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How to Become
A Neonatal Nurse

Neonatal nurses are specialized registered nurses who care for infants during the first month after birth. These babies may be premature, healthy, or suffering from a particular medical condition. Neonatal nurses also often care for the mothers and show parents the best way to care for newborns.

What Does a Neonatal Nurse Do?

There are three different levels of neonatal nursing, and the responsibilities will vary from level to level.

  1. Those who work in a Level I nursery are responsible for taking care of healthy babies.Their duties often include: Feeding, bathing, changing, talking to the infants, and teaching infant care to parents.
  2. Those who work in a Level II nursery are responsible for premature infants.Their duties include: Monitoring infant health, protecting babies from contracting infectious diseases, watching for potential medical problems such as temperature shock, and performing minor medical treatments as needed.
  3. Those who work in Level III nurseries have the most demanding role. The clinical setting at this level is Neonatal Intensive Care Units (NICU), for premature, low birth-weight babies. Neonatal nurses may be required to perform invasive surgical procedures or even emergency resuscitation. One of their other invaluable roles in this setting can be supporting and reassuring worried parents who are unsure how to meet their infant's medical needs.

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Steps to Becoming a Neonatal Nurse

  1. Get the appropriate education.

    If you are interested in becoming a neonatal nurse, the first step is to obtain a Bachelor of Science degree in Nursing (BSN). If possible, pursue a concentration in infant or child care. If you are still in high school, you can prepare for your degree by taking biology, chemistry and mathematics courses. While diploma programs and associate degrees in nursing exist, according to the National Association of Neonatal Nurses (NANN), diploma programs are being phased out in many areas of the country, and a bachelor's degree provides more career flexibility than an associate degree. However, NANN also points out that most associate degree programs in nursing are set up in a flexible manner to enable graduates to go on to bachelor's degree programs.

  2. Become a licensed nurse.

    After graduating with a BSN, take the national licensing exam, called the National Council Licensure Examination (NCLEX-RN). According to the NCSBN, in the U.S. and Canada this entails two separate processes. First, you contact the board of nursing/regulatory body where you intend to practice and request a licensure/registration application. You will need to pay a fee and submit it along with your application. Second, you will need to register with the testing vendor, Pearson VUE, to take the exam. Third parties, such as your nursing school or an employer, can pay your testing fee. With a passing score, you obtain your nursing license to practice. Your test results will be mailed to you within six weeks of the exam directly from the boards of nursing/regulatory bodies where you applied to practice.

  3. Gain relevant work experience.

    Your next step is to begin working as a nurse to gain experience. Two to three years of nursing experience are often required to move into a neonatal nurse position. According to NANN, while you may not be able to work in a neonatal intensive care unit (NICU) right away, you should work in a hospital that has a NICU. If possible, you should start in a pediatric unit or a well-newborn nursery and participate in any NICU orientation programs that are available to you to facilitate your transition.

  4. Obtain additional neonatal certifications.

    After working as a neonatal nurse for at least 2,000 hours, you could also obtain a variety of credentials in neonatal intensive care nursing. These each require passing an examination, though study books and courses specifically for these certifications are available. The certifying body is the American Association of Critical Care Nursing (AACN), and the neonatal certifications available through this body include:

          • Specialty Certification: CCRN -- Acute/Critical Care Nursing (Adult, Pediatric & Neonatal)
          • Specialty Certification: CCRN-K -- Acute/Critical Care Knowledge Professional (Adult, Pediatric & Neonatal)
          • Advanced Practice Consensus Model Based Certification: ACCNS-N -- Clinical Nurse Specialist; Wellness through Acute Care (Neonatal)
          • Advanced Practice Certification: CCNS -- Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal)
          • Pursue additional education.

Expert Advice on How to Be a GREAT Neonatal Nurse

An interview with assistant professor at the Duke University School of Nursing
Wanda T. Bradshaw

Although health care is one of the fastest-growing industries, the job can still be competitive. To find out how neonatal nurses can excel in their careers, we sat down with Wanda T. Bradshaw, MSN, RN, NNP-BC, PNP, CCRN and assistant professor at the Duke University School of Nursing.

Q: How is neonatal nursing different from other nursing specialties?

Neonatal nurses care for infants from 23 weeks gestation onward. The full term of a pregnancy is 37 weeks, so neonatal nurses may be responsible for preterm infants as well as full term infants, all of whom require special care.

Q: What skills are required to be a great neonatal nurse?

Neonatal nurses should be experienced with:

      • Variety of ventilatory support (nasal cannula, CPAP, ventilators [conventional and high frequency], and surfactant replacement therapy)
      • Umbilical arterial and venous catheters and monitoring of arterial BP and CVP
      • Other intravenous catheters: PIVs, PICCs, CVLs, subclavian, peripheral arterial, jugular, femoral
      • Vasoactive agents: dopamine, dobutamine, epinephrine, vasopressin drips
      • Body cooling
      • Delivery room experience: NRP certified, stabilization of the newly born, including prematurity (23 - 37 weeks' gestation); anomalies; genetic issues; GI problems (gastroschisis, omphalocele, TEF); diaphragmatic hernia; infection; neurological issues (myelomeningocele)
      • CPR including full resuscitation efforts
      • Sterile technique
      • Developmental care
      • Neonatal skin care
      • Family centered care including palliative, end-of-life, and parent education including discharge teaching
      • Charge nurse experience
      • Admissions (both expected and unplanned), transfers, discharges
      • Active participation on unit based committees

Q: What is the process for becoming a neonatal nurse?

Neonatal nursing is not an entry-level nursing position. In order to become a neonatal nurse, you should first become an RN, and then apply for NICU RN positions after gaining relevant education and experience.

Resources for Neonatal Nurses

  • Bureau of Labor Statistics, Registered Nurses
  • American Academy of Pediatrics (AAP)
  • Council of International Neonatal Nurses (COINN)

Sources:

1.
"Registered nurses," Bureau of Labor Statistics Occupational Outlook Handbook, http://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-4
2.
"Neonatal Nursing Career Info," National Association of Neonatal Nurses, http://www.nann.org/education/content/neonatal-nursing-career-info.html
3.
"About Boards of Nursing," National Council of State Boards of Nursing, https://www.ncsbn.org/about-boards-of-nursing.htm
4.
"Certification," American Association of Critical Care Nursing, http://www.aacn.org/dm/mainpages/certificationhome.aspx
5.
"Neonatal Resuscitation Program," American Academy of Pediatrics, http://www2.aap.org/nrp/
6.
Wanda T. Bradshaw, MSN, RN, NNP-BC, PNP, CCRN and assistant professor in the Duke University School of Nursing
Interview spotlight
Wanda T. Bradshaw
Assistant professor

"Neonatal nursing is not an entry-level nursing position. In order to become a neonatal nurse, you should first become an RN, and then apply for NICU RN positions after gaining relevant education and experience."

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