Neonatal and intensive care (NICU) nurse career guide

HomeNursingNeonatal and intensive care (NICU) nurse

According to the National Association of Neonatal Nurses (NANN), an estimated 40,000 infants are born with low birth weight in the United States each year. Thanks to advances in technology, science, and medicine, the survival rate of these infants has dramatically increased.

As such, Neonatal and Intensive Care nurses, known as NICU nurses, are in high demand. These nurses need to have extensive knowledge and expert skills to care for critically ill and premature newborns. The U.S. Bureau of Labor Statistics (BLS) predicts employment of Registered Nurses (RNs) to grow by 7% between 2019 and 2029. This is faster than the average rate for other occupations. For NICU nurses, in particular, that demand may be even higher.

An introduction to NICU Nursing

Apart from specialized skills and credentials, it takes a calm, comforting, and resolute demeanor to work as a NICU nurse. These professionals must also have strong communication skills to inform and support worried parents during what’s often a traumatic experience.

NICU nurses are usually on the front lines of newborn care in neonatal and intensive care units that operate 24/7. As such, they’re often required to work 12-hour shifts during the week, as well as on weekends and holidays. You’ll find NICU nurses in public and private hospitals, medical centers, and specialized NICU facilities.

Empathy, emotional strength, and effective stress management are all vital in the fast-paced, strenuous NICU environment. Additionally, the patients are extremely fragile, so immaculate attention to detail is crucial.

Earning potential

The latest available data from the BLS shows the median annual wage of a registered nurse was $73,300 in 2019. The lowest-earning 10% were paid less than $52,080 a year, while the highest-earning 10% were paid more than $111,220 per year.

The 2021 average annual salary for a clinical nurse specialist with neonatal intensive care unit skills is $84,406.

What does a NICU nurse do?

Neonatal is defined as the month directly after birth. However, NICU nurses typically work with infants up to 2 years old. They provide specialized care to premature and critically ill patients with health conditions such as congenital defects, infections, or heart deformities.

NICU levels of care can be defined as follows:

  • Level I  General newborn care – for healthy infants
  • Level II  Moderate newborn care – for less severe neonatal cases
  • Level III  Neonatal intensive care -where most NICU nurses work
  • Level IV  Advanced care for babies with severe congenital disabilities or illnesses

Generally, NICU is considered level 3 nursing care, but NICU nurses can technically work at any of the above levels. Their duties usually include:

  • Assistance during childbirth
  • Measuring and weighing newborns
  • Providing basic care, like changing diapers and feeding infants
  • Recording and monitoring vitals such as breathing, blood circulation, and digestion
  • Operating medical equipment, performing tests, and administering medication
  • Formulating and adjusting treatment plans as needed
  • Assisting physicians with treatments and procedures
  • Providing comfort to infants in distress
  • Educating and supporting infants’ parents and family members

The pros and cons of being a NICU nurse

Neonatal nursing is an in-demand subspecialty, requiring dedicated RNs with advanced skills and knowledge to care for vulnerable and ill newborns. Before considering a NICU nursing career, it’s crucial to understand some of the pros and cons.

Advantages

  • Career advancement

NICU RNs can acquire additional training, education, and certification for more advanced roles in NICU nursing. These include positions such as Chief Nurse, Neonatal Nurse Practitioner (NNP), and NICU Clinical Nurse Specialist (CNS).

  • Increased earning potential

More advanced roles often come with a higher salary and better benefits. Additional certifications are available for NICU RNs who wish to enhance their skills and knowledge in a particular subspecialty. As such, they may be able to find higher-paying places of employment.

  • Job satisfaction

 Many NICU RNs enjoy fulfillment when a healthy infant is discharged. This career often comes with a sense of profound appreciation for the miracle of life.

Disadvantages

  • High-pressure working environment

Sick and premature infants can be extremely unstable patients. They can develop complications without warning, so NICU RNs must be attentive, precise, and agile at all times. Accurate record-keeping and medical dosages are vital.

  • Emotionally taxing

 The nature of vulnerable, premature, or critically ill infants means that, sadly, death could occur despite the medical staff’s best efforts. NICU RNs often have to deal with distraught parents in these scenarios.

If you can’t see yourself coping in these kinds of situations, it may be worth considering an alternative career that isn’t as stressful. Some options include a nurse midwife, an OB/GYN nurse, or a nursery nurse. 

However, if you think NICU nursing is the right fit for you, then keep reading to explore more about the profession.

How to become a NICU nurse

The steps it takes to become a certified NICU nurse can be summarized as follows:

  • Earn an approved nursing diploma, an associate’s degree, or a bachelor’s degree
  • Get your RN licensure
  • Gain a minimum of 2 years’ clinical experience
  • Obtain certification

Earn an ADN or BSN degree

Many NICU nurses choose to earn a traditional 4-year Bachelor of Science in Nursing (BSN) degree. An Associate Degree in Nursing (ADN) is also usually accepted, typically taking 18 to 24 months of full-time study.

Additionally, some hospitals offer 1- to 3-year nursing diplomas, although this route is being phased out. You’ll need to find out the precise program requirements from your State Board of Nursing.

It’s best to choose a program with elective neonatology coursework to help you prepare for a career in NICU nursing. While some employers may accept candidates with a diploma or ADN, BSN-holders are generally preferred.

A BSN is more extensive than an ADN and usually includes 800 clinical practice hours and 120 credits. It’s also a typical admission requirement for advanced studies, such as a master’s or doctoral program.

Students can usually find online or hybrid options, which may be more flexible and cost-effective. The latter is a combination of on-campus and online learning. Alternatives, such as accelerated, bridge, or direct-entry programs, are also available and include the following:

  • LPN-BSN:

Ideal for Licensed Practical Nurses (LPNs) who don’t have an ADN, BSN, or RN license. Students are usually allowed to apply their previous education to their BSN while fulfilling RN licensure requirements.

  • RN-BSN

Suitable for licensed RNs with an ADN or diploma who want to pursue their BSN. These programs usually allow students to transfer existing credits to reduce study time.

  • Accelerated BSN

 Ideal for candidates with a non-nursing bachelor’s degree who want to earn their BSN.

The time it takes to become a NICU nurse depends on the program type and format you choose. Generally, an ADN takes 2 years and a BSN takes 4 years to complete. RN licensure and NICU certification both usually require at least 2 years of clinical practice.

BSN programs usually comprise subjects like ethics, pharmacology, microbiology, anatomy, and nutrition. However, elective neonatal coursework may also include:

  • Pathophysiology
  • Neonatal theory
  • Neonatal respiratory care
  • Health assessment and nutritional support
  • Thermal management
  • Infection control
  • Neonatal acute care
  • Neonatal critical care

While specific admission requirements depend on the school and program you choose, a high school diploma, minimum GPA of 3.0, and strong SAT or ACT scores are general prerequisites. A personal statement, recommendations, and a background check may also be required.

Become a Registered Nurse

Upon earning your State Nursing Board-approved degree or diploma, you can take the NCLEX-RN exam. This 6-hour test is a requirement for obtaining RN licensure. It tests candidates on general nursing subjects like pharmacological and parenteral therapies, basic care and comfort, and safety infection and control.

Once you’ve passed the exam, you can apply for your Registered Nurse license from your State Board of Nursing. Some states may require a criminal background check or have other criteria. If you’re in a participating state, you may be eligible for the Nurse Licensure Compact (NLC) multistate license. It allows RNs to practice in member states without additional licenses.

With licensure, NICU RNs can choose to find employment before becoming certified or pursuing further study. Experience in Level III neonatal and intensive nursing care is ideal and often required for certification.

Get your certifications

While not mandatory, certification demonstrates competency and may enhance career opportunities. It can also make it easier for RNs to secure employment as a NICU nurse.

Neonatal and intensive care nurses can choose to become certified in a variety of subspecialties. The American Association of Critical-Care Nurses offers the CCRN® (Neonatal) certification.

The National Certification Corporation (NCC) has various options available, including:

  • Neonatal Intensive Care Nursing (RNC-NIC®)
  • Neonatal Neuro-Intensive Care (C-NNIC)
  • Maternal Newborn Nursing (RNC-MNN®)
  • Electronic Fetal Monitoring (C-EFM(®))
  • Obstetric and Neonatal Quality and Safety (C-ONQS)
  • Care of the Extremely Low Birth Weight Neonate (C-ELBW)

Certification requirements vary but typically include a valid RN license and 2 years of relevant clinical experience, comprising at least 2,000 hours. Employment in the specialty within the last 24 months is another general prerequisite. Moreover, NICU nurses may need to renew their NCC certifications every 3 years.

Accreditation

When looking for a school to get your nursing degree or diploma, accreditation is vital to ensure that a nursing education program meets high-quality standards. Authorities approved by the U.S. Department of Education typically assess and accredit programs on a national level. State Board accreditation refers to a program approved only in a specific state.

The majority of educational institutions won’t allow the transfer of credits from a non-accredited program. Additionally, potential employers might not accept a non-accredited qualification.

It’s essential to make sure that your chosen program is accredited by a reputable authority. Prominent accrediting bodies in the nursing profession include:

  • The Commission on the Collegiate Nursing Education (CCNE)
  • The Accreditation Commission for Education in Nursing (ACEN)

Degree costs

Precise degree costs depend on numerous factors: Your chosen educational institution, degree type, and part- or full-time study affect what you might pay. Online, hybrid, and direct-entry degree programs may cost less than traditional on-campus options.

The annual average costs of tuition and fees as follows:

For a full-time student at a public 4-year institution:

  • Bachelor’s degree: $8,760
  • Master’s degree: $8,950
  • Doctoral degree $11,440

For a full-time student at a private nonprofit 4-year institution:

  • Bachelor’s degree: $37,500
  • Master’s degree: $29,670
  • Doctoral degree: $44,910

Financial aid opportunities

Eligible NICU nursing students may be able to apply for financial aid, such as scholarships or grants. It’s advised to inquire whether your educational institution offers any form of financial assistance.

Governmental and private organizations may also have financial aid opportunities, such as work-study programs, loan forgiveness programs, grants, scholarships, and other forms of financial assistance available.

The following organizations may have financial aid opportunities for NICU nursing students:

  • Academy of Neonatal Nursing (ANN)
  • National Association of Neonatal Nurses (NANN)
  • American Association of Critical-Care Nurses (AACN)
  • American Association of Post-Acute Care Nursing (AAPACN)

Here are a few additional financial aid opportunities:

  • The Free Application for Federal Student Aid (FAFSA)
  • The Foundation of the National Student Nurses’ Association Scholarship
  • The Jane M. Buckman Husted Memorial Nursing Scholarship
  • American Red Cross Jane Delano Student Nurse Scholarship
  • Dr. Francis Anthony Beneventi Medical Scholarship
  • Geraldine “Polly” Bednash Scholarship

Further education

Once in the field, NICU nurses can advance their careers and enhance earning potential by pursuing further education. Options include certificates, master’s degree, and doctoral degree programs.

Besides educational institutions, the following organizations offer continuing education (CE) programs, certifications, or resources for NICU nurses:

  • National Association of Neonatal Nurses
  • Association of Women’s Health, Obstetric, and Neonatal Nurses
  • American Academy of Pediatrics
  • National Certification Corporation

Neonatal and intensive care nurses can also choose to further their careers with a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree.

Master of Science in Nursing (MSN)

MSN programs typically take 2 years of full-time study, while part-time programs take longer. There are also online, hybrid, and accelerated MSN degree programs available. These include:

  • RN-MSN  – A fast track for RNs with an ADN or diploma
  • ADN-MSN – Designed for RNs with an ADN
  • BSN-MSN – Suitable for RNs with a BSN

Admission requirements usually include a valid RN license, a minimum GPA of 3.0, and GRE test scores. Letters of recommendation, a resume, and a statement of purpose are other general prerequisites. A practicum of 500 or more clinical hours is also usually required to graduate.

MSN programs generally prepare NICU nurses for Advanced Practice Registered Nurse (APRN) careers and other leadership roles. Coursework may include:

  • Advanced pharmacology
  • Advanced pediatric and neonatal assessment
  • Embryology and Developmental Anatomy
  • Healthcare policy and finance
  • Organizational leadership

Doctor of Nursing Practice (DNP)

The Doctor of Nursing Practice (DNP) degree is ideal for NICU RNs who want to pursue advanced clinical, educational, leadership, or administration roles in NICU nursing. DNP graduates typically hold positions where they oversee the management of resources or staff, develop healthcare policies, implement care programs, and educate other professionals. Course concentrations may include:

  • Health informatics systems
  • State and national health policies
  • Management and administration
  • Executive leadership
  • Ethics
  • Epidemiology
  • Biostatistics
  • Population health

There are also direct-entry or accelerated DNP programs available, such as:

  • ADN-DNP – Ideal for NICU nurses with an ADN
  • BSN-DNP –  Suitable for BSN-holders
  • MSN-DNP or Post-Master’s DNP –  Designed for candidates with a master’s degree

It can take up to 6 years to earn your DNP, but this depends on your chosen program. Schools usually specify which types of degree-holders are eligible. For example, some MSN-DNP programs might require candidates to be certified Nurse Practitioners (NPs), while others accept MSN-holders.

DNP programs don’t usually include a dissertation, but students generally need to complete 500 or more clinical hours and a residency project. The admission requirements are usually similar to MSN program prerequisites.

Doctorate of Philosophy (Ph.D.)

This is a research-focused degree suitable for NICU nurses who wish to pursue scientific, academic, or research-based roles. It can take 8 years or more and generally requires a dissertation.

In addition to an accredited bachelor’s or master’s degree, the admission criteria are generally the same as MSN or DNP programs.

Potential career pathways

Here are a few possible career options for NICU nurses:

As Advanced Practice Registered Nurses (APRNs), NNPs provide specialized nursing care to NICU patients with complex health issues. Their scope of practice is broader than that of NICU RNs and may include treatment planning, diagnosis, and prescribing medication. NNPs often work in Level III and Level IV nursing units, found in hospitals, medical centers, or specialized NICU facilities.

Average annual salary: $105,932

NICU CNSs also fall under the APRN category. Their duties are similar to that of the NNP and include specialized NICU care. However, Neonatal and intensive care CNSs also fulfill management and supervision roles. They conduct evidence-based research, develop and implement healthcare policies, and find ways to improve patient outcomes. NICU CNSs often work as part of an interdisciplinary team and act as expert consultants, collaborators, and leaders.

Average annual salary: $84,406

CNOs typically maintain compliance, manage nursing teams, and direct nursing activities in a hospital setting. CNOs may be tasked with resource management, budgeting, and patient care strategies. Additionally, they may be in charge of directing orientation programs for nursing staff.

Annual average salary: $131,526

PNPs typically provide primary care to children from birth to young adulthood. They often work independently, treat and diagnose acute, chronic, or critical illnesses,  and administer immunizations. PNPs also perform physical examinations, develop treatment plans, and counsel patients and families on health maintenance and issues.

Annual average salary: $90,912

In summary

NICU nursing takes compassionate individuals, committed to caring for the most vulnerable patients — premature and extremely ill infants. It also takes effective stress and emotional management under highly pressurized conditions. However, it can be profoundly fulfilling to help, support, and nurse NICU patients to health.

If you think a career in NICU nursing is for you, determine the type of accredited education program you wish to pursue. Once completed, you can obtain RN licensure and become certified in numerous NICU subspecialties. Graduate-level degree programs also provide career advancement and higher earning opportunities.

National Association of Neonatal Nurses (NANN)

NANN is a membership organization for RNs specializing in neonatal care. It provides educational development, advocacy, and resources for neonatal nursing professionals.

The National Association of Neonatal Nurse Practitioners (NANNP)A division of NANN, the NANNP provides support for NNPs and CNSs in particular. It’s also a membership organization.

American Nurses Association (ANA)

ANA promotes ethics, policy, and practice in the nursing profession. It provides publications, conferences, and other resources to members.

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)

AWHONN is a nonprofit association that promotes advocacy, research, and education in women’s health, obstetric, and neonatal nursing.

American Academy of Pediatrics (AAP)

AAP is an organization dedicated to the well-being of infants, children, and adolescents. It provides professional development, advocacy, and educational resources to its members.