Neonatal Nurse Practitioner with baby

For a neonatal nurse practitioner, nothing is more than caring for newborns and giving them the best start in life. A neonatal nurse practitioner (NNP) is an advanced registered nurse (RN) who specializes in caring for newborn babies, also known as neonates.

The neonatal period covers the first four weeks of a baby’s life. After that, babies undergo considerable growth and development from their birthday to the first month. The first 30 days of their lives help establish feeding patterns and attachment to their parents.

The first month of life is also when many congenital disabilities or developmental disorders become noticeable. A neonatal nurse practitioner can work with parents whose children are born with or diagnosed with these conditions early in life and help them navigate uncertainties and concerns. 

Becoming an NNP allows you to perform more hands-on care and treatments than a neonatal nurse. You can provide specialized care and attention to babies born neurotypical and neurodivergent; some NNPs even specialize in caring for newborns born with disabilities.

To start your career as a neonatal nurse practitioner, you’ll need to earn a bachelor’s and master’s degree. The process starts in nursing school when you begin studying to become an RN.

This guide will cover everything you need to become a neonatal nurse practitioner in 6 years.

What are the steps to becoming a qualified NNP?

NNPs all begin their careers as registered nurses (RNs). They then gain experience in neonatal care and earn an advanced degree (master’s or doctoral) before gaining their NP qualification.

You’ll have to study hard and work harder, but the career map to becoming an NNP is worth it. First, let’s cover how you can reach your goals in 6 steps. 

Attend Nursing School and Earn Your BSN

A Bachelor of Science in Nursing is your first step toward becoming an NNP. RNs who earn a bachelor’s degree gain comprehensive training in practical nursing and clinical management. 

While you can earn an associate’s degree and become an RN, the BSN program is best for aspiring NNPs. The reason is that all NNPs must hold a master’s degree or higher — going from a BSN to MSN will be much easier than an ASN to MSN.

Some of the topics you can expect to learn are:

  • Anatomy. The structure and systems of the human body. Emphasis is placed on each system’s parts, like the heart in the cardiovascular system and the brain in the nervous system.

  • Physiology. The interaction between the body’s systems and the functionality of individual organs. The nervous system affects every other part of the body, but feedback constantly occurs throughout nerve cells and the brain.

  • Pharmacology. This studies the chemical makeup of medications and drugs, how they affect the body, and how they are used in healthcare.

  • Nutrition. This course studies how food affects the body and the importance of nutrition in maintaining wellness.

  • Nursing theory. Nursing theory explores ideas and cognitive systems that outline nursing processes from different perspectives. There are three major nursing theories: grand, middle-range, and practical. 

  • Psychology and psychiatry. The mental health of a person has a tremendous impact on their body. Nurses must understand how healthcare, poor health, and hospitalization affect mental health. Psychiatry focuses on using medication to treat mental health symptoms.

  • Health assessment. Nurses learn the skills needed to perform health assessments and gather patient information about their health and symptoms.

Additionally, BSN programs include nurse research, leadership, and case management courses. This makes it easier for someone with a BSN to step into higher roles later, like a charge nurse or nurse manager. 

But for now, you need to earn a BSN to transition into an MSN program later. You may choose to earn your MSN while you are working as an RN or take a combined BSN and MSN program. 

Study for and Pass the NCLEX Exam

Before earning a license,  you must pass the NCLEX-RN exam administered by The National Council of State Boards of Nursing (NCSBN). This is the certifying exam for nurses in the U.S. and Canada. 

The NCLEX-RN tests your nursing knowledge in a multitude of areas. However, there are four primary subjects you’ll find on the NCELX:

  1. Maintaining a safe and effective care environment.

  2. Promoting and maintaining patient health.

  3. Psychosocial integrity among patients.

  4. Physiological integrity among patients. 

The NCLEX-RN uses a pass-fail computer system to administer and grade applicants’ answers. The scoring system is adaptive, so it will change the questions it asks based on your answers. 

To give yourself a head start, it’s best to pick up an NCLEX study guide and take an online prep course. Practicing ahead of time will also allow you to gauge your strengths and weaknesses, so you know what to focus on studying before the day of your exam.

Get Your State Nursing License

Apply to your state’s board of nursing to receive your RN license. You will need to renew this license according to your state’s regulations every few years. Make sure you meet all the requirements for licensure, including any required number of clinical hours. 

Learn more about your state’s board of nursing by simply googling “[Your State Here] nursing board” or “[Your State Here] RN requirements.” 

Gain Bedside Experience as a Nurse

NNPs' work is hands-on with infants who often have critical care needs. However, you’ll need bedside experience as a neonatal nurse before you can work with them independently. You can earn a Neonatal Intensive Care Unit (NICU) nurse certification with the RNC-NIC.

Working with newborns who have an emergency and intensive care needs will help you gain confidence in your practice. NNPs work in a variety of settings, but many are often with infants who require acute and specialty healthcare. 

Around two years of bedside experience is enough for you to build confidence in your skills and work toward your NNP certification. Employers for NNPs will usually look for 2 to 5 years of relevant clinical experience. 

Study for and Pass the Neonatal Nursing Certification to Become a Certified NNP

The NNP requires you to hold a graduate degree in nursing. This is an MSN or DSN. MSNs are best for practitioners who want to work with patients or take on administrative roles. A DSN is ideal for nurses who wish to work in research or academic settings. 

You can also pursue a DSN after your MSN, working as an NNP in the meantime. Holding a DSN doesn’t change your NNP certification, but it is an amazing academic achievement for a nurse who aspires to reach the highest level of their field.

The Neonatal Nursing Certification (NNC) is a computerized test with 175 multiple choice questions. You have 3 hours to complete your exam. 

Scores for NCC exams are on a pass-fail basis. You can expect to see the results in your online account within 15 days of your test.

You must earn your NNP no later than eight years after being awarded your master’s or doctoral diploma. The alternate certification program (ACP) helps nurses who don’t meet the typical eligibility requirements still earn their NNP qualification. 

Can you become an NNP online?

NNPs can study online, and it’s even easier to earn your master’s or doctoral program remotely. Each school and state sets its requirements for clinical rotations, and advanced degrees are usually no exception.

If you’re already working as an RN and getting a master’s or doctoral degree, clinicals will focus on your area of expertise. 

You can start your studies through an online nursing school, but make sure the program is accredited and meets your state’s nursing education requirements.

Check the CCNE to look for accredited nursing programs in your state. The CCNE has been the American Association of Colleges of Nursing’s (AACN) leading accreditation for over 20 years.

You can also search AACN member schools, filtering by location and program type to find your perfect match.

What is the difference between an NNP and NICU Nurse?

A neonatal nurse is an advanced practicing nurse who works directly under a physician. They are qualified to provide more treatments and healthcare to infants in the NICU and other healthcare settings.

A NICU nurse is an RN who may or may not have additional certifications. The neonatal nurse usually takes care of one or two patients simultaneously; they offer infant care, administer medications, perform medical treatments, and manage patients who need ventilation support. 

The NNP performs assessments, orders lab work, makes diagnoses and performs some procedures under the physician’s supervision. In addition, they have more specialized skills and education in advanced neonatal care. 

While there are no set requirements to become an NNP, 2 to 3 years of NICU experience is best. This allows you to gain confidence and develop your skills as a neonatal nurse. 

What’s more, hospitals will set their experience requirements for NNPs. Usually, they’ll require several years of experience treating high-risk babies before allowing you to work with their patients. 

What is the difference between an NNP and an RN?

An RN is a registered nurse who can work with patients of any age in various settings. For example, you can be an emergency nurse, surgical nurse, pediatric nurse, and more. An RN is the base qualification every nurse needs to work.

An NNP is an advanced practicing nurse who has furthered their education beyond an RN status. They are qualified to administer medications, offer treatments, assess, and diagnose neonates. 

The NNP is more specialized than an RN, and they have also spent more years working in school and on the floor. 

What positions can you advance to from being an NNP?

The next highest credential for an NNP would be a neonatologist. These are medical doctors who have completed medical school and a residency. Neonatologists treat newborns at all NICU care levels, providing immediate interventions and ongoing care for babies in intensive care.

To become a neonatologist, you must apply to medical school and complete a residency. Afterward, you can become board-certified through the American Board of Pediatrics.

You can also earn additional certifications through the NCC:

  • High-risk obstetric nursing

  • Women’s health care 

  • Reproductive/endocrinology/infertility

  • Telephone nursing

Do your NNP qualifications expire?

You will need to renew your RN license and NNP certification regularly. States require RNs to renew every 2 to 4 years; NNP certification expires every three years. Make sure that you also check recertification/renewal procedures. 

Many states and certifying boards require you to submit a renewal application at least 30 days before your expiry date.

How much do NP Nurses make?

Salaries for NNPs are comparable to neonatal nurses, ranging between $55,914 and $102,300. We found the average neonatal nurse earns $71,267, or approximately $34 an hour. You can expect lower pay at the start of your career when you have the least amount of experience. 

With a higher degree and certifications, your base salary should automatically increase. Your earnings should also rise as you gain more experience. An NNP with five years of experience will likely earn less than one with 15 years of experience. 

Be sure to advocate for yourself in the workplace; nurses deserve fair pay, especially those who have worked to earn advanced degrees and become specialists in their field. 

How long does it take to become an NNP?

Expect to spend at least six years becoming an NNP. Nursing school takes 2 to 4 years, but since NNPs need at least a master’s degree, you’ll have to earn your BSN, which takes four years. Then, with an additional 2 to 3 years of work experience, you’ll be qualified to work as a certified NNP in most hospitals and healthcare settings.