Neonatal Nurse Practitioner (NNP) Career Guide


    GUIDE
    March 18, 2020
    Nurse checking on newborn infant

    Nurse Practitioners deliver advanced care to a variety of patients in clinical settings. 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 health care services.” Neonatal Nurse Practitioners (NNPs) are a specialty within the Nurse Practitioner field. 

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    Part One What is a Neonatal Nurse Practitioner?

    Neonatal Nurse Practitioners deliver care to preterm and sick infants with neonatologists in acute and nonacute settings. They also can assist in delivering patients in certain settings. NNPs care for patients suffering from conditions including:

    • Prematurity
    • Genetic disorders
    • Drug addiction and withdrawal 
    • Surgical birth defects including Myelomeningocele, Omphalocele, Cardiac defects, Gastrointestinal disorders, and Birth Trauma

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    Part Two What is the Salary Range for Neonatal Nurse Practitioners?

    According to the Bureau of Labor Statistics, the mean pay for nurse practitioners in 2019 was $115,800 per year, with salary ranges from $81,410 to $152,160. Unfortunately, the BLS does not differentiate between different types of Nurse Practitioners. However, Salary.com reports that the median salary for an NNP as of June 2020 was $124,756. 

    As with any employment situation, NNPs should think about many factors when looking at a job offer, such as local cost of living and total benefits package, including health and dental insurance, retirement benefits, and tuition reimbursement options. Search for positions in the location where you want to work to find out more about the specific NNP salary ranges in your area.

    Map depicting average nurse practitioner salary by area

    Highest Paying Cities and States for Nurse Practitioners

    The BLS reports that in May 2019 the highest paying states for nurse practitioners were:

    • California: $138,660
    • Washington: $126,920
    • Hawaii: $124,000
    • New Jersey: $123,810
    • Minnesota: $122,850

    The top five states with the highest concentration of jobs and locations for CRNPs include:

    • Mississippi
    • Tennessee
    • Maine
    • Kansas
    • Alabama

    The BLS also reported that the top five metropolitan cities for nurse practitioner pay were:

    • Vallejo-Fairfield, CA: $175,060
    • Spokane-Spokane Valley, WA: $160,110
    • San Francisco-Oakland-Hayward, CA: $157,150
    • Longview, CA: $150,520
    • Sumter, SC: $147,210

    The top five non-metropolitan cities for nurse practitioner pay, according to the BLS, were:

    • Eastern Sierra-Mother Lode Region of California nonmetropolitan area: $137,450
    • Central Louisiana nonmetropolitan area: $136,910
    • Connecticut nonmetropolitan area: $136,580
    • Middle Georgia nonmetropolitan area: $133,800
    • Coastal Plains Region of Texas nonmetropolitan area: $130,480

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    Part Three What do Neonatal Nurse Practitioners Do?

    Neonatal Nurse Practitioners perform a variety of duties relating to providing care to sick and premature newborns. Specific duties include: 

    • Order, perform and interpret diagnostic and laboratory tests 
    • Order and perform specific procedures such as intubation and central line placement
    • Diagnose and treat acute and chronic conditions 
    • Record and examine the medical history, diagnoses, and symptoms 
    • Educate patients and family on the disease process and plan of care
    • Monitor specialized equipment, including incubators, ventilators, heart/lung bypass machines, total body cooling, and dialysis equipment 
    • Conduct neonatal resuscitation in collaboration with other team members
    • Communicate with other frontline clinicians and bedside nurses
    • Start and maintain IV lines, specifically central catheters and umbilical lines
    • Design treatment plans and prescribe medications (independently or in a collaborative agreement with a physician)
    • Assess vital signs
    • Perform physical examinations and patient observations
    • Admit and discharge patients
    • Participate in post-discharge primary care management
    • Participate in high-risk newborn transport if this service is available 
    • Provide staff development by participating in educational programs
    • Collaborate with other healthcare professionals
    • Detect changes in a patient’s health and change the treatment plan if necessary

    >> Related: Neonatal Intensive Care Nurse Career Guide

    4 Levels of Care for Newborns

    In general, the setting in which NNPs work determines the tasks they perform. In the United States, there are four different levels of care for newborns. Most hospitals have three specific levels of care that group infants according to their needs, with only the most advanced hospitals having Level 4 NICUs.

    Level One, Newborn Nursery Care: This is for healthy, full-term infants. As such, the need for NNPs in level one care is limited.

    Level Two, Intermediate Nursery Care: This is generally where premature and sick babies who are in need of constant attention are assigned.

    Level Three, Neonatal Intensive Nursery Care: This is intended for the most seriously ill neonates with critical health issues who must be constantly monitored (usually referred to as the NICU).

    Level Four, Neonatal Intensive Care Unit: To be in this level, this must meet all level III capabilities, plus have the ability to care for infants born earlier than 32 weeks gestation and weighing less than 1,500 grams, provide life support, perform advanced imaging including MRI and echocardiography, and provide a full range of respiratory support.

    Part Four Where can a Neonatal Nurse Practitioner Work?

    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

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    Part Five How to Become a Neonatal Nurse Practitioner

    If you want to become a neonatal nurse practitioner, you’ll need to complete the following steps:

    Step 1: Earn a BSN degree 

    To become an NNP, you must first have your Bachelor’s Degree in Nursing (BSN). If you only have an Associate’s Degree in Nursing (ADN), you must first obtain a bachelor’s degree. This is a must before any graduate program can be started. 

    If you’re working as an RN with an ADN, there are two programs that would help you achieve your goals. They are an RN-BSN bridge program and an online BSN program. Each program has its own requirements and it’s important to determine which programs you qualify for before applying. Furthermore, decide if you are a distance education learner or need hands-on classroom instruction.  

    • RN-BSN bridge programs: These are ideal for nurses who completed an ADN program or are diploma RNs and now need to further their education. This program is ideal for working individuals with families and life commitments because it provides more flexibility with a heavy emphasis on online learning. Prospective BSN bridge program students should first reach out to their Human Resources department to inquire about tuition reimbursement through the healthcare system. Some hospitals have strong associations with certain online universities. This will allow employees to have a direct point of contact for the program, a streamlined application process, and may receive a higher level of tuition reimbursement.
      • Basic requirements: The applicant must possess an RN license in good standing with no disciplinary action. An ADN degree is required. Working a minimum of 30 hours per week or pass an equivalency exam. Pass a criminal background check.
      • Online RN-BSN programs are great for busy, working professionals. These programs allow the student to work when their schedule permits and can be completed at their own pace. 

    Most programs have a progression they like their students to take. This is because each course builds upon the previous course. Programs are generally expected to be completed within two to three years. It is suggested to take two courses per semester. Some programs will allow students to take up to three courses in one semester but special consideration may need to be given.

    If you know that you want to become a NNP, it is important to start classes for your BSN as soon as possible. This education will take several years to complete, depending on the program and will ultimately delay applying for your NNP courses. 

    Step 2: Get An RN License

    Once you are deemed eligible by the state board of nursing you are seeking a license from, you must sit for and pass the NCLEX in order to earn your RN license. Once you pass the NCLEX and meet all additional requirements, you will receive licensure in your state. 

    Step 3: Gain Experience 

    You’ll likely need at least two years of experience in a neonatal intensive care unit or comparable clinical experience in order to be accepted into an MSN or DNP graduate program. 

    Step 4: Earn an MSN or DNP 

    Next, you’ll need to earn either your MSN or DNP from an accredited program with a specialty in Neonatal Nursing. There are two main types of NP programs offered both in-person and online: 

    • MSN-NP: One of the most common options for NP programs, the MSN-NP is for students who already have their BSN and enroll directly into the program at the graduate level. 
      • Basic requirements: Applicant must possess a BSN degree. 
    • DNP: Doctorate Nurse Practitioner programs allow students to receive their doctorate degrees while meeting the requirements to become an NP. The DNP is generally suited for nurses who plan on working more in an academic or research-based setting, 
      • Basic requirements: Applicant must possess a BSN degree. 
    • Post-graduate certificate: If you have a graduate degree that is different from the area that you wish to specialize in now with your NP, you can search for a school that offers a post-graduate certification option to allow you to enroll directly into the program. 
      • Basic requirements: Post-grad certificate programs require you to either possess your Master’s Degree of Science in Nursing (MSN) or have a Nurse Practitioner qualification in another specialty.

    Neonatal Nurse Practitioner Program Overview

    NNP programs will adhere to the Nurse Practitioner framework and core competencies established by the American Association of Colleges of Nursing for Nurse Practitioners. Those nine competencies are:

    • Scientific Foundation
    • Leadership
    • Quality
    • Practice Inquiry
    • Technology and Information Literacy
    • Policy
    • Health Delivery System
    • Ethics
    • Independent Practice

    NNP Program Curriculum

    The Neonatal Nurse Practitioner's curriculum is very different from other NP programs because it is about a very specific population. Total credit hours are between 33-45, depending on the program. A program can take 2-3 years to complete and most can be completed on a part-time or full-time basis. Students are encouraged not to work during the program; however, it is feasible with the exception of during practicum. 

    Neonatal program coursework may include:

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

    Neonatal Nurse Practitioner Program Requirements 

    Though every Neonatal Nurse Practitioner degree program is different, most have similar entry requirements, which generally include:

    • A minimum of two years of nursing experience in a Level III NICU
    • Satisfactory completion of an accredited baccalaureate program with at least 3.0 GPA on a 4.0 scale
    • Submission of official transcripts from all postsecondary schools attended
    • Unencumbered, active RN license in state of practice (Some programs will require an RN license in the state of the program)
    • Two or three professional references
    • Completion of undergraduate statistics with a grade of C or better
    • Written statement of professional goals for graduate study and nursing career
    • Professional resume or curriculum vitae
    • Successful completion of a personal interview with the Nursing Admissions Committee
    • GRE if applicable
    • TOEFL test if applicable

    Step 5: Get your NNP Certification From the National Certification Corporation

    After successful completion of an accredited program, individuals must sit for their boards. 

    This is an entry-level examination that tests the knowledge of students regarding the care of critically ill neonates. In order to sit for the exam students must fulfill the following requirements:

      • Current U.S. nursing licensure
      • Successful completion of an accredited graduate nurse practitioner program that meets NCC program requirements and prepares neonatal nurse practitioners. The program can be a master's DNP or post-master's. NCC no longer accepts certificate prepared applicants.
      • Examination within 8 years of completion of program.

    Additional information regarding the examination includes,

    • $325 testing fee
    • Exams must be scheduled within the first 30-days of the eligibility window
    • Computerized exam at a designated testing facility
    • This exam is a 3-hour test consisting of 175 multiple-choice questions. Of the 175 questions, 150 are scored and 25 are used to gather statistical data on item performance for future exams.

    After completing the specialty certification exam, individuals will have to become board certified in their specific state of practice. Requirements for certification will vary state by state. It is highly advisable to contact your local state’s board of nursing. 

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    Part Six What is the Scope of Practice for Neonatal Nurse Practitioners?

    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 (Ohio, Pennsylvania, and Utah) and restricted practice (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.

    Map detailing practice authority for nurse practitioners by state

    Nurse Practitioners evaluate their patients holistically, including both the emotional and mental aspects of the patient’s condition and not just the physical. For this reason, a great deal of time is spent on the education aspect of patient care.

    CRNPs provide teaching and supportive counseling and refer patients and families as appropriate. They focus on health education, health promotion, and disease prevention. 

    Part Seven What is the Job Outlook for Neonatal Nurse Practitioners?

    While the BLS does not separate the potential growth of different types of NPs, one can safely assume that the need for NNPs will always be in need as long as there are babies being born. 

    The idea of working independently of physicians is a great incentive for some people to move into the nurse practitioner career. In fact, the profession rates #5 as the best job in health care and No. 7 job overall in the top 100 jobs, according to the U.S. News & World Report 2019.

    The U.S. Bureau of Labor Statistics (BLS) reported that employment opportunities for all nurse practitioners would grow by 28% between 2018 and 2028. This is much faster than the national average of other healthcare-related professions including Registered Nurses. As of 2018, there were 240,700 advanced practice nurses with an expected need of an additional 62,000 by 2028. Additionally, as the healthcare industry continues to change there will continue to be a need for CRNPs. 

    Part Eight Neonatal Nurse Practitioner Resources 

    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

    Part Nine Other Nurse Practitioner Specialties

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

    Part Ten Neonatal NP FAQs

    • 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 an NNPs is $123,857
    • How do you 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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