Neonatal Nurse Practitioner Education, Schools, and Career Overview

Neonatal Nurse Practitioner Education, Schools, and Career Overview

According to the National Association of Neonatal Nurses (NANN), "neonatal nurse practitioners are advanced practice nurses who work with the physicians and nursing staff to provide comprehensive critical care to the infants in the NICU." The NICU is an acronym for "neonatal intensive care unit."

Newborns that are admitted into NICUs can suffer from a variety of serious health conditions such as premature birth, illnesses, cardiac and respiratory problems, low birth weight, infections, birth defects, and hereditary diseases. The term "neonatal" refers to the first twenty-eight days of life of an infant. However, neonatal nurse practitioners (NNPs) will often assist in the care of infants beyond this twenty-eight day time period, usually until the infant patient is released from the NICU.

While a newborn is receiving medical attention in an NICU, neonatal nurse practitioners also work in collaboration with affected parents and families in order to assist them in learning how to understand, cope, and properly care for their infant's specific condition. Unlike registered nurses, neonatal nurse practitioners have the authority to determine the type of care that is required to resolve immediate or emergency issues as they arise in infants. Because of the highly sensitive nature of the profession, neonatal nurse practitioners are substantially educated in the field of nursing with significant specialized training in neonatal care.

Neonatal Nursing Specializations

There are three levels of NICUs, and neonatal nurse practitioners are relied upon in each. Level I NICUs contain newborns that have less serious health conditions. Neonates in these NICUs are not premature and generally stabilize after a very short period of time and then are transported into specialty care units (SCUs):

  • Level I NICUs are becoming less common throughout the United States. However, newborns that are placed in Level II NICUs are often premature by four-weeks or less and suffer from more severe health conditions that require more time and attention from NNPs. 
  • The most premature and seriously afflicted newborns are treated in Level III NICUs. Babies that need the assistance of mechanical ventilators, high-tech imaging devices, and surgical procedures are the one's found in these Level III NICUs. Unlike newborns placed in Level I and Level II NICUs, these infants will likely require persistent care well after the first twenty-eight days of life.

Neonatal Nurse Practitioner Duties

According to the National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC), the neonatal nurse job description involves four major responsibilities: general assessment, general management, identification of disease processes, and professional conduct. Perinatal, neonatal, and family integration assessment is one of the key functions of a neonatal nurse practitioner. Here, NNPs perform physical examinations, behavioral analysis, clinical laboratory tests, diagnostic procedures, data interpretation, operate medical equipment, and follow up evaluations to better understand health conditions affecting neonates and their families. 

Another important aspect of a neonatal nurse practitioner's job description is the health management of the neonatal patient. Often NNPs are required to monitor and manage the thermoregulation, nutrition, stabilization and resuscitation, pharmacology, and fluids that are essential to maintaining the best possible conditions for restoring neonatal health. Also, since neonates suffer from a wide range of debilitating disorders, neonatal nurse practitioners must use their extensive knowledge to identify the impact of diseases and ailments on the body in order to accurately recognize, comprehend, diagnosis, and suggest treatments for each patient. 

On a more personal level, neonatal nurse practitioners will sometime use touch therapy or "kangaroo care" to physically, mentally, and emotionally soothe infants in NICUs. Here, NNPs hold the newborn up to the chest for up to an hour at a time. This kind of intimate physical contact is thought to improve sleeping habits, regulate breathing, promote recovery, and provide overall comfort to the ailing infant.

How to Become a Neonatal Nurse Practitioner

The first step to becoming a neonatal nurse practitioner is to graduate from high school. While in high school, students are encouraged to complete as many science, health, and mathematics courses as possible. Advanced-placement courses are especially helpful. The next step is to earn either an associate of science degree in nursing (ADN) or a bachelor's of science degree in nursing (BSN) from an accredited school.

By pursuing an undergraduate degree in nursing, students will often qualify to sit for the national examination necessary to become registered nurses (RNs) or vocational/practical nurses (PNs). This examination is called the National Council Licensure Examination, or the NCLEX. All neonatal nurse practitioners are required to pass the NCLEX.

After gaining a few years of experience working as an RN, the next step is to pursue a master's or doctorate program specifically designed to provide specialized neonatal nurse practitioner education and training. After pursuing a graduate degree, graduates pursue national neonatal nurse practitioner certification prior to employment. In addition, all states (as well as the District of Columbia) require nurse practitioners, regardless of specialization, to obtain state licensure. Neonatal nurse practitioners should contact the Board of Nursing in the state in which they intend to practice and learn about any additional professional requirements.

Neonatal nurse practitioner degree programs

Most neonatal nurse practitioner degrees are available through graduate programs found in both private and state colleges and universities. Reputable online schools have established academic programs and degrees as well. 

All neonatal nurse practitioners (NNPs) need to earn a master's degree or higher in a specialized degree program. Therefore, virtually all NNP degree programs exist at the graduate level. Here, the most widely available degrees are a Master of Science in Nursing:

  • Neonatal Nurse Practitioner
  • Post-Master's Certificate in Neonatal Nurse Practitioner
  • Doctor of Nursing Practice: Neonatal Nurse Practitioner

As this profession continues to expand and grow in complexity, students will continue to find a more diverse selection of degree programs to choose from. Some additional master's degrees include: Master of Science in Nursing: Nurse Practitioner Acute Neonatal Care, Master of Arts in Nursing: Neonatal Nurse Practitioner, and Master of Science in Nursing: Care of Children and Families/Pediatric Nurse Practitioner/Neonatal Nurse Practitioner.

Neonatal nursing certification

The National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC) is the premier certifying body for neonatal nurse practitioners. Currently, there are three major eligibility requirements that need to be completed before the NCC will allow neonatal nurse practitioners to take the competency examination that results in certification. 

  • First, all candidates must hold an active license to practice as a registered nurse either in the United States or Canada.
  • Next, all candidates must show evidence that they have completed a formal education program that resulted in a master's, post-master's, or doctor of nursing practice degree in the specialty of neonatal nurse practitioner.
  • Finally, candidates must have graduated from their specific degree program during a set range, confirmed by the NCC. Once all qualifications have been meet and the examination is successfully passed, the NCC will officially grant certification for approved neonatal nurse practitioners.

In order to maintain NCC certification, neonatal nurse practitioners must complete at least forty-five contact hours of continuing education that is directly related to their specialty every three years. Those that do not wish to engage in continuing education activities do have the alternative option of re-examination by the NCC. Some common ways to earn continuing education credits include participating in preceptorships, academic coursework, presentations, and literary publications. 

Students that want to enter into an educational program that will help them qualify to get certified as a neonatal nurse practitioner are encouraged to select one that is accredited by the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC). 

Neonatal nursing schools

Schools may require applying students to submit GRE scores along with official transcripts indicating previous coursework and GPAs. The completion of pre-requisite courses in subjects such as statistics and health and physical assessment can also be expected. In addition, most neonatal nurse practitioner programs only accept students with prior work experience in the field. As a result, students may need a current registered nurse license and at least six months to two years of nursing practice in a setting such as a Level III NICU. Schools also typically ask for professional references, current employment information, resumes, and personal goal statements. 

In addition, some schools will even offer accelerated degree programs to accommodate students that already hold degrees in nursing and want to fast-track neonatal nurse practitioner specialization. For example, students may complete accelerated degrees such as Bachelor of Science in Nursing to Doctor of Nursing Practice in Neonatal Nurse Practitioner (available online also), Post-Master's to Doctor of Nursing Practice in Neonatal Nurse Practitioner, Master of Science in Nursing to Doctor of Philosophy in Care of Children and Families/Pediatric Nurse Practitioner/Neonatal Nurse Practitioner.

These neonatal nurse practitioner programs are mainly campus-based. However, students that reside in a state that does not offer a neonatal nurse practitioner degree program should not be discouraged because many colleges and universities allow out-of-state students to participate through online or distance learning participation. 

Since students are involved in clinical training throughout neonatal nurse practitioner programs, drug screenings, immunizations, criminal background checks, malpractice insurance, neonatal resuscitation certification, health insurance, and CPR certification are common admission requirements.

Neonatal Nurse Practitioner Salary and Career Outlook

The availability of jobs in this field can vary greatly depending on factors such as location, employment setting (university, hospital, or other), and what you specialize in. However, the general trend seems to be a need for health related professionals continuing to increase, and the need for health related educators following suite. Here’s a snapshot of data to show job growth outlook in the field:

CareerTotal Employment
Nurse Practitioners200,600
2019 Occupational Employment Statistics and 2018-28 Employment Projections, Bureau of Labor Statistics,

The salary for neonatal nurse practitioners can vary greatly depending on the type of employment setting, region of the country, years of experience, tenure and rank, and the availability of the skilled individual. You can get an idea of salary possibilities for nursing in the table below:

CareerAnnual Mean WageBottom 10% Annual WageTop 10% Annual Wage
Nurse Practitioners$111,840$81,410$152,160
2019 Occupational Employment Statistics and 2018-28 Employment Projections, Bureau of Labor Statistics,

1.     2011 AANP National NP Compensation Survey, American Association of Nurse Practitioners.
2.     Nurse Practitioners, Bureau of Labor Statistics, Occupational Employment Statistics, May 2014.
3.     Salary Averages According to Degree, ADVANCE for NPs & PAs, 2012.

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