Are you considering becoming a neonatal nurse? Perhaps you were told it is the ideal career for you. Maybe you were torn between working with children and working with patients, and you were advised to research neonatal nursing as a career. Or you wanted to do something related to obstetrics without being a labor and delivery nurse. While neonatal nurses are among the busiest in the hospital, we tend not to think about it unless we’re in the delivery rooms ourselves. If you’re considering pursuing a career as a neonatal nurse, here is everything you need to know about the profession.
Why Would Someone Become a Neonatal Nurse?
Neonatal typically refers to infants from birth to one month of age, though neonatal nurses may work with pregnant mothers or older infants as well. Neonatal nurses usually choose the profession because they love babies and want to give every one of them the best chance in life. They’re responsible for anywhere from one to four babies, each with their own unique needs and challenges.
One of the benefits of becoming a neonatal nurse is that you tend to work with the same infants until they go home. You know that you’re doing something that saves lives and truly affects the lives of the newest members of a family. Neonatal nursing is a good way to combine an interest in obstetrics, critical care and pediatrics, because it truly sits at the intersection of all three disciplines.
Another benefit of becoming a neonatal nursing is the strong professional community. Nonprofits, universities, hospitals and families all appreciate what they do and support them in their effort. Neonatal nursing graduates are highly sought after and receive ample assistance finding jobs.
What Should You Expect Working as a Neonatal Nurse?
Neonatal nurses provide care for the most delicate newborns and infants with health problems. They’re the ones who staff the premature infants’ ward. They will work with babies with health problems, whether they have contracted an infection, have a birth defect, or have other issues.
They will have received advanced training in dealing with these vulnerable, complex cases. They have learned how to perform blood draws, give oxygen and insert IVs in the smallest of patients. They aren’t just changing diapers and feeding babies as they would in the main nursery, though they do that, too.
Neonatal nurses may monitor vital signs, run tests and administer medications to other newborns, as well. They may be called into the well-baby ward to assess the child when they change “stations” or levels. Level One is a well or completely healthy baby, while Level 4 is a baby that requires life-sustaining measures. Level 4 includes but isn’t limited to surgery, ongoing life support and other advanced interventions.
The start of every day involves learning the history of new arrivals, the current condition of all children assigned to you, learning about their needs, and then meeting their needs. Performing a complete physical assessment of each child upon arrival and at the start of each shift is normal. Any changes in the child’s condition are documented and reported to the doctor or nurse practitioner in charge of the ward. Then comes the routine procedures like giving medications, adjusting oxygen levels, taking blood samples as required, as well as feeding and changing the baby. Nurses will report a child’s status to the parents as required. At the end of their shift, they give their report to the next nurse before going home.
Many neonatal nurses work in the Neonatal Intensive Care Unit, or NICU, providing specialized care to at-risk newborns and critically ill older infants. For example, most of the children they take care of are newborns less than a month old, but a one year old in need of heart surgery will also land in their ward. A six-month-old who is severely ill or injured will arrive in the NICU, too.
A few neonatal nurses provide at-home care for these same infants. They are likely to teach the parents how to perform key tasks themselves, as well. For example, they may teach parents how to administer medication, clean a feeding tube or use a nebulizer. They may also be present at the delivery of at-risk infants so the children can be evaluated and treated as necessary. Neonatal nurses may accompany these medically delicate infants into surgery and provide support before, during and after surgery. These nurses may transfer a sick baby from one hospital to their hospital’s NICU unit or travel with the child from one hospital to another.
The Pros and Cons of Neonatal Nursing
One of the benefits of neonatal nursing is that it is less physically demanding than other nursing roles. You’re carrying infants or rolling around incubators, not helping adults get in and out of bed. You’re going to spend more time supervising infants in incubators, often in the same room, instead of walking several miles a day making rounds.
Neonatal nursing does come with risks, however. One of the challenges you’ll face is the emotional rollercoaster of seeing very young children improve and regress. A baby that was doing well at the end of your last shift may have gone downhill overnight.
You also have to deal with the possibilities of some passing away as well. This is an emotionally draining risk every nurse takes, and one you have to be ready for. However, you also get to enjoy seeing babies who were in critical condition being able to go home and start a normal life after your care.
You have to be able to handle the emotional reactions of others around you. It is normal for parents to come visit their sick children every day. You’re going to be exposed to their fear, their worry, their anger and their grief. The family members are as stressed out as the babies. Furthermore, you’ll have to deal with infants that are crying in frustration, pain and discomfort. You shouldn’t work in neonatal nursing if you can’t handle young children crying while their parents are begging you to do something.
You’ll also have to face ethical dilemmas that are more challenging than average, such as deciding which infant to take care of first or what to do when family members disagree over how to handle the child’s care.
Neonatal nursing is demanding. This is why neonatal nurses have fewer cases to manage than other nurses. They will face overwhelming pressure, because they’re dealing with often unstable and fragile patients. You can’t make a mistake with a patient that small or that sick. The quality of care must be higher. For example, you cannot even make a small mistake with medication dosage and your calculations must be correct every time. This is one of the reasons why neonatal nurses are some of the best paid nurse practitioners.
How Do You Become a Neonatal Nurse?
Before someone can become a neonatal nurse, they must be at least a registered nurse. You can become a registered nurse either by completing a diploma program with the hospital-based school, an associate’s degree from a community college, or a bachelor’s degree from a university.
The diploma programs from hospital-based schools are being phased out, while hospitals are increasingly demanding at least a bachelor’s degree in nursing to work in the ward. Advanced degrees like a master’s or doctorate in nursing is necessary to work in more sensitive positions like neonatal nursing. This is why neonatal nurses are considered to be advanced practice registered nurses.
Note that if you have a BSN, you can complete a master’s program in neonatal care to move into the NICU, while doctoral programs open up more career opportunities. A nursing license is required to work as a nurse in all fifty states, including in the NICU. You can get it by sitting for, and passing, the licensing exam.
To become a neonatal nurse, many NICU units require nurses to have experience with infants or children. Nursing students may get this experience through internship opportunities while earning their degree, working in the hospital nursery before applying to work in the NICU, or working in pediatrics before seeking to work in the neonatal ward. A few NICU units offer on-the-job training, teaching someone what they need to do in order to do basic tasks in the ward under the supervision of experienced neonatal nurses.
Many have completed an advanced degree in neonatal nursing, since that credential is universally recognized. Neonatal nurses do not necessarily have to have an industry certification in pediatrics or neonatal nursing. However, you can earn certifications in niches like pediatric transport and intensive care. Others gain certifications on maternal neonatal nursing, fetal monitoring and related fields so they can focus on treating both mother and child before the baby arrives.
What Are the Job Prospects for Neonatal Nurses?
The job prospects for neonatal nurses are strong. This job is always in demand because several million babies are born every year, and more than forty thousand are born with a birth weight so low they land in the NICU. Only neonatal nurses have the expertise to take care of them. On top of this, there are babies with birth defects who are in need of highly skilled nursing care, such as full-term infants with heart defects or in need of an organ transplant.
Demand for neonatal nurses, like all nurses, is expected to increase by a quarter over the next ten years. Those with advanced training and experience are in greater demand than nurses with basic skills and only a BSN degree. Demand is greatest in urban areas and underserved rural areas.
Demographic trends are probably going to add to the demand for neonatal nurses. The increased use of fertility treatments is increasing the number of multiple births, and these tend to produce multiple premature infants. The increasing number of women having children at later ages also increases the rate of premature births and the number of pregnancies that have complications.
Neonatal nurses typically work in hospitals, especially children’s hospitals and hospitals that take care of labor and delivery. A few also work in surgical hospitals providing support for babies and toddlers undergoing surgery. For those that work at labor and delivery facilities, they will provide care for any infant with health problems and they may help move the child to a hospital with a full NICU unit if necessary. They could end up on call when a midwife discovers there are problems. Neonatal nurses can expect to be asked to drop by the maternity ward from time to time to do an assessment. For example, they may be asked to resuscitate infants or help a new mother breastfeed. They’ll also integrate parents into critical care when the baby has been taken to the NICU.
Neonatal nurses have strong career prospects. Neonatal nurses with advanced training can become the NICU unit manager, nursing manager or chief nurse. Others become a developmental care specialist or clinical care specialist. A few will move to research or teaching positions.
How Much Are Neonatal Nurses Paid?
The average neonatal nurse salary per year is $96,000 according to Payscale. Pay rates are higher with a DNP, especially those working in major hospitals and with critically ill patients like premature infants. A DNP or doctor of nurse practitioner degree prepares you for taking the place of a doctor, leading a team of nurses or handling the more difficult cases.
Many neonatal nurses work in special care, premature care or intensive care because these specialties pay better than healthy newborn care. If you already hold a bachelor’s degree in nursing and have several years of experience in the NICU or neonatal intensive care ward, you can be fast-tracked into a DNP program with a higher pay grade. Then you’re qualified for these higher paying nursing specialties.
Neonatal nurses are there when many infants first arrive in the world, and they are often with the children until they’re ready to go home. Every victory is hard-won, and there is a risk of heartbreak. Yet saving lives and enabling children to start their lives with the best possible outcomes is just a part of the job.