How to Become a Neonatal Nurse: Schools, Salary & Certification Info

Neonatal nursing is a term that defines a branch of nursing, or healthcare, that focuses on the proper infant care. Neonatal nurses have the task to provide care for infants who are born with birth defects, heart deformities, possible infections, and babies who are prematurely born. The first month to a year after birth for these infants is very important, seeing as the infants are very vulnerable and at a high risk. Fortunately, advancements in this healthcare branch, together with advancements in technology and healthcare in general has ensured that most of the infants that need this special type of care are able to overcome this difficult period and grow up into very healthy children.

neonatal nursing degreeNeonatal nurses work in special Neonatal Intensive Care Units. If you want to become a neonatal nurse, you need to follow the guidelines provided below, as taking care of the sensitive infants is a highly delicate task, and they need medical care that is highly specialized. Considering the delicacy of the tasks of a neonatal nurse, it comes as no surprise that this profession is one of the most apprehensive healthcare careers, and has a great impact on many lives.

Neonatal period is a term that refers to the first 28 days of an infant’s life, because these initial weeks of life are very important to infants in general, not only to infants that are born prematurely, or with heart deformities and infections. However, unlike normal, healthy infants, infants that are born this way need even greater care, and many of them remain in the Neonatal Intensive Care Unit for weeks after birth, depending on the gravity of their situation, and some of them might remain in the Unit for a year or more, if necessary.

The kind of care that the neonatal nurse needs to be prepared to give to the infant depends on the infant, and each infant is unique, and thus, needs specialized care. It depends on the infant’s overall health to begin with, but another very important factor is the infant’s gestational age, the nature of the ailments, infections or deformities it was born with, as well as the delivery method. All of these things have a say in the proper care for the infant, which is why one of the biggest tasks of a neonatal nurse is to prepare a proper plan of care for the infant, and to decide whether the infant needs intensive care and is very critical, or if the infant only needs light monitoring and is only in the Neonatal Intensive Care Unit for a short period of stabilization.

Prospective neonatal nurses need to be prepared for the responsibility, and for the wide range of different, yet specialized care that these infants need. During the first year of life, infants need vaccines, medications and various other medical tests, and, most of the infant spend this period in incubators, and have other needs, which means the prospective neonatal nurse needs to be ready to administer the vaccines and medications in the correct way for each baby, as the tiniest mistake can have a great impact on the infant’s life. Additionally, the neonatal nurses also need to be prepared to work with incubators, ventilators, and other sophisticated medical equipment, which is what makes this position highly demanding, but also incredibly rewarding.

Below, we have elaborated on what you need to do to become a neonatal nurse, the kind of education you will need, as well as what kind of working environment you can expect, which hospitals and healthcare units you can work in, and what the average annual salary of a neonatal nurse is, and the job prospects of the medical branch in the future.

An overview – What do Neonatal Nurses do?

In normal situations, newborns, along with the new mothers, remain the hospital for a week or two after the infant’s delivery. In the past, neonatal nurses took care of the babies in this initial period of life, taking care of them and making sure that their every need has been taken care of. Additionally, infants born with heart deformities, premature infants, as well as infants born with infections were not able to thrive and, for lack of a better word, survive to toddlerhood because there weren’t enough advancements in medicine and technology to aid these babies. Today, that has changes. Neonatal nurses take care of infants that need specialized care, while maternity nurses take care of the healthy babies.

In general, since the proper care of infants depends on many factors, and needs to be specialized, there are different levels of neonatal nurses. One of the reasons for the leveled division is to give time to newly registered (more on that later) nurses time to get properly acquainted with the Neonatal Intensive Care Unit, and to get assimilated into the workforce before moving on to upper levels to attend to babies in the upper, more specialized nursery levels.

Below is how the usual Neonatal Intensive Care Units are divided.

Level I

level I is where the healthy infants reside. Level I neonatal nurses take care of these healthy babies by monitoring them when they are not staying in their mother’s ward. They ensure that the new infant is well fed, warm, and clean. This level can be found in almost every hospital or health center, and, as mentioned above, is often tended by maternity nurses, depending on the location and organization of the hospital workforce.

Level II

Level II nursery is where infants who are affected by an ailment that is not serious, or who are born prematurely, but are generally healthy, are housed. These infants get to leave the unit and go home in a matter of weeks, sometimes even after a few days’ care. Their needs are on a slightly higher level than the needs of normal babies, because in addition to getting properly fed and kept warm, these babies often need oxygen masks, special medications, and special feeding methods and periods. However, despite the specialization, these special care units can be found in most community hospitals and health centers as Level I units.

Level III

Level III nursery wards house premature babies and babies who are ill or infected and need special care with medical equipment, such as respiratory support, as well as babies who are critically ill and need high-tech care, but not surgical interventions.

Level IV

Level IV nursery wards are the most advanced and complex wards of the Neonatal Intensive Care Unit. This ward houses babies who are in very critical conditions, and usually need surgical interventions. The infants stay there for a prolonged period of time which can last all the way to toddlerhood, depending on the condition. This ward is staffed by neonatal nurses who are seasoned and have the most experience, as they not only need to provide the care of the previous three levels, they also need to take care of infants both before and after surgery.

Level III and Level IV wards are highly specialized, and usually a part of large hospitals in big metropolises. The neonatal nurses that staff these wards need to be prepared for long shifts, irregular hours, and quite often working on holidays and weekends, because the infants in these wards need constant care by a qualified neonatal nurse. They also need to be prepared to work together with the infant’s parents and families, and know how to interact with them and make sure that they understand their baby’s special needs, especially after discharging, because the infants housed in these two wards often need to continue their treatment after coming home.

On the other hand, level I and II neonatal nurses work in more relaxed conditions and a more relaxed atmosphere, as the babies there are usually discharged within weeks, and most often do not need extended treatment. They rarely have irregular hours, or need to work weekends and holidays, unless it is an emergency situation.

Educational background of neonatal nurses – what are the requirements?

Becoming a qualified neonatal nurse requires a lot of work and time. To begin with, you need to become a registered nurse. You can become a registered nurse by completing an associate or a bachelor degree program in college or university. An associate degree takes about two years to complete, while a bachelor’s degree needs an additional two. After that, you can seek placement and positions in neonatal departments of hospitals and healthcare centers. It is highly important that you be prepared for further training on the job, and to look for internships and positions in neonatal wards before graduating in order to gain experience which will help you in your position, and help you move ahead in your career. In order to become a registered nurse, after completing a bachelor’s or an associate’s degree, you will need to go through the National Council Licensure Examination for Registered Nurses.

Analytical approach – Which level of education do you need?

An Associate Degree Program lasts two years and it gives you enough knowledge, credentials and training to work as a registered nurse. Most programs focus on preparing you for general nursing work in the field of medicine, but you might be able to branch out in other fields like pharmacology, psychiatric nursing, health maintenance, and patient care management. With an associate’s degree in nursing, you can work as a registered nurse in the neonatal ward, usually in Level I or Level II. It is a very good start for nurses who do not meet the necessary educational background to be registered nurses, or registered nurses who wish to branch out in different fields.

A bachelor’s degree offers a higher level of training, education and knowledge for prospective neonatal nurses. Most bachelor’s degree programs offer courses in nursing theory, but they also offer hands on experience via hands-on training in clinics and in classroom practices. After getting the bachelor’s degree in nursing, you need to take the NCLEX-RN exam to become a registered nurse, after which you are eligible to work as staff in a neonatal nursing ward or department in hospitals and health centers. It is better to get a bachelor’s degree rather than an associate’s degree in nursing if you wish to pursue a career in neonatal nursing, as it gives you the educational background to continue on to graduate level in neonatal nursing.

Pursuing a graduate degree means you will get coursework specialized in neonatal nursing. Many hospitals and health centers offer their neonatal nursing staff opportunity and, in some cases, financial aid to complete their studies to move forward in their career as neonatal nurses. You can become a Neonatal Nurse Practitioner, or reach the highest level of Doctor of Nursing Practice. These two programs are highly advanced, and will help you improve your clinical skills, however, this does not mean that you need to abandon your work – there are plenty of programs that need only minimum attendance, and plenty of online courses to allow you to keep working as you’re pursuing your degree. After finishing these two highly advanced programs, you are eligible to work in Level III and Level IV neonatal wards, the wards that house the infants that need the most specialized care and are in extremely critical conditions. Another benefit of getting becoming a NNP or DNP is the fact that you can branch out in administrative work in these wards, and advance further in the field.

Another way to become a NNP – Neonatal Nurse Practitioner is if you already have a Master of Science in Nursing. You can use this background to attend a post-master’s program and get a certificate in neonatal nursing and become a Neonatal Nurse Practitioner.

Registered nurses who have worked in the neonatal field can get neonatal nursing certificated from the National Certification Corporation, if they have a background of 2000 hours of experience. In order to enter a higher degree program, you need to have at least two years of experience in order to be eligible. After getting the degree, you will be able to take the NCC certification exam to be a licensed Neonatal Nurse Practitioner. The courses in these programs teach embryology, neonatal physiology, pathology, and pharmacology, in order to prepare you for clinical work in specialized infant care. These programs usually take about two years to complete, so you need to be prepared to dedicate the time and effort, if you wish to have a neonatal nursing career.

certificationBecoming certified means that you have worked for a longer period in a specialized field and that you have passed an examination, which is important if you want to explore your career in neonatal nursing. Additionally, in order to keep that certification, you will need to show active experience in the field in the manner of education credits, which are usually given to certified nurses by their employers. Getting certified will also give you a kaleidoscope of opportunities to advance your career, and achieve further specializations, especially since taking care of infants who need specialized care has so many different fields, from leadership, family education, education of other staff, as well as become a member or a leader of a research team in advanced neonatal nursing. Some of the most common further specialization certificate offered to neonatal nurses and practitioners include Neonatal Intensive Care, Neonatal Pediatric Transport, Neonatal Nurse Practitioner, Low Risk Neonatal Nursing, Inpatient Obstetric Nursing, Maternal Newborn Nursing, Electronic Fetal Monitoring and others.

Work Environment of Neonatal Nursing

The work environment of the branch of neonatal nursing by and large depends on the level of the ward the neonatal nurse is assigned to. Level I is where the healthy babies are taken care of, while Level IV has babies which need intensive care, life-support, and post-surgical treatment with advanced technology. Depending on the delivery method, the type of illness to befall the infant, and the level of prematurity of birth, babies are placed in either one of those levels.

This means that the usual working day of a neonatal nurse begins with going over reports from nurses from the previous shifts. A neonatal nurse needs to always be on top of the infant’s medical history, current condition and if there had been any changes, as well as what kind of education has been given to the infant’s family, and whether that needs to undergo changes as well. This requires a high level of concentration, especially if the ward houses a large number of babies. Every infant needs to be constantly monitored: the performance of the heart and the lungs, as well as full physical assessment, and then administer any medications or preparations if such acts are needed. In the higher levels, especially III and IV, a neonatal nurse needs to draw blood for diagnosis, and properly asses the infant’s condition and determine the proper care for the following shift, day, or even week in advance, or, make proper changes to a previous plan according to new readings and results from previous examinations of the infant.

The neonatal nurse also needs to be able to properly educate the members of the infant’s family, especially the infant’s parents, and be able to communicate with them in a kind and understanding manner. It requires a lot of patience and concentration, as well as quick thinking and capability to calm the parents down should they panic, something that occurs very often if their infant is in critical condition.

Other responsibilities include attending a delivery in case the newborn needs instant intensive care due to pre-natal complications. Another part of a neonatal nurse’s capabilities and responsibilities will fall under transport of infants in critical conditions from one department to another within the hospital, or within different hospitals (especially since Level II and IV are quite uncommon in community hospitals and small health centers). At the end of the day, the neonatal nurse needs to craft a report for the neonatal nurses coming in the following shift, to enable them to continue where they left off in the care of the infants.

Neonatal nurses need to be able to conduct critical thinking and be very quick at taking critical decisions. An infant’s health changes daily in neonatal wards, and the health status of each baby needs to be constantly updated and monitored. Another important skill is attention to detail, because a neonatal nurse is expected to work with sensitive and high-tech equipment, such as fetal monitoring units, blood pressure cuffs, oxygen administration devices, infant feeding supplies, intravenous catheters, as well as know how to use specialized software that comes along with the advanced technological equipment.

Neonatal nurses also usually take care of more than one infant at a time. Prospective neonatal nurses should be prepared for a fast working environment, and be able to split their attention equally between all of their charges. They also need to be prepared to create a good method of communication with his or her colleagues, and be able to work as a part of a big team that works on keeping the critical infants not only healthy, but alive. It makes for a very fast, very demanding job environment, however, it also makes the work incredibly rewarding. Last, but not least, a neonatal nurse needs to be prepared for infantile death – because advancements in technology can only do so much with the extremely critical cases, cases that are quite often terminal. A neonatal nurse needs to be prepared to maintain composure, be emotionally and psychologically stable and be able to deal with both the good and the bad at the job.

Salary and job outlook of neonatal nursing

salary-icon-3In 2014, the average annual salary of registered nurses was $66,640. This number refers to all nurses, and it is not specialized by fields in which the nurse works. According to the information from the Bureau of Labor Statistics, Minimum annual salary of a registered nurse (RN), not depending on the field he or she is working in, is $45,880. Depending on specialization, hospital, health center and location, a registered nurse can earn up to $98,880 per year. Salaries also rise if the nurse has a higher level of education, especially if they have a masters or a doctorate degree.

Neonatal nurses who have a master’s degree and become NNP’s, have annual salaries that average around $95,350, but this number usually rises if the NNP has a doctorate.

Due to advancements in technology and medicine, the job outlook for the profession and career in neonatal nursing looks very promising, with a growth of 19% for neonatal registered nurses, and an even higher 34% for NNPs. This is also aided by the sad fact that in modern times, one of every eight babies is born prematurely and needs special care to reach toddlerhood and later childhood. The predicted job growth of 34% for neonatal nurse practitioners stems from the fact that most hospitals and employers prefer to hire registered nurses who have at the very least a bachelor’s degree, and who are prepared to advance further into the field, which is what makes it imperative that aspiring neonatal nurses take the time and put in the effort into getting certified.

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