Neonatal Nurse

Neonatal intensive care units (NICUs) have been a part of the American healthcare system since 1922. For a century, neonatal nurses in the United States have given premature, underweight, or sick babies a fighting chance to survive. According to the March of Dimes, nearly one in ten live births in the United States were born before 37 weeks, equating to 383,979 NICU patients in 2021. When a live birth happens earlier than expected, neonatal nurses do their best to ensure premature babies have the best chance to thrive and develop healthfully.  

As a result of the exceptional care provided by NICU nurses in US-based hospitals, the survival rate for preterm babies increased by nearly 3 percent from 2013 to 2018. Read on to discover what it takes to join the challenging yet gratifying field of neonatal nursing.

Specializing in around-the-clock care, neonatal nurses nurture and administer immediate care after live births and stillbirths. When a baby is born live preterm, anywhere from 25 to 37 weeks, NICU teams are prepared with life-saving techniques and technologies to help infants develop vital bodily functions, such as breathing, cardiovascular circulation, digestion, elimination, and immune systems. In addition, nurses can learn neonatal nursing skills on the job and through educational and certification programs.

Like other fields of nursing, neonatal nurses are expected to be in demand in the coming years. The US Bureau of Labor Statistics (BLS) shows that registered nursing (RN) and advanced practice registered nursing (APRN) careers will grow substantially in the coming decade. According to the BLS, openings for registered nurses (RNs) will grow 6 percent from 2021 to 2031, about as fast as the national average for all occupations. An estimated 194,500 new RN positions will open in the same period. By comparison, nurse practitioners (NPs) and other APRN positions will grow by an astonishing 40 percent. This equates to 118,600 new jobs.

Most RNs enter the workforce with an associate degree (or higher) and may later earn training and certification in neonatal nursing. APRNs hold an MSN, DNP, or post-master’s certificate in neonatal acute care and pursue certification through an organization, such as the American Association of Critical-Care Nurses, which offer the CCRN Neonatal certification. 

Read on to learn more about the field of neonatal nursing.

To become a neonatal nurse requires an undergraduate, graduate, or doctorate degree, clinical hour requirements, and specialty certification. Each state has specific requirements to license nurses, but here are the common neonatal nursing specializations and degree types. 

Neonatal Nurse Specializations

RNs may choose to have a neonatal specialization, while APRNs are required to have board certification in one or more areas. Here are some common specializations for neonatal nurses: 

• Critical care (clinical)
• Critical care (clinical nurse specialist, nurse educator, nursing administrator 
• Advanced critical care (clinical and administrative)

In general, three organizations confer certifications to neonatal RNs and APRNs:

• American Association of Critical-Care Nurses (AACN) 
• National Certification Corporation (NCC)
• State-specific requirements through a state board of nursing (SBON)

More information about these organizations is in the section certification and licensure below.

Neonatal Degree Types 

There are many educational pathways to becoming a neonatal nurse. Here is a list of standard nursing degree programs and their time-to-completion: 

• LPN/LVN: Licensed practical or vocational nurse (one year or less)
• ADN: Associate of science degree in nursing (two years)
• RN-to-BSN: For those with an ADN degree (two years) 
• BSN: Bachelor of science in nursing (four years)
• ABSN: Accelerated BSN for those with non-nursing degrees (one to three years)
• RN-to-MSN: For those with an ADN degree (three to four years)
• MSN: Master of science in nursing (two to three years)
• Post-master’s certificate: For those with an MSN or higher (one to two years)
• BSN-to-DNP: For those with a BSN who want to earn a DNP (three to four years)
• DNP: Doctorate of nursing practice (two to five years)

Admission requirements for neonatal nursing programs vary, but most have standard requirements: 

• Associate’s degree in nursing (ADN) or bachelor of science in nursing (BSN)
• Criminal background check 
• GRE scores
• Letters of recommendation
• Resume
• Statement of purpose
• Unencumbered RN license (for MSN, DNP, and post-master’s certificate programs) 

Two organizations accredit nursing programs: 

• Accreditation Commission for Education in Nursing (ACEN) 
• Commission on Collegiate Nursing Education (CCNE)
• State Boards of Nursing (SBONs)

Both organizations accredit nursing programs at the undergraduate, graduate, and doctoral levels and make sure nursing programs meet high standards of academic excellence. In addition, graduating from an ACEN- or most states require CCNE-accredited program to be eligible to take the NCLEX exam to earn an RN license.

Most neonatal nursing programs are at the master’s degree level, as most ADN and BSN degree programs are generalist.

University of California-San Francisco – MSN and post-master’s certificate in neonatal nursing

The University of California San Francisco prepares prospective neonatal nurses to be empathetic nurses working to close the disparity gap in neonatal access. The program accepts both master’s and post-master’s degree students. The university requires candidates to have two years of RN experience in acute care neonatal or infant experience before admissions. 

In combination with pediatric and neonatal care education residency working hands-on with the regional community provides real-time access to care work in the field. After completing educational coursework and residency practice, students are eligible for the neonatal nurse practitioner certification in California and the neonatal clinical nurse specialist under the California Board of Registered Nursing licensure and with the American Association of Critical-Care Nurses certificate. 

• Location: San Francisco, CA
• Duration: Two years
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $68,471 total 

Wayne State University – MSN with neonatal NP specialty

Wayne State University offers a neonatal nurse practitioner clinical specialty program. Three main pillars are the focus of nurse work: prevention of disease and disability, evidence-based clinical management, and health promotion, emphasizing family providing care with nurse practitioners. This 47-credit program prepares nurses to take the National Certification Corporation (NCC) to become licensed neonatal nurse practitioners (NNP). 

The curriculum includes twelve master’s core credits and forty-seven credits of course requirements, including neonatal pharmacology for the APN and pathophysiology clinical care management I, II, and III. 

The U.S. News & World Report ranks this school as one of the best grad schools for nursing degrees in DNP in 2023, MSN in 2023, and BSN in 2022.

• Location: Detroit, MI 
• Duration: Two to three years
• Accreditation: Commission on Collegiate Nursing Commission
• Tuition: $855.09 per credit (residents); $1,714.14 per credit (non-residents)

University of Virginia – MSN and post-master’s certificate in neonatal nursing 

The UVA School of Nursing ranks #6 on the U.S. News & World Report’s list of best public MSN programs. It provides prospective students with many opportunities to complete a degree and find work in neonatal nursing within two years. The program is geared toward BSN nurses with two years of experience in neonatal care and an advanced career opportunity. 

The programs can be completed full- or part-time and feature cutting-edge technology, supportive faculty, and top-tier clinical locations. Some of the required courses listed are processes for healthcare, advanced pathophysiology, genetics, and physiology. 

• Location: Charlottesville, VA 
• Duration: Two to three years
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $23,356 (residents); $36,688 (non-residents)

The University of Tennessee Health Science Center – DNP in neonatal nursing

The University of Tennessee Health Science Center offers a DNP specialization in neonatal nursing that students can complete in one year full-time. Applicants should have five years of work experience in acute care neonatal or pediatrics to be admitted to the program.

The curriculum focuses on professional collaborations, support for families, practice through an evidenced-based lens, and supervised clinical work. In addition, the program offers APRNs with or without a neonatal certification and neonatal nurse practitioners the opportunity to complete a DNP.  

• Location: Memphis, TN
• Duration: One year 
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $10,800 (residents); $11,700 (non-residents)

Case Western Reserve University – MSN and post-master’s certificate in neonatal nursing 

Case Western Reserve provides neonatal nurse practitioner candidates looking for a full-time program to be completed over four consecutive semesters with the best mid-western university fit for their educational needs. 

The program consists of 40 credits and 700 clinical experience hours in level III NICUs. Students work directly with an NNP or neonatologist to learn hands-on what patient care means. In addition, understanding the ins and outs of neonatology through online and in-person didactic lessons will prepare students for future work. After graduation, students are ready to take the National Certification Corporation exam in NNP practice. 

• Location: Cleveland, OH
• Duration: Four semesters
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $2,263 per credit

East Carolina University College of Nursing– Online MSN and post-master’s certificate in neonatal nursing 

The East Carolina University College of Nursing provides a 42-semester hour online neonatal MSN program that prepares nurses to care for critically-ill newborns and pediatric patients. Students can attend part- or full-time and learn through online didactic courses and in-person clinical experiences. 

Courses include advanced techniques in pharmacological and advanced neonatal nursing. A post-master’s certificate is available for applicants with an MSN or DNP. Graduates from this neonatal nursing program are eligible to sit for the Neonatal Nurse Practitioner exam offered by the National Certification Corporation.

• Location: Greenville, North Carolina 
• Duration: Five to seven semesters
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $289.55 per credit, resident; $1,020.05 per credit, non-resident

Rush University – Online DNP in neonatal clinical nurse specialist 

Rush University offers an online DNP for graduates to become neonatal clinical nurse specialists. This program is designed for experienced neonatal nurses seeking leadership roles. It features class sizes of five students and focuses on the core of education around systems and organizations, direct patient care, nurses, and practices. As a result, graduates find themselves prepared for their positions to lead neonate teams and families toward positive health outcomes. 

• Location: Chicago, IL
• Duration: 2-3.5 years
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $1,286 per credit 

Duke University – Online MSN with neonatal NP specialty 

The Duke University School of Nursing ranks #2 on the U.S. News & World Report’s list of best graduate nursing schools and offers an online neonatal nurse practitioner MSN degree. This 43-credit program features clinical foundations taught through distance-based learning and 616 clinical hours. 

The clinical practice work is designed to provide each student with a one-to-one experience in diverse neonatal settings, including birthing rooms, neonatal transitional care rooms, neonatal intensive care units (NICU), pediatric/neonatal surgery, and radiology. Preparing nurses for the care of neonates is the program’s highest priority, and this program emphasizes the uniqueness of every family and the importance of culturally responsive practices in healthcare. 

• Location: Durham, NC
• Duration: 2.5 years
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $12,896 per semester 

Thomas Jefferson University – Online MSN with neonatal NP specialty 

Thomas Jefferson University offers an online MSN neonatal nurse practitioner program comprising 12 courses, 36 credits, and sixteen weekly hours of clinical rotations. Students can transfer up to six credits to the MSN program. This program teaches students essential clinical skills such as evaluating with scientific techniques that focus on patient technology, promoting quality care, and positive health outcomes. 

• Location: Philadelphia, PA
• Duration: 2-5 years 
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $1,224 per credit

Ohio State University – Online MSN, DNP, and post-master’s certificate in neonatal nursing

Ohio State University ranks #2 on the U.S. News & World Report’s list of best online master’s programs and offers graduate degrees and certificates in neonatal nursing. The program provides neonatal nurse practitioners the option of earning an MSN, DNP, or post-master’s certificate with the flexibility of a full-time or part-time track. Three in-person clinicals are required in the last four semesters of the program.  

The programs promote evidence-based practices that prepare graduates for the best possible patient outcomes. One component of the program that sets it apart from others is its focus on clinician wellness and patient-focused research. The university encourages nurse practitioners to put their health and wellness at the forefront of their practice to become the best possible practitioners in the field. 

• Location: Columbus, OH 
• Duration: Two years
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $47,568 (full-time); $64,511.80 (part-time)

Depending on the educational pathway, it takes approximately 11 years to become a neonatal nurse. This includes a high school diploma, degree completion, and clinical experience.

Step 1: Graduate from High School or Complete a GED (Four Years)

Graduating high school requires four years or one year for a GED. High school students are encouraged to take as many AP courses as possible in science and mathematics. Earning credit through community outreach and humanities can build a firm foundation in early education.  

Step 2: Complete an Associate Degree or Bachelor of Science in Nursing (Two to Four Years)

An ADN degree generally requires two years of post-secondary study, while a BSN degree typically requires four years. 

There are accelerated BSN options for those with associate’s degrees (one to two years) or bachelor’s degrees in non-nursing fields (one to four years). Most BSN programs include clinical experiences which provide valuable hands-on learning opportunities. 

Step 3: Become a Registered Nurse (Timeline Varies)

After earning a BSN from an accredited university, prospective nurses can complete the National Council Licensure Examination (NCLEX-RN) to gain their RN license. All state boards of nursing require candidates to take and pass the NCLEX-RN exam to become registered nurses (RNs). In addition, an RN is required for all MSN, DNP, and post-master’s certificate programs. 

Step 4: Gain Work Experience (Two to Five Year Minimum)

Before an MSN or DNP candidate applies for neonatal graduate programs, gaining work experience of two to five years is necessary. Neonatal nursing programs require some expertise in acute care and neonate-focused work. 

Step 5: Complete a Graduate Degree in Neonatal Nursing (Two to Four Years, Optional)

An advanced degree such as a master of science in nursing (MSN) or doctorate of nursing practice (DNP) is an option for professionals seeking a nurse practitioner title. Both of these degrees help prepare nurses aspiring to this specialization. In addition, pursuing a DNP in neonatal practice is helpful for individuals seeking employment advancement and increased practice independence. 

Step 6: Obtain National Certification (Timeline Varies)

Two organizations grant board certification to neonatal nurse practitioners (APRNs with MSN or DNP degrees). Two certification examples include: 

• CCRN (Neonatal): Specialty certification for neonatal nurses providing direct care to critically ill neonate patients.
• NNP-BC: Focuses on patient care for those with high-risk neonates; concentrates on the specialty care of the neonate and their families in the ICU setting.

Detailed information about certifications is in the certification and licensure section below. 

Step 7: Obtain State Licensure (Timeline Varies)

State licensure for nurses varies according to the state. In the United States, one can become an RN through a licensed vocational nursing program, an associate’s degree, or a bachelor’s degree. Nurses seeking licensure should inquire about state-level requirements with the state board of nursing. 

Step 8: Maintain All Certifications and Licensures (Every One to Five Years)

Similar to every field of medical practice, maintaining RN certification is an integral part of working in a state-regulated profession. Every state has its requirements for continuing education. For example, in Oregon, a one-time course in pain management is required for nurses renewing their RN licenses.

Neonatal nurses provide critical care for neonate infants and patients up to two years old. Work settings include the intensive care unit (ICU), emergency room (ER), clinics, and research hospitals.  

Here’s a list of neonatal nurse responsibilities: 

• Provide direct support for infants and mothers pre- and post-birth 
• Check vital signs
• Monitor patients
• Perform neonatal tests during and after pregnancy

Certification and licensure requirements in the specialty field of neonatal nursing vary depending on state licensure laws and employers. While it may be preferable for an RN to have a certification, APRNs must have board certification to work legally. To be eligible for these certification exams, candidates must practice as RNs or APRNs and have a specific number of neonatal clinical hours.

Here are two of the most common organizations and the certifications they offer to neonatal nurse practitioners:   

American Association of Critical-Care Nurses (ACCN)

• ACCNS-N (Neonatal) – Advanced critical care nurse specialists
• CCRN (Neonatal) – Critical care registered nurse
• CCRN-K (Neonatal) – Critical care registered nurse specialist

National Certification Corporation (NCC)

• NNP-BC – Neonatal Nurse Practitioner Board Certification

Each organization requires candidates to meet specific eligibility requirements to earn certification. For example, the AACN offers a two- and five-year option for the CCRN:  

• Two-year option: RNs and APRNs pursuing a CCRN (Neonatal) certification on the two-year option must have a minimum of 1,750 hours as a registered nurse with acute care neonatal patients in the past two years, and applicants must accrue 875 hours in the year before application. 
• Five-year option: RNs and APRNs pursuing a CCRN certification with the five-year option must have 2,000 hours of acute care experience with acute care pediatric patients and 144 hours earned in the year before application.

The US Bureau of Labor Statistics (BLS May 2021) shows 3,047,530 registered nurses were employed. The mean annual wage for registered nurses was $82,750, with an hourly wage of $39.78 per hour. 

The following list provides information on percentile wage estimates for registered nurses: 

• 10th percentile: $59,450
• 25th percentile: $61,790
• 50th percentile (median): $77,600
• 75th percentile: $97,580
• 90th percentile: $120,250

As for neonatal nurse practitioners, BLS (May 2021) data shows that 234,690 nurse practitioners were employed and earned median annual salaries of $118,040 per year or $56.75 per hour. 

Here are the salary percentiles for nurse practitioners: 

• 10th percentile: $79,470
• 25th percentile: $99,540
• 50th percentile (median): $120,680
• 75th percentile: $129,680
• 90th percentile: $163,350

Here are some career alternatives for those who want an adjacent career to neonatal nursing to get started, gain experience, or work with NICU patients. 

Become an EMT or Paramedic

Emergency medical technicians (EMTs) and paramedic professionals provide immediate on-call response care for patients in critically ill positions. These professionals travel to respond to calls by persons experiencing or witnessing medical emergencies. They also provide transportation and care en route to a hospital for continued care. 

• Typical Education: Four-year bachelor’s degree or two-year associate degree; post-secondary non-degree award program
• Licensing or Certifying Organization: National Association of Emergency Medical Technicians (NAEMT) 

Become a Nurse Anesthetist, Nurse Midwife, or Nurse Practitioner

Nurse anesthetists, nurse midwives, and nurse practitioners provide patients with general or specialty care. These specialties in the nursing field work alongside colleagues in surgery, obstetric services, and public and private clinics.

• Typical Education: MSN, DNP, or post-master’s certificate 
• Licensing or Certifying Organization: National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)

Become a Licensed Practical or Licensed Vocational Nurse

Licensed practical and licensed vocational nurses provide care in a variety of settings. These settings may include extended care facilities, nursing homes, physician’s offices, hospitals, or private homes.

• Typical Education: Post-secondary degree or non-degree
• Licensing or Certifying Organization: Dependent on the state board of nursing