What is a Neonatal Nurse Practitioner?


Written By: Caitlin Goodwin MSN, CNM, RN

In the United States, a baby is born every 9 seconds (2018). Of the more than 3.7 million babies born, approximately 14.4 % required a stay in the Neonatal Intensive Care Unit (NICU). Who nurses our tiniest and most vulnerable little people? Professionals like neonatal nurse practitioners guide the care of the babies who need it the most.

Specifically, what is a neonatal nurse practitioner? A neonatal nurse practitioner is an advanced practice registered nurse who cares for newborn babies. Read on to learn all there is to know about what an NNP does and how to become one.


Formal Definition: What is a Neonatal Nurse Practitioner?


A neonatal nurse practitioner (NNP) is an RN with advanced training in neonatal care. The NNP will care for newborn babies who require acute care due to prematurity, infection, congenital defects, and organ malformations. A neonatal nurse practitioner will perform physical assessments, collect patient history, order lab and diagnostic tests, diagnose, and prescribe medications for babies.


What Does a Neonatal Nurse Practitioner Do?


Neonatal nurse practitioners typically care for babies for the first four weeks of life. However, NNPs care for these babies long past that time because many of these babies are sicker for more than a month. The average length of stay for all NICU babies is 13.2 days, and for babies born under 32 weeks, the average stay is 46.2 days. Thankfully, NNPs care for these critical infants between birth and hospital discharge.

Have you ever seen a newborn resuscitation? It may have been a Neonatal Nurse Practitioner managing a team of professionals to revive the infant. When a hospital calls a code pink, the NNP responds to the labor and delivery room with the code team. The code pink team adheres to the Neonatal Resuscitation Program (NRP)- an evidence-based approach. NNPs must be well-versed in facilitating NRP and confident in leading the team.

However, neonatal nurse practitioner duties don’t stop there. Neonatal nurse practitioners round on critical infants each day. NNPs often serve as the primary care provider for a newborn baby who is receiving critical care. Neonatal nurse practitioners place lines, manage newborn resuscitations, and perform consultations.


What is the Scope of Practice for Neonatal Nurse Practitioners?


The scope of the neonatal nurse practitioner role depends on the state in which the NNP is licensed. The specific scope will also vary related to the needs of each neonate. However, the Advanced Practice Registered Nurse (APRN) consensus model was created in 2008 with the goal of national acceptance by 2015. The overarching goal is that all nurse practitioners can practice to the full extent of their scope. The APRN consensus model aims to standardize the regulation of NPs across the country.


What is the Difference Between a Neonatal Nurse and a Neonatal Nurse Practitioner?


Both neonatal nurses and neonatal NPs care for newborns who are preterm or sick and require advanced care. Neonatal nurses are typically registered nurses (RNs) that implement orders from clinicians like neonatologists and neonatal nurse practitioners. An RN can get hired as a neonatal nurse without further schooling, while a neonatal nurse practitioner requires advanced training and a graduate degree.

But what is a neonatal nurse practitioner? An NNP is an RN and still possesses all of the skills of a neonatal nurse but has the autonomy and scope to practice independently and to order the necessary tests and medications for those newborns.

What are the Different Types of Neonatal Nurse Practitioner Sub-Specialties?


In the case of neonatal nurse practitioners, the population focus is neonatal. A neonatal nurse is a specialty of advanced practice nursing that performs care for newborn babies.

Neonatal nurse practitioners (NNP) work at different levels of nursery care.

• Level I is the traditional healthy newborn nursery that is pictured in most movies. However, the availability of level I nurseries is dwindling as most babies stay in the room with their mother.

• Level II nurseries care for premature babies from the 32nd to the 36th week. These nurseries also care for sicker term babies that need closer attention.

• Level III NICUs care for babies born at less than 32 weeks gestation as well as babies born with a critical illness, at all gestational ages. These NICUs offer readily available monitoring around the clock as well as immediate respiratory support and imaging. These babies may be on ventilators and in incubators.

• A Level IV NICU provides the highest level of acute care. The hospitals with a Level IV NICU can perform complex surgeries for both congenital and acquired disease. Level IV NICUs have a broad range of pediatric subspecialties and anesthesiologists on site. They often transport neonates from outside facilities and provide community outreach and education.

There are also two sub-specialty certification exams that an NNP may sit for:

Neonatal Pediatric Transport which is designated as C-NPT. This certification is for healthcare providers who stabilize and transport critically ill pediatric or neonatal patients across all settings.

Electronic Fetal Monitoring which is designated as C-EFM. This certification if for healthcare professionals who use electronic fetal monitoring and interpretation of the data obtained for obstetrical patients. NNPs are less likely to need this certification than other specialties.


What Education is Required to Become a Neonatal Nurse Practitioner?


There are many different options to pursue to become a neonatal nurse practitioner.

The first step is to go to school to become a registered nurse.

• The Associate Degree of Nursing (ADN) or Associate of Science of Nursing (ASN) program typically takes about two years to obtain the education required to sit for your Registered Nursing licensure. However, the length of time can vary depending on what prerequisite courses that you have completed. Many programs have extensive waitlists, which is important to take into account when choosing your path. After completing your ADN or ASN program, you will sit for your registered nursing license and may be able to apply to an RN to MSN nurse practitioner program.

• The Traditional BSN program typically takes four years, although some complete it in less time. Traditional BSN programs are set up differently. Some take prerequisites for nursing and the sciences for the first two years, with the final two being strictly nursing clinical experiences. Others integrate nursing clinical throughout the entire program.

To become a nurse practitioner, you need to have an active, unencumbered RN license. In the 1980s, neonatal nurse practitioners began to graduate with a Master of Science of Nursing degree but there was no consensus on what the education or clinical practicum included (source). Now, the entry-level neonatal nurse practitioner degree requires a graduate degree, typically a Master of Science in Nursing. If you are an RN looking to further your education, there are many prerequisites for admission to nurse practitioner school.

• The RN to MSN Nurse Practitioner Program is designed for RNs with an associate's degree in nursing (ADN). These programs are usually harder to find than BSN to MSN NP programs; however, there are still many programs available.

• The Traditional Nurse Practitioner Program is two to three years and is completed following sitting for your RN license and Baccalaureate degree.

• The Direct Entry MSN Nurse Practitioner Program is for students who have a bachelor's degree in a non-nursing field and want to obtain an MSN to become a nurse practitioner.

Some programs even offer the opportunity to continue directly past your nurse practitioner and graduate degree to obtain your Doctorate of Nursing Practice (DNP).


How Long do You Have to go to School to be a Neonatal Nurse Practitioner?


When you are looking into neonatal nurse practitioner schooling, be sure that you take into account timelines. Some people want to get it done as quickly as possible and enter into their dream career. However, If you have a non-nursing Bachelor’s degree, there are two quick ways to become a nurse practitioner.

Program Type Pathway Full-Time Part-Time
MSN RN to MSN 30 to 36 months 36 to 48 months
BSN to MSN 15 to 24 months 24 to 48 months
Direct Entry MSN 20 to 24 months 24 to 48 months
DNP BSN to DNP 3 to 4 years 4 to 7 years
MSN to DNP 2 years 2 to 4 years
Certificate Post-Master's Certificate 12 to 16 months 16 to 24 months


How Much Does Schooling Cost to Become a Neonatal Nurse Practitioner?


The tuition for nurse practitioner programs ranges depending on the type of program that you are considering. An RN to MSN or Direct Entry MSN program are typically more expensive than a BSN to MSN. For example, an elite Ivy League private college will cause significantly more than a state college.

On the flip side, taking an associate’s degree program at a community college, finishing your BSN for a low cost through your hospital’s tuition reimbursement program, and finishing your MSN at a state school will save you money.

Program Type Pathway Tuition Ranges
MSN RN to MSN $22,070 - $231,600
BSN to MSN $18,810 - $185,280
Direct Entry MSN $22,570 - $222,340
DNP BSN to DNP $26,490 - $254,260
MSN to DNP $17,660 - $169,510
Certificate Post-Master's Certificate $9,710 - $83,690


How to Obtain Certification and Licensure?


The American Academy of Pediatrics issued a statement of support for the role of the NNP back in 1982 and recognized the scope of advanced neonatal nursing practice. National neonatal nurse practitioner certification began shortly after this endorsement in 1983. Initially, the NAACOG Certification Corporation certified qualified NNPs.

After graduating from an accredited neonatal nurse practitioner program, the candidate tests through the National Certification Corporation (NCC) for Obstetrics, Gynecologic, and Neonatal Nursing Specialties. The neonatal nurse practitioner test is a computer-based test and upon completion, the candidate learns if they have passed or not.

After achieving certification through the national certification board, they must then apply through their state. Typically, the NNP will apply through the state board of nursing. The candidate will need to maintain their active, unencumbered RN license to remain an NNP. The certification of board-certified neonatal nurse practitioners is NNP-BC.


Neonatal Nurse Practitioner Residency and Fellowship Programs


A neonatal nurse practitioner residency or fellowship program is typically based in a tertiary level III or IV Neonatal Intensive Care department at a major health system. The program typically lasts one year and has rigorous application criteria where few NNP fellows are accepted. The goal of the program is to further one’s neonatal experience and clinical skills to thrive in a fast-paced NICU setting for a smooth transition alongside neonatalogists and neonatal nurses.


Where do They Work?


Neonatal nurse practitioners make a difference in the lives of newborns and their families everywhere they work. NNPs typically work in the following settings:

• Neonatal Intensive Care Units (NICU)
• Hospital nurseries
• Children’s hospitals
• Labor and delivery rooms
• Clinics for consultations
• Community education or outreach


Working Conditions


Neonatal nurse practitioners have a high-pressure job. With vulnerable babies come frightened parents, resulting in a lot of stress and anxiety. NNPs make split-second decisions when communicating with a team influences neonatal outcomes. The NNP works with newborn patients, doctors, family members, nurses, and hospital technicians to ensure quality care.


Work Hours


Because babies need essential health care 24 hours a day, neonatal nurse practitioners work around the clock too. A neonatal nurse practitioner works evenings, overnight, and weekends. An NNP will typically work set hours and may occasionally take on-call time. However, they typically have a schedule with personal input. While work-life balance may not be as ideal as some other nurse practitioner positions, caring for such a vulnerable patient population may help with that. According to Payscale, neonatal nurse practitioners quote a 3.9 out of 5 for job satisfaction.


Starting Salary of a Neonatal Nurse Practitioner


The starting salary of a neonatal nurse practitioner may only be slightly more than that of an experienced neonatal nurse. A starting salary of a NP can range dramatically depending on one’s location, company size, skills, and additional certifications. However, as neonatal nurse practitioners become more experienced, the salary increases exponentially.

The hourly rate of a starting NNP is $41.75, the monthly rate is $7,240, and the annual pay is $86,830. An NNP may also receive additional benefits like continuing medical education, licensure reimbursement, and tuition benefits.

Hourly Monthly Annual
$41.75 $7,240 $86,830


Average Annual Neonatal Nurse Practitioner Salary


Neonatal nurse practitioners make a significant amount of money. Taking on the challenge of returning to school to pursue a graduate nursing degree is a large undertaking. Becoming a neonatal nurse practitioner also means taking on more responsibility and liability, but the wage increases accordingly. The average hourly rate of an NNP is $57.35, the monthly average pay is $9,940, and the annual salary is $119, 290.

Hourly Monthly Annual
$57.35 $9,940 $119,290


Annual Salary By Level of Experience


With experience comes tremendous skill and value. Neonatal nurse practitioners are paid according to their experience. After twenty years in the field, a neonatal nurse practitioner can make nearly twice a new provider’s starting salary at more than $150,000.

Type Hourly Monthly Annual
Starting (Entry-Level) $41.75 $7,240 $86,830
1-4 Years of Experience $47.58 $8,250 $98,970
5-9 Years of Experience $56.31 $9,760 $117,130
10-19 Years of Experience $65.14 $11,290 $135,490
20 Years or More Experience $78.02 $13,520 $162,290


Which State Pays Neonatal Nurse Practitioners the Most?


California currently employs at least 13,900 nurse practitioners and the average salary of a neonatal NP is close to $150,000. Unfortunately, California’s cost of living is third in the United States, only surpassed by Hawaii and the District of Columbia. While the pay in California is extraordinary, the cost of housing may quickly eliminate any benefit to the increased salary.

California
Hourly Monthly Annual
$71.10 $12,320 $147,895


Salary by State


With the cost of living varying so much across the country, some of these salaries wind up being more attractive than an NNP salary in California. For example, Iowa and Ohio have a low cost of living and better housing affordability than most other states. Even if the NNP salaries in Ohio and Iowa are similar to most states, you will get more bang for your buck elsewhere.

State Hourly Monthly Annual Salary Range
Alabama $51.06 $8,850 $106,201 $76,430 - $137,880
Alaska $59.43 $10,300 $123,608 $65,630 - $176,710
Arizona $57.17 $9,910 $118,905 $69,930 - $165,690
Arkansas $54.27 $9,410 $112,889 $88,360 - $140,870
California $71.10 $12,320 $147,895 $111,880 - $202,600
Colorado $54.75 $9,490 $113,870 $77,740 - $150,380
Connecticut $59.04 $10,230 $122,808 $82,980 - $169,220
Delaware $57.65 $9,990 $119,918 $89,320 - $158,210
District of Columbia $57.41 $9,950 $119,406 $93,080 - $152,170
Florida $52.05 $9,020 $108,271 $66,400 - $140,450
Georgia $54.19 $9,390 $112,708 $81,500 - $149,990
Hawaii $63.59 $11,020 $132,258 $80,310 - $175,900
Idaho $56.85 $9,850 $118,243 $48,800 - $169,220
Illinois $55.31 $9,590 $115,043 $84,200 - $148,810
Indiana $54.55 $9,460 $113,465 $88,720 - $140,780
Iowa $56.36 $9,770 $117,230 $90,170 - $149,670
Kansas $51.56 $8,940 $107,247 $67,910 - $137,520
Kentucky $51.05 $8,850 $106,191 $73,070 - $142,510
Louisiana $54.48 $9,440 $113,316 $71,300 - $161,770
Maine $54.85 $9,510 $114,084 $87,550 - $140,500
Maryland $57.33 $9,940 $119,246 $86,620 - $162,650
Massachusetts $62.68 $10,870 $130,381 $95,650 - $174,310
Michigan $55.72 $9,660 $115,897 $90,190 - $142,330
Minnesota $63.00 $10,920 $131,032 $97,990 - $165,330
Mississippi $56.79 $9,840 $118,115 $83,240 - $164,520
Missouri $53.87 $9,340 $112,046 $87,070 - $141,400
Montana $55.96 $9,700 $116,387 $89,670 - $144,280
Nebraska $54.07 $9,370 $112,473 $88,490 - $140,820
Nevada $59.47 $10,310 $123,694 $92,240 - $163,040
New Hampshire $56.76 $9,840 $118,051 $87,790 - $152,270
New Jersey $63.49 $11,000 $132,056 $98,960 - $168,740
New Mexico $57.40 $9,950 $119,385 $89,880 - $157,230
New York $62.84 $10,890 $130,712 $91,220 - $173,280
North Carolina $54.30 $9,410 $112,942 $88,590 - $144,990
North Dakota $56.89 $9,860 $118,339 $89,800 - $151,660
Ohio $53.22 $9,220 $110,692 $86,160 - $142,580
Oklahoma $58.05 $10,060 $120,739 $90,660 - $162,930
Oregon $58.17 $10,080 $120,984 $90,040 - $163,150
Pennsylvania $52.28 $9,060 $108,740 $77,800 - $137,860
Rhode Island $59.13 $10,250 $122,990 $94,900 - $157,630
South Carolina $51.63 $8,950 $107,385 $86,200 - $136,020
South Dakota $52.42 $9,090 $109,039 $86,310 - $137,150
Tennessee $49.49 $8,580 $102,938 $66,020 - $137,020
Texas $59.20 $10,260 $123,128 $90,480 - $167,750
Utah $53.97 $9,350 $112,249 $74,630 - $152,900
Vermont $54.27 $9,410 $112,889 $86,740 - $152,370
Virginia $55.95 $9,700 $116,377 $88,310 - $150,040
Washington $65.08 $11,280 $135,373 $92,390 - $172,350
West Virginia $52.90 $9,170 $110,041 $82,730 - $141,920
Wisconsin $57.50 $9,970 $119,598 $94,350 - $142,980
Wyoming $60.57 $10,500 $125,976 $90,630 - $170,690


Job Outlook


According to the 2016 Neonatal Nurse Practitioner Workplace Survey, there are 205,000 nurse practitioners across the country and 5433 are neonatal nurse practitioners. This means that neonatal nurse practitioners already make up nearly 3% of all nurse practitioners. With the need for nurse practitioners projected to grow by a whopping 26%, it is the perfect time to become a Neonatal Nurse Practitioner.

Professional Organizations and Associations


National Association of Neonatal Nurses

The National Association of Neonatal Nurses (NANN) is an organization that represents the nursing professionals who care for neonates who are born with health issues such as prematurity, congenital deficits, cardiac malformations, and infection or sepsis. NANN was started in California back in 1984 to represent the expert voice promoting evidence-based care to high-risk newborn patients. NANN was established o further elevate the practice of neonatal nurse practitioners and touted the positive results related to NNPs. There are currently more than 7,000 members.

The NANN promotes education for neonatal nurses to advance the profession by way of advocacy, collaboration, and to improve neonatal care. The National Association of Neonatal Nurses influences the neonatal nursing community’s “standards of practice through advocacy, education, networking, collaboration, and leadership.” The NANN also presents annual conferences where neonatal nursing professionals stay abreast of the most recent research.

National Association of Neonatal Nurse Practitioners

The National Association of Neonatal Nurse Practitioners (NANNP) was established in 2007 and is the unified voice of NNPs and neonatal clinical nurse specialists (CNSs). The overarching goal of NANNP is to address the unique practice issues in the neonatal advanced practice nursing profession. The NANNP publishes journals and other publications for neonatal APRNs. The National Association of Neonatal Nurse Practitioners is committed to leadership, expertise, and community. NANNP is an extension of NANN- in order to join NANNP, you must first be a member of NANN.


Conclusion


Approximately 40,000 low-birth-weight infants are born each year in the U.S. With significant medical advances and qualified clinicians, survival rates are ten times higher than they were 15 years ago. The next time that you’re asked, “what is a neonatal nurse practitioner?” make sure to describe all the ways that NNPs prepare for and have a crucial role in caring for these infants.


Caitlin Goodwin MSN, CNM, RN
Caitlin Goodwin is a Certified Nurse-Midwife who has been a nurse for 12 years, primarily in women’s health. She is passionate about caring for children with developmental disabilities, as her son has Autism Spectrum Disorder. Caitlin loved working as a camp nurse for a summer camp for those with special needs