What Does a Neonatal Nurse Do?

Jul 29, 2020
Ashley Elsbernd BSN, RN, RNC-NIC, CCRN

What are the typical responsibilities of a Neonatal Nurse?

The typical responsibilities of a Neonatal, or Neonatal Intensive Care Unit (NICU), nurse are the day-to-day care of critically ill babies. There is a range of patient acuity, from babies who are close to discharge (commonly referred to as grower-feeders), to incredibly sick and unstable patients on advanced life support.

We take vital signs, ensure proper thermoregulation, draw labs, perform head-to-toe assessments, feed patients, and act as the eyes and ears of the providers, watching for very subtle changes in condition that could signify a decline in patient status.

The National Association of Neonatal Nurses also has some more information on the more technical or logistical side of the role.

Side note: Are NICU Nurses and Neonatal Nurses the same thing? If you’re getting really technical, then no. Neonatal just refers to a newborn, so that could be NICU or it could just be a newborn nursery. That said, there aren’t a lot of places that still have a dedicated newborn nursery with nurses who work only there, so the terms are loosely interchangeable.

baby sleeping in hospital in open bin neonatal nurse

What should nurses entering this specialty expect to encounter on a regular basis?

Nurses should expect to encounter babies, of course, but along with that comes the families. You are not only caring for a sick infant, but their brand new parents, who likely did not anticipate a NICU stay. Your patient is not only the baby in the bed, but their caregivers as well.  

A “typical day” in the NICU can vary greatly from hospital to hospital, depending on what level the unit has been designated—Level I being the least critical (a typical newborn nursery), and Level IV being high-acuity, medically complex cases (many children’s hospitals). Most units will have patient ratios of 1 nurse to 2-3 babies, though the patient load will vary depending on the acuity of the babies.

My experience as a Neonatal Nurse

My first exposure to the NICU was visiting my baby cousin right after she was born. After a job shadow as a junior in high school, I knew I was hooked. I began working in the NICU as an intern my final semester of college, where I accepted a job offer as a new grad. 

After that, I moved to a large children’s hospital that sees anything from micro-preemies to very sick term babies on ECMO (and everything in between). After 2 years there, I spent 2.5 years as a travel nurse in Level II-IV units before coming back to my home hospital to work PRN alongside my job at Trusted.

What are some of the benefits of working as a Neonatal Nurse?

I could list the benefits of being a Neonatal Nurse all day long—the smells and messes are small, the “combative” patients don’t tend to hurt you, patients that yell can be quieted with a pacifier or a bottle, plus you get to snuggle babies from time to time.  You get to be a part of a lot of birthdays and milestone celebrations, and it’s the best feeling ever to finally send a baby home with their family. 

The thing I love the most about being a NICU nurse, tough, is the wide variety of conditions that I see. Where adults typically have dedicated Cardiovascular, Surgical, or Neurological ICUs, the NICU sees all of those subspecialties in one unit. 

We get the opportunity to get familiar with disease processes affecting all body systems, sometimes all within the same baby.
baby in incubator with cables attached neonatal nursing

What are some of the not-so-great parts of working as a Neonatal Nurse?

Not all families make caring for their baby easy. Some feel that they know more than the medical team and make providing proper care difficult, and there are some very complex social situations that the team has to help the family members navigate. 

Being a NICU nurse can also be very emotionally draining. With very sick babies, there is the reality that not all of them will make it. While it’s always an incredible honor to be part of the end of a patient’s life, when it’s a baby, it can be extremely distressing and difficult to cope with, especially early on in your career. (This can often lead to some recurrent feelings—and symptoms—of moral injury or compassion fatigue.) 

I take a special interest in the particularly complicated babies, so I have lost my fair share of patients. There are a few babies that I hold close to my heart, and my experiences with their families have played a major part in shaping me into the nurse, and person, that I am today. 

child looking through window at baby in hospital room nicu nursing

Share your favorite piece of advice for nursing new grads or students looking to become a Neonatal Nurse

My favorite piece of advice for anyone looking to become a NICU nurse is to take every opportunity you can to job shadow! It can be an intense environment, but it can also be so much fun and full of joy. Also, be sure to start developing time management skills early on, and remember that attention to detail is exceedingly important with these little ones. 

Also, brush up on your arts and crafts skills. With all of the unknowns of a NICU stay, and the grief of not having a “normal” newborn experience, it’s really meaningful to parents to do those little things to make life in the unit a little brighter. 

Looking for a New Neonatal Nurse Job?

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