How to Become a Neonatal Nurse Practitioner? (Answered By a Nurse)
Written By: Caitlin Goodwin MSN, CNM, RN
In the United States, nearly 3.8 million babies were born in 2018
, and about one in seven
of those went to the neonatal intensive care unit (NICU). In fact, nearly 90% of infants born at a gestational age of fewer than 34 weeks are admitted to the NICU. The collaborative critical care from a team of neonatal professionals during the first hour of a baby’s life in the NICU sets the stage for the baby’s long-term health and outcomes.
For those who want to dedicate their career to caring for newborns, neonatal nurse practitioners (NNPs) take care of the infants who require additional support. This article will cover everything you need to know to answer the lingering question, how do I become a neonatal nurse practitioner?
What is a Neonatal Nurse Practitioner?
A neonatal nurse practitioner (NNP) is an advanced practice registered nurse who specializes in newborn babies
. NNPs often work in the NICU or special care newborn nursery. They collaborate with a team of professionals like neonatal nurses, neonatologists, respiratory therapists, lactation consultants, and dieticians. While a neonate’s technical definition is a baby 28 days old or less, NNPs may care for infants who stay in the NICU for much longer. For example, an infant stayed at the Cleveland Clinic’s NICU
for 18 months.
There are many reasons that an infant may need a higher acuity of care that the NICU, neonatologist, or NNP provide. Some of these include:
● congenital defects
● organ malformations.
NNPs can perform many of the same duties
as neonatologists (physicians who specialize in newborns), such as:
● perform physical assessments on newborns
● resuscitate infants
● collect maternal and infant history
● order labs and diagnostic tests on babies
● diagnose conditions
● prescribe medications and oxygen
● order formula and gastric feedings
● perform procedures like
○ umbilical vein catheter
○ central line placement
○ chest tube insertion
○ lumbar puncture
Why Become a Neonatal Nurse Practitioner?
The benefits of becoming an NNP are some of the competitive wages and positive job outlook of all nurse practitioners. NNPs also have the opportunity for professional advancement beyond the role of a registered nurse. Other advantages include:
● More autonomy
- NNPs have more independence than a neonatal nurse. NNPs may work in the scope of what the hospital or their collaborating neonatologist spell out, or they may completely work independently depending on the state.
● Caring for acutely ill babies
- Many NNPs pursue that career because they want to care for the critically ill babies in their community. While most people love babies, NNPs are special because they care for the very tiny and very ill babies.
● Serving the community and families
- Every day they go into work, NNPs touch the lives of babies, their families, and the community they serve.
Skills and Characteristics Required to Be a Successful Neonatal Nurse Practitioner
Neonatal nurse practitioners should possess specific skills and characteristics to be successful. All NPs that work with children should be compassionate, empathetic, and communicate well with worried parents and family members. However, to become a neonatal nurse practitioner, some particularly necessary characteristics or personality traits include:
When an infant’s life is on the line, it is crucial to make quick decisions in stressful situations. NNPs must resuscitate and perform critical procedures with minimal warning.
● Supportive of Breastfeeding:
Breastfeeding requires a lot of support among all infants, but babies born early or critically ill need even more support. While NNPs refer parents to a lactation consultant, being supportive of breastfeeding is crucial. However, NNPs should be sensitive to those who choose not to or who are unable to breastfeed, as well.
Family members’ nerves will be frazzled when dealing with the illness of a baby. NNPs must be accommodating to parents who are understandably worried about their child.
Skilled NNPs have the manual dexterity to work precisely on a small scale on infants.
Following is a Step-by-Step Process to Becoming a Neonatal Nurse Practitioner
The following will give you precise guidance for each step along the way to become a neonatal nurse practitioner:
1. Complete a bachelor’s degree:
For those wondering how to become a neonatal nurse practitioner, education is the first step—a bachelor’s or associate's degree in nursing the backbone to start the NNP journey. Many programs require that you have a bachelor’s degree of some type to start NNP school, but some allow you to bridge from your associate’s degree to the graduate degree.
2. Obtain licensure as a registered nurse (RN):
Before starting the process to become an NNP, you must obtain RN licensure. To become an RN, you must pass the NCLEX-RN
exam and obtain licensure in your state through the board of nursing.
3. Gain experience as a nurse:
By pursuing a career as a NICU or special care nursery nurse, you will begin to prepare yourself to be an NNP. The general recommendation is one to two years of experience, but it varies.
4. Obtain special certifications:
After working as an RN, you can achieve additional certifications like:
5. Apply to NNP school:
○ RN Certification for Neonatal Intensive Care Unit (RNC-NIC)
○ RN Certification for low-risk neonatal intensive care nursing (RNC-LRN)
○ RN certification in maternal-newborn nursing (RNC-MNN)
One of the most important steps in your pursuit of becoming a neonatal nurse practitioner is to gain entry into an NNP program. The application process can be lengthy and elaborate. Schools often look for:
6. Attend NNP school:
○ Prerequisite nursing coursework
○ A curriculum vitae or résumé
○ Personal statement
○ Professional references
○ Goals and objectives
NNPs will have to take core classes like statistics, epidemiology, evidence-based practice, professional roles, human physiology, and pathophysiology. Your coursework also includes specialized NNP centric courses like:
7. Complete clinical with a neonatal provider:
○ Pharmacology for neonatal patients
○ Development of neonates, infants, and toddlers
○ The professional role of the neonatal nurse practitioner
○ Neonatal population health
○ Assessment of the neonate
All NNPs participate in clinical experience specializing in neonates (a minimum of 600 hours
) integrated throughout their educational program.
8. Graduate NNP school:
Completing your NNP education successfully with good grades is important. After graduating from a neonatal NP program, there are only a few more steps to becoming a neonatal nurse practitioner.
9. Sit for the NNP certification exam:
First, the graduate must take a neonatal nurse practitioner certification exam
by the National Certification Corporation (NCC). The NNP core certification exam is entry-level and competency-based, covering acute and critically ill neonatal patients and their families. To take the exam, the NCC must receive proof of examination from your school so you can schedule your exam. The exam is 175 questions, and you have three hours to complete it.
10. Receive pass or fail results:
Once you pass your NNP exam, you will be a board-certified neonatal NP (NNP-BC).
11. Obtain advanced practice nursing licensure in your state:
○ If you pass, apply to your state’s board of nursing to receive licensure as an NNP. Some states require collaborative agreements with a physician or additional certification or training to write prescriptions with your state APRN licensure.
○ If you fail, pay your fee and reschedule your exam. Study until you are confident with the material and pass!
Licensure varies by state, but the certifying body will usually report your results to the board of nursing. The nursing board will process your exam results and application for licensure and provide you with an advanced practice registered nurse (APRN) license for the state. Some states label NNPs as advanced practice nurses (APNs) instead. However, the difference is semantics. For those who practice in more than one state, they must apply to multiple boards of nursing. In August of 2020, the National Council of State Boards of Nursing proposed a model compact APRN law
. While it is not in effect, it would enable APRNs with licenses of any of the involved states to receive reciprocity to practice your profession in the others.
12. Find employment:
While NNPs are in high demand, some areas require more support than others. Some new graduates consider moving, while others network in their NICU nurse roles to find connections in the specialty. Once you get a job offer, consider negotiating for salary, malpractice insurance, continuing education reimbursement, and paid time off.
How Long Does It Take to Become a Neonatal Nurse Practitioner?
To become an NNP, you must first be a registered nurse with an active, unencumbered nursing license. Becoming an RN can take anywhere between two to four years. Some programs require having one to two years of nursing experience before applying to NNP school.
Once accepted, the full-time NNP master of science (MSN) in the nursing program is about 40 credits. If you have a bachelor’s of science in nursing (BSN), that will take about two years. If you have an associate’s degree in nursing (ASN or ADN), it will take about three years. Those on the doctoral track (doctorate of nursing practice or DNP) will add at least a year to their program. For those that attend school part-time, it will take longer, regardless of the program.
How Much Does It Cost to Become a Neonatal Nurse Practitioner?
The cost is an important factor when you are considering starting an NNP program. Tuition ranges from $700 to $1000+ per credit. There are also program fees, technology costs, course materials, and books. Cost depends on many factors:
● Online or in-person
● Public or private
● MSN vs. DNP
● In-state or out of state
How Much Does a Neonatal Nurse Practitioner Make?
NNPs are paid exceptionally well. In fact, NNPs are one of the highest-paid professions
of all nurse practitioners. On average, NNPs make $110,249 per year, which breaks down to $9,190 per month and $53 per hour. According to the U.S. Bureau of Labor Statistics
, this is more than the median of all types of nurse practitioners combined ($109,820).
| Per Hour||$53.00|
The Top Paying States
When looking at the top paying states for NNPs, New York is the highest and pays $58.14 per hour or $120,929 per year. Rounding out the top ten are Massachusetts, Washington, New Hampshire, Hawaii, Maryland, Connecticut, Rhode Island, Alaska, and Vermont.
| Rank|| State|| Per Hour|| Per Year|
| 1|| New York|| $58.14|| $120,929|
| 2|| Massachusetts|| $57.59|| $119,785|
| 3|| Washington|| $57.19|| $118,950|
| 4|| New Hampshire|| $56.05|| $116,580|
| 5|| Hawaii|| $55.31|| $115,045|
| 6|| Maryland|| $53.37|| $111,012|
| 7|| Connecticut|| $53.35|| $110,977|
| 8|| Rhode Island|| $52.92|| $110,075|
| 9|| Alaska|| $52.85|| $109,933|
| 10|| Vermont|| $52.63|| $109,476|
Job Market for Neonatal Nurse Practitioners
The job market for NNPs is thriving. NNPs are needed because of how they support a collaborative care model and positive outcomes. While more students than ever are enrolling in nurse practitioner school, the number of NNPs in the pipeline is not increasing adequately
Not only is there an NNP shortage, but there is also an increasing demand for NNPs due to a number of factors
● NICU units utilizing NNPs at increased rates
● Retiring NNPs
● Increased NICU patients
● Closure of NNP education programs
● Decrease in hours for medical residents in the NICU for safety purposes
National Association of Neonatal Nurses:
The National Association of Neonatal Nurses (NANN) is the voice for all neonatal nurses and has been speaking for neonatal nurses since it was founded in 1984. With over 8,000 members and 30 chapters, NANN is a significant advocate for neonatal nurses.
“To be the professional voice that shapes neonatal nursing through excellence in practice, education, research, and professional development.”
The National Association of Neonatal Nurse Practitioners:
The national association represents the unified voice of NNPs in the United States. It’s a division of the National Association of Neonatal Nurses formed in 2007 that focuses on NPs.
Academy of Neonatal Nursing:
The Academy of Neonatal Nursing specializes in neonatal nursing education through professional, evidence-based publications, national resources, and other educational resources to advance knowledge in providing superior patient care.
“To provide high-quality education for health care professionals working across all levels of neonatal care to improve outcomes for newborns and their families.”
Association of Women’s Health, Obstetric and Neonatal Nurses:
The Association of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN) is the primary nursing organization that advocates for the well-being of women and newborns and performs research to yield high quality, evidence-based guidelines.
“Making a difference in the lives of women and newborns.”
“Empower and support nurses caring for women, newborns, and their families through research, education, and advocacy.”
Neonatal nurse practitioners save the lives of babies and build families in their communities. NNPs are incredible nurses and professionals that leave an impact each day. As Florence Nightingale, the most recognized name in the history of nursing, stated, “I attribute my success to this; I never gave nor took any excuse.” Becoming an NNP is hard work, but it is worthwhile. While this article answered the challenging question, “how to become a neonatal nurse practitioner?” There is only one question left: when do I get started?
Frequently Asked Questions Answered by Our Expert
1. What’s the difference between a neonatal nurse practitioner (NNPs) and a doctor?
While NNPs can perform many of the same skills as a neonatologist, the state board of nursing limits the specifics of their scope of practice. NNPs are trained in the nursing model while physicians are trained in the medical model. Physicians attend medical school, while NNPs are registered nurses who attend NNP school. Neonatologists earn nearly twice the salary that NNPs do.
2. Are there internships available for neonatal nurse practitioners (NNPs)?
A traditional internship would be on the job training that lasts several months to a year, which is in essence, the clinical practicum. During neonatal nurse practitioner school, the student must attend approximately 500-700 hours of clinical experience caring for neonates and their families. Typically, there are no additional internships because this clinical time is spent with neonatal experts like neonatologists and NNPs. A traditional internship is “on the job training” that lasts several months to a year, which is essentially the clinical practicum.
3. Are there externships available for neonatal nurse practitioners (NNPs)?
No, nurse externships are typically direct patient care experiences offered to undergraduate nursing students. Following graduation, there are NNP fellowship programs. A fellowship is a postgraduate experience to prepare new neonatal nurse practitioners for their new role. Fellowships prepare them for a career in high acuity NICUs.
4. What is the age of patients that neonatal nurse practitioners (NNPs) care for?
Medicine defines a neonate as a newborn child in the period between birth to 28 days old. However, premature and critically ill babies often have long-term NICU stays. NNPs may care for infants six months of age or older.
5. Do Neonatal Nurse Practitioners deliver babies?
No, they don't deliver babies. Certified nurse-midwives can manage the labor and birth of babies. NNPs attend the birth of high-risk infants to provide them with critical care.
6. What are the outcomes from neonates cared for by neonatal nurse practitioners (NNPs)?
Positive. According to a recent study (2020), the outcomes for NNPs who lead transport teams
are comparable to neonatologists. The study also reported that satisfaction levels are high, and NNPs add value to the team. Research has consistently demonstrated the positive effect APRNs
have on patient outcomes and healthcare costs across the board.
Caitlin Goodwin MSN, CNM, RN
Caitlin Goodwin is a Certified Nurse-Midwife who has been a nurse for 12 years, primarily in women’s health. She is passionate about caring for children with developmental disabilities, as her son has Autism Spectrum Disorder. Caitlin loved working as a camp nurse for a summer camp for those with special needs