Neonatal Nurse Career

Neonatal nurses provide direct patient care to newborns in hospitals for the first month after birth. The babies they care for may be normal, they may be born prematurely, or they may be suffering from an illness or birth defect. Some of the babies require highly technical care such as surgery or the use of ventilators, incubators, or intravenous feedings.

Neonatal Nurse Career History

Neonatal care in some basic form has been around since the dawn of time. But the specialized field of neonatal nursing did not develop until the 1960s as advancements in medical care and technology allowed for the improved treatment of premature babies. According to the March of Dimes, one of every 13 babies born in the United States annually suffers from low birth weight. Low birth weight is a factor in 65 percent of infant deaths. Neonatal nurses play a very important role in providing care for these infants, those born with birth defects or illness, and healthy babies.

Neonatal Nurse Job Description

Neonatal Nurse CareerNeonatal nurses care for newborn babies in hospitals. Depending on the size of the hospital, their duties may vary. Some neonatal nurses may be in the delivery room and, as soon as the baby is born, they are responsible for cleaning up the baby, visually assessing it, and drawing blood by pricking the newborn’s heel. This blood sample is sent to the laboratory, where a number of screening tests are performed as required by the state. These assess­ments help the staff and doctor determine if the baby is normal or needs additional testing, a special diet, or intensive care. Sharon Stout, RN, who was a neonatal nurse for six years in Georgia, said she loved being in the delivery room and caring for the newborn because she enjoyed seeing the interaction with the baby and the new mother and family. “It was usually a very happy time.”

“However,” she says, “if a baby needed special care that we could not provide at our facility, we stabilized it until the neonatal transport team arrived from a larger hospi­tal to transfer the baby to its special neonatal care unit.”

Babies who are born without complications are usu­ally placed in a Level I nursery or in the mother’s room with her. However, because of today’s short hospital stays for mother and child, many hospitals no longer have Level I, or healthy baby nurseries. Neonatal or general staff nurses help the new mothers care for their newborns in their hospital rooms.

Level II is a special care nursery for babies who have been born prematurely or who may have an illness, disease, or birth defect. These babies are also cared for by a neonatal nurse, or a staff nurse with more advanced training in caring for newborns. These babies may need oxygen, intravenous therapies, special feedings, or because of underdevelopment, they may simply need more time to mature.

Specialized neonatal nurses or more advanced degree nurses care for babies placed in the Level III neonatal intensive care unit. This unit admits all babies who can­not be treated in either of the other two nurseries. These at-risk babies require high-tech care such as ventilators, incubators, or surgery. Level III units are generally found in larger hospitals or may be part of a children’s hospital.

Neonatal Nurse Career Requirements

High School

In order to become a neonatal nurse, you must first train to be a registered nurse. To prepare for a career as a reg­istered nurse, you should take high school mathematics and science courses, including biology, chemistry, and physics. Health courses will also be helpful. English and speech courses should not be neglected because you must be able to communicate well with patients.

Postsecondary Training

There is no special program for neonatal nursing in basic RN education; however, some nursing programs have an elective course in neonatal nursing. Entry-level requirements to become a neonatal nurse depend on the institution, its size, and the availability of nurses in that specialty and geographical region. Some institutions may require neonatal nurses to demonstrate their ability in administering medications, performing necessary math calculations, suctioning, cardiopulmonary resuscitation, ventilator care, and other newborn care skills. Nurses who wish to focus on caring for premature babies or sick newborns may choose to attend graduate school to become a neonatal nurse practitioner or clinical nurse specialist.

Certification or Licensing

Neonatal nurses who work in critical care may become certified in neonatal critical care nursing by the AACN Certification Corporation, a subsidiary of the American Association of Critical Care Nurses (AACN). Applicants must hold an unrestricted registered nurse license, have completed a graduate-level advanced practice program that includes a minimum of 500 supervised clinical hours, pay an application fee, and take and pass a three-and-one-half-hour exam.

Other Requirements

Neonatal nurses should like working with mothers, newborns, and families. This is a very intense nursing field, especially when caring for the high-risk infant, so the neonatal nurse should be compassionate, patient, and able to handle stress and make decisions. The nurse should also be able to communicate well with other medical staff and the patients’ families. Families of an at-risk newborn are often frightened and very worried about their infant. Because of their fears, family members may be difficult to deal with, and the nurse must display patience, understanding, and composure during these emotional times. The nurse must be able to communi­cate with the family and explain medical terminology and procedures to them so they understand what is being done for their baby and why.

Exploring Neonatal Nurse Career

You can explore your interest in neonatal nursing by reading books on careers in nursing; by talking with high school guidance counselors and neonatal nurses; and by visiting hospitals to observe a health care setting and talk with hospital personnel.


Neonatal nurses are employed by hospitals, managed-care facili­ties, long-term-care facilities, and government agencies.

Starting Out

The only way to become a regis­tered nurse is through comple­tion of one of the three kinds of educational programs plus pass­ing the licensing examination. Registered nurses may apply for employment directly to hospi­tals, nursing homes, and com­panies and government agencies that hire nurses. Jobs can also be obtained through school placement offices, by signing up with employment agencies spe­cializing in placement of nurs­ing personnel, or through the state employment office. Other sources of jobs include nurses’ associations, professional jour­nals, and newspaper want ads.


Neonatal nurses seeking career advancement, but who would like to continue to care for babies, might consider becoming a neo­natal nurse practitioner or clini­cal nurse specialist. They can do this by gaining at least two years of experience in a neonatal intensive care unit (recom­mended by the National Association of Neonatal Nurses) and then completing graduate school training in their desired specialty.


Salary is determined by many factors, including nurs­ing specialty, education, and place of employment, shift worked, geographic location, and work experience. According to the U.S. Department of Labor, registered nurses working at hospitals had a median annual income of $53,450 in 2004. The lowest paid 10 percent of all registered nurses earned less than $37,300 per year. The highest paid 10 percent made more than $74,760. How­ever, neonatal specialty nurses can generally expect to earn more, especially when advancing to administra­tive positions. According to the National Association of Neonatal Nurses, nurses just starting out in this field may have starting salaries in the upper $30,000s to mid-$40,000s. Given these high beginning salaries, it is logical to expect a neonatal nurse with some experience to earn more than the national median for all registered nurses.

Flexible schedules and part-time employment oppor­tunities are available for most nurses. Employers usually provide health and life insurance, and some offer edu­cational reimbursements and year-end bonuses to their full-time staff.

Work Environment

Neonatal nurses can expect to work in a hospital envi­ronment that is clean and well lighted. Inner-city hos­pitals may be in a less than desirable location, and safety may be an issue. Generally, neonatal nurses who wish to advance in their careers will find themselves working in larger hospitals in major cities.

Nurses usually spend much of the day on their feet, either walking or standing. Many hospital nurses work 10- or 12-hour shifts, which can be tiring. Long hours and intense nursing demands can create burnout for some nurses, meaning that they often become dissatis­fied with their jobs. Fortunately, there are many areas in which nurses can use their skills, so sometimes trying a different type of nursing may be the answer.

Neonatal Nurse Career Outlook

The U.S. Department of Labor predicts that employment for all registered nurses will grow faster than the average through 2014. In addition, nursing specialties should be in great demand in the future. The outlook for neonatal nurses is very good, especially for those with master’s degrees or higher. According to the National Association of Neonatal Nurses, positions should be available due to downsizing in previous years. These cutbacks have led to a decrease in the number of nurses choosing advanced practice education. Also, the average neonatal nurse today is middle-aged and may be moving on to less stressful areas of nursing.

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