NICU Nurse with baby in the hospital

Choosing a career in nursing takes a special kind of heart, especially specializing in the Neonatal Intensive Care Unit (NICU). These devoted nurses care for the most delicate patients, the ill, premature babies, and infants with various congenital disabilities.

NICU Nurses help scared and worried parents get through the traumatic experiences. They provide comfort and education to these parents on how to handle the first few days or weeks in the NICU. 

NICU Nurses are registered nurses with experience caring for neonatal patients. Neonatal nurse education and training help them perform various duties in intensive care units, birthing rooms, and nurseries.

Recommended Reading - What is a Neonatal Nurse (NICU Nurse) in The USA?

NICU Nurses What Are the Steps to Becoming a Qualified NICU Nurse?

NICU Nurses monitor the infant's progress and conduct cognitive tests. They assess the test results, administer the proper treatment and inform the parents about the special care their baby needs. 

Your career as a neonatal nurse starts with earning a Bachelor of Science degree in nursing (BSN) or an associate degree in nursing (ADN).

You’ll also need a valid registered nurse (RN) license and a state license where you wish to practice.

Study and Pass an ADN or BSN Degree

The quickest way to become a practicing neonatal nurse is to earn an associate degree in nursing (ADN) and then pass the NCLEX-RN exam. This process only takes about two years or less.

However, if you have a Bachelor of Science degree in nursing (BSN), you’ll have more job opportunities and a better chance to earn more.

You can also advance your education by earning a doctor of nursing practice (DNP) degree or a master’s degree in nursing (MSN). These qualifications prepare you for nursing leadership positions and more income.

Earning an ADN Degree

An associate degree in nursing (ADN) is the fastest way to any registered nurse (RN) career, including neonatal nursing. This degree prepares you for the NCLEX-RN, and you can transfer the credits to a BSN program.

You’ll learn skills such as

  • Effective communication

  • Interpersonal skills

  • Implementing safety procedures

  • Providing quality care

  • Organizational skills

  • Collaborating with other healthcare professionals

Earning a BSN Degree

Most employers require a BSN, and the positions are often better-paying. Besides preparing you for the NCLEX-RN, this degree paves the way to administrative nursing positions.

There are different types of BSN programs, such as

  • RN-to-BSN programs - take about 12 months or less if you have an RN license

  • Regular four-year programs

  • Accelerated nursing programs for non-nursing majors - take 20 months or less if you have a bachelor’s degree in a non-nursing field

  • LPN to BSN programs - take between 28 and 32 months

You’ll learn skills such as:

  • Management and organizational skills

  • Teamwork and collaborative skills

  • Educating families on patient care 

  • Safety procedures

  • Providing quality patient care

  • Interpersonal skills

  • Effective communication

As a neonatal nurse, you can further your education to become an advanced practice registered nurse (APRN). You can also pursue a master of science in nursing (MSN) to become a neonatal nurse practitioner. You'll have a wide variety of career opportunities and a higher salary.

Studying and Passing the NCLEX-RN Exam

Registered nurses in the US must pass the National Council Licensing Examination for registered nurses or NCLEX-RN. The National Council of State Boards of Nursing oversees the NCLEX. 

Once you get a nursing degree, it’s time to get your registered nurse (RN) license. This step requires sitting for the National Council Licensure Exam for registered nurses or NCLEX-RN. 

This exam evaluates your knowledge in four primary nursing areas, including

  • Physiological integrity and the ability to provide proper nursing care

  • Psychosocial integrity and coping with work-related stresses of a nurse

  • Health promotion, care, and maintenance

  • Safe, effective care environments

Once you pass the NCLEX-RN, you can submit your application for an RN license.

Gaining Clinical Neonatal Care Experience

The next step after getting your RN license is gaining clinical experience in neonatal care. Most employers require at least two years of experience working in the NICU unit at a clinic or hospital. This experience should include managing critically and acutely ill neonatal patients and supporting their families.

As your career progresses, you can decide to focus on various specializations such as

  • Neonatal nurse practitioner (NNP) - Collaborates with nursing staff and physicians to offer comprehensive critical care to the newborns in the NICU.

  • Neonatal staff nurse - Offers supportive care for mildly ill or convalescent infants or specialized care for acutely sick infants.

  • Neonatal clinical nurse specialist - Offers updated education and guides nursing and support staff as they learn clinical skills.

  • Neonatal nurse manager - Holds leadership positions and oversees the administration of the NICU.

  • Neonatal developmental care specialist who offers direct care and supports other nurses to help them meet the developmental needs of premature and sick infants.

Studying and Passing a National Neonatal Exam

After getting experience working in the NICU, the next step is sitting for one or more certification exams. These exams affirm your knowledge to help you advance your neonatal nurse career.

Several tests touch on neonatal nursing provided by various certification organizations.

Some examples are:

  • The American Association of Critical Care Nursing- offers CCRN® certifications for nurses who provide direct care to critically or acutely ill neonatal patients.

  • Neonatal Pediatric Transport (C-NPT) and Electronic Fetal Monitoring (C-EFM)- These are sub-specialty certifications for RNs and other healthcare professionals

  • National Certification Corporation (NCC)- They provide certifications in National Intensive Care Nursing (RNC-NIC) and Low-Risk Neonatal Nursing (RNC-LRN).

You should have some basic certifications as a neonatal nurse, regardless of your specialty.

They include:

  • Neonatal Resuscitation Program (NRP)

  • Advanced Cardiovascular Life Support (ACLS)

  • Basic Life Support (BLS)

Levels of Neonatal Care

There are four primary neonatal care levels offered in healthcare facilities:

Level I - Basic Newborn Care

In neonatal nursing, level I care is for newborns whose physical condition is good. These newborns stay in units called "well newborn nurseries."

Neonatal nurses offer basic postnatal care for infants born at 35 to 37 gestation weeks. They also care for ill infants born before 35 gestational weeks till they are ready to move to other units.

Neonatal nurses providing level I care can:

  • Administer injections

  • Perform neonatal resuscitation

  • Conduct vision and hearing tests

  • Educate mothers on how to care for their infants

Level II - Special Care

Level II nurseries host infants born at or after 32 weeks who weigh 1500 g or more at birth and have mild health issues.

Neonatal nurses in special care nurseries can perform all level I duties in addition to:

  • Providing feeding support and administering medication to infants

  • Caring for newborns recovering from intensive treatment

  • Providing assisted ventilation to infants with breathing issues

Neonatal nurses care for these infants until they improve enough to move to a higher-level facility. 

Level III - Intensive Care

A neonatal intensive care unit offers continuous life support and assisted ventilation for as long as necessary, often beyond 24 hours.

Level III neonatal nurses have specific training to handle infants born before 32 gestation weeks, weigh less than 1500g, or have severe surgical or medical conditions.

Level IV (Regional NICU) - Highest Care Level

Level IV neonatal facilities specialize in repairing severe acquired or genetic conditions. 

They can handle all other care levels in addition to:

  • Assisting in various advanced surgeries such as ECMO (Extracorporeal Membrane Oxygenation)‍ and open-heart surgeries

  • Providing mechanical ventilation

These neonatal nurses care for infants born at 22 to 24 gestation weeks with critical health complications.

NICU Nurses Can You Become a NICU Nurse Online?

It’s possible to complete a neonatal nursing program online. Online schools have the same education quality as physical institutions and should get evaluated based on the same standards.

NICU Nurses What Is the Difference Between a NICU Nurse and an ICU Nurse?

Both NICU Nurses and ICU Nurses handle critically ill patients. However, a neonatal intensive care unit (NICU) nurse specializes in caring for premature or sick newborns.

ICU nurses specifically care for critically ill adult patients. ICUs are often inadequate for handling newborns in need of critical care and treatment.

NICU Nurses What Positions Can You Progress to From Being a NICU Nurse?

Neonatal nursing provides many opportunities to advance your career. You can pursue a doctor of nursing practice (DNP) degree or a master of science in nursing (MSN) to manage leadership roles in the NICU.

You can also pursue advanced roles in the NICU, such as:

Neonatal Critical Care Clinical Nurse Specialist 

Clinical nurse specialists in the NICU offer direct patient care and research ways of improving patient outcomes.

You’ll need to get a Master of Science in Nursing and pass the ACCNS exam. This exam is a requirement to work as a clinical nurse specialist.

Neonatal Nurse Practitioner

Neonatal nurse practitioners are advanced practice nurses who care for infants with life-threatening or chronic conditions. These nurse practitioners counsel and educate parents on caring for their infants. They also handle high-risk births to ensure immediate care for the newborns.

You’ll need two or more years’ experience working as a neonatal nurse and a Master of Science in Nursing. You’ll also sit for the Neonatal Nurse Practitioner exam administered by the National Certification Commission.

Neonatal Transporter

In some cases, infants who need critical care require transportation to different institutions with suitable facilities or personnel. Neonatal transport teams handle the complex transportation process via helicopters or ambulances.


A neonatologist is a pediatrician who cares for infants in the NICU. They collaborate with other medical personnel such as respiratory therapists, obstetricians, and nurses.

You’ll need a medical degree and three years’ residency in a pediatric unit. You’ll then complete three more years of fellowship in neonatology.

NICU Nurses Do your NICU Nurse Exam Qualifications Expire?

In general, nursing licenses remain valid for two years. You must contact the state nursing board for renewal if your license expires or becomes inactive.

Other certifications such as Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) also expire after two years.

NICU Nurses How Much Do NICU Nurses Make?

In general, NICU Nurses earn higher salaries than other nursing specialties due to the acuity and complexity of their patients. On average, a NICU nurse in the US earns $71,267.04 per year or $34.26 per hour.

The salary for NICU Nurses varies depending on your location, experience level, and workplace facility. 

Recommended Reading - How Much Do Neonatal Nurses Make?

NICU Nurses How Long Does It Take to Become a NICU Nurse?

If you start your neonatal nurse career with an ADN degree, it will take you two years to finish the course. A BSN degree takes about four years, but you'll have more job opportunities and a higher salary.

Pursuing an MSN or a doctoral degree will take two to four more years of studying.

Recommended Reading - How Long Is Nursing School in The USA?

NICU Nurses How Much Does It Cost to Become a NICU Nurse?

The tuition fee for nursing courses depends on the institution you select and the specific degree. In general, tuition can cost between $40,000 and $100,000 annually in top nursing schools and private and established institutions. 

The NCLEX-RN exam costs $200, and there's an additional fee for the state license. Depending on the specific state, the amount varies between $75 and $200. An MSN degree from an accredited institution costs between $37,000 and $40,000. 

Recommended Reading - How Much Is Nursing School In The USA?