How to Become a Neonatal Nurse Specialist or Practitioner

Working with newborn babies—many who are critically ill—can be a challenge. Are you up for it?

neonatal nurse with newborn baby
neonatal nurse with newborn baby

Neonatal Nurse at a glance

Where you’ll work: Neonatal intensive care units (NICUs) in hospitals, home health and clinics.

What you’ll do: Care for critically ill infants shortly after they are born. This may include premature babies and babies that have been born with other complications.

Minimum degree required: ADN or BSN, though many places require neonatal nurses to have at least a BSN. If you want to be a neonatal nurse practitioner, you need to have an APRN license which requires an MSN or DNP degree.

Who it’s a good fit for: Nurses who work with infants experience a full spectrum of emotions in their job. On one hand, they get to feel the supreme joy of helping a sick baby and see them go home with their family, but they may also be subjected to intense grief if an infant does not survive. Someone who is thinking of pursuing neonatal nursing should be passionate about working with infants, while also understanding the emotional intensity of the job.

Job perks: You get to care for infants in their first days, weeks or months of life.

Opportunities if you pursue a higher degree or certification: Nurses who decide to become APRNs, which is common in neonatal nursing, can earn much more money than someone who is just an RN. They also have more professional responsibility.

Median annual salary: $77,600

One of the most demanding—and rewarding—careers in the growing healthcare field is neonatal nursing. This nursing specialty focuses on the care of newborn infants with health problems in the first days or weeks after birth. Neonatal nurses are trained to work with babies with physical defects, infection, cardiac irregularities, and other problems that may require the infant to spend time in the neonatal intensive care unit (NICU). 

What Does a Neonatal Nurse Do?

A neonatal nurse cares for newborn babies. They help new parents hold, bathe, and feed their baby, and often act as a bridge between the parent and the specialists working with the infant. Neonatal nurses typically work in hospitals or clinics, but they can also work in a community setting, providing at-home follow-up care for high-risk babies and their families once the babies leave the hospital.

“The job involves a lot of observation to determine if behavior is normal or not normal,” says Beth Morgan, a neonatal-certified registered nurse with 15 years of experience in the NICU. “They watch carefully for circulation issues and blood oxygenation and check vital signs frequently. They also learn to give (the babies) a lot of contact with the mothers right away.”

Many babies are born prematurely or have developed other illnesses. For this type of seriously ill infant, round-the-clock care is given exclusively in the NICU. Neonatal nurses who work as part of the NICU team are often called “NICU nurses.”

The job of a neonatal nurse, whether working in the NICU or elsewhere, requires good intuition and attention to subtle changes in babies’ behaviors. Joan Rikli, director of NICU and pediatric services for Helen DeVos Children’s Hospital, in Grand Rapids, Michigan, and also president of the National Association of Neonatal Nurses (NANN), says that “some infants are too little to even cry, so you have to understand subtle signs of potential problems.”

The job can be challenging, but also incredibly rewarding. “We can save babies, and they can become almost a part of the family,” says Rikli, who has been a nurse for more than 40 years and has worked extensively in the NICU. “I get cards and letters and visits all the time. You get invited to their children’s graduations.”

Is a Neonatal Nurse and a NICU Nurse the Same Thing?

The roles of neonatal nurses and NICU nurses may seem interchangeable, but they are not always the same.

The job title “neonatal nurse” describes nurses who work with critically ill infants. NICU nurses work specifically in the neonatal intensive care unit. In other words, NICU nurses are neonatal nurses, but not all neonatal nurses work in the NICU.

Babies born prematurely or with certain birth defects are considered Level II care babies, who require constant monitoring. Infants with the most serious health concerns—usually those born at less than 32 weeks of gestation, as well as babies born with critical illnesses—require Level III care.

NICU nurses care for these fragile babies in neonatal intensive care units, where the infants are placed on ventilators, tube-fed, and usually isolated to prevent potential infections.

How Can I Become a Neonatal Nurse?

There are two levels of neonatal nursing practice you can pursue.

To work as a neonatal nurse, you must be licensed as a registered nurse (RN). To work as a neonatal nurse practitioner, a more advanced role with more professional responsibilities, you must be licensed as a nurse practitioner (NP) or clinical nurse specialist (CNS). Both of these roles are for advanced practice registered nurses (APRNs).

What Education, Licensing, and Certifications Do I Need?

To become a neonatal nurse, you must earn at least a two-year Associate Degree in Nursing (ADN), although a four-year Bachelor of Science in Nursing (BSN) degree is becoming more commonly required. You must also be licensed as a registered nurse.

Neonatal nurses must also be certified in neonatal resuscitation and earn specific NICU certificates if they’re working in the NICU. You may also be required to have a minimum number of years of clinical experience in a hospital setting.

To become a neonatal nurse practitioner, you will need at least two years of clinical experience in a neonatal intensive care unit before pursuing an advanced degree. Currently, NNPs need at least a Master of Science in Nursing (MSN) degree, although The National Organization of Nurse Practitioner Faculties decided in 2018 to move all entry-level nurse practitioner education to the Doctor of Nursing Practice (DNP) degree by 2025. You must also earn state certification as a neonatal nurse practitioner in the state in which you wish to practice.

Neonatal Nurse

Degree you’ll need:
At least an Associate Degree in Nursing (ADN), although a Bachelor of Science in Nursing (BSN) is most often required

Licensing required:
Registered nurse (RN)

Neonatal Nurse Practitioner

Degree you’ll need:
At least a Master of Science in Nursing (MSN)

Licensing required:
Advanced practice registered nursing (APRN) license, such as nurse practitioner (NP) or clinical nurse specialist (CNS)

How Much Can I Make?

The BLS doesn’t provide specific figures for neonatal nurses or neonatal nurse practitioners. It does, however, track salaries for registered nurses and nurse practitioners, which are the licenses required for neonatal nurses and neonatal nurse practitioners, respectively. The median annual salary for RNs is $77,600 and the median annual salary for nurse practitioners is $120,680, according to the BLS. Here are salaries by state and different earning percentiles:

Registered Nurses

National data

Median Salary: $77,600

Projected job growth: 6.2%

10th Percentile: $59,450

25th Percentile: $61,790

75th Percentile: $97,580

90th Percentile: $120,250

Projected job growth: 6.2%

State data

State Median Salary Bottom 10% Top 10%
Alaska $99,110 $77,450 $127,020
Alabama $60,510 $47,390 $78,670
Arkansas $61,530 $47,510 $79,440
Arizona $78,260 $60,750 $100,200
California $125,340 $78,070 $165,620
Colorado $78,070 $60,550 $100,870
Connecticut $83,860 $61,470 $110,580
District of Columbia $95,220 $62,700 $129,670
Delaware $75,380 $59,900 $99,780
Florida $75,000 $49,680 $95,630
Georgia $75,040 $58,400 $98,410
Hawaii $111,070 $75,380 $129,670
Iowa $61,790 $48,290 $79,260
Idaho $75,560 $59,640 $98,030
Illinois $77,580 $59,640 $100,650
Indiana $62,400 $48,400 $90,260
Kansas $61,790 $47,630 $79,360
Kentucky $62,480 $48,000 $82,410
Louisiana $64,450 $48,920 $94,360
Massachusetts $94,960 $61,180 $151,310
Maryland $78,350 $60,420 $101,650
Maine $75,040 $59,640 $98,780
Michigan $76,710 $60,120 $98,510
Minnesota $79,100 $60,850 $101,610
Missouri $61,920 $47,350 $94,690
Mississippi $60,790 $47,210 $78,670
Montana $75,000 $60,320 $97,260
North Carolina $72,220 $51,420 $95,360
North Dakota $73,250 $59,810 $95,360
Nebraska $64,000 $55,040 $84,910
New Hampshire $77,230 $59,900 $99,580
New Jersey $94,690 $70,920 $117,990
New Mexico $78,340 $60,320 $98,660
Nevada $79,360 $61,790 $119,530
New York $96,170 $61,260 $127,080
Ohio $74,080 $59,540 $94,690
Oklahoma $62,170 $47,960 $79,940
Oregon $99,410 $76,180 $127,680
Pennsylvania $76,940 $59,640 $98,680
Rhode Island $78,900 $61,340 $101,650
South Carolina $72,650 $47,860 $86,820
South Dakota $60,550 $47,470 $77,360
Tennessee $62,390 $48,190 $81,950
Texas $77,320 $59,780 $99,070
Utah $75,000 $59,640 $95,160
Virginia $76,900 $59,170 $100,990
Vermont $75,380 $59,640 $98,030
Washington $96,980 $74,070 $127,320
Wisconsin $76,560 $60,060 $98,970
West Virginia $62,390 $47,450 $87,440
Wyoming $75,000 $59,650 $98,140

Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2031. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Nurse Practitioners

National data

Median Salary: $120,680

Projected job growth: 45.7%

10th Percentile: $79,470

25th Percentile: $99,540

75th Percentile: $129,680

90th Percentile: $163,350

Projected job growth: 45.7%

State data

State Median Salary Bottom 10% Top 10%
Alaska $123,140 $48,670 $164,840
Alabama $99,750 $76,290 $128,460
Arkansas $99,910 $77,770 $130,770
Arizona $121,070 $95,850 $162,820
California $149,910 $103,910 N/A
Colorado $102,370 $78,230 $131,970
Connecticut $125,360 $79,470 $163,710
District of Columbia $121,470 $96,420 $164,900
Delaware $121,470 $90,280 $152,130
Florida $101,110 $61,990 $130,630
Georgia $101,690 $77,660 $141,880
Hawaii $131,000 $80,130 $167,750
Iowa $121,470 $94,590 $163,080
Idaho $102,060 $47,490 $152,710
Illinois $122,960 $97,950 $141,200
Indiana $104,020 $96,040 $131,000
Kansas $100,590 $78,480 $128,550
Kentucky $100,260 $78,380 $130,630
Louisiana $103,610 $77,940 $152,960
Massachusetts $128,160 $98,860 $167,980
Maryland $104,550 $95,710 $141,140
Maine $119,550 $96,040 $135,150
Michigan $102,060 $94,430 $130,630
Minnesota $127,690 $92,710 $163,360
Missouri $101,180 $61,820 $129,510
Mississippi $101,840 $77,940 $154,130
Montana $122,100 $96,040 $130,630
North Carolina $102,370 $95,460 $133,790
North Dakota $103,550 $95,970 $129,970
Nebraska $103,340 $93,020 $133,840
New Hampshire $121,070 $96,040 $153,070
New Jersey $129,240 $100,660 $163,420
New Mexico $121,070 $78,660 $159,790
Nevada $127,620 $95,530 $164,070
New York $128,220 $96,420 $167,750
Ohio $103,310 $95,280 $135,180
Oklahoma $109,660 $80,280 $152,130
Oregon $127,690 $96,040 $165,520
Pennsylvania $106,700 $84,940 $165,900
Rhode Island $125,540 $96,550 $167,750
South Carolina $100,020 $76,490 $130,200
South Dakota $102,060 $80,650 $129,270
Tennessee $99,630 $48,060 $129,510
Texas $121,010 $81,160 $154,080
Utah $105,220 $60,280 $163,350
Virginia $102,860 $78,660 $152,130
Vermont $101,790 $78,690 $152,920
Washington $128,980 $98,500 $164,900
Wisconsin $121,310 $97,090 $131,100
West Virginia $100,020 $77,720 $129,480
Wyoming $102,370 $93,720 $148,870

Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2031. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Morgan says that salary levels will always vary by region and experience. When she started as an RN in Wichita, Kansas, in 2004, for instance, she was earning a salary at the low end of the RN average. Later, when she moved to the larger city of Houston, where demand for neonatal nurses is higher, she was making significantly more in the NICU.

Once she completes her studies to earn a master’s and becomes a neonatal nurse practitioner, she said she can expect another significant salary increase.

Neonatal Nurse Specialist Career Outlook

As with most nursing careers, demand for neonatal nurses and neonatal nurse practitioners is expected to increase significantly over the next 10 years, even in rural or suburban areas.

“Everyone’s still having babies,” Morgan notes, “and about 10% of them will always need extra care.”

The job is not only in demand but also an enjoyable one.

“(Neonatal nurses) develop a wonderful rapport with each family,” says Joan E. Edwards, a tenured professor at Texas Woman’s University in Houston and director of its Center for Global Nursing. “It’s not just a science, it’s also an art. There’s a lot of caring behind what we do.”

How to Stay Informed in this Field

Fortunately for future neonatal nursing students, there are several associations, blogs, podcasts, and other social media feeds to keep you on top of the latest developments in the field.

  • Academy of Neonatal Nursing—Provides access to peer-reviewed publications, national conferences, online resources, and other educational offerings.
  • AWHONN Insights—This podcast from the Association of Women’s Health, Obstetric, and Neonatal Nursing features advice from leading experts in the field.
  • NANNcast—The National Association of Neonatal Nurses hosts a monthly podcast in which members can present advice, tips, and expertise to better inform neonatal nurses, industry partners, and families of NICU patients.

“It’s best to join one of these groups before graduation,” Edwards suggests, so you can take full advantage of the networking information and opportunities the sites can offer. Most offer a range of podcasts and online blogs about neonatal nursing experiences.

The Facebook pages of neonatal associations are also good resources for gathering quick tips and information about neonatal nursing, Morgan says. Also, some hospitals have Facebook and LinkedIn pages where prospective neonatal nurses and NNPs can gather to discuss their latest experiences in the field. “NICU students should put questions out there on Facebook,” Morgan says, “such as ‘Are there any NICU nursing tips to share?’ You’ll get hundreds of people replying.”

Is Neonatal Nursing the Right Specialty for You?

Most people who try to pursue a neonatal nursing career find out pretty quickly if they’re suited for the demands.

“There are emotional and spiritual aspects to the job” that may not come naturally to some nursing students, Morgan notes. Morgan’s mother is a retired neonatal nurse, so she has been steeped in the care of newborns from an early age.

Many times, neonatal nurses work with new parents during a time of crisis and worry. “They are often scared or in panic mode,” Morgan says. “Some are recovering from drugs. (As a nurse,) you can go from crying and grieving to joyful in the same hour. It’s not a skill you just walk in with. There are a lot of wonderful things and sad things that can happen, and then a miracle can occur—they stay with you.”

“It’s so miraculous when a you see a baby take its first breath,” says Edwards. “It’s very special to work in that environment.”


randy woods

Written and reported by:

Randy Woods

Contributing Writer

With professional insight from:

joan edwards

Joan E. Edwards, PhD, RNC, CNS, FAAN

Professor, Texas Woman’s University (TWU); Director, TWU Center for Global Nursing

beth morgan

Beth Morgan, RN

NICU Nurse

joan rikli

Joan Rikli, MBA, MSN, RN, CPNP-PC, NE-BC

Director of NICU and Pediatric Services, Helen DeVos Children’s Hospital