Neonatal Nurse Practitioner (NNP) Career Guide

NNPs are specialized nurse practitioners who use advanced clinical skills to treat neonate patients. According to the American Association of Nurse Practitioners (AANP), NPs work “autonomously and in collaboration with healthcare professionals and other individuals, to provide a full range of primary, acute and specialty healthcare services.”

Neonatal nurse practitioners deliver care to preterm and sick infants with neonatologists in acute and nonacute settings. In some environments, they may also assist in delivering patients. NNPs care for patients suffering from conditions including:

• Prematurity
• Genetic disorders
• Drug addiction and withdrawal
• Birth trauma
• Gastrointestinal disorders
• Surgical birth defects (e.g. Myelomeningocele, Omphalocele, or Cardiac defects)

The average neonatal nurse practitioner salary in the US is $137,140 annually or $66 per hour, according to data from Salary.com in December 2023. They are the second highest-paid nurse practitioner specialty.

NNP incomes are also higher than nurse practitioners in general, which is $121,610 annually, as reported by the US Bureau of Labor Statistics (BLS) in 2022. 

Highest Paying Cities and States for Nurse Practitioners

Your location may be one of the biggest factors that impact your salary as an NNP. According to the BLS, the following states have the highest annual nurse practitioner salaries:

• California - $158,130
• New Jersey - $143,250
• Massachusetts - $138,700
• Oregon - $136,250
• Nevada - $136,230

The BLS also reported the following highest-paying metropolitan cities for nurse practitioners:

• San Jose-Sunnyvale-Santa Clara, CA  - $199,630
• San Francisco-Oakland-Hayward, CA - $190,070
• Napa, CA - $189,190
• Vallejo-Fairfield, CA  - $180,990
• New York-Newark-Jersey City, NY-NJ-PA  - $170,320

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NNPs perform several duties to care for sick and premature newborns. Some day-to-day neonatal nurse practitioner responsibilities include the following:

• Ordering and interpreting diagnostic tests
• Recording and examining medical histories, diagnoses, and symptoms
• Performing physical examinations
• Diagnosing and treating acute and chronic conditions
• Designing care plans and ordering medications
• Ordering or performing procedures like intubation or central line placement
• Monitoring specialized equipment (e.g. incubators, ventilators, dialysis, etc...)
• Collaborating with team members to conduct neonatal resuscitation
• Starting and maintaining IV lines, specifically central catheters and umbilical lines
• Participating in high-risk newborn transport

Additionally, neonatal nurse practitioners may provide post-discharge primary care services. They're also responsible for educating patients and families about the disease process and care plan. 

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Neonatal NPs can work in a variety of settings. Most commonly, they work in Neonatal Intensive Care Units, but they can also work in the following healthcare settings:

• Medical Evacuation and Transport Services
• Outpatient settings
• Private homes providing health care services
• Hospice and palliative care services
• Government and community health agencies
• Universities and research agencies
• Healthcare or health industry businesses
• Private practice
• Phone triage centers
• Rural care facilities
• Nurse-managed medical centers

Neonatal & Newborn Care Settings: 4 Levels of Newborn Care

Most US hospitals have at least three levels of care for infants, with the most advanced hospitals having level four NICUs. These care levels group neonates and infants based on their needs. NNPs can work in any of these settings, though their daily tasks and duties will change depending on the environment.

>> Related: Neonatal Intensive Care Nurse Career Guide

Level One: Newborn Nursery Care

Level one newborn care is for healthy, full-term infants. As such, the need for NNPs in level-one care is limited.

Level Two: Intermediate Nursery Care

Premature or sick babies who need constant attention are generally assigned to level two care. Since these newborns have more risk factors, there's a higher need for NNPs at this care level.

Level Three: Neonatal Intensive Nursery Care

This care level is reserved for the most seriously ill neonates. Patients assigned to level three care have critical health issues and need constant monitoring.

Level Four: Neonatal Intensive Care Unit (NICU)

Hospitals must meet all level three capabilities and be able to care for infants born earlier than 32 weeks gestation weighing less than 1,500 grams. They must also be able to provide life support, perform advanced imaging, including MRI and echocardiography, and provide a full range of respiratory support.

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In total, it takes between eight and twelve years to become a neonatal nurse practitioner. This timeline includes your undergraduate education, gaining relevant experience, grad school, and certification. 

The following section is a step-by-step guide to becoming a neonatal nurse practitioner.

Step 1: Become a BSN-RN

Before attending a nurse practitioner program, you must earn a Bachelor of Science in Nursing (BSN) degree and become a registered nurse (RN).

If you're already a practicing RN with an Associate Degree in Nursing (ADN), you must return to school and complete your BSN education. An RN to BSN program can take as little as one year, while traditional BSN degrees take three or four years to complete.

Additionally, you'll need to sit the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to earn RN licensure. ADNs who complete an RN-to-BSN program will not need to retake the NCLEX.

Step 2: Gain Experience 

Most neonatal nurse practitioner programs require at least two years of relevant experience for admission. You can gain this experience working as a neonatal RN or in another comparable, relevant role in a NICU setting.

Step 3: Attend an NNP Program 

Neonatal nurse practitioner programs culminate in a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree. Earning an MSN takes one to two years, while DNP programs take three to four years to complete. 

If you already have an MSN or DNP in another specialty, you can earn a post-graduate NNP certification instead of attending another graduate program.

>> Related: Easiest Nurse Practitioner Programs to Get Into

Step 4: Get Certified

After earning your graduate degree, you'll sit for the NNP board certification provided by the National Certification Corporation (NCC).  

The Neonatal Nurse Practitioner (NNP-BC) Certification is an entry-level exam that tests your knowledge about caring for critically ill neonates. To sit for the exam, you must have completed an accredited MSN, DNP, or post-graduate NNP certificate program within the last eight years and hold current U.S. nursing licensure.

Remember, certification standards may vary by state. In addition to becoming board-certified through the NCC, you should contact your state's board of nursing to ensure you complete all certification requirements.

>> Show Me Online Nurse Practitioner Programs

To help you choose the best route for becoming a neonatal nurse practitioner, we compiled a list of the top neonatal NP programs based on numerous factors, including graduation rate, cost, credit hours, and more. Check out our article on the best neonatal nurse practitioner programs for the full list of programs, as well as details like admission dates, tuition, and program length.  

1.  Duke University 
2. University of Pennsylvania 
3. Rush University 
4. Vanderbilt University 
5. Ohio State University 

What to Expect From a Neonatal Nurse Practitioner Program

Like other NP programs, neonatal nurse practitioner degrees adhere to the nurse practitioner framework and core competencies established by the National Organization of Nurse Practitioner Faculties (NONPF). However, NNP education differs greatly from other specialties.

Curriculum

Since NNPs focus on a very specific, vulnerable population, they have quite a niche curriculum. While they take common nurse practitioner courses like advanced pharmacology and pathophysiology, they also attend classes like:

• The Child with Special Health Care Needs
• High-Risk Neonate I and II, Theory
• Neonatal Seminar
• Pediatric Physiologic Development
• Essentials of Human Genomics for Nurses
• Neonatal Practicum (600 hours including delivery room, Level I, II, and III)
• Neonatal & Infant Assessment and Neonatal Health Promotion

Requirements

Though every neonatal nurse practitioner degree path is different, most have similar entry requirements, which generally include:

• Two or more years of nursing experience in a Level III NICU
• BSN from an accredited program with at least a 3.0 GPA
• Official transcripts from all postsecondary schools
• Unencumbered, active RN license
• Two or three professional references
• Written statement of professional goals
• Professional resume or curriculum vitae
• Personal interview
• GRE or TOEFL scores

Neonatal nurse practitioners are granted the same rights as all other NPs throughout the country. Specializing doesn’t exclude them from any of the laws for this profession. 

In 23 states, nurse practitioners have “full practice authority,” which means they do not have to work under the supervision of a doctor. Full practice states include Oregon, Maine, Alaska, Hawaii, Washington, and Iowa. 

In states with reduced practice (e.g., Ohio, Pennsylvania, and Utah) and restricted practice (e.g., Texas, California, and Florida), NPs must have a medical doctor sign certain medical patient care decisions. NPs have prescriptive privileges in all 50 states and can administer controlled substances in 49 states.

>> Related: Full Practice Authority for Nurse Practitioners by State

This NP specialty is a stable career choice since, as long as people keep having babies, the world will need neonatal nurse practitioners. Additionally, high satisfaction rates and the allure of working independently generate interest in the career field, which may contribute to its growth.

While the BLS does not separate growth estimates by types of NPs, it does project that the entire nurse practitioner field will grow by 38% between 2022 and 2032. This is much faster than the national average of other healthcare-related professions, including registered nurses.

Check out these organizations for additional information and resources:

• National Association of Neonatal Nurse Practitioners
• Advances in Neonatal Care
• National Certification Corporation
• American Academy of Nurse Practitioners
• Academy of Neonatal Nursing
• American Association of Colleges of Nursing

1. General Nurse Practitioner
2. Family Nurse Practitioner
3. Aesthetic Nurse Practitioner
4. Psychiatric Nurse Practitioner
5. Pediatric Nurse Practitioner
6. Acute Care Nurse Practitioner
7. Women's Health Nurse Practitioner
8. Orthopedic Nurse Practitioner
9. Emergency Nurse Practitioner
10. Adult-Gerontology Nurse Practitioner
11. Oncology Nurse Practitioner

• What do Neonatal Nurse Practitioners Do?

  • Neonatal nurse practitioners care for premature and sick newborns, including diagnosing them, providing treatment plans, and prescribing medication.

• How Much do Neonatal Nurse Practitioners Make?

  • According to Salary.com, the median salary for NNPs is $137,140. 

• How do I Become a Neonatal Nurse Practitioner?

  • Earn an MSN or DNP with a Neonatal Nurse Practitioner specialty from an accredited program, then get your NNP certification from the national certification corporation.

• How Long Does it Take to Become a Neonatal Nurse Practitioner?

  • If you already have your bachelor's degree, it will usually take another two years to complete your Master’s degree or three to four years to complete your DNP. 

• How Many Hours Does a Neonatal Nurse Practitioner Work?

  • This depends on the type of facility they are working in. Working hours for a neonatal nurse practitioner can range from 36 to 40 hours per week.

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