, notes the following among the commonly treated conditions: extreme prematurity, septic shock, neonatal encephalopathy, neurologic disorders, and surgical needs.

Medical professionals try to have babies born at facilities with the appropriate level of care. This increases the chance that the child will survive without serious complications. However, it’s not always possible. Newborns may be cared for in facilities with lower levels of care until they stabilize.

NICUs utilize nurses with varied skill sets. Some babies have matured to the point where they breathe well but need support feeding. Some NICUs utilize neonatal/ lactation nurses.

Halifax Health notes that one in ten infants are admitted to an NICU at some level ( This may be less surprising when one considers that decades ago, it was believed that all mothers and babies needed fairly lengthy hospital stays. The once ubiquitous Level I unit — a nursery for healthy babies – is no longer common. Often those babies are with mom – and they’re on their way home. (Healthy babies need some perinatal care, but it’s likely the facility will use a different term like mother-baby.)

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How to Become a Neonatal Nurse

Neonatal nurses need confidence as well as skill. Some infants are very tiny and very fragile.

Neonatal nursing units require experienced, adept nurses. However, they utilize some new grads as well. Although one can achieve RN licensure with an associate’s or bachelor’s degree, the BSN can be better preparation for a neonatal intensive care unit. Some premier hospitals offer residencies to new graduates. They often require the BSN.

These residencies can be competitive in other ways. They may value high GPA, prior experience working with a similar age group, and other honors or areas of service. Whether or not NICU residency is offered at a particular time may depend on the needs of the facility. Memorial Hospital in Colorado Springs, MultiCare Health System, and Lucile Packard Children’s Hospital- Stanford are among those that offer an NICU residency at least some of the time.

Sometimes talented students even get some experience in before graduation. Children’s Hospital of The King’s Daughters, for example, has a pediatric externship program that could potentially put a student in the NICU (

Career Development and Advancement

Neonatal nurses at some facilities participate on flight or ground transport teams. They care for infants who are en route to facilities that have NICUs at the appropriate level. Some experienced nurses have, as their primary duty, critical care transport. Flight nurses may also care for older infants and children.

Some neonatal nurses contribute to the profession through their ideas. Major facilities may have committees such as parent advisory and developmental care. Developmental care is a potential area for career advancement.

Some neonatal nurses go on to become neonatal nurse practitioners, an advanced practice role. Advanced practice requires at least a master’s degree. Training often takes place at the doctoral level.

Life on the neonatal ward is changing. The National Association of Neonatal Nurses reports that medical breakthroughs have increased the survival rate for vulnerable low birth-weight babies by 10 times in just 15 years (

Some neonatal advances are high tech. MedStar Georgetown cites the following among the therapies they are equipped to utilize: extracorporeal membrane oxygenation (ECMO), high frequency oscillator ventilation, and bedside patent ductus arteriosus ligation.

Neonatal units are also seeing a return to good old-fashioned care, including the importance of physical contact and nurturing. They may utilize baby cuddlers. One may find infants with neonatal abstinence syndrome being treated with massage.

Neonatal Nursing Certification

Neonatal Resuscitation Program (NRP) certification is a basic requirement.

More comprehensive neonatal nursing certifications are available through the National Certification Corporation (NCC). NCC offers Low Risk Neonatal Nursing (RNC-LRN) and Neonatal Intensive Care Nursing (RNC-NIC). A licensed RN who has been employed in the specialty during the prior two year period will need to have accrued, over the course of his or her career, at least 24 months of experience and no fewer than 2,000 hours.

Electronic Fetal Monitoring (C-EFM) and Neonatal Pediatric Transport (C-NPT) are considered sub-specialties. C-EFM and C-NPT certifications are available to RNs as well as some other health professionals (for example, paramedics and physician assistants). The certifying body recommends two years of experience prior to obtaining the C-EFM.

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