What is a Neonatal Nurse (NICU Nurse) in The USA

By ShiftMed Team//Nursing Profession
NICU Nurse with a child in the hospital

NICU Nurses are specialists in infant care. They work in the Neonatal Intensive Care Unit (NICU) to nurse babies back to health so they can go home with their families. In addition, a NICU Nurse works with infants who are born prematurely, born with congenital disabilities, disabilities, or other illnesses. 

While neonatal nurses can sometimes work with children up to two, the NICU is a specialized unit reserved for infants or babies who are critically ill or need extra support until their bodies develop to term. 

If you love working with children and the idea of nurturing babies in a hospital or critical care setting, this career guide is for you.

While being a NICU Nurse requires additional training and specialization, it can be gratifying for the dedicated nurse who loves helping infants and supporting parents. 

Additionally, NICU Nurses also need to be excellent communicators. They also must be empathetic to the needs of parents whose children they care for. 

What Does NICU Mean?

NICU stands for neonatal intensive care unit. This ward in a hospital specializes in treating infants who:

  • Are born before the gestational period of 32 weeks or after 42 weeks.

  • Born significantly underweight or overweight.

  • Born underdeveloped and require breathing equipment.

  • Require specialized nursing or healthcare.

  • Born with congenital disabilities.

  • Born to a parent with a drug or alcohol addiction.

  • Born with injuries caused by labor and delivery complications.

What is the Difference Between a NICU Nurse and a Registered Nurse (RN)?

NICU Nurses have specialized training to work with infants requiring intensive care. In addition, registered nurses can gain experience in pediatrics, but they do not hold the same specializations in neonatal care as NICU Nurses.  

What Qualifications Does a NICU Nurse Need?

A NICU Nurse must have an RN license in their state and additional qualifications in NICU care. 

Before finding work in the NICU, you will likely have to complete at least two years in neonatal care. However, working in pediatrics and labor and delivery can help you get the necessary work experience you need to begin pursuing a NICU specialization.

There are additional certifications employers may require for you to work as a NICU Nurse. These include:

  • RNC-NIC: RNC Certification for Neonatal Intensive Care

  • CCRN-Neonatal: Neonatal Critical Care Registered Nurse 

  • RNC-LRN: Low-risk Neonatal Intensive Care Registered Nurse

  • RNC-MNN: Maternal Newborn Nursing

What Work Does a NICU Nurse Do Day To Day?

A NICU Nurse’s day involves providing immediate care to newborns in the NICU ward. The duties include monitoring vitals, administering medication, feeding, changing, bathing, and comforting babies who require additional support. They also respond to the emergency needs of infants in the NICU, which may include intubation, CPR, and PICC line insertion,

NICU Nurses also work with newborns who require incubators. Incubators help babies maintain a stable body temperature while making it easy for nurses to monitor and adjust any additional equipment they need. 

Daily responsibilities for a NICU Nurse can include:

  • Performing regular infant care, such as feedings and diaper changes

  • Providing constant, round-the-clock care for babies in the NICU

  • Assisting neonatologists and NICU physicians with medical procedures and treatments

  • Providing parents with care, ongoing support, and instructions on at-home care 

  • Offer critical care to newborns who need respiratory support or life-supporting equipment

  • Taking babies’ vitals, monitoring their weights, and updating their records to track growth and progression

  • Report patient statuses to physicians and other staff members

Where Do NICU Nurses Work?

NICU Nurses work primarily in hospitals’ neonatal intensive care units. 

They work closely with their fellow NICU Nurses as well as neonatal physicians. They will perform at different levels depending on their preference and specializations.

There are four levels of neonatal care that a hospital can provide based on its staff and equipment. 

  • Level I – Well Baby Nursery. The well baby nursery provides immediate care to newborns born prematurely or before 35 weeks. In addition, they can give resuscitation at delivery and stabilize infants born ill or injured but otherwise physiologically stable. 

  • Level II – Special Care Nursery. This level of NICU is for infants born 32 weeks and under and who weigh 1,500 grams or less. In addition, moderately ill babies who need help with respiratory support, feeding, and stabilization are level two.

  • Level III – Neonatal Intensive Care Unit. The NICU provides all of the services and support as the first two levels with the addition of specialized support. With sustained life support, pediatric surgeons, medical specialists, and advanced imaging and respiratory support, this is an intensive unit for babies with the most urgent need for care.

  • Level IV – Regional NICU. Hospitals with level IV NICUs provide the highest level of intensive care. Infants who need organ transplants, surgical repair of congenital disabilities, and advanced surgical and medical support will be transferred to these units. 

Depending on your preferences, you can choose what level to work at, but additional certifications are often required as you increase the level of NICU care. 

Some NICU Nurses may also provide at-home follow-up care for babies after discharge. 

What is it Like to be a NICU Nurse?

Being a NICU Nurse is rewarding but demanding. You will spend most of your time working with critically ill infants, so there can be a great deal of pressure and anxiety involved. 

You must also comfort scared and distraught parents whose babies may be receiving life support or have serious diagnoses. They are facing not only immediate challenges but fear of an uncertain future for their baby. As such, you need to work well under pressure and be able to present important information in a caring yet clear and concise way.

Schedules tend to vary, though many NICU Nurses work 12-hour shifts. You may work during the day or overnight, but NICU Nurses are needed 24-hours a day at the hospital. Typically, a NICU Nurse can expect to work 12-hour shifts, three to four days a week, often consecutively. 

While there are fewer patients than on a typical hospital floor, the stakes tend to be much higher. As you care for some of the most fragile patients possible, the pressure to keep a baby alive can sometimes be overwhelming.

A NICU Nurse needs to handle stress, maintain a calm demeanor, and stay optimistic about their patients' outcomes. This directly influences how parents feel, and supporting them is a significant part of the job.

NICU Nurses also need to have sharp critical thinking skills. Since a patient’s status can change minute to minute, you need to be able to make decisions in urgent situations. But even with the stress and often urgent need for medical attention, the rewards of seeing a patient discharged make it all worthwhile. 

How Much Do NICU Nurses Make?

NICU Nurses’ salaries vary by state, but the average annual salary is approximately $71,000. This annual salary equates to roughly $34 an hour. 

Are There Different Specialties of NICU Nurses?

NICU nursing is a specialty in and of itself. However, additional certifications in neonatal care or critical care can prepare you to work with infants at the highest risk level. 

Neonates – babies 28 days old and under — are some of the most amazing patients you can treat. They are little heroes, often fighting against seemingly impossible odds and overcoming disabilities and defects from their first day of life. 

Choosing to specialize in neonatal care allows you to support the smallest infants with the most significant level of support, no matter their circumstances. 

There’s room for career growth. You may also be eligible for promotions within your current role. For example, NICU Nurses become neonatal nurse practitioners, developmental care specialists, and nurse managers within the NICU. In addition, you’ll assume a position where you guide and support patients' and parents' direct educational programs.

Advantages and Disadvantages of a Career as a NICU Nurse

NICU nursing is a rewarding profession, but it can be challenging. Nurses who want to specialize in NICU should know the pros and cons before entering the field. 

Advantages of Choosing a Career as a NICU Nurse

  • Care for babies and be a part of their growth and development.

  • Provide hands-on care to infants, knowing you’re doing something meaningful every day.

  • Support parents and help ease stress and anxiety during what is likely the most challenging period of their lives.

  • Job stability with typical nursing schedules and a designated environment.

  • Less physically demanding than other nursing jobs because the patients are so small.

  • Connect with others and have the experience of seeing even the sickest of babies improve and be discharged.

Disadvantages of Choosing a Career as a NICU Nurse

  • Emotionally draining and stressful at times.

  • Facing the death of an infant who you cared tirelessly for.

  • Pressure from parents who are counting on you to save their baby.

  • A high-stress environment that requires you to be ready for crisis intervention or emergency at any minute.

How To Become a NICU Nurse

You can become a NICU Nurse by starting your nursing education through an accredited program. 

Being a NICU Nurse starts with earning your RN. Then, to become a registered nurse, you can earn an associate’s or bachelor’s degree.

Both ADN/ASN and BSN programs are available throughout the country, including online, to help you jumpstart your career.

Once you’ve passed the NCLEX-RN exam, you can begin looking for jobs in hospital nurseries or pediatrics to gain experience in neonatal care. After gaining at least two years of experience and possibly additional certifications, you may apply for employment in a NICU. 

Frequently Asked Questions About NICU Nurses

These are some of the most frequently asked questions about becoming a NICU Nurse. 

How Long Does it Take to Become a NICU Nurse?

It takes two to four years to become an RN, and earning additional certifications can take two to five years. So while you can start working with infants within four years of gaining your RN qualification, it will likely take five to seven years of education and work before you are working in the NICU. 

Some History About NICU Nurses

Here are some interesting facts about neonatal intensive care and how it has evolved over the years.

  • Neonatal intensive care began in the late 19th century. 

  • French obstetrician Pierre-Constant Budin provided specialized care, including an early feeding tube, to infants who did not take breast milk or bottles.

  • Etienne Stephane Tarnier, another French obstetrician, created the first incubator for premature babies who cannot regulate their body temperatures.

  • Special Care Baby Units were the earliest versions of the NICU in the United States, formed shortly after World War II.

  • The Newborn Individualized Developmental Care and Assessment Program in the 1970s by Heidelise Als promoted individualized care for infants in the NICU. 

What is The Difference Between NICU and ICU?

The NICU provides intensive care to neonates and babies 28 days or younger. 

The PICU, or pediatric intensive care unit, cares for babies and children up to age 17.  While NICU and PICU nurses do share similar qualifications, they typically do not cross over in terms of patient care. 

The ICU is The Intensive Care Unit. The ICU cares for critically ill adult patients over the age of 18.