Neonatal intensive care unit (NICU) nurses deliver specialized care to infants who have been born prematurely or suffer from problems such as birth defects, low birth weight, or other severe illnesses. These infants can be fragile. They require the skilled hands-on touch and knowledge of expertly trained NICU nurses who can gently guide them towards recovery. NICU nurses support parents by showing them how to handle, feed, and communicate with their newborns. They assist young mothers to learn lactation techniques and encourage fathers to take an active role.
There are four levels of acuity NICU nurses’ work; each one has different responsibilities. When NICU nurses care for infants with mild deficits, the goal is to “feed and grow” the baby. Higher levels of acuity require closer observation using cardiac monitoring, respiratory support, and feeding tubes to provide nutrition. NICU nurses who work with severely premature infants must balance needed hands-on care while limiting overstimulation.
NICU nurses often receive advanced training to improve their skills in neonatal care. There are a slew of certifications they can obtain. Some become advanced practice registered nurses (APRNs) either as neonatal nurse practitioners (NNPs) or clinical nurse specialists (CNSs) specializing in neonatal intensive care.
All NICU nurses must scrub before caring for their patients to reduce infection. Depending on the acuity level, age, and strict feeding schedule, NICU nurses care for one to three babies at a time, usually during a 12-hour shift.
NICU nurses provide specialized care based on the level of care for the infant.
Level 1: Well newborns only need basic care.
Level 2: Special care of early-born infants born before 32 weeks with low weight and mild health problems. Nurses may provide IV antibiotics, phototherapy, and other support.
Level 3: Life support for infants born before 32 weeks of gestation, weighing less than 1500g, or who have severe medical/surgical conditions. These neonates require assisted ventilation, cardiopulmonary monitoring, lab work tracking, temperature monitoring, and may require advanced imaging scans.
Level 4: Require regional NICU designated facilities possessing a comprehensive medical team capable of providing surgical care of complex medical and surgical conditions 24 hours a day. Local hospitals transfer their sickest patients here. In addition, level 4 centers can provide advanced respiratory support such as extracorporeal membrane oxygenation and perform complex surgeries. These babies may or may not be premature but have severe medical or surgical needs. They receive all the care in level 3 plus may need the care of two nurses at a time.
NICU nurses may also go to the OR directly to admit a new infant and meet the parents after a C-section or emergency delivery.
NICU nurses primarily work in hospitals, neonatal intensive care units, and medical transport units but also can work in home healthcare or community organizations.
You can advance your career by getting an MSN or doctoral degree with a neonatal intensive care focus. Alternatively, you can become a Neonatal Nurse Practitioner (NNP) or Clinical Nurse Specialist (CNS) and become an educator or manager.
NICU nurses must be BCLS certified. All NICU nurses must be Neonatal Resuscitation (NRP)
certified to work in the NICU regardless of what level of NICU they work.
The CCRN (Neonatal) and Neonatal Intensive Care Nursing (RNC-NIC) certifications are from different organizations that can be taken after gaining approximately 2,000 hours of providing direct care to acutely/critically ill neonatal patients. Each organization has other additional requirements, but NICU nurses can study and take both certification exams.
In addition, the NCC offers several other related neonatal or maternal certifications.
NICU nurses typically make between $65,871- $106,378, with a median salary of $82,055, according to Salary.com.
The May 2021 Bureau of Labor and Statistics report shows which states have the highest and lowest wages for nurses. They do not list by nurse specialty, but NICU nurse salaries would likely follow suit. The highest-paid states are California, Hawaii, and Oregon. The lowest-paid states are South Dakota, Alabama, and Mississippi.
