A neonatal registered nurse (RN) primarily cares for neonates (infants less than four weeks old) who require continuous medical monitoring in a neonatal intensive care unit (NICU). A NICU nurse is capable of assessing patients, monitoring signs and symptoms, and using advanced technologies to deliver specialized care to these very young and often premature patients. NICU nurses are also responsible for educating parents and other caregivers about the plan of care and ongoing needs of the infant. Neonatal nurses work as a team with other nurses, respiratory therapists, and neonatologists (physicians who specialize in the care of newborns) to provide around-the-clock care to the smallest patients and their families.
What Does a NICU Nurse Do?
As a specialized type of registered nurse, NICU nurses use evidence-based practice to care for patients using a variety of skills and interventions. The scope of practice for a NICU nurse will vary between state and type of NICU, but examples of daily tasks include:
Collecting medical histories from patients’ families
Reviewing prenatal and delivery notes of the newborn
Assessing newborns from head-to-toe
Collecting vital signs, such as blood pressure
Monitoring continuous vital signs, such as oxygen level
Identifying nursing diagnoses and intervening appropriately
Administering medications and assessing their effects
Utilizing equipment, such as heart monitors and ventilators
Providing neonatal resuscitation efforts, such as rescue breathing or chest compressions
Creating plans of care with families and caregivers
Collaborating with other healthcare providers
In addition to scheduled tasks, a NICU nurse is also responsible for communicating with physicians and families and responding to changes in patients’ conditions throughout the shift. A NICU nurse may be responsible for only one very sick infant during a shift. Other times, a NICU nurse cares for two or three neonates during a shift. A NICU nurse must also carefully document all conversations and nursing care in the patient’s medical record.
How Much Does a NICU Nurse Make Per Year?
NICU nurses’ salaries are similar to that of other RNs and can vary greatly by employer, location, and experience. The median pay for RNs was $75,330 a year in 2020, which is just over $36 per hour in the United States. The median pay represents the middle: half of RNs earned more than that amount, and half earned less.
Neonatal nurses most commonly work in NICUs in hospitals. The median RN pay in hospitals was $76,840 in 2020. Annual salaries for registered nurses vary greatly by geographical location. RNs can expect a higher rate of pay at metro area hospitals than in rural areas, but metro areas also have a large range of pay across the country. Some of the highest-earning nurses in the country reported annual salaries of nearly $150,000.
Citation: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, at https://www.bls.gov/oes/current/oes291141.htm#st (visited January 15, 2022).
Where and When Do NICU Nurses Work?
The care of healthy newborns is typically done by nurses in the maternity unit of the hospital, where infants often stay in the same room as the parent(s). However, NICUs are specialized units in which nurses provide care to newborns with additional needs or who benefit from additional monitoring. NICUs are found in acute care hospitals and provide different levels of care to sick infants depending on the specialized resources available. In the United States, NICUs are designated as Level I, II, III, or IV.
Level I NICUs, or nurseries, are for infants born at 34 weeks gestation or later and who are relatively healthy.
Level II nurseries care for infants who may require extra time and assistance with feeding before going home. These nurseries are often found in smaller hospitals.
Level III nurseries care for infants who require interventions, such as ongoing breathing assistance using a machine, that are not available in Level I and II nurseries. Level III nurseries are typically located within large medical centers or children’s hospitals.
Level IV nurseries provide care for patients needing Level III interventions plus surgical or transport care. Similar to Level III NICUs, Level IV NICUs are found in teaching hospitals, metro areas, or children’s hospitals and are often a regional resource.
A NICU nurse can find employment in nearly any hospital thanks to this range in care. NICU nurses can work in the type of unit that appeals to them, caring for relatively healthy infants or for extremely complicated patients. Registered nurses interested in caring for neonates may start their careers in pediatric, labor and delivery, or postpartum units before advancing into neonatal intensive care.
In NICUs, nurses often work shifts that are 12 hours long. Shifts are usually 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m. There are some exceptions, but these long shifts provide more consistent care for patients and their families. A full-time NICU RN may work three, 12-hour shifts in a seven day period. On-call shifts may also be required for NICU RNs. Since intensive care units are open 24 hours a day and 365 days a year, NICU nurses may be required to work during weekends and holidays. New hires may be required to work all day shifts, or all night shifts, at the beginning of their employment as registered nurses to fulfill on-the-job training requirements.
How Do I Become A NICU Nurse?
NICU and other intensive care unit nurses are registered nurses with either a bachelor’s or associate’s degree in nursing. A Bachelor of Science in Nursing (BSN) is often preferred by employers over an associate’s degree. Undergraduate degree programs take 18 months to four years to complete. Upon graduation, an aspiring registered nurse, known as a graduate nurse, is able to take the NCLEX-RN (National Council Licensure Examination for Registered Nurses). A graduate nurse becomes an “RN” after passing the NCLEX.
Student nurses who have an interest in neonatal nursing should strive for excellent grades in courses related to newborns, pediatrics, and women’s health. Volunteering or shadowing in NICUs and well-child nurseries shows commitment and provides exposure to this specialty. Externships, or patient-care learning experiences with professional nurses, are often part of nursing degree programs, and interested students should request placement in a NICU if possible. Good alternatives are pediatrics, labor and delivery, and postpartum or maternity units.
What Are the Benefits of Being A NICU Nurse?
NICU nurses are able to celebrate their patients growth every day, achieving new milestones, and preparing to go home with their families. Utilizing nursing skills and advanced technology to improve the health of a child can be very satisfying. NICU nurses can also be excellent teachers and aid new caregivers in becoming experts in caring for their children.
However, patients do not always show improvement every day, and unfortunately, some will never go home with their families. For all the joy to be found in caring for newborns, NICU nurses must also be prepared to support families through loss. These difficult circumstances allow NICU nurses to be a source of comfort and strength for families experiencing a wide range of emotions during their time in the NICU.
NICU nurses with experience can also pursue nursing education or management positions to guide others caring for neonates. Additional training and certification are available as well. NICU nurses are essential members of the teams that move neonates to higher-level NICUs when needed. Critically ill neonates are transported by NICU transport nurses and respiratory therapists by ambulance or by helicopter.
An experienced NICU nurse wishing to further their education can enroll in a master’s or doctoral program to become an advanced practice registered nurse (APRN), specifically a neonatal nurse practitioner (NNP). Upon completing an accredited program, RNs can take the Neonatal Nurse Practitioner-Board Certified (NNP-BC) exam from the National Certification Corporation.
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