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Steps-to-Become a NICU Nurse + Salary + Pros and Cons
Written By: Pattie Trumble, MPP, MPH
NICU nurses are healthcare professionals who work with premature infants and other severely ill newborns in specialized neonatal intensive care units. NICU nurses are in high demand: Over the past three decades, the preterm birth rate in the U.S. has remained relatively steady, but advances in neonatal intensive care have greatly improved health outcomes for these most fragile of infants. Are you wondering how to become a NICU nurse? This article provides a comprehensive look at the role of a NICU nurse – what is it, steps-to-become, pros & cons, and salary.
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Table Of Contents
WHAT EXACTLY IS A NICU NURSE?
NICU nurses are employed in neonatal intensive care nurseries (NICUs) where they care for infants born with a variety of issues, including prematurity, low birth weight, cardiac malformations, other birth defects, drug addiction, meconium aspiration, infections, and complications from trauma. NICU nurses typically care for these infants from birth until the time the infants are discharged from the hospital.
NICU nurses are vitally important members of a multidisciplinary team. Their time is often equally divided between sophisticated clinical tasks and parent education so that parents will know how to meet their child’s special needs when it comes time to take these babies home. Another term that’s often used for “NICU nurse” is “neonatal nurse” although the two terms are not strictly equivocal.
10 INTERESTING NICU FACTS
1. In the early 1900s, premature babies in incubators were a leading attraction on Coney Island and Atlantic City boardwalks
. Admission was a quarter, and the infants were cared for by dedicated nurses. At that time, there were no such things as intensive care nurseries, and exhibiting the tiny infants in this manner was the only way to subsidize their healthcare costs. Cornell Hospital in New York City didn’t open up the first dedicated nursery for premature units until 1943—which not coincidently was the last year the Coney Island preemie show was open.
2. The tiniest baby ever born to survive long enough to go home with her parents was Kwek Yu Xuan, a 25-week preemie, who weighed just 7 ½ ounces at birth
—the size of an apple. When she was discharged from Singapore's National University Hospital 13 months later, she weighed 14 pounds.
Any baby born before 37 weeks is considered premature.
4. Famous preemies include Napoleon Bonaparte, Albert Einstein, Winston Churchill, Isaac Newton, Charles Darwin, and Pablo Picasso
5. The first incubators were wooden boxes with glass lids that were heated by hot water bottles
6. The first hospital-based nursery for premature infants was established in 1922 at the Michael Reese Hospital in Chicago
. It was not called a neonatal intensive care unit but a “premature infant station”.
Of all 50 states, Mississippi has the highest percentage of premature births (13.6 percent)
, and Vermont has the lowest (7.5 percent).
8. One percent of all full-term infants in the U.S. end up being hospitalized in neonatal intensive care units
9. Seventy-five percent of NICU admissions are preemies, but 25 percent are full-term infants
Twins, triplets and other multiple births are frequently admitted to the NICU. That’s because these babies tend to be born earlier and smaller than single-birth babies. Prematurity rates among twins can be as high as 54 percent
WHAT DOES A NICU NURSE DO? – 12 MAIN DUTIES AND RESPONSIBILITIES
What does a NICU nurse do? Like all nurses, NICU nurses provide and coordinate patient care, which in a neonatal intensive care unit can mean anything from suctioning the ventilation tubing of an intubated infant to comfort measures like changing diapers. Here are the 12 primary responsibilities and duties of a NICU nurse:
1. Monitoring vital signs:
Many infants in a NICU are on cardiopulmonary monitoring, a system of electrodes that adhere to an infant’s chest and abdomen and are attached by wires to pieces of equipment that provide continuous readings of the infant’s cardiac activity. NICU nurses must know how to interpret the waveforms that indicate the infant’s heart rate, respiratory rate, oxygen saturation and blood pressure to make sure these vital signs stay within therapeutic limits.
2. Administering medications: Many neonatal patients receive as many as 20 intravenous (IV) medications a day
. IV medications are delivered using specialized IV pumps.
3. Administering blood products:
The infusion of blood products in NICUs (as in all hospital units) follows strict, time-consuming protocols.
4. Drawing lab work specimens: The most common types of tests done in the NICU are blood tests
. Even in medical centers that employ phlebotomists, NICU nurses are frequently called up to perform these tests because they’re the most familiar with infant blood draw protocols. Other common tests include computed tomography (CAT) scans, ultrasounds (including echocardiograms), electrocardiograms (EKGs), magnetic resonance imaging (MRIs), and various urine tests.
5. Inserting intravenous lines:
Infant IV sites are very different from adult IV sites. IV placement depends upon the prescribed therapy but common sites include the hand, arm, foot, and scalp.
6. Using and adjusting specialized medical equipment:
Specialized medical equipment in a NICU can include radiant warmers, incubators and other specialized infant beds; vital sign monitors; ventilators, nasal cannulas and other types of respiratory equipment; IV pumps; and phototherapy lights.
7. Assisting physicians, neonatal nurse practitioners and physician assistants with medical procedures and treatments:
NICU nurses assist with intubations, central line placements, and other procedures that require advanced skills.
8. Developing nursing care plans:
In the NICU, an infant patient is often assigned a primary team of nurses—one on each shift. These NICU nurses are responsible for developing a nursing care plan that specifically addresses this infant’s unique needs. Nursing care plans like these help ensure continuity of care when other NICU nurses must step in from time to time to care for the infant.
9. Performing comfort measures like feeding and changing diapers:
First and foremost, a preemie is a baby—and every baby needs food and a clean diaper.
10. Assisting parents with holding infants: A preterm birth can be an extremely stressful event for any family
. NICU nurses play a vital role in helping mothers and fathers bond with their newest and tiniest family member.
11. Educating parents:
NICU nurses also play a vital role in educating parents about their premature infant’s special needs and what they should expect in terms of needs, development and behavior when the day finally arrives that they get to take their baby home.
12. Recording information in patient charts:
An important part of a NICU nurse’s job involves recording patient assessments, interventions and evaluations of interventional effectiveness in the patient’s electronic health record.
WHERE DOES A NICU NURSE WORK? – TOP WORK SETTINGS
The majority of NICU nurses work in neonatal intensive care units associated with medical centers, hospitals, and clinics. These NICUs can be either Level II, Level III or Level IV nurseries
• Level II nurseries:
In Level II nurseries, neonatal nurses care for infants who weigh more than 3.3 pounds and whose gestational age is 33 weeks or older. These infants may be affected by issues like jaundice, thermoregulation or an undeveloped swallow reflex that interferes with feeding. Level II NICU nurses also care for full-term newborns who require extra care and support for issues like meconium aspiration.
• Level III nurseries:
In Level III nurseries, NICU nurses care for infants of practically all gestational ages who require ventilation.
• Level IV nurseries:
“Level IV” is a designation that’s only used in certain states and by certain hospitals, but it denotes the most critical standards of care. NICU nurses working in Level IV nurseries care for infants as young as 22 to 24 weeks gestation and who require the most sophisticated types of respiratory support such as extracorporeal mechanical oxygenation (ECMO).
NICU nurses are also employed in community settings and by home health agencies to follow up on high-risk infants who’ve been discharged from a neonatal intensive care unit.
WHAT IS THE TYPICAL WORK SCHEDULE OF A NICU NURSE?
Seventy-five percent of nurses employed by hospitals work 12-hour shifts, and that includes NICU nurses
. Most 12-hour shifts are either 7:00 a.m. to 7 p.m. or 7 p.m. to 7 a.m. Since work in a neonatal care unit goes on round the clock, NICU nurses typically work every other weekend as well as on occasional holidays.
Neonatal intensive care unit nurses who work outside hospital settings will work the hours their facility is open. Community clinics are likely to be open Monday through Friday, 8:00 a.m. or 9 a.m. to 5:00 p.m. or 6:00 p.m. NICU nurses working with home health agencies have more control over deciding their own schedules.
7 MUST-HAVE PERSONALITY TRAITS NEEDED TO BE A SUCCESSFUL NICU NURSE
NICU nursing is not for everyone. First and foremost, to become a NICU nurse, you must have a passion for working with newborn infants and their families. Here are seven other personality traits every nurse working in a neonatal intensive care unit should possess:
1. Resilience: NICUs can be stressful places. Alarms on ventilators, pulse oximeters, vital sign monitors and IV pumps are constantly going off, sparking a chorus of beeps and flashing lights. Many if not most of these alarms are not clinically significant, however. If you’re an excitable person who over-reacts every time an alarm goes off, working in a NICU may not be for you.
2. Attention to detail: Even the smallest change may be clinically significant when you’re dealing with a human being as tiny as the average NICU patient. As a NICU nurse, you must pay close attention to the details that give you important clues about your patients’ conditions.
3. The ability to think on your toes: NICU nurses often work from protocols, which are sets of predetermined criteria that define appropriate nursing interventions for managing patient care under various sets of circumstances. In order to manage patient care most effectively, NICU nurses must be able to assess the circumstances that trigger these protocols quickly.
5. Manual dexterity: Your fingers must be nimble when you work with patients who are tiny and fragile.
6. Excellent communication skills: A great deal of your time as a NICU nurse will be spent communicating with your patients’ parents. You’ll be the main point person for teaching mothers and fathers what they need to know when they’re finally able to bring their little one home. You’ll also be the one explaining hospital treatments to parents. Additionally, you’ll be the one reporting the changes in your patients’ clinical status that prompt physicians to order those treatments.
7. Empathy: As a NICU nurse, in a very real sense, you are acting as a parental substitute to the patients you’re assigned. You must be able to combine your sophisticated clinical skills with a loving heart.
8 MOST ESSENTIAL SKILLS NEEDED TO SUCCESSFULLY PERFORM YOUR DUTIES AS A NICU NURSE
In addition to characteristic patterns of feelings and behaviors that can make you a suitable candidate for becoming a NICU nurse, there are also skills you’ll learn through education or through training. Here are eight of the most essential of those skills:
1. Clinical competencies:
As a NICU nurse, at a bare minimum, you’ll need to know how to interpret telemetry, administer micro-dosages of medications without making errors, insert peripheral IV lines, perform diagnostic labs and work with sophisticated medical equipment like ventilators and ECMO.
2. Assessment skills:
You’ll need to be able to assess a patient’s status quickly and respond appropriately to help stabilize that patient.
3. CPR and other life support skills:
NICUs treat a large number of patients with potentially life-threatening conditions. The nurses who work in this practice setting must be experts in advanced life support techniques for infants. Most NICUs make the Neonatal Resuscitation Program
offered by the American Academy of Pediatrics
a condition of employment.
4. Understanding of the principles of developmental care:
Most premature babies are not neurologically equipped to deal with life in a NICU. They face a constant barrage of tests, procedures, noises, and lights for which they are not developmentally prepared. An important part of your role as a NICU nurse will be to meet your patient’s comfort needs, decrease stimulation from noxious stimuli and provide your tiny charge with the support he or she needs to mature and develop as they would if they were still in the womb.
5. Knowledge of basic NICU protocols:
As noted above, NICUs develop protocols, which are sets of guidelines designed to assist healthcare providers with clinical management. These guidelines deal with issues like respiratory interventions, nutrition and feeding protocols, infection control and the like. While every hospital NICU has its own unique set of protocols, there are commonalities among them, and prospective NICU nurses should familiarize themselves with these commonalities.
6. Teaching ability:
As noted above, most of the parent education done in NICUs is done by nurses. As a NICU nurse, you will be in charge of teaching parents how to help support their infants’ motor, language, and cognitive development
NICUs use far fewer nursing assistants than other hospital departments do. Consequently, working in a NICU often involves more hands-on tasks than working in practically any other hospital unit. You must be able to stay on top of your workload, and that will involve learning how to multi-task and prioritize.
8. Team player:
NICU nurses are members of a multi-disciplinary team that also consists of neonatologists, pediatricians, pediatric residents, neonatal nurse practitioners, social workers, lactation consultants, nutritionists, pediatric respiratory therapists, and other ancillary medical personnel. Cohesive team dynamics are essential to providing high-quality patient care.
ARE YOU A GOOD FIT FOR A NICU NURSE POSITION? – 10 QUESTIONS TO ASK YOURSELF
Thinking about being a NICU nurse but wondering whether NICU nursing is the right fit for your personality and skill set? Here are ten questions to ask yourself. If you can answer “Yes,” to seven or more of these questions, NICU nursing may be your right career path.
1. Do you like babies?
NICU patients may have other special needs, but first and foremost, they are babies and need love and tenderness to thrive. If you don’t have a soft spot in your heart for infants, you may still be a great NICU nurse, particularly if you have a Type A personality. But you’ll miss out on many of the things that make working in this practice setting so rewarding.
2. Can you deal with death, disability and other negative patient outcomes?Even with the best care, 13 percent of the infants in NICUs throughout the U.S. end up dying
. And the prevalence of severe, moderate and mild disabilities once preemies are discharged from the hospital stand at 22, 24 and 34 percent respectively
. If you find the prospect of dealing with these types of statistics overwhelming, working in a NICU is probably not the best use of your talents. You may find your work environment too sad to deal with.
3. Do you enjoy working with patients’ families?
A great deal of the work you do in the NICU setting will involve providing support to parents in various ways. From implementing skin-to-skin bonding (also known as “kangaroo care”) to educating family caregivers about what to expect when their child is discharged to setting up complex care conferences with families, parents are some of a NICU nurse’s most important collaborators.
4. Do you understand pathophysiology? Premature babies have complex physiological issues
. In order to ensure they are receiving the right types of care and treatment, you will have to have a thorough understanding of the types of pathophysiology involved and you’ll need to be able to recognize the clinical signs of medical complications.
5. Can you be assertive when circumstances call for it?
Advocacy is one of the most important functions of a NICU nurse. If a neonatologist is ignoring you when you tell him or her that you’re observing early signs of respiratory decompensation in an infant you are caring for, you can’t just shrug and walk away; you have to continue being persistent until you get the order you think is appropriate. You’re not being rude or inappropriate in this situation; you’re being assertive.
6. Are you intimidated by medical equipment?
As noted above, many different types of medical equipment are used in a NICU. Commonly used equipment includes apnea monitors, cardiopulmonary monitors, bilirubin lights, high-frequency and mechanical ventilators, nasal cannulas, oxygen hoods—the list goes on. NICU nurses must know the fundamentals of operating this equipment even if adjusting it is not part of their job description. A NICU is no place to work for anyone who is nervous around machinery.
7. Do you like teaching?
As noted above, teaching is one of the most critical components of the work you’ll be doing as a NICU nurse. If you have an aptitude for teaching, you’ll be ahead of the game.
8. Can you handle working in a fast-paced environment?
NICUs can be extremely hectic environments, particularly in the early morning on daytime shifts when the medical team is rounding and orders are being changed. As a NICU nurse, you must be able to keep up with the rapid pace.
9. Would you describe yourself as well-organized?
As a NICU nurse, you can expect to be assigned to either one, two, three, or four patients. Even full-term newborns cannot care for themselves, so you can expect to be extremely busy. The only way to keep your workload under control will be to tackle it in a systematic fashion. If your NICU unit doesn’t offer pre-printed worksheets with places where you can note the vital signs, feedings, medications and labs you’ll be expected to do each hour, consider drafting one of your own.
10. Are you a critical thinker?
Last but not least, critical thinking will be extremely important to you. You’ll be faced constantly with situations where you have to make a decision when you work in a NICU, and every decision you make has the potential to make a huge difference to your patient’s outcome. You need to be able to analyze situations correctly and utilize evidence-based solutions.
WHAT ALL IS REQUIRED TO BECOME A NICU NURSE?
What Education Is Required To Become A NICU Nurse?
To become a NICU nurse, you’ll need to graduate either from an accredited two-year Associate Degree in Nursing
(ADN) or diploma nursing program, or an accredited four-year Bachelor of Science Degree in Nursing
(BSN) program. A high school diploma is a condition for admission into both types of programs. Admission into nursing degree programs is becoming increasingly competitive, so you may want to streamline your high school transcripts by focusing on chemistry, biology, and mathematics coursework.
Fifty-seven percent of all NICU RNs have either a BSN or some other bachelor’s degree
while 33 percent have either an ADN, a diploma, or some other associate degree. While there is no legal requirement for NICU nurses to possess BSNs, 41% of hospitals and healthcare facilities now require a BSN from all candidates for nursing jobs
, including those applying for employment in neonatal intensive care units, and 82 percent of employers stated a marked preference for BSN-prepared job candidates. Currently, there are 996 BSN programs in the U.S.
Some employers will actually ask ADN-prepared nurses to enroll in a BSN program as a condition of employment before hiring them to work in a NICU. There are currently 777 RN-to-BSN programs offered in the U.S.
, and more than 600 of those programs are offered, at least partially, as distance learning programs.
Eight percent of RNs working in NICUs have Master of Science in Nursing
(MSN) degrees. Neonatal nursing is considered an advanced practice specialization, so the university programs that are singled out for their excellence are all graduate degree programs:
• University of Rochester
: The University of Rochester offers students a choice between programs that are completely online, programs that are mostly online with short residencies and programs that are a hybrid between campus and online learning.
• Duke University
: Distance-based programs with some campus components.
• University of Pennsylvania
: Campus-based program.
• Regis University
: Synchronized web-based program.
• Case Western Reserve University
: Didactic coursework split between online and campus; clinical rotations scheduled in the Cleveland area.
What Licensure Is Required To Become A NICU Nurse?
In order to become a NICU nurse, RNs must hold a valid nursing license in the state in which they wish to practice. Licensure requirements vary from state to state
, and so do licensure costs, but one requirement all states share is that prospective RNs must pass the National Council Licensure Examination for Registered Nurses
(NCLEX-RN) exam before a registered nursing license will be issued.
The NCLEX-RN exam is a multiple-choice exam, but there’s no set number of questions. The examination utilizes a technology called “computer adaptive testing,” which customizes questions in order to provide a more personalized measure of the test-taker’s knowledge. The fee to take the NCLEX-RN is $200, and the passing score is zero logits.
What Certifications Are Required OR Recommended For A NICU Nurse?
Almost all employers require nurses working in neonatal intensive care to hold current certifications in Basic Life Support
(BLS), Advanced Cardiovascular Life Support
(ACLS), and Neonatal Resuscitation (NRP).
BLS is the standard for first-responder resuscitative care. It teaches how to clear airway obstructions, perform cardiopulmonary resuscitation and use automated external defibrillators on individuals of every age.
ACLS builds on skills learned in BLS certification and includes early recognition of respiratory and cardiac arrest as well as airway management and related pharmacology.
NRP is a certification for all professionals working with newborns, including midwives and NICU nurses. It emphasizes effective team-based care for newborns at the time of their delivery.
Other certifications that can be useful for NICU nurses include:
Not all patients in NICUs are low-weight neonates. In NICUs in children’s hospitals where the patient population may be older than your typical preemie, nurses are frequently urged to attain a PALS certification. PALS is sponsored by the American Red Cross and is geared to healthcare providers who must administer life-saving treatments to infants and children. It can be particularly helpful for NICU nurses working in children’s hospitals who are expected to float from time to time between the NICU and the Pediatric Intensive Care Unit (PICU). Depending on the course provider, PALs certification can cost anywhere between $100 to $250.
This certification is offered by the National Certification Corporation
(NCC). It covers the type of care that nurses are likely to provide in a Level II nursery. The testing fee is $325.
This certification is offered by the American Association of Critical-Care Nurses
. It focuses on the types of interventions necessary to stabilize critically ill newborns and it’s designed for nurses who work in cardiac care units and trauma units, and on critical care transport flights as well as in NICUs. In order to become a NICU nurse with this certification, at a minimum you must have logged 1,750 hours in direct care of acutely or critically ill neonatal patients during the previous two years. The testing fee for AACN members is $235; for non-members, the testing fee is $340.
This certification is also offered by NCC and is only open to registered nurses who have completed a minimum of 2,000 hours of specialty experience either providing direct patient care, education, administration, or research. The testing fee is $325.
This certification is also offered by NCC. It focuses on the care of neonates who are at risk for developing neurological complications. The testing fee is $210.
This certification establishes your knowledge base in the nursing care of neonates whose birth weight is extremely low. It, too, is offered by NCC. The testing fee is $210.
This certification vets your ability to interpret cardiac irregularities commonly found in neonates and older infants. It’s yet another certification offered by NCC. The testing fee is $210.
What Additional Training And Experience Is Required To Become A NICU Nurse?
It used to be difficult for new graduates to land NICU jobs straight out of nursing school. But the nursing shortage
changed all that. These days, medical centers with Level II nurseries will hire new grads with the right qualifications. The best way to get on a hospital’s NICU short list is to lobby strongly to do your pediatric clinical rotation in a neonatal intensive care unit and to start racking up any NICU-relevant certifications you may be eligible to pursue.
Licensed nurses will have an easier time. If you want to get a job in a NICU, work for a year or two in the ICU or emergency room, or on the postpartum ward if your hospital has an obstetrics unit. You will also want to begin pursuing any certifications you’re eligible to pursue that will validate your knowledge about preemie care.
Most hospitals offer a 12-week orientation for nurses who are new to the NICU setting
. They will be assigned a preceptor who will mentor them through the learning process, and their learning assignments will progress in difficulty over the course of the three months they spend training.
What Are The Continuing Education Requirements For A NICU Nurse?
Individual employers may have specific continuing education requirements for the RNs who work in their NICUs, but there are no continuing education requirements specific to NICU nurses at the state level. Most states do, however, have CEU requirements for RN licensure renewal. These requirements vary from state to state
WHAT IS THE STEP-BY-STEP PROCESS TO BECOME A NICU NURSE?
While there’s no single path to becoming a NICU nurse, here are the steps you should anticipate if you want to become a NICU nurse:
1. Attain a high school diploma:
If you’re one of the fortunate few who realizes early on what you’d like your career path to be, focus on science and math, and take as many biology-oriented electives as you possibly can.
2. Attend nursing school:
Hospitals prefer hiring BSN-prepared nurses because these nurses have taken leadership classes that prepare them to function more autonomously than ADN-prepared nurses. Choose a nursing school that has a relationship with a local hospital that has a Level II nursery. When you are assigned your pediatric clinical rotation, lobby strongly to perform it in that Level II nursery.
3. Pass the NCLEX-RN:
Passing the NCLEX-RN is a condition of licensure in every one of the 50 states as well as the District of Columbia.
4. Obtain your registered nursing license:
Each state has a different set of requirements for RN licensure.
5. Apply for employment:
As noted above, medical centers these days will hire new graduates. Keep in mind, though, that NICU nursing requires a highly specialized skill set on top of your general nursing knowledge, and you will find yourself scrambling often in that first couple of years. An easier path to entry might be working in a postpartum unit for a couple of years to get some experience working with well babies and transferring from there.
WHAT IS THE TIME AND COST INVOLVED IN BECOMING A NICU NURSE?
How Long Does It Take To Become A NICU Nurse?
No set timeline is associated with NICU employment. At a minimum, if you pursue an ADN degree and are lucky enough to get hired into a NICU as soon as you obtain your license, it will take you three years: two years to finish your degree, six months to study for and pass the NCLEX-RN and six months to be licensed. (It often takes less time than six months to get licensed, but it’s prudent to plan on the long side.)
In most instances, however, it will take longer than this. First because since NICUs prefer to hire BSN-prepared nurses, it’s smartest to attend and graduate from a four-year nursing program. But also because you can’t count on being hired by a NICU directly out of nursing school. Unless the hospital you want to work for is experiencing a serious shortage of NICU nurses, they will prefer to employ a nurse with some experience. Realistically speaking, it’s likely to take you six years to become a NICU nurse: four years to complete nursing school, one year to pass the NCLEX-RN and obtain licensure, and another year to accumulate the nursing experience that will make you an attractive candidate for employment.
How Much Does It Cost To Become A NICU Nurse?
Becoming a NICU nurse can cost anywhere between $10,000 and $103,00. Here’s the cost breakdown:
• Nursing education: If you decide to pursue an ADN degree, you can expect to spend between $7,000 and $21,000 on your nursing education. BSN programs are pricier: Total costs for a four-year nursing program range between $40,000 and $100,000, depending upon the school.
• NCLEX-RN: The test fee is $200, but you’d be well-advised to sign up for a test preparation class as well, and that will set you back $500.
• RN licensure: The fees for RN licensure vary from state to state, but they typically run between $125 and $200.
• Certifications: Several of the certifications associated with being a NICU nurse can only be pursued after you’ve become a NICU nurse and accumulated experience. The ones that are open to you before you find NICU employment cost between $100 and $250.
Total costs: Expect to spend anywhere between $10,000 and $103,000 on the education and training that will qualify you to be a good NICU nurse.
WHAT ARE THE BEST CAREER ADVANCEMENT OPPORTUNITIES FOR A NICU NURSE?
The most popular career advancement opportunities for NICU nurses entail pursuing an MSN degree with a concentration in neonatology. This degree will allow them to become either neonatal nurse practitioners or neonatal clinical nurse specialists.
Neonatal nurse practitioners
(NNPs) are advanced practice RNs who care for high-risk infants in NICUs, emergency rooms, delivery rooms, and outpatient developmental clinics. While the patients they treat are similar to the patients NICU nurses care for, the NNP’s expanded scope of practice means NNPs can diagnose, prescribe medications, perform invasive procedures, and order lab work. In 25 states, NNPs do these things under the supervision of a licensed physician, but in 25 states and the District of Columbia, NNPs can practice independently to the full extent of their education and training
. In addition to obtaining an MSN with a focus on neonatology, NNPs must pass the Neonatal Nurse Practitioner exam offered by the NNC.
Neonatal clinical nurse specialists
, on the other hand, are advanced practice RNs whose orientation is more programmatic. Though they are fully qualified to provide direct medical care to neonates, they are more often involved in education, research, and administration. In neonatal intensive care unit settings, they often prepare the educational materials used to teach NICU nurses. They may also function as lactation consultants. In addition to obtaining an MSN with a focus on neonatology, they must pass the ACCNS exam
offered by the American Association of Critical-Care Nurses.
NICU nurses may also decide to pursue a Doctor of Nursing Practice
(DNP) degree. The DNP degree is the terminal degree in clinical nursing. NICU nurses who pursue DNP degrees often go on to become administrators, clinical educators in nursing programs, and policymakers. A few DNP programs are coupled with neonatal nurse practitioner training programs.
Some NICU nurses go on to join the neonatal transport teams that are charged with bringing critically ill newborns from areas that don’t have the resources to care for them properly to Level III and Level IV nurseries. Often, nurses actively employed in a NICU moonlight as members of neonatal transport teams.
WHAT ARE THE TOP CONS OF BEING A NICU NURSE?
There are good things and bad things about working in a neonatal intensive care unit. Here are the top cons of being a NICU nurse:
1. NICUs are high-pressure environments: Critically ill babies can decompensate very quickly
, so you can never safely take your eyes off your patients for more than a few minutes at a time. There is no margin of error, and this can be extremely stressful for NICU nurses who are taking care of two or three babies at a time. One of the cons of becoming a NICU nurse is that you always have to stay in a state of red alert.
Ventilated infants receive one-to-one nursing, but this can be stressful as well since mechanical ventilation, while necessary at times, is often linked to negative outcomes in infants such as atelectasis, pneumothorax, and bronchopulmonary dysplasia
. And there is always the constant cacophony of the alarms though thankfully, in most cases, they are false alarms.
2. NICU nursing can be emotionally taxing:
Even when their babies are doing well by NICU standards, being around the parents of your patients can be heartbreaking. Most mothers blame themselves to some degree when they give birth prematurely, and there may be little you can tell them that will persuade them otherwise.
You may find yourself ricocheting frequently between emotional extremes, on the verge of crying with one family whose little one is experiencing a setback but rejoicing with another family whose physician has just announced that their baby can come home. This degree of volatility can be hard on your nervous system.
3. Requires highly specialized skills:
As a nurse, you already understand how important it is to get everything right with any patient, but the stakes are even higher with newborns because they cannot indicate when they are not feeling well, and they can decompensate so quickly. It’s also harder to do things like initiate IV lines, monitor central lines, draw arterial blood gases, and administer medications through IV drips when bodies are tinier. There’s an adage in NICU circles: There’s more difference between the physiology of a 25-weeker and a full-term baby than there is between a three-year-old and an adult.
4. You’ll fall out of practice caring for adult patients:
The skill sets you develop while taking care of infant patients are highly specific and not easily transferable to adult care. This can make it extremely difficult if you decide at some point to transition out of the NICU practice setting. This is one of the biggest disadvantages of being a NICU nurse: You come to feel very out-of-sync with medical procedures and medications for adults. This may result in feeling trapped in the NICU, even when you no longer want to work there, because there’s simply no other place where you feel comfortable working.
5. High mortality rates:
Another one of the top cons of being a NICU nurse is the comparatively high patient mortality rate. Even with the best of care, 13 percent of the infants hospitalized in a neonatal intensive care unit will die. This is heartbreaking for all their caretakers but particularly for the nurses who’ve spent weeks or months caring for these infants and who’ve formed close bonds with these infants’ families. NICU nurses who’ve cared for a baby who’s died run the risk of becoming seriously depressed.
6. High potential for burnout:
In a study
published in the March 2020 issue of The Journal of Perinatal Medicine
, 37 percent of the NICU nurses surveyed reported some degree of burnout. A similar study
published in 2016 in The Journal of Perinatology
found that 25 percent of their NICU nurse subjects reported symptoms consistent with burnout and that individual burnout rates across the board varied from 7.5 to 54 percent.
Burnout in the NICU is another one of the disadvantages of becoming a NICU nurse. It’s more prevalent in NICUs that are busier and treat a larger volume of patients. NICU nurses in hospitals with the highest NICU admission rates tend to exhibit the highest levels of burnout
7. Hostile parents:
If you’re a nurse in a NICU, you’ve probably run across this parent: “My baby looks perfectly well to me,” this mother or father will say. “Why can’t she come home?” There are often power struggles between NICU nurses and NICU parents.
Parents of babies in the NICU experience a serious degree of psychological stress related to disruptions to parent-baby bonding and the perception of loss of the parenting role. They may intellectually understand the reasons why their baby has to continue being monitored in the NICU, but it’s difficult for their hearts to accept. Some of them may end up taking out their anger and frustration on you—and this can be very difficult to deal with.
8. Uninvolved parents:
The flip side of that is the parents who never come in at all. In many cases, this is related to parental guilt that something they did caused the premature birth or to parental fear that the baby either is going to die or exhibit developmental disabilities, so there is no point in becoming involved emotionally. This can be a heartbreaking scenario for you as a nurse when you’ve developed affection for your tiny charge.
9. Worrying what will happen to the baby when it goes home:
When you’ve cared for a baby for months, it can be very stressful to send that child home on a monitor and with a specific schedule for feeding and respiratory treatments when you suspect the parents will not be up to the task of caring for that child adequately. Some 15 percent of infants discharged from the NICU require rehospitalization within a year of that discharge
. In some instances, this happens even when parents are trying their best, but in others, it happens as a result of parental neglect. It’s nerve-racking to see patients discharged into negligent situations.
10. Ethical dilemmas:
Practically every NICU nurse has had to deal with the ethically ambiguous situation that arises when parents insist everything be done for their child even though that child’s quality of life will not be good in the increasingly unlikely event that he or she survives.
When you are taking care of a 25-weeker with severe bronchodysplasia who’s lost most of his intestines to necrotizing enterocolitis, it can be very difficult not to become furious with the parents. You understand the baby’s prognosis; they either cannot or will not. Their decision is coming from a very deep pain, but that may not make it any easier for you to accept it.
WHAT ARE THE TOP PROS OF BEING A NICU NURSE?
NICU nursing can put you through the emotional wringer at times, but it can also be intensely rewarding. Here’s a look at the top pros of being a NICU nurse:
1. NICU nursing isn’t as physically demanding:
From a nurse’s standpoint, one of the biggest advantages of being a NICU nurse is that it’s easier on their backs than working in other units. A large part of the nursing workload consists of lifting and repositioning patients. This can be an ordeal with adult patients: In a 1998 Bureau of Labor Statistics ranking of occupations at the highest risk for sustaining on-the-job back injuries, nurses and other healthcare workers accounted for 6 of the top 10 positions
. In fact, back injuries and chronic back pain affect 38 percent of all RNs in the U.S.
But neonatal patients are a lot lighter than their adult counterparts. Consequently, as a NICU nurse, you’ll suffer far fewer back injuries—or, indeed, other types of musculoskeletal injuries—than your colleagues working on other hospital units. Additionally, if you’re assigned more than one patient, chances are your patients will be within 10 to 20 feet of one another. Say goodbye forever to running down the hall so that Patient B will get his medications on time!
2. There are many opportunities for career advancement:
The NICU is a gateway to many other careers. Certification will qualify you for more advanced roles in the units where you already work. You can also enroll in an MSN program that will prepare you to become a nurse practitioner, a clinical nurse specialist or some other category of advanced practice RN, thereby expanding both your scope of practice and your earning capacity. Some NICU nurses go on to become members of the teams that transport fragile newborns by ambulance or by air to Level II and Level III nurseries hundreds of miles from their homes.
3. It’s very gratifying:
NICU nursing is unique in that it blends the best of technology with a family-centered care focus. You’ll experience the awe of seeing just how positive scientific advances can be as well as the joy that comes from looking into the face of a parent doing skin-to-skin bonding for the very first time. You’ll play a special role in the life of many, many families, providing comfort to them throughout one of the most difficult times in their lives. NICU nursing can be immensely emotionally rewarding.
4. High salaries:
NICU nursing can also be financially rewarding. NICU salaries vary with state from a high of $151,700 in California to a low of $74,060 in South Dakota, but as a NICU nurse, you’ll earn an average salary of $101,232 a year, which is 74 percent higher than the average salary for all occupations throughout all parts of the U.S. ($58,260 a year). If you work the 7:00 p.m.-to-7:00 a.m. shift, you can expect to average even more because nurses working night shifts earn a shift differential. Salary is one of the top pros of being a NICU nurse.
5. High demand:
NICU nurses are in high demand because an increasing number of infants require special care in a NICU after they’re born. Not all of these infants are preemies; NICU nurses also care for full-term babies who are low birth weight, septic, have heart defects or other congenital abnormalities, have seizures, have respiratory problems linked to meconium aspiration, or are victims of trauma.
A 2020 cohort study published on the JAMA Network Open
found that between 2010 and 2018, approximately 10 to 15 percent of all infants born in the U.S. spent some time in a neonatal intensive care unit. If you’re a BSN-prepared nurses with advanced training and experience, you’ll probably be able to write your own ticket. That’s one of the advantages of becoming a NICU nurse.
6. Never routine:
Because patients are grouped according to chronological age rather than diagnosis, in a single NICU shift, you can be a respiratory nurse, a cardiac nurse, a surgical nurse, a dialysis nurse or a neuro nurse depending on what’s going on with the baby you’re caring for. Their tiny size makes NICU patients physiologically unstable. When it comes to neonatal care, every day is different.
7. The science is interesting:
This is particularly true if you work in a Level III or IV unit associated with a large regional hospital. You’ll get to see a lot of interesting things—like rare metabolic diagnoses or whole-body hypothermia or ECMO technology in action—that most nurses only get to read about in textbooks. And most NICU units offer lots of in-services to help you keep abreast of the skills you have as well as learn new ones. In a NICU unit, you never stop learning.
8. You get a lot of respect:
NICU nurses are highly admired—by other nurses, by doctors and by the parents of the babies they care for. If you work in a teaching hospital, the interns and residents will likely ask you what you think the appropriate intervention should be before they write any new orders. NICU nurses have an unusual combination of technical skills, empathy and compassion, and this garners respect from other healthcare professionals as well as from the population at large.
9. Physicians are available 24/7:
In many hospitals, physicians may not be on the unit once morning rounds are over. If you need a physician so that you can relay vital information about an unstable patient that may lead to a new set of orders, you’ll have to page one, and that can lead to a long delay. But in the NICU setting, 24-hour physician coverage is mandatory. When you need them the most, you’ll always be able to get hold of a neonatologist, a neonatal nurse practitioner, or a neonatology physician assistant.
10. NICU nurses are in high demand as travel nurses: The shortage of neonatal intensive care unit nurses throughout the U.S. is pegged at about 32 percent for all patients and is as high as 85 percent for acutely ill patients
. This means that NICU nurses are highly sought after as traveling nurses. Living in interesting new places is one of the real pros of becoming a NICU nurse for many NICU RNs. Traveling NICU nurses often earn higher salaries at their assignment sites than the nurses who work there permanently, and the travel nursing agency often pays housing expenses. To become a NICU travel nurse, you need to have graduated from an accredited nursing program, be licensed, and have at least two years of professional NICU experience.
NICU NURSE SALARY + BENEFITS
What Is The Starting Salary Of A NICU Nurse?
The starting salary of a NICU nurse is $34.97 an hour, $1,399 a week, $6,060 a month, or $72,730 a year. Even entry-level NICU nurses make 27 percent more than the average earnings for all occupations throughout the U.S. ($58,260 a year).
Even experienced nurses go through an extensive orientation and mentoring process that can last as long as 12 weeks when
they start a new job. During this time, neither the newly hired nurse nor his or her mentor is counted in staffing, and that means the NICU is incurring additional operational costs. The lower salaries paid to entry-level NICU nurses is an attempt on the facility’s part to make up part of these onboarding costs.
What Is The Average Salary Of A NICU Nurse?
The average NICU nurse salary is $48.67 an hour, $1,947 a week, $8,440 a month, or $101,232 annually. NICU nurses typically reach this benchmark around their seventh or eighth year on the job.
Since NICU nurses are typically hourly rather than salaried employees, they are subject to the stipulations of the Fair Labor Standards Act
, which means they must be paid overtime at a rate of time and half if they work more than 40 hours a week. Although specific NICU nurse overtime statistics have not been aggregated, researchers estimate that an average of between 4 and 6 percent of a nurse’s total average earnings represent overtime worked
Many NICU nurses also receive yearly bonuses
that augment their NICU nurse salary. These range from $200 to $7,600 a year. NICU nurses who work in for-profit hospitals may also participate in profit sharing.
How Much Does The NICU Nurse Salary Grow With Experience?
Over time, NICU nurses get more skilled at their profession, and this is reflected in the fact that NICU nurses with more experience make more money. But NICU nurses with one to four years of experience only make 4 percent more than what entry-level NICU nurses earn ($72,730). This may be because the NICU is such a specialized and challenging environment that NICU RNs with one to four years of experience still need a lot of institutional support.
By the time NICU nurses have garnered five to nine years of experience, they are earning $94,930 a year—which is 31 percent more than entry-level NICU nurse salaries. NICU nurses with 20 or more years of experience make more than twice the entry-level salary. This may be a strategy designed to help keep NICU nurses from retiring. More than 60 percent of all NICU nurses are 40 years of age or older
, and the average age of retirement among all nurses is 58 years old
. It stands to reason that many RNs with 20 or more years of experience are thinking about leaving the workforce. High salaries may deter them from doing so, however.
| Level of Experience || Annual || Weekly || Monthly || Hourly |
| Entry-Level || $72,730 || $1,399 || $6,060 || $34.97 |
| 1-4 Years of Experience || $75,590 || $1,454 || $6,300 || $36.34 |
| 5-9 Years of Experience || $94,930 || $1,826 || $7,910 || $45.64 |
| 10-19 Years of Experience || $119,370 || $2,296 || $9,950 || $57.39 |
| 20 Years or More Experience || $147,110 || $2,829 || $12,260 || $70.73 |
What Benefits And Perks Can You Expect As A NICU Nurse?
Employers offer NICU nurses non-cash compensation in addition to salaries. These perks are called benefits. Employers like benefits because they’re a way to attract highly qualified employees while employees like them because they represent non-taxable income. Some employment benefits like workers’ compensation and unemployment insurance are mandated by law. Local laws in some states and municipalities also mandate paid sick time. Most benefits are offered at the employer’s discretion. According to a 2022 analysis from the Bureau of Labor Statistics, nurses receive a higher percentage of benefits compared to all workers in the U.S.
Benefits that NICU nurses routinely receive include:
• Workers’ compensation:
Workers’ compensation is legally mandated in all states except for Texas
. Workers’ comp provides cash benefits and/or medical care for employees who are injured or become ill as a direct result of their jobs.
• Unemployment insurance:
Unemployment insurance is legally mandated by the federal government. Unemployment insurance pays money on a weekly basis to people who’ve lost jobs, providing those people meet certain eligibility requirements.
Sick leave is a paid leave of absence granted because of an illness of injury. Sick time is a mandated benefit in Arizona, California, Colorado, Connecticut, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and Washington, D.C.
Holiday leave refers to time off that’s accrued by employees who work state holidays or when a paid holiday falls on a day the employee would otherwise have off anyway.
Vacation is a paid leave of absence.
Healthcare insurance (also known as medical insurance or health insurance) is an insurance policy that covers a percentage of physician visits, hospital stays, and other medical bills.
Employers frequently contribute amounts to the retirement savings plans based on the amount of an employee’s annual contribution.
Bonuses are financial remunerations above expected salary. Employers typically award bonuses for high performance or as hiring incentives.
AVERAGE NICU NURSE SALARY BY STATE
What are the highest paying states for NICU nurses? NICU nurses earn their highest annual salaries in California ($151,700), Hawaii ($130,320), Oregon ($120,660), Alaska ($118,950) and Massachusetts ($118,210). NICU nurses earn their lowest annual salaries in South Dakota ($74,060), Alabama ($75,750), Mississippi ($77,230), Iowa ($79,510) and Arkansas ($80,520).
The most important factor in state-by-state variations in average salary is state-by-state variations in the cost of living. California, Hawaii, Oregon, Alaska and Massachusetts are among the ten states with the highest cost indices
. But there is another factor at play here as well: California, Hawaii, Oregon and Massachusetts are states where participation in a nurses’ union is mandatory for all RNs
. Nurses’ unions are strong advocates for higher salaries as well as for safer working conditions.
Mississippi, Alabama, Iowa and Arkansas are among the states with the lowest cost of living indices
. Though California NICU nurses make almost double what Mississippi nurses make, the cost of living in California
is 69 percent higher than the cost of living in Mississippi
. Additionally, Mississippi, South Dakota, Alabama, Arkansas and Iowa are right-to-work states: NICU nurses do not have to participate in unions; indeed, there is a lot of pressure from NICU nurse employers to dissuade nurse participation in unions, which means employers have no little or no incentive to participate in the types of collective bargaining that would raise NICU nurses’ salaries.
| State || Hourly || Weekly || Monthly || Annual |
| Alabama || $36.42 || $1,457 || $6,310 || $75,750 |
| Alaska || $57.19 || $2,288 || $9,910 || $118,950 |
| Arizona || $48.00 || $1,920 || $8,320 || $99,830 |
| Arkansas || $38.71 || $1,548 || $6,710 || $80,510 |
| California || $72.93 || $2,917 || $12,640 || $151,700 |
| Colorado || $47.45 || $1,898 || $8,220 || $98,690 |
| Connecticut || $52.07 || $2,083 || $9,030 || $108,300 |
| Delaware || $45.74 || $1,829 || $7,930 || $95,130 |
| Florida || $42.35 || $1,694 || $7,340 || $88,080 |
| Georgia || $44.34 || $1,773 || $7,690 || $92,220 |
| Hawaii || $62.65 || $2,506 || $10,860 || $130,320 |
| Idaho || $43.31 || $1,733 || $7,510 || $90,090 |
| Illinois || $46.03 || $1,841 || $7,980 || $95,740 |
| Indiana || $40.52 || $1,621 || $7,020 || $84,280 |
| Iowa || $38.23 || $1,529 || $6,630 || $79,510 |
| Kansas || $39.15 || $1,566 || $6,790 || $81,430 |
| Kentucky || $39.56 || $1,582 || $6,860 || $82,280 |
| Louisiana || $41.39 || $1,656 || $7,180 || $86,100 |
| Maine || $43.31 || $1,732 || $7,510 || $90,080 |
| Maryland || $48.62 || $1,945 || $8,430 || $101,120 |
| Massachusetts || $56.83 || $2,273 || $9,850 || $118,210 |
| Michigan || $44.66 || $1,786 || $7,740 || $92,890 |
| Minnesota || $49.42 || $1,977 || $8,570 || $102,800 |
| Mississippi || $37.13 || $1,485 || $6,440 || $77,230 |
| Missouri || $39.87 || $1,595 || $6,910 || $82,930 |
| Montana || $43.29 || $1,732 || $7,500 || $90,050 |
| Nebraska || $41.08 || $1,643 || $7,120 || $85,450 |
| Nevada || $52.23 || $2,089 || $9,050 || $108,630 |
| New Hampshire || $46.03 || $1,841 || $7,980 || $95,750 |
| New Jersey || $52.75 || $2,110 || $9,140 || $109,720 |
| New Mexico || $45.63 || $1,825 || $7,910 || $94,920 |
| New York || $54.88 || $2,195 || $9,510 || $114,160 |
| North Carolina || $41.88 || $1,675 || $7,260 || $87,100 |
| North Dakota || $41.88 || $1,675 || $7,260 || $87,100 |
| Ohio || $42.13 || $1,685 || $7,300 || $87,640 |
| Oklahoma || $40.10 || $1,604 || $6,950 || $83,410 |
| Oregon || $58.01 || $2,320 || $10,060 || $120,660 |
| Pennsylvania || $44.70 || $1,788 || $7,750 || $92,970 |
| Rhode Island || $50.15 || $2,006 || $8,690 || $104,310 |
| South Carolina || $40.92 || $1,637 || $7,090 || $85,120 |
| South Dakota || $35.61 || $1,424 || $6,170 || $74,060 |
| Tennessee || $39.22 || $1,569 || $6,800 || $81,570 |
| Texas || $46.53 || $1,861 || $8,070 || $96,790 |
| Utah || $42.81 || $1,713 || $7,420 || $89,050 |
| Vermont || $44.21 || $1,768 || $7,660 || $91,950 |
| Virginia || $45.10 || $1,804 || $7,820 || $93,810 |
| Washington || $56.08 || $2,243 || $9,720 || $116,650 |
| West Virginia || $39.78 || $1,591 || $6,900 || $82,750 |
| Wisconsin || $45.20 || $1,808 || $7,830 || $94,010 |
| Wyoming || $43.01 || $1,720 || $7,460 || $89,460 |
AVERAGE NICU NURSE SALARY BY METRO
What are the highest paying metros for NICU nurses? The highest-paying metros for NICU nurses are San Jose ($189,900), the San Francisco Bay Area ($185,510), Sacramento ($165,750), Fresno ($146,590) and Los Angeles ($142,040). These cities are all in California, which is the state where NICU nurses earn their highest average salaries ($151,700).
Just as there are variations between NICU nurse salaries on a state-by state-basis, there are also variations between NICU salaries on a city-by-city basis in the same state. In Texas where average NICU nurse earnings are $87,640 a year, salaries in the state’s major cities range from a high of $102,630 a year in Houston (5 percent more than the state average) to a low of $84,700 a year in El Paso (12 percent less than the state average). In Ohio where average NICU nurse earnings are $87,640 a year, salaries in the state’s major cities range from a high of $91,630 a year in Cleveland (6 percent more than the state average) to a low of $85,610 a year in Toledo (2 percent less than the state average). These differences can probably be explained by regional differences in the cost of living.
San Juan, Porto Rico is an outlier here with an average NICU nurse salary of $45,150, which is less than half the average salary that NICU nurses living in American states make. Again, this probably reflects a much lower cost of living.
| Metro || Hourly || Weekly || Monthly || Annual |
| Akron, OH || $41.96 || $1,678 || $7,270 || $87,270 |
| Albany-Schenectady-Troy, NY || $45.71 || $1,828 || $7,920 || $95,070 |
| Albuquerque, NM || $46.80 || $1,872 || $8,110 || $97,340 |
| Allentown-Bethlehem-Easton, PA-NJ || $44.82 || $1,793 || $7,770 || $93,230 |
| Ann Arbor, MI || $49.89 || $1,996 || $8,650 || $103,780 |
| Atlanta-Sandy Springs-Roswell, GA || $47.50 || $1,900 || $8,230 || $98,800 |
| Augusta-Richmond County, GA-SC || $42.59 || $1,704 || $7,380 || $88,590 |
| Austin-Round Rock, TX || $47.89 || $1,916 || $8,300 || $99,620 |
| Baltimore-Columbia-Towson, MD || $48.87 || $1,955 || $8,470 || $101,640 |
| Baton Rouge, LA || $41.35 || $1,654 || $7,170 || $86,000 |
| Birmingham-Hoover, AL || $37.41 || $1,497 || $6,490 || $77,820 |
| Boise City, ID || $44.41 || $1,776 || $7,700 || $92,370 |
| Boston-Cambridge-Nashua, MA-NH || $58.78 || $2,351 || $10,190 || $122,270 |
| Bridgeport-Stamford-Norwalk, CT || $53.49 || $2,140 || $9,270 || $111,260 |
| Buffalo-Cheektowaga-Niagara Falls, NY || $47.49 || $1,899 || $8,230 || $98,770 |
| Cape Coral-Fort Myers, FL || $43.18 || $1,727 || $7,490 || $89,820 |
| Charleston-North Charleston, SC || $42.74 || $1,710 || $7,410 || $88,900 |
| Charlotte-Concord-Gastonia, NC-SC || $43.09 || $1,723 || $7,470 || $89,620 |
| Chicago-Naperville-Elgin, IL-IN-WI || $47.82 || $1,913 || $8,290 || $99,460 |
| Cincinnati, OH-KY-IN || $42.58 || $1,703 || $7,380 || $88,570 |
| Cleveland-Elyria, OH || $44.05 || $1,762 || $7,640 || $91,630 |
| Colorado Springs, CO || $46.18 || $1,847 || $8,010 || $96,060 |
| Columbia, SC || $40.79 || $1,632 || $7,070 || $84,840 |
| Columbus, OH || $43.09 || $1,724 || $7,470 || $89,630 |
| Dallas-Fort Worth-Arlington, TX || $48.38 || $1,935 || $8,390 || $100,630 |
| Dayton, OH || $42.43 || $1,697 || $7,360 || $88,260 |
| Denver-Aurora-Lakewood, CO || $48.74 || $1,949 || $8,450 || $101,370 |
| Des Moines-West Des Moines, IA || $39.38 || $1,575 || $6,830 || $81,900 |
| Detroit-Warren-Dearborn, MI || $45.39 || $1,816 || $7,870 || $94,420 |
| Durham-Chapel Hill, NC || $42.93 || $1,717 || $7,440 || $89,300 |
| El Paso, TX || $40.72 || $1,629 || $7,060 || $84,700 |
| Fort Wayne, IN || $40.45 || $1,618 || $7,010 || $84,130 |
| Fresno, CA || $70.48 || $2,819 || $12,220 || $146,590 |
| Gainesville, FL || $43.51 || $1,740 || $7,540 || $90,500 |
| Grand Rapids-Wyoming, MI || $42.33 || $1,693 || $7,340 || $88,040 |
| Greensboro-High Point, NC || $42.56 || $1,703 || $7,380 || $88,530 |
| Greenville-Anderson-Mauldin, SC || $40.75 || $1,630 || $7,060 || $84,750 |
| Harrisburg-Carlisle, PA || $44.18 || $1,767 || $7,660 || $91,890 |
| Hartford-West Hartford-East Hartford, CT || $51.12 || $2,045 || $8,860 || $106,330 |
| Houston-The Woodlands-Sugar Land, TX || $49.34 || $1,974 || $8,550 || $102,630 |
| Indianapolis-Carmel-Anderson, IN || $41.75 || $1,670 || $7,240 || $86,830 |
| Jackson, MS || $38.85 || $1,554 || $6,730 || $80,810 |
| Jacksonville, FL || $41.43 || $1,657 || $7,180 || $86,180 |
| Kansas City, MO-KS || $42.23 || $1,689 || $7,320 || $87,840 |
| Knoxville, TN || $35.79 || $1,432 || $6,200 || $74,440 |
| Las Vegas-Henderson-Paradise, NV || $53.07 || $2,123 || $9,200 || $110,380 |
| Lexington-Fayette, KY || $39.38 || $1,575 || $6,830 || $81,900 |
| Little Rock-North Little Rock-Conway, AR || $40.97 || $1,639 || $7,100 || $85,220 |
| Los Angeles-Long Beach-Anaheim, CA || $68.29 || $2,732 || $11,840 || $142,040 |
| Louisville/Jefferson County, KY-IN || $41.18 || $1,647 || $7,140 || $85,650 |
| Madison, WI || $49.04 || $1,962 || $8,500 || $102,010 |
| Memphis, TN-MS-AR || $40.29 || $1,612 || $6,980 || $83,810 |
| Miami-Fort Lauderdale-West Palm Beach, FL || $43.65 || $1,746 || $7,570 || $90,800 |
| Milwaukee-Waukesha-West Allis, WI || $45.98 || $1,839 || $7,970 || $95,640 |
| Minneapolis-St. Paul-Bloomington, MN-WI || $50.99 || $2,039 || $8,840 || $106,050 |
| Nashville-Davidson--Murfreesboro--Franklin, TN || $41.70 || $1,668 || $7,230 || $86,740 |
| New Haven, CT || $52.66 || $2,106 || $9,130 || $109,530 |
| New Orleans-Metairie, LA || $43.39 || $1,736 || $7,520 || $90,250 |
| New York-Newark-Jersey City, NY-NJ-PA || $57.91 || $2,316 || $10,040 || $120,450 |
| North Port-Sarasota-Bradenton, FL || $42.58 || $1,703 || $7,380 || $88,570 |
| Oklahoma City, OK || $41.13 || $1,645 || $7,130 || $85,550 |
| Omaha-Council Bluffs, NE-IA || $42.10 || $1,684 || $7,300 || $87,570 |
| Orlando-Kissimmee-Sanford, FL || $42.80 || $1,712 || $7,420 || $89,020 |
| Oxnard-Thousand Oaks-Ventura, CA || $67.36 || $2,694 || $11,680 || $140,110 |
| Philadelphia-Camden-Wilmington, PA-NJ-DE-MD || $48.14 || $1,926 || $8,350 || $100,140 |
| Phoenix-Mesa-Scottsdale, AZ || $48.60 || $1,944 || $8,420 || $101,090 |
| Pittsburgh, PA || $43.03 || $1,721 || $7,460 || $89,510 |
| Portland-Vancouver-Hillsboro, OR-WA || $59.82 || $2,393 || $10,370 || $124,430 |
| Providence-Warwick, RI-MA || $50.11 || $2,004 || $8,690 || $104,230 |
| Raleigh, NC || $42.51 || $1,700 || $7,370 || $88,420 |
| Richmond, VA || $45.25 || $1,810 || $7,840 || $94,120 |
| Riverside-San Bernardino-Ontario, CA || $65.70 || $2,628 || $11,390 || $136,650 |
| Rochester, MN || $50.86 || $2,034 || $8,820 || $105,780 |
| Rochester, NY || $44.74 || $1,790 || $7,760 || $93,060 |
| Sacramento--Roseville--Arden-Arcade, CA || $79.69 || $3,188 || $13,810 || $165,750 |
| Salt Lake City, UT || $44.45 || $1,778 || $7,700 || $92,450 |
| San Antonio-New Braunfels, TX || $46.39 || $1,856 || $8,040 || $96,490 |
| San Diego-Carlsbad, CA || $66.55 || $2,662 || $11,540 || $138,420 |
| San Francisco-Oakland-Hayward, CA || $89.19 || $3,568 || $15,460 || $185,510 |
| San Jose-Sunnyvale-Santa Clara, CA || $91.30 || $3,652 || $15,830 || $189,900 |
| San Juan-Carolina-Caguas, PR || $21.71 || $868 || $3,760 || $45,150 |
| Scranton--Wilkes-Barre--Hazleton, PA || $41.47 || $1,659 || $7,190 || $86,250 |
| Seattle-Tacoma-Bellevue, WA || $58.41 || $2,336 || $10,120 || $121,490 |
| Shreveport-Bossier City, LA || $41.54 || $1,662 || $7,200 || $86,410 |
| Sioux Falls, SD || $34.68 || $1,387 || $6,010 || $72,140 |
| Spokane-Spokane Valley, WA || $54.48 || $2,179 || $9,440 || $113,310 |
| Springfield, MA-CT || $47.72 || $1,909 || $8,270 || $99,250 |
| Springfield, MO || $36.20 || $1,448 || $6,280 || $75,300 |
| St. Louis, MO-IL || $41.55 || $1,662 || $7,200 || $86,420 |
| Syracuse, NY || $44.37 || $1,775 || $7,690 || $92,290 |
| Tampa-St. Petersburg-Clearwater, FL || $43.16 || $1,726 || $7,480 || $89,770 |
| Toledo, OH || $41.16 || $1,646 || $7,130 || $85,610 |
| Tucson, AZ || $46.36 || $1,854 || $8,040 || $96,420 |
| Tulsa, OK || $40.07 || $1,603 || $6,950 || $83,350 |
| Urban Honolulu, HI || $63.33 || $2,533 || $10,980 || $131,730 |
| Virginia Beach-Norfolk-Newport News, VA-NC || $44.33 || $1,773 || $7,680 || $92,200 |
| Washington-Arlington-Alexandria, DC-VA-MD-WV || $52.38 || $2,095 || $9,080 || $108,950 |
| Wichita, KS || $37.21 || $1,488 || $6,450 || $77,390 |
| Winston-Salem, NC || $42.95 || $1,718 || $7,450 || $89,340 |
| Worcester, MA-CT || $51.98 || $2,079 || $9,010 || $108,110 |
HIGHEST PAID NICU NURSES IN THE NATION
What Are The 10 Highest Paying States For NICU Nurses?
The highest-paid NICU nurses work in California. NICU salaries in the Golden State are 16 percent higher than they are in Hawaii, the state where NICU nurses earn their second-highest salaries. In fact, California’s average NICU nurse salaries are so much higher than NICU salaries elsewhere in the nation that if you took them out of the equation, the average NICU salary would be $93,803 a year—7 percent lower than the existing national average of $101,232.
Except for Nevada, the states where NICU nurses earn their highest salaries are all Pacific-facing states or states in the northeast.
| Rank || State || Average|
| 1 || California || $151,700 |
| 2 || Hawaii || $130,320 |
| 3 || Oregon || $120,660 |
| 4 || Alaska || $118,950 |
| 5 || Massachusetts || $118,210 |
| 6 || Washington || $116,650 |
| 7 || New York || $114,160 |
| 8 || New Jersey || $109,720 |
| 9 || Nevada || $108,630 |
| 10 || Connecticut || $108,300 |
What Are The 10 Highest Paying Metros For NICU Nurses?
The highest-paying metros for NICU nurses are all in California. The highest-paid NICU nurses work in the Santa Clara Valley, also known as “Silicon Valley,” where they average $189,900 a year. The Silicon Valley is home to one of the top-rated neonatal intensive care units, too: It’s located in the Lucile Packard Children's Hospital at Stanford.
As noted above, California NICU nurses’ high earning potential reflects the power of nurses' unions in the Golden State as well as the high cost of living. Additionally, California has the only nurse-to-patient ratio law in any of the nation’s 50 states
, and this also serves to drive up salaries by increasing demand.
| Rank || Metro || Average|
| 1 || San Jose-Sunnyvale-Santa Clara, CA || $189,900 |
| 2 || San Francisco-Oakland-Hayward, CA || $185,510 |
| 3 || Vallejo-Fairfield, CA || $179,050 |
| 4 || Santa Rosa, CA || $173,030 |
| 5 || Napa, CA || $170,880 |
| 6 || Santa Cruz-Watsonville, CA || $170,770 |
| 7 || Sacramento--Roseville--Arden-Arcade, CA || $165,750 |
| 8 || Salinas, CA || $159,670 |
| 9 || Modesto, CA || $156,260 |
| 10 || Hanford-Corcoran, CA || $152,660 |
What Are The Highest Paying Work Settings For NICU Nurses?
Very few NICU nurses work outside of neonatal intensive care units associated with medical centers and hospitals. As a rule, even non-healthcare-related employees who work for large medical systems make higher salaries than their counterparts at smaller hospitals, so it’s likely that the highest-paying work settings for NICU nurses are large medical systems consisting of one or more hospitals, at least one physician group and a cluster of affiliated clinics and other outpatient centers.
5 Tips To Become One Of The Highest Paid NICU Nurses
NICU nurses make very comfortable salaries, but everyone can use more money, right? Here are five tips to keep in mind if you’d like to maximize your earning potential as a NICU nurse:
• Acquire experience:
As noted above, the more years you work as a NICU nurse, the higher your salary will be. NICU nurses with 10 to 19 years of experience average $119,370 a year, which is 18 percent more than the average NICU salary nationally.
• Get certified:
NICU certifications such as the RNC-NIC will enhance your marketability, which puts you in a position to negotiate a higher compensation package.
• Get educated: BSN-prepared NICU nurses average $73,566 a year, which is 9 percent higher than what ADN-prepared NICU nurses make ($67,366)
• Become a NICU travel nurse:
In addition to a sign-on bonus and hourly pay, NICU travel nurses also get housing, food and mileage stipends and miscellaneous travel expenses. Those perks can really add up!
As noted above, different states pay their NICU nurses different salaries. Unless you live in California, you always have the option of moving to a higher-paying state if you want to boost your salary as a NICU nurse.
NICU NURSE JOB OUTLOOK
Is There A High Demand For NICU Nurses?
The demand for NICU nurses is very high. Between 1995 and 2013, the number of NICU beds in the U.S. increased by 69 percent
, and it’s likely that expansion of neonatal intensive care nursery resources continues to be a high healthcare-related priority. Neonatal intensive care units cannot be staffed without NICU nurses.
What Are The Top 5 Reasons Contributing To The Demand For NICU Nurses?
There are a number of reasons why the demand for NICU nurses is high. Here are the top five:
1. Premature birth rates are increasing: In 2016, the premature birth rate was 9.85 percent; by 2017, the premature birth rate had risen to 9.93 percent
while by 2020, the premature birth rate stood at 10.2 percent. Most premature babies need to spend some time in a NICU
2. Preemie survival rates are climbing:
Thanks to enhancements in NICU care, the survival rates for premature infants is rising. Between 2008 and 2012, 76 percent of infants born between 22 and 28 weeks of gestation lived, but between 2013 and 2018, 78 percent of infants born between 22 and 28 weeks of gestation lived. In particular, survival rates for the most fragile preemies, born between 22 and 25 weeks, are soaring.
3. IVF is becoming more popular: The number of births in the U.S. that rely upon in vitro fertilization (IVF) and/or other forms of assisted reproductive technology have tripled since 1996. IVF increases the probability of premature birth by about 7 percent.
4. Childbearing age is rising: Fertility rates for women between the ages of 40 and 45 increased by 132 percent between 1990 and 2020
. Advanced maternal age is associated with higher rates of prematurity.
5. Maternal health issues:
In the past 20 years, there’s been a rise in maternal health issues such as diabetes and high blood pressure that have an impact on a woman’s ability to carry a pregnancy to full term. The Office of Women’s Health, a department within the U.S. Department of Health and Human Services, estimates that one in every nine women in the U.S. has diabetes
. Infants born to mothers with diabetes have a significantly higher risk of NICU admission.
What Are The 10 States With The Highest Demand For NICU Nurses?
The states with the highest premature birth rates are not necessarily the states with the highest demand for NICU nurses. In 2020, 8.8 percent of California’s live births were preterm
while in Georgia, the percentage of preterm births is 10.8 percent
. Yet NICU nurse demand is higher in the Golden State. This probably has to do with the fact that there are 121 NICU units in California
but only 46 NICU units in the Peach State
| Rank || State |
| 1 || California |
| 2 || New York |
| 3 || Texas |
| 4 || Florida |
| 5 || Pennsylvania |
| 6 || Illinois |
| 7 || Ohio |
| 8 || North Carolina |
| 9 || Michigan |
| 10 || Georgia |
What Are The 10 Metros With The Highest Demand For NICU Nurses?
Unsurprisingly, the 10 metros with the highest demand for NICU nurses are cities with hospitals that have highly lauded NICUs. New York-Presbyterian Hospital-Columbia and Cornell
in the New York City Metropolitan Area, Ann and Robert H. Lurie Children's Hospital of Chicago
, Boston Children's Hospital
, Children's Hospital of Philadelphia
, UCSF Benioff Children's Hospitals in the San Francisco Bay Area
, Children's Hospital Los Angeles
and Children's National Hospital
in the District of Columbia are ranked among the top ten NICUs in the U.S. by U.S. New & World Report.
| Rank || Metro |
| 1 || New York-Newark-Jersey City, NY-NJ-PA |
| 2 || Los Angeles-Long Beach-Anaheim, CA |
| 3 || Chicago-Naperville-Elgin, IL-IN-WI |
| 4 || Philadelphia-Camden-Wilmington, PA-NJ-DE-MD |
| 5 || Boston-Cambridge-Nashua, MA-NH |
| 6 || Dallas-Fort Worth-Arlington, TX |
| 7 || Houston-The Woodlands-Sugar Land, TX |
| 8 || Miami-Fort Lauderdale-West Palm Beach, FL |
| 9 || Detroit-Warren-Dearborn, MI |
| 10 || Washington-Arlington-Alexandria, DC-VA-MD-WV |
5 MOST COMMON INTERVIEW QUESTIONS AND ANSWERS FOR NICU NURSE JOBS
NICUs are a specialized occupational environment where interpersonal skills are valued just as highly as technical expertise. You can expect the most common NICU nurse interview questions to be a blend of inquiries that gauge your compassion and ability to work as a team player as well as your clinical competencies. Here are five questions you’re likely to run into in some form.
Question #1: How do you respond when a pulse oximeter shows that an infant’s oxygen saturation is falling?
What the Interviewer Really wants to Know: This question, based upon a situation that is very common in a neonatal intensive care unit, is designed to test not only your assessment skills and knowledge of basic NICU protocols but also your common sense—because the number one reason why alarms go off in a NICU unit is that they’re reading incorrectly for some reason.
Sample Answer: The first thing I’d do is verify that the pulse oximeter is reading correctly! I’d do that by making sure it’s securely attached to my baby’s palm or foot, by measuring the baby’s respiratory rate and by looking for signs of nasal flaring, circumoral cyanosis or other signs that the baby might be in respiratory distress. Some babies just forget to breathe! You can remind them to breathe by tapping them lightly on the foot. If I can verify that the infant is indeed experiencing some kind of distress, I would immediately give the baby oxygen according to the NICU protocols in place for that infant and inform the neonatologist on duty.
Question #2: How would you deal with a parent who refuses to believe you when you tell them their baby isn’t stable enough to hold?
What the Interviewer Really wants to Know: This question is designed to ascertain how you respond to situations that are emotionally tense. It’s another situation that is very common in every NICU: Parents feel powerless when they’re surrounded by high-tech equipment and another person is caring for their child. Your answer will need to emphasize your adherence to NICU policies, your focus on what’s best for the infant, your empathy for the parents and your flexibility.
Sample Answer: I would be compassionate but firm. I would help them understand that right at this moment, their baby needs to rest, but I would shy away from using terms like “unstable,” which will probably scare them. Instead, I would suggest that they talk or sing to their baby, and I would recommend that they schedule some time to talk to their baby’s neonatologist who would be able to explain why it’s best not to hold him at this time.
If the parents persisted, I would summon the charge nurse to talk with them at greater length, so that I could get on with the other work I had to do.
Question #3: You notice that the nurse at the station next to yours is falling behind in her work. How do you respond?
What the Interviewer Really wants to Know: This question is designed to evaluate whether or not you’re a team player. The NICU is an extremely busy environment, and nurses fall behind on their tasks frequently. Most often, this is not a measure of how competent that nurse is but a testimonial to inadequate staffing ratios.
Sample Answer: After I’d gotten my own workload out of the way, I’d go up to the other nurse and ask her, “How can I help?”
Question #4: What made you decide to become a NICU nurse?
What the Interviewer Really wants to Know: This question is one of the classic standbys, and there really isn’t any right way or wrong way to answer it. It’s probably best to emphasize that you like working with babies, and that you respect the improvements NICU care has made in the lives of children who were fragile at birth. And if you have any personal experience with preemies, now is the time to talk about it.
Sample Answer: While I was still in nursing school, my niece was born, and she was seven weeks premature. I still remember how frightened I was and the other members of my family were the first time we visited the baby in the neonatal intensive care unit! And how impressed I was by the clinical competence and caring of the nurses we encountered there. That’s when I made my decision to focus on NICU nursing.
Question #5: How do you prioritize everything you’re responsible for doing on a typical NICU shift?
What the Interviewer Really wants to Know: As noted above, NICUs are extraordinarily busy environments. And, too, priorities may differ from NICU to NICU: In one NICU, developmental care may be prioritized while in another, it may be your patient’s respiratory status. With this question, it’s best to focus on your own system for keeping on top of your workload rather than to generalize about priorities.
Sample Answer: As I get report from the NICU nurse going off duty, I clarify any ongoing issues. We review any new orders together and make sure all the bedside equipment like oxygen, suction and the like are in working condition. Then I make a master check sheet. The check sheet includes all the times that medications and feedings must be given, which gives me some leeway for things like linen changes, feeding tube changes and the like. It’s important to keep in mind that your baby won’t die if his feeding tube isn’t changed on schedule, but he might die if he doesn’t receive his medications at precisely the time they’re prescribed to be given.
5 MOST COMMON CHALLENGES NICU NURSES FACE AND HOW TO OVERCOME THEM
Challenge #1: Patient deaths.
About the Challenge: The reality of working in a NICU is that some of your most vulnerable patients are not going to make it. When a NICU patient dies, it’s always a heart-rending experience.
How to Overcome it: Your colleagues who also work in the NICU are in the best position to understand the nature of the sorrow you feel, so take advantage of the support they offer. Let yourself cry if you need to. And don’t blame yourself: In all likelihood, there is nothing you personally could have done that would have changed the outcome here.
Challenge #2: Other negative patient outcomes.
About the Challenge: Death is not the only potentially negative outcome NICU patients face. Most premature babies live, but many face intellectual or developmental disabilities in their subsequent lives as well as ongoing issues with their lungs, eyes, and other organs. This can create serious ethical dilemmas, especially for NICU nurses who stop to consider the costs of NICU hospitalizations and what other types of resources the money going into NICU hospitalizations could support.
How to Overcome it: Remind yourself that ethical dilemmas of this sort are way above your pay scale. You were hired to provide the best possible nursing services to the infants under your care, and by giving high-quality care, you may mitigate some of the risks these infants will face later on in life.
Challenge #3: Understaffing.
About the Challenge:
NICU understaffing threatens to compromise the quality of nursing care in neonatal intensive care units. Some analyses estimate NICUs are understaffed by as much as 31 percent
if national guidelines for high-acuity infants are used as a staffing norm.
How to Overcome it:
There is nothing you can do on a personal level about NICU understaffing. It’s a systemic issue. But you can focus on your colleagues as team members and help them out as much as possible if they are falling behind with their assigned tasks. And you can keep in mind that unless you live in a mandatory overtime state
, you are under no obligation to pick up extra shifts if the NICU you work in is short-staffed.
Challenge #4: Environmental hazards
About the Challenge: The strident sound of alarms and constant glare of fluorescent lighting is harmful to caregivers as well as for patients in the NICU. NICU lighting may impact the circadian rhythms of NICU nurses and interfere with their sleep patterns while excessive noise is a stressor linked to hypertension, increased blood glucose, increased serum cholesterol, increased muscle tension, disturbed sleep and altered immune functions.
How to Overcome it: Unfortunately, there is nothing you personally can do to make the NICU a less stress-inducing work environment. But prioritizing self-care and maintaining a healthy work/life balance will go a long way toward minimizing stressors at work.
Challenge #5: Maintaining professional boundaries.
About the Challenge: Infants are hospitalized in the NICU for much longer intervals of time than patients in other units, so you get to know the families of your patients very, very well. It can be difficult to remain compassionate while enforcing professional distance, but if you don’t, you put yourself at risk of burnout.
How to Overcome it: Self-care should always be one of your own top priorities. Making sure your personal needs for companionship and social support are being met outside the therapeutic nurse-patient relationships you form in the workplace will help keep you grounded.
USEFUL RESOURCES FOR NICU NURSES
Organizations And Associations
• National Association of Neonatal Nurses
(NANN): NANN represents the professional interests of nearly 8,000 neonatal nurses, neonatal intensive care nurses, neonatal nurse practitioners, and neonatal clinical nurse specialists. It also offers a level of institutional membership for nurse managers and other healthcare administrators. Membership benefits include a subscription to the organization’s publication Advances in Neonatal Care
and networking opportunities, including participation in the association’s annual conference in mid-September. Individual membership fees are $130 a year.
• The Academy of Neonatal Nursing
(ANN): ANN’s mission is to provide high-quality educational opportunities to neonatal and NICU nurses. Membership includes a subscription to the publication Neonatal Network: The Journal of Neonatal Nursing
, free continuing education units and a 30 percent discount on publications such as ANN’s Guide to Neonatal Ventilation and ANN’s Guide to NICU Care. ANN also awards scholarships as well as annual Academy of Neonatal Nursing Excellence in Neonatal Nursing Practice Awards. Membership fees are $115 a year.
• Association of Women’s Health, Obstetric and Neonatal Nurses
(AWHONN): AWHONN also publishes a professional journal called The Journal of Obstetric, Gynecologic, & Neonatal Nursing
; a subscription is one of the membership perks. Other membership benefits include access to volunteer opportunities, scholarships, and excellence awards. The organization is divided into 51 chapters, representing each of the 50 states as well the U.S. Armed Forces. Membership fees are $216 a year.
• NICU 101: The Basics from a NICU Nurse
: This 12-minute video produced by NICU nurse Anna Drake is a very thorough review of newborn nursery levels and the procedures associated with each level of care. Its target audience is nursing students who are interested in NICU nursing but aren’t entirely sure what NICU nursing involves as well as the parents of infants who end up being hospitalized in a neonatal intensive care nursery.
• A Day in the Life of a Saint Luke's NICU Nurse
: This is a short, two-minute video but worth watching because it takes you to the bedside of a tiny, relatively stable NICU patient so that you get a chance to see some of the routine NICU procedures.
• What Is Neonatal Nursing
? This three-minute video was produced by the National Association of Neonatal Nurses. It’s another video that contains many shots of NICU nurses interacting with their patients as well as interviews with NICU nurses and parents of babies who’ve spent time in a NICU.
• How to Become a Neonatal Nurse
: RegisteredNurseRN.com produced this four-and-a-half-minute video. It’s a good review of how to land a job in a neonatal intensive care unit.
: The National Association of Neonatal Nurses produces an entire podcast series devoted to NICU nurses. It’s available through the Apple podcast network. So far, NANN has produced 36 episodes with titles like “Safe Staffing in the NICU,” “Surgical Anomalies in Neonates” and “Empowering NICU Parents”.
• Neonatal Resources, the Podcast
is a series about NICU nursing produced by three NICU nurses with more than 40 years of combined NICU experience. The series is available through the PlayerFM network. Six episodes have been released so far with titles like “Late-Term/Post-Term Infants” and “Late Pre-term Infants.” Episodes review the challenges you can expect when caring for infants in these categories.
BONUS! WHAT IS THE TYPICAL DAY IN THE LIFE OF A NICU NURSE LIKE?
What is it like being a NICU nurse? To find out, let’s talk to Jo who has worked the 7:00 a.m. to 7:30 p.m. shift in a nursery associated with a children’s hospital in a major U.S. city for the past five years.
7:00 a.m. – 7:30 a.m.:
My NICU’s policy involves scrubbing in to reduce the risk of infection even though we wear gloves when we touch the babies. Scrubbing in means washing my hands, forearms and fingernails with a bactericidal soap. Our NICU is an open unit, which means that all the babies’ incubators, radiant warmers and cribs are in one large space.
After scrubbing in, I check out my assignment for the next 12 hours. I’ve been assigned three babies: Jose, Olivia, and Jennifer. Jennifer is what we refer to in the NICU lingo as a “feeder and grower,” and I am one of her primary nurses. I’ve been taking care of Jennifer since she was first admitted to the NICU six weeks ago as a three-pound 30-weeker. Back then, she had multiple IV lines, monitors and medications, but now Jennifer’s only job is to eat and grow.
Olivia is a full-term baby whose mother is addicted to heroin. She is receiving methadone every three hours and requires a lot of consoling and TLC.
Jose is also a feeder and grower, but he still receives a small amount of oxygen through a nasal cannula, so he is fed through a nasogastric tube. He also has a peripheral IV in case he crashes, and we need to administer medications to him in a hurry.
I get report from the night nurse, and I make up my check sheet for the day. It’s based upon feeding, medication administration, and diaper times. We try to cluster all interactions we have with the babies at a few set times so that they are disrupted as little as possible. None of the babies I’m taking care of today are in incubators; they’ve all graduated to radiant warmers. No new orders have been written on any of these three infants throughout the night, which is a sign that they are more-or-less stable.
7:30 a.m. – 8:00 a.m.:
I check all the bedside equipment like oxygen and suction, and I sanitize high-touch areas like bedside tables, my stethoscope and my work phone to reduce the risk that any type of infection might spread.
I visit all three infants’ bedsides and say good morning to Jennifer and Jose’s parents. (Sadly, Olivia is all alone.)
8:30 a.m. – 9:00 a.m.:
Jennifer is already awake, crying and hungry, so I begin with her this morning. I take vital signs and do a head-to-toe assessment on her, writing all the relevant data on my check sheet. I change her diaper, measure her abdominal girth, and perform oral care and eye care before settling her down into her mother’s arms for her early morning feeding. Jennifer has no problems eating, and I am sure she will be ready to be discharged home in the very near future. While Jennifer is being fed by her mother, I take the opportunity to do some parent teaching.
9:00 a.m. – 9:30 a.m.:
Olivia receives her methadone dose every three hours, and the medication has to be administered on time, so I go to her bedside next. I complete all the tasks on my check sheet. Unlike most other NICU patients, Olivia is a baby who needs all the cuddling she can get, and there is no family. I resolve to come back to her bedside when I have a little spare time to hold her and rock her.
9:30 a.m. – 10: a.m.:
In addition to the tasks I performed with Jennifer, I also need to check Jose’s NG tube placement and the patency of his IV. He appears to be breathing well, and I am pretty certain we’ll be able to wean him from his nasal cannula very soon, which means he’ll be able to begin eating by mouth. His parents can’t wait.
10:00 a.m. – 10:30 a.m.:
I begin my charting on all three patients. I record their vital signs, my assessments, the medications I administered, and the parent education. Some NICU nurses prefer to do their charting at the end of a shift, but I like to keep up with mine as I perform care because you never know what’s going to happen in a NICU.
10:30 a.m. – 11:00 a.m.:
The neonatologists and the neonatal nurse practitioners on call have finished their morning rounds. Jose’s primary NNP has a question for me: Do I think Jose will tolerate having his oxygen rate turned down? Yes! I tell her. One of the neonatologists also has a question about Olivia: Is it time to consider weaning her to a lower dose of methadone? No, I say. One of the reasons I enjoy working in the NICU is that the healthcare providers who write the orders really listen to what the nurses have to say.
11:00 a.m. – 11:30 a.m.:
I take my first break of the day. Some nurses actually work through their break periods, but I never do. I think self-care makes me a better nurse.
11:30 a.m. – 1:00 p.m.:
I begin the second round of feeding, assessing, changing diapers, and administering medications. I spend some extra time with Jose to assess how he’s doing on a smaller amount of oxygen. He’s tolerating it like a champ! During that time, I also do some teaching with Jose’s parents on what signs to look for that could indicate Jose is experiencing respiratory insufficiency since when he goes home, he won’t be discharged on a pulse oximeter.
1:00 p.m. – 1:30 p.m.:
Once again, I catch up on my charting.
1:30 p.m. – 2:00 p.m.:
Finally, I have some time to interact with little Olivia. She is a sweet little thing and has required more frequent diaper changes than any of my other patients today. Diarrhea is a rather common symptom in babies born with drug dependencies.
2:00 p.m. – 2:30 p.m.:
I assist in setting up an incubator and bedside for a possible new admission. Our hospital’s policy is to have a NICU nurse present at all high-risk births in case the infant needs to be admitted into the NICU, so the nurse who may be receiving the new admit isn’t available to set up. Fortunately, the birth went well and the baby’s Apgar scores
were high enough so that the baby will not need to be cared for in our Level III NICU.
2:30 p.m. – 4:00 p.m.:
Third round of feeding, administering medications etc. Jose’s NNP grills me about how he’s doing on the lesser amount of oxygen and tells me that she is thinking of weaning Jose off oxygen altogether tomorrow. “Can I tell Jose’s parents?” I ask. The NNP tells me I can, and it’s great to see how happy they are about this news.
4:00 p.m. – 4:30 p.m.:
I do my third round of charting.
4:30 p.m. – 5:00 p.m.:
I take my second lunch break.
5:00 p.m. – 6:30 p.m.:
My final round of feedings, meds, vital signs and diaper changes for the day. Today has been a relatively low-key day, and I am grateful for that. As an experienced NICU nurse, I’ve had many single-patient assignments where the patient has been ventilated and so ill that the day has been filled with IV lines, alarming monitors, and blood transfusions. I appreciate those days because they reaffirm my clinical expertise, but I also appreciate days like this when I have more time to interact with parents and babies.
6:30 p.m. – 7:30 p.m.:
I clean and organize my patients’ bedsides so that everything will be ready for the night shift as they come in. I give report to the night shift nurse, and then it’s time to go home.
MY FINAL THOUGHTS – IS BECOMING AN NICU NURSE WORTH IT?
This article has explored the role of the NICU nurse – what is it, steps-to-become, pros & cons, and salary—at great length. There’s no question that the job has much to recommend it: The salary is good, demand is high and it gives you the opportunity to utilize both your clinical competencies and your interpersonal skills in a way few other nursing jobs do. Is becoming a NICU nurse the right profession for you, though? Not every NICU patient lives happily ever after, and that can be extremely difficult to deal with. If you have the emotional resilience to accept both the highs and the lows, NICU nursing can be an excellent occupation.
FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT
1. Is NICU Nurse A Good Career Choice?
NICU nursing is a great career choice if you’re an emotionally resilient person. NICU nurses earn high salaries with excellent benefits; they’re in high demand; they have many opportunities for career advancement; and they’re relatively satisfied with their jobs. Mortality rates in the NICU are higher than they are in many other hospital units, though.
2. Is It Hard To Become A NICU Nurse?
Landing your first NICU job can be difficult because many employers are reluctant to hire new graduates or nurses who do not have previous NICU experience. Once you have some experience under your belt, however, you’ll never have any trouble finding employment.
3. Are NICU Nurses Happy With Their Jobs?NICU nurses are relatively happy with their jobs
. Much of their satisfaction comes from their level of autonomy, caring for patients under extremely stressful conditions and assuming an important role as part of a multi-disciplinary care team.
4. What Are The 4 Most Common Myths About NICU Nurses?
1. All NICU nurses are women. Not true! Eleven percent of NICU nurses are men, and that percentage grows every year.
2. NICU nurses spend their days changing diapers and giving babies bottles. Another misconception. NICUs are one of the most hectic units in any hospital, and NICUs routinely utilize cutting-edge technologies to treat their patients.
3. NICU nurses wish they’d gone to medical school. Not the case! Most NICU nurses choose their occupation because it’s a unique blend of technology and family-centered healthcare. Physicians rarely get the opportunity to develop relationships with patients’ families that are as close as the relationships NICU nurses develop.
4. NICU nurses are all “nice”. Most NICU nurses are nice. But they’re not treacly sweet. The amount of black humor that goes on behind the scenes would surprise you. This is true, by the way, not only of most NICU nurses but of most nurses and, in fact, of most individuals in front-line occupations. Humor is an effective means of dealing with stress.
5. What Is The Fastest Way To Become A NICU Nurse?
Because of the NICU nurse shortage, hospitals are hiring qualified new graduates to work in neonatal intensive care units. The most effective way to help ensure that you will be hired is to pursue a BSN rather than an ADN, and when it comes time to do your pediatric clinical rotation, see if your program will allow you to do the rotation in a NICU rather than on a pediatric ward.
If you aren’t able to get hired into a NICU as a new grad, take another job in that same hospital that will allow you to spend time caring for newborns and infants. These jobs include postpartum units where you’ll be able to work with healthy newborns and pediatric units. When you have a year of experience under your belt, reapply for a NICU job. Nurse managers generally prefer hiring internal candidates to external candidates, so your chances of being hired into the NICU will be good.
6. What Are The 3 Main Qualities Every NICU Nurse Should Possess?
Every NICU nurse should be emotionally resilient, pay attention to details and have the ability to think on their toes.
7. What Are The 3 Most Common Daily Duties And Responsibilities Of A NICU Nurse?
On a daily basis, NICU nurses must be able to perform and interpret clinical assessments, administer medications, and support and educate parents.
8. What Are The 3 Main Skills Required To Perform Your Duties As A NICU Nurse?
To carry out your responsibilities as a NICU nurse, you will need first-rate clinical competencies, a thorough knowledge of NICU protocols, and an appreciation of the principles of developmental care.
9. What Are The Top 3 Workplaces Where NICU Nurses Work?
NICU nurses primarily work in Level II, Level III, and Level IV neonatal intensive care units.
10. What Other Healthcare Professionals Does A NICU Nurse Work With?
NICU nurses routinely work with neonatologists, pediatricians, pediatric residents, neonatal nurse practitioners, social workers, lactation consultants, nutritionists, pediatric respiratory therapists, and other ancillary medical personnel.
11. How Many Hours A Week Does A NICU Nurse Work?
Most NICU nurses work three 12-hour shifts a week.
12. Do NICU Nurses Work On Holidays?
Yes, NICU nurses who work in hospitals are expected to work on holidays.
13. Is The Job Of A NICU Nurse Stressful?
A NICU nurse’s job can be extremely stressful at times.
14. Do I Need To Be Certified To Work As A NICU Nurse?
You don’t have to be certified to be a NICU nurse, but certification enhances your professional credibility and validates a higher level of clinical competence to your prospective employers.
15. What Is The Best Certification For A NICU Nurse?
The most useful certification for BSN-prepared NICU nurses is the Registered Nurse Certified - Neonatal Intensive Care Nursing (RNC-NIC) accreditation.
16. How Much Does A New NICU Nurse Make?
Entry-level NICU nurses earn $34.97 an hour, $6,060 a month or $72,730 a year.
17. On Average, How Much Does A NICU Nurse Make Per Hour?
The average NICU nurse salary per hour is $48.67.
18. On Average, How Much Does A NICU Nurse Make Per Week?
The average NICU nurse salary per week is $1,947.
19. On Average, How Much Does A NICU Nurse Make Per Month?
The average NICU nurse salary per month is $8,440.
20. On Average, How Much Does A NICU Nurse Make Per Year?
The average NICU nurse salary per year is $101,232.
21. Do NICU Nurses Make Good Money?
NICU nurses make excellent money. On average, NICU nurses make 74 percent more than the average salary for all occupations throughout the U.S.
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22. What State Pays The Highest Salary For NICU Nurses?
The highest-paid NICU nurses work in California. NICU nurses in the Golden State average $72.93 an hour, $12,640 a month, or $151,700 annually.
| California |
23. What Metro Pays The Highest Salary For NICU Nurses?
San Jose, California pays the highest salaries to its NICU nurses. In the Greater Metropolitan San Jose-Sunnyvale-Santa Clara Region, NICU nurses average $91.30 an hour, $15,830 a month, or $189,900 a year.
|San Jose-Sunnyvale-Santa Clara, CA|
24. Does A NICU Nurse Get Paid More Than Other Nurses?
Yes, NICU nurses get paid more than other nurses on average. The average annual salary of a nurse is $88,810; a NICU nurse’s average annual salary is 14 percent higher ($101,232.)
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25. Are NICU Nurses Satisfied With Their Salaries?
No studies specifically address NICU nurses’ satisfaction with their salaries, but according to the Nursing Salary Research Report released in 2018
by the online nursing resource nurse.com, 85 percent of all nurses are satisfied with their salaries—and there’s no reason to disbelieve that NICU nurses aren’t part of that 85 percent.
26. Are NICU Nurse Jobs Hard To Get?
NICU nurse jobs can be hard to get if you’re a new grad or an experienced nurse with no previous experience working in a NICU.
27. What Are The 5 Best Organizations/Companies In The Nation To Work For As A NICU Nurse?
The NICUs in these five hospitals are the best places for neonatal intensive care unit nurses to work:
1. Children’s National Hospital in Washington D.C.
2. Children’s Hospital Los Angeles
3. Lucile Packard Children’s Hospital Stanford in Palo Alto, California
4. UCSF Benioff Children’s Hospitals in San Francisco and Oakland, California
5. Rady Children’s Hospital in San Diego, California
28. Are There Any Travel Jobs For NICU Nurses?
Yes, there are many travel jobs for NICU nurses. To qualify for them, you’ll need at least one year of experience working in a neonatal intensive care setting. NICU travel agencies look favorably upon the following certifications: BLS, ACLS, PALS, NRP, RNC-NIC.
29. Are There Any Work From Home Jobs For NICU Nurses?
No, NICU nursing is a hands-on job. You cannot do it from home.
30. What Are Some Other Jobs Similar To A NICU Nurse?
Occupations that are similar to the NICU nurse job description include neonatal nurse practitioner, neonatal clinical nurse specialist, postpartum unit nurse, pediatric intensive care unit nurse, and neonatal transport nurse.
31. Can I Be A NICU Nurse As A New Grad?
New grads can become NICU nurses, but they will face greater challenges persuading employers to hire them.
32. What GPA Do I Need To Be A NICU Nurse?
Prospective employers do not typically ask to see your nursing school transcripts, so your GPA is irrelevant to the hiring process.
33. What Is The Difference Between NICU And PICU?
A neonatal intensive care unit (NICU) specializes in the care of critically ill newborns. A pediatric intensive care unit (PICU) specializes in the care of critically ill children from infancy through the end of adolescence. While PICU nurses work with young babies upon occasion, NICU nurses only work with babies. The majority of babies cared for in NICUs are premature infants.
34. What Is The Difference Between A NICU Nurse And A Neonatal Nurse?
The term “neonatal nurse” refers to a nurse who works with newborns, but the term “NICU nurse” refers to a nurse who works in the neonatal intensive care unit. All NICU nurses are neonatal nurses in other words, but not all neonatal nurses are NICU nurses. Many neonatal nurses are affiliated with hospital labor and delivery units where they help take care of healthy newborns in the first few hours after they are born.
35. What Is The Difference Between A NICU Nurse And A Neonatal Nurse Practitioner?
A neonatal nurse practitioner is an advanced practice registered nurse who has finished an MSN. A NICU nurse is a registered nurse who works in a neonatal intensive care unit.
36. How Many Patients Does A NICU Nurse Work With?
This depends upon patient acuity. If a patient is ventilated and on multiple IV drips and medications, the staffing ratio will typically be one-to-one. When patients are less acutely ill and are staying in the NICU primarily to gain weight, a NICU nurse may take care of three or even four patients.
37. How Hard Is The CCRN Neonatal Certification?
The CCRN is generally considered to be a difficult test. Of the 16,000 nurses who take it every year, only 79 percent pass
38. How Long Is The CCRN Neonatal Certification?
You will have three hours to complete the 175 multiple test questions on the CCRN Neonatal Certification exam.
39. How Much Does The CCRN Neonatal Certification Cost?
You will be charged a $50 non-refundable application fee and a $275 exam fee if you want to take the CCRN Neonatal Certification exam, so you will end up spending $325.
40. How Many Questions Should I Answer Correctly To Pass The CCRN Neonatal Certification?
The CCRN Neonatal Certification exam consists of 175 multiple choice questions, but only 150 of those questions are used to determine your test score. You will need to answer 70 percent of those questions correctly to pass the exam, which means you will have to answer 105 questions correctly.
41. How Hard Is The RNC-NIC Certification?
The RNC-NIC Certification is considered to be a difficult exam.
42. How Long Is The RNC-NIC Certification?
The RNC-NIC Certification exam lasts three hours.
43. How Much Does The RNC-NIC Certification Cost?
You will be charged a $50 non-refundable application fee and a $275 exam fee if you want to take the RNC-NIC Neonatal Certification exam, so you will end up spending $325.
44. How Many Questions Should I Answer Correctly To Pass The RNC-NIC Certification?
The RNC-NIC Certification exam has 175 questions, but only 150 of those are scored. You have to answer 70 percent of the scored questions correctly, which means you will have to answer 105 questions correctly.
45. What Are The Different Levels Of NICU Care?
NICU care consists of Level II, Level III and Level IV nurseries. Level I nurseries are typically affiliated with a hospital’s labor and delivery department.
46. Can NICU Nurses Deliver Babies?
No, NICU nurses cannot deliver babies.
47. Do NICU Nurses Perform Surgery?
No, NICU nurses do not perform surgery.
48. Do NICU Nurses Work Weekends?
Yes, NICU nurses must work weekends.
49. Do NICU Nurses Work Alone?
No, NICU nurses work as part of a well-integrated, multidisciplinary team.
50. Why Are NICU Nurses So Important?
NICU nurses are so important because they have the clinical skills necessary to care for medically fragile infants.
51. Why Are NICU Nurses Special?
NICU nurses are special because they combine excellent clinical competencies and exceptional interpersonal skills in equal measure.
52. How Many Days A Week Does A NICU Nurse Work?
NICU nurses typically work three 12-hour shifts a week.
53. Are NICU Nurses On Call?
NICU nurses are not typically on call.
54. How Long Are NICU Nurse Shifts?
NICU nurse shifts typically last 12 hours.
55. What Is It Like Working In A NICU Unit?
Working in a NICU unit can be both extremely stressful and incredibly rewarding.
56. Is NICU Considered ICU?
NICUs can be thought of as highly specialized intensive care units. But the term “ICU” is not generally used when the care of newborns is being referenced.
57. How Long Do Babies Stay In NICU?
The amount of time that babies stay in a NICU is highly variable. Most babies are discharged from the NICU in a matter of weeks, but there have been infants who’ve stayed in a NICU for as long as two years.
58. How Much Does A NICU Nurse Make With A Master’s Degree?
A NICU nurse with a Master’s degree can expect to earn $63.27 an hour, $10,970 a month, or $131,602 a year on average.
59. How Much Does A NICU Travel Nurse Make?
A NICU travel nurse can expect to make $55.97 an hour, $2,239 a week, $9,700 a month, or $116,420 a year on average.
|Annual||$116,420|Pattie Trumble, MPP, MPH
Pattie Trumble is a nurse who worked in both California and New York for many years as an emergency room nurse. She holds a Bachelor’s Degree in Economics from the University of California, Berkeley, and an Associate Degree in Nursing from the Samuel Merritt Hospital School of Nursing. After 10 years of providing direct care, she went back to school and earned concurrent Master’s degrees in both public policy and public health from the University of California, Berkeley. Thereafter, she worked for various public health agencies in California at both the community and state levels providing economic and legislative analysis.