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The term neonatal refers to newborns in the first 28 days of life. Although neonatal nurses are skilled to care for healthy newborns, it is the neonatal nurse practitioner who is skilled in providing care for newborns in need of specialized attention.
Neonatal nurse practitioners (NNP) are advanced practice nurses that care for premature and sick newborns in neonatal intensive care units (NICU), emergency rooms, delivery rooms, or specialty clinics. Since NNPs care for neonates in need of constant attention, they often serve as primary caregivers to premature or ill newborns. A neonate under the care of an NNP may need specific, focused care due to premature birth, low birth weight, respiratory distress, heart abnormalities, congenital abnormalities, and other disorders.
Although NNPs work under the direction of a neonatal fellow or neonatologist, they assume total responsibility for their patients, exercising judgment when necessary to assess, diagnose, and initiate medical procedures.
NNPs’ level of care allows them to perform a number of duties, including:
- Monitoring specialized equipment, including incubators and ventilators
- Providing education and support to patients’ families regarding neonatal, intensive and, postpartum care
- Dispensing medications under collaborative agreement with a physician
- Performing diagnostic tests and other procedures, such as intubation and blood draws
- Ensuring proper feeding and basic care
In general, the setting in which NNPs work determines the tasks they perform. Most hospitals have three specific levels of care that group infants according to their needs:
- Level One, Newborn Nursery care is for healthy, full-term infants. As such, the need for NNPs in level one care is limited.
- Level Two, Intermediate Care Nursery is generally where premature and sick babies who are in need of constant attention are assigned.
- Level Three, Neonatal Intensive Care Nursery is intended for the most seriously ill neonates with critical health issues who must be constantly monitored (usually referred to as the NICU).
Education and Degree Options
Neonatal nurse practitioners are considered highly skilled, advanced practice nurses. As such, an advanced level of education is required. The first step to becoming an NNP involves obtaining an RN license and working as an RN for a few years to achieve fundamental training.
Although aspiring NNPs have the option to pursue Doctor of Nursing Practice programs specific to the neonatal patient population, a Master of Science in Nursing with a concentration in neonatology is currently acceptable for national certification and advanced practice licensure or recognition through all state Boards of Nursing. Many nurses choose to pursue a generalist MSN, and later earn a post-master’s NNP certificate. Most advanced degree programs in neonatal nursing require at least two years’ experience in Level III nursing as an eligibility requirement.
All advanced practice programs will include core curricula in embryology, neonatal physiology, advanced neonatal assessment, and neonatal pharmacology and pharmacotherapeutics. Most graduate level programs are designed to meet the requirements for national certification through the National Certification Corporation, by offering didactic study and clinical preceptorships that emphasize management strategies, well-baby care, and developmental care.
All NNPs must also complete supervised clinical practicums with newborns and infants.
National NNP Certification
Upon completion of a graduate or post-graduate education, applicants are then eligible for national certification through a national certifying body that recognizes NNPs. The majority of states require national certification for NNP licensure, although not all states recognize the same national specializations. It is important to check with your state’s board of nursing beforehand to determine which NNP specializations are recognized.
The National Certification Corporation offers the following certifications for neonatal nurse practitioners:
Core Certifications
- Inpatient Obstetric Nursing
- Maternal Newborn Nursing
- Low-Risk Neonatal Nursing
- Neonatal Intensive Care Nursing
Nurse Practitioner Certification
- Neonatal Nurse Practitioner (NNP-BC)
Subspecialties
- Electronic Fetal Monitoring
- Neonatal Pediatric Transport
To be eligible for neonatal intensive care nursing, low risk neonatal nursing and maternal newborn nursing certifications, applicants must meet the following requirements:
- A current RN license in the U.S. or Canada
- At least 24 months experience in specialty area (must compromise at least 2,000 hours)
- Employment in the specialty area within the last 24 months
To be eligible for the neonatal nurse practitioner certification, applicants must meet the following requirements:
- A current RN license in the U.S. or Canada
- The completion of a formal nurse practitioner program that results in a master’s, post-master’s or doctorate degree in the specialty area
- Applicants must have graduated from 2005 or later to be eligible for certification
To be eligible for the electronic fetal monitoring subspecialty exam, applicants must meet the following requirement:
- A current license as a nurse, NP, physician, physician assistant or nurse midwife
To be eligible for the neonatal pediatric transport subspecialty exam, applicants must meet the following requirements:
- A current license as an RN, NP, physician, respiratory therapist, paramedic or physician assistant
- No practice experience is required; however, it is recommended that all applicants have at least 2 years of experience before taking the exam.
NNP Professional Resources
- National Association of Neonatal Nurses
- Association of Women’s Health, Obstetric and Neonatal Nurses
- The Academy of Neonatal Nursing
- Journal of Obstetric, Gynecologic and Obstetric Nursing
NNP Salaries
According to the National Salary Report 2011, which is published by Advance for NPs & PAs, neonatal nurse practitioners earned $99,810 on average, while those with part-time positions earned an average of $45.31 per hour.