How to Become a Neonatal (NICU) Nurse

Neonatal Intensive Care Unit (NICU) nursing is a specialty of nursing that deals with the care of sick or premature babies and babies with birth defects. NICU nurses are registered nurses who have gained experience working with neonatal patients and potentially also become certified in an area related to this. You can have either an ADN or a BSN to work as a neonatal nurse.

It takes a special person to become a nurse, but that's even more true for those who go on to become Neonatal Intensive Care Unit (NICU) nurses. These dedicated professionals care for the most fragile patients: sick and premature newborns. In addition, they are on the front lines when it comes to helping scared parents through what is often a traumatic experience. 

Find out more about what it takes to become a NICU nurse and why those who choose this track are doing society a special service.

There are many specialty nursing careers, some of which deal with a particular type of patient. That is the case for neonatal intensive care unit (NICU) nurses. Their primary patients are sick and/or premature babies or babies with various forms of birth defects. These patients need to be cared for and monitored, sometimes for weeks or months, until they are hopefully healthy and developed enough to go home.

According to the National Association of Neonatal Nurses (NANN), approximately 40,000 low-birth-weight infants are born each year in the United States. Thanks to advances in medicine, highly skilled NICU nurses, and other healthcare professionals, survival rates are improving. In fact, the survival rate is now 10 times better than it was 15 years ago. 

>> Show Me Neonatal Nursing Programs

NICU stands for neonatal intensive care unit, and the patients nurses care for in the NICU are often in acute or critical condition. So, in addition to hands-on patient care, monitoring, and feeding the babies, NICU nurses also work intimately with moms and dads who are going through this emotional experience with their newborns. Neonatal nurses provide comfort and education to help families get through this trying time.

According to NANN, NICU nursing generally involves care for newly-born infants in crisis. It also encompasses neonates who suffer from long-term problems related to being born early or from some severe illness encountered soon after birth. Some NICU nurses may even care for babies up to about 2 years of age.

However, NICU nurses' responsibilities reach beyond their infant patients. They also care for the entire family unit. Neonatal nurses act as a shoulder to cry for distraught parents, assist new mothers with breastfeeding, and provide lasting memories to new parents. 

Day in the Life of a NICU Nurse

A day in the life of a NICU nurse is demanding and can range from basic newborn care to monitoring seriously ill patients. NICU units operate 24/7, so most neonatal nurses work 12-hour shifts, which include some nights and weekends. Most large private and public hospitals have a NICU, while smaller facilities or medical centers may not have a full department or any at all.

A neonatal nurse will, at times, have more “downtime” than a typical bedside nurse. Because sleep and rest are so important to growth in the neonatal population, a NICU nurse will generally provide hands-on care to patients every three to four hours and monitor in between.

NICU nurses will monitor the vital signs of the more seriously ill or premature infants day and night to make sure they are breathing and developing properly. They also administer medications, record the newborn’s progress and recovery, change diapers, and calm babies in distress.

NICU Levels of Care

There are four levels of NICU nursing care that may impact a neonatal nurse's daily duties. Working in a neonatal intensive care unit is considered level three, while level one is for healthy infants and level two is for less serious neonatal cases. Here's a breakdown of the different levels of neonatal care:

1. Level I: Basic newborn care
2. Level II: More advanced newborn care 
3. Level III: Neonatal ICU (Where most NICU nurses will work)
4. Level IV: This is the most intense level of newborn care for babies born with serious birth defects. Usually found at children's hospitals, university hospitals, or destination centers.

How Many Patients Does a Neonatal Nurse Work With?

Depending on the status of the patients and how many babies are born in a given period of time, a NICU nurse may work with just a few infants at a time. If there are serious medical issues, the more experienced NICU nurses in a team might focus on just one or two cases.

NICU Nurse Required Skills

It takes a specialized set of skills–beyond just medical ones–to work in the NICU. Neonatal intensive care units are fast-paced, stressful, and emotional, especially when working with family members.

In general, having strong communication skills and a calm, empathetic demeanor are paramount. In addition, because the patients are so tiny and even the smallest error can be life-threatening, precise attention to detail cannot be understated.

Neonatal Nurse Scope of Practice

Like other RNs, NICU nurses work under a scope of practice, a set of state laws that define your rights and responsibilities as a nurse and authorize you on how to function when providing various aspects of medical care.

You can find your state’s Nurse Practice Act via the National Council of State Boards of Nursing. 

^{This content used under license from "Ask Nurse Alice."}

A reliable way to estimate nursing salaries is to use the RN salary as a baseline and understand that specialty nursing roles will have slightly higher compensation. Though that isn't true for every specialty, NICU nursing does conform to this rule of thumb. Due to the complexity and acuity of neonatal nursing patients, NICU nurses tend to earn more than bedside RNs and even other nursing specialties.

The baseline RN salary in the US is $81,220 per year or $39.05 per hour, per the US Bureau of Labor Statistics. In comparison, ZipRecruiter reports the average NICU nurse salary as $136,592 per year or $66 per hour as of July 2023.

But location may also increase or decrease salary expectations. For example, New York neonatal nurses make an average of $163,945 annually, while those in Ohio make $127,140 (ZipRecruiter). 

The highest paying states for NICU nurses, according to ZipRecruiter, are:

Highest Paying States for NICU Nurses

State	Annual Salary	Hourly Wage
New York	$163,945	$78.82
Vermont	$148,368	$71.33
New Jersey	$142,201	$68.37
Wisconsin	$141,450	$68.01
Nevada	$141,024	$67.80

It’s fair to say that NICU nurses–and in all areas of nursing–salary is commensurate with experience, and large cities and well-known medical institutions will pay higher salaries.

Opportunities for overtime, bonuses, and other financial perks will also vary by employer. However, in most cases, when working for a hospital or medical facility, neonatal nurses receive a generous benefits package to go along with their salary.

>> Show Me Neonatal Nursing Programs

The job outlook for nursing professionals of all types is expected to be strong. As reported in The Atlantic, about one million registered nurses (RNs) working today (about a third of the workforce) are over the age of 50. Nearly 700,000 nurses are projected to retire or leave the labor force by 2024. The U.S. Bureau of Labor Statistics estimates that the healthcare sector has lost nearly half a million workers since February 2020. While the number doesn’t specifically identify the number of nurses that have left - an overwhelming number are bedside nurses.

As they begin retiring over the next decade, new RNs will be in demand to fill those roles; in fact, there are expected to be 1.2 million vacancies between 2014 and 2022. As such, the BLS projects that the employment of registered nurses should grow 6 percent from 2022 to 2032. Making a nursing career an excellent choice. 

For NICU nurses specifically, that demand may even be slightly greater. Anytime specialized credentials and skills are involved, it can be more challenging to keep the talent pipeline full. In other words, RNs who become neonatal nurses are equipped with a skill set that will be in demand for years to come.

Before you can begin working as a NICU nurse, you must meet certain neonatal nurse requirements. These include earning your RN licensure and gaining relevant experience. The steps you can take to become a NICU nurse are as follows:

1. Become an RN

To become an RN, you must first attend an accredited nursing program to earn an ADN or BSN degree. Then, you will sit the NCLEX-RN exam and, upon passing, apply for RN licensure with your State Nursing Board.

2. Gain Experience

You cannot begin working as a NICU nurse without gaining relevant clinical experience. So, you must work for two or more years with neonatal patients before applying to take a certification exam for NICU nursing. Some relevant nursing units you can work in to earn this experience include:

• Pediatric Nursing
• Maternal-Child Nursing
• Well Baby Nursing
• Labor and Delivery Nursing

3. Take a Certification Exam

Although you don't necessarily need a neonatal nursing certification to work in a NICU, earning one will help with career advancement and qualify you for higher-level positions.

There are several certifications available to NICU nurses. These include:

Certifying Agency	Certification	Description
American Association of Critical Care Nursing	Critical Care Registered Nurse (CCRN) Neonatal	Board certification for neonatal nurses providing acute or critical care to neonatal patients
National Certification Corporation (NCC)	RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC)	Demonstrates proficiency and knowledge needed to provide acute or critical care to high-risk neonatal patients in an intensive care environment
National Certification Corporation (NCC)	RNC Certification in Low-Risk Neonatal Intensive Care Nursing (RNC-LRN)	Certifies NICU nurses' ability to care for low-risk neonatal patients, identify life-threatening conditions, assess care through knowledge application, and promote patient health in the hospital and at home
National Certification Corporation (NCC)	Neonatal Neuro-Intensive Care (C-NNIC)	Certifies NICU nurses and other healthcare workers' ability to provide neurological neonatal care in an intensive care environment
National Certification Corporation (NCC)	Care of the Extremely Low Birth Weight Neonate Subspecialty Certification (C-ELBW)	Demonstrates NICU nurses and other healthcare workers' ability to provide acute or critical care to neonatal patients with extremely low birth weight in an intensive care environment

Methodology

We ranked the top NICU nursing programs based on several factors, including:

• Reputation
• NCLEX pass rate
• Tuition
• Acceptance rate, when available
• Only ACEN or CCNE-accredited schools are eligible

Nurse Panel

Our selection panel is made up of 3 Registered Nurses with years of experience and multiple degrees:

• Tracy Everhart, MSN, RN, CNS
• Tyler Faust, MSN, RN
• Kathleen Gaines, MSN, BSN, RN, BA, CBC

There are numerous registered nursing programs, and our panel of nurses ranked them based on factors mentioned in the methodology. Because individual nursing pathways and careers take various forms, the top 10 neonatal NICU nurse programs are ranked in no particular order. 

1. University of Massachusetts Boston

Annual In-State Tuition: $14,905 | Annual Out-of-State Tuition: $36,581

Online: No

Program Length: 4 years

The University of Massachusetts Boston, located on the water right next to the John F. Kennedy Library and Presidential Museum, offers a prime combination of excellent location and low cost for MA residents. The BSN program takes 2.5-4 years to complete (depending on whether students select direct entry or transfer in), and students get to enjoy clinicals at excellent locations across the area, including the renowned Boston Children's Hospital. This could help students gain early NICU exposure, preparing them for their future careers. Also, all NE region residents receive a discounted tuition rate, so students in the area should consider this program.

2. University of Pennsylvania

Annual Tuition: $58,620

Online: No

Program Length: 4 years

A private, Ivy League school located in Philadelphia, the University of Pennsylvania might have the best all-around nursing school in the nation. Students who enroll in the BSN learn important nursing skills with an emphasis placed on cultural awareness and community involvement.

Those planning on becoming NICU nurses could benefit from the great clinical locations, including the Children's Hospital of Philadelphia, the nation's first-ever hospital devoted entirely to children. The cost of this private school is steep, but BSN students would have a hard time finding a better program. 

3. University of Washington

Quarterly In-State Tuition: $4,215 | Quarterly Out-of-State Tuition: $13,999

Online: No

Program Length: 4 years

Located in Seattle, the University of Washington is one of the best schools in the state. Perhaps best known for its research degrees, UW still boasts an excellent BSN program that sees students complete over 1,000 clinical hours at sites across the region.

Aspiring neonatal nurses could get placed at Seattle Children's Hospital, one of the best children's hospitals in the West. Over 98% of nurses in the program graduate, and UW boasts an above-average NCEX pass rate for first-time test-takers. 

4. University of Colorado Denver

In-State Tuition Per Credit Hour: $472-$588 | Out-of-State Tuition Per Credit Hour: $1,019

Online: No

Program Length: 4 years

With its main campus located in downtown Denver, the University of Colorado Denver is the state's only public, urban research institution. However, students enrolled in the BSN will attend courses at CU Denver's nearby campus in Aurora.

Students can choose from various BSN routes, though most students choose the traditional BSN, a two-year program that accepts students who completed two years of prerequisite courses. The program uses a cohort system, so nursing students work closely with one another. Also, the university might place students in clinicals at Children's Hospital Colorado, a top-ranked children's hospital. 

5. Georgetown University

Tuition: $32,448 Per Semester, Full-Time | $2,704 Per Credit, Part-Time

Online: No

Program Length: 4 years

Georgetown University, located in Washington, D.C., is one of the nation's top research universities. The university also happens to be private, meaning students don't get access to discounted tuition rates.

While costly, nursing students do get to earn one of the best BSN degrees in the nation. The BSN allows for direct entry, and students begin clinicals during their first year. By the end of the program, students will have earned over 850 clinical hours at excellent sites in the area, including Children's National Hospital. Graduates of the program end up in a variety of positions, including neonatal nursing. 

6. Xavier University

Tuition: $23,948 Per Semester

Online: No

Program Length: 4 years

A Jesuit university located in Cincinnati, Xavier University is a mid-sized school with just 4,500 undergraduate students. The small size might make the nursing school more exclusive, but Xavier's 98% of graduates find a healthcare role within six months of graduating.

Many graduates also end up working at Cincinnati Children's Hospital Medical Center, a great place to earn NICU experience and one of Xavier's top clinical rotation sites. Xavier may have a high private school cost, but many students secure some form of financial aid. 

7. University of California Los Angeles

Annual In-State Tuition: $11,928 | Annual Out-of-State Tuition: $42,954

Online: No

Program Length: 4 years

Known for its great location and excellent sports, the University of California Los Angeles also has some of the top academic programs in the region, including its BSN. A great choice for anyone who wants to become a nurse in California, UCLA's BSN includes plenty of clinical experience and a clinically-based scholarly project at the end of students' fourth year.

UCLA nursing students enjoy clinicals at great sites, including Children's Hospital Los Angeles. The early exposure to working with children and UCLA's location could help graduates secure a NICU position in California. 

8. University of Pittsburgh

In-State Tuition: $8,412 Per Term | Out-of-State Tuition: $15,650 Per Term

Online: No

Program Length: 4 years

Founded in 1787, the University of Pittsburgh now teaches nearly 23,500 undergraduate students. Pitt strives to give nursing students an all-around education, requiring courses through the Dietrich School of Arts and Sciences as students also take nursing courses.

Students get clinical exposure during their first year through a skills lab, then get placed in rotations during their second year. Clinical sites include many of the best regional healthcare facilities, including Pitt's own UMPC Children's. Graduates could end up finding a position at UMPC Children's or other great spots in the area.

9. University of Houston

Annual In-State Tuition: $11,150 | Annual Out-of-State Tuition: $23,110

Online: No

Program Length: 4 years

With over 46,000 students, the University of Houston is one of the largest on this list. However, UH's size doesn't detract from the quality of its nursing program. BSN students earn over 900 hours of clinical experience through rotations and labs, and those interested in neonatal nursing could gain experience at Texas Children's Hospital.

Nursing students complete the first two years of the BSN in Houston, followed by two years at the Katy instructional site. On top of the low in-state tuition rate, students can also secure financial aid and scholarships.

10. The Ohio State University

Annual In-State Tuition: $12,859 | Annual Out-of-State Tuition: $38,365

Online: No

Program Length: 4 years

The Ohio State University, a top public university located in Columbus, enrolls over 68,000 students, making it the largest school on this list. Despite the university's large size, OSU's BSN program is highly competitive, particularly for Ohio residents looking to secure in-state tuition.

Graduates end up finding excellent careers, and gaining clinical experience at Columbus' Nationwide Children's Hospital could help prepare students for a career in NICU nursing. Overall, OSU offers relatively low tuition rates for a great education, making this a good pick for anyone looking to become a NICU nurse. 

>> Show Me Neonatal Nursing Programs

NICU nurses do not innately have specific requirements beyond state-mandated continuing education. However, advanced certifications such as the CCRN and RNC-NIC do require specific CEUs.

All neonatal nurses are required to maintain an RN license regardless of advanced certification.

Continuing education requirements for the license differ for each state. Monetary fees and other state-specific criteria are also associated with all license and certification renewals.  

Examples of continuing education requirements for RNs are as follows: 

• California - 30 CEUs every two years
• Florida - 24 CEUs every two years
• Hawaii - 30 CEUs every two years
• Oklahoma - 24 CEUs every two years
• Pennsylvania - 30 CEUs every two years

 A comprehensive list can be found here.  

Certification CEU requirements are specific to the certification. It is important to check the certification body prior to the renewal date to ensure all requirements are being met. For example, the CCRN Neonatal requires the following for recertification:

• Completion of 100 CERPs is required, with a minimum of 60 CERPs in Category A and 10 each in Categories B and C, plus 20 in the category of your choice.
  • CERPs are a specific type of continuing education
• Clinical practice hours are required. Practice as an RN or APRN for 432 hours in the direct care of acutely/critically ill neonatal patients during the three-year certification renewal period, with 144 of those hours accrued in the 12-month period prior to the scheduled renewal date, is required.

Neonatal Intensive Care Unit Nurses and Neonatal Nurse Practitioners are similar roles, but the difference is in the education requirements and scope of practice. A Neonatal Nurse is a Registered Nurse that works in the NICU and works under the supervision of physicians and Neonatal Nurse Practitioners. Neonatal Nurse Practitioners have completed either a Master's or Doctorate level of education and become certified.

For more on what a Neonatal Nurse Practitioner is and what they do, check out our Neonatal Nurse Practitioner Career Guide. 

>> Show Me Neonatal Nursing Programs

To learn more about Neonatal and NICU nursing, take advantage of the resources provided and consider joining the following professional associations:

• Neonatal (NICU) Nurse Salary Guide
• Academy of Neonatal Nursing
• Association of Women's Health, Obstetric, and Neonatal Nurses
• Council of International Neonatal Nurses, Inc. 
• National Association of Neonatal Nurses

The more advanced your degrees and/or certifications are, the more likely you are to get the position you want as a Neonatal Intensive Care Nurse. 

The best opportunities will be in large hospitals that have a full-fledged NICU department that provides both level II and level III care. 

NICU nurses play perhaps one of the most important roles in our healthcare system in that they are there when life begins and are often instrumental in helping high-risk newborns survive and thrive. They also act as a great source of comfort and information to the parents who spend those first few days or weeks as parents in the NICU.

For aspiring nurses who love the idea of working with infants to improve their health and get them home, NICU nursing is not only a high-demand specialization but also a fulfilling career choice. Check out NICU nurse jobs hiring now on our job board. 

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