Neonatal nursing

Neonatal nursing is a nursing subspecialty that concentrates on newborn conditions and diseases that develop within the first month of birth, such as prematurity, infections, birth defects, congenital heart defects and other cardiac deformities, and surgical complications. Some infants require long-term neonatal care for premature birth conditions or illnesses acquired after birth. Neonatal nursing focuses on infants during the first 28 days of life, although some infants may continue to receive specialized pediatric care until discharge or beyond. Most neonatal nurses care for certain patients from the time of birth until discharge time. Within the last fifteen years, significant medical innovations have aided physicians and nurses in raising the survival rates of neonatal patients.

Neonatal nursing takes place in a medical setting, often in a level II nursery with moderately ill or recuperating patients, or in a level III nursery with infants in more critical states. Neonatal nurses generally supervise up to four infants at a time, depending on the nursery’s specific occupancy rates and medical care requirements. Nurses are expected to work for twelve-hour shifts, including weekends and holidays, though many neonatal care units only require eight- or ten-hour shifts with more flexible alternatives. Neonatal nurses can also be assigned to community care facilities to offer home care or visits to more high-risk infants.

Background

Neonatal nursing concentrates on the care of newborn infants who are born prematurely, have certain illnesses at birth, or have developed conditions within the first month of life. It is a comparatively new subspecialty in comparison to adult health, midwifery, and other nursing subspecialties. Neonatal nurses (registered nurses, or RNs) and neonatal nurse practitioners (NNPs) can be employed in clinics, community-based healthcare settings, hospitals, or neonatal intensive care units (NICUs). RNs, NNPs, parents, patients, neonatologists, and other nursing specialists work together closely as a team to attain the most holistic, positive health results for infants.

An entry-level neonatal nurse in the United States must be an RN, have completed a four-year bachelor of science in nursing (BSN) degree (although not universally mandatory), and have a certification from the neonatal resuscitation program (although often obtained during the induction and not necessarily a prerequisite). Certain hospitals require entry-level neonatal nurses to fulfill a minimum number of years of clinical experience as part of the job requirements. On the other hand, NNPs must have received a master of science in nursing (MSN) degree, with some programs now requiring or preferring a Doctor of Nursing Practice (DNP) specializing in neonatology, in conjunction with an advanced practice registered nurse (APRN) or clinical nurse specialist (CNS) license. Usually, admission to these programs requires at least 1–2 years of experience as an RN in a high-acuity NICU. All neonatal nurses must be certified by their respective state nursing boards, with NNPs additionally requiring certification from a national agency, such as the Neonatal Nurse Practitioner Board Certification (NNP-BC) through the National Certification Corporation.

Neonatal nurses may work in Level I well-newborn nurseries and in Level II, III, or IV neonatal care units, depending on patient needs and the facility’s capabilities. Level I nurseries are designated for healthy infants and require minimal nursing care, given that mothers and infants tend to stay in the same room and are only in the hospital for a few days. Level II or intermediate care nursing focuses on premature and ill infants who require continuous care and assistance such as auxiliary oxygen sources, intravenous therapy, and specialized feeding. Level III neonatal nurses work with infants who have more serious illnesses and are placed in the NICU within the first twenty-eight days after birth. Level III units are closely attached to surgical units and are part of large general hospitals or children’s hospitals. Level III neonatal nurses must constantly supervise infants’ ventilators and incubators, as well as educate parents and family members regarding an infant’s health and care requirements. Level IV units provide the highest level of neonatal care, including complex surgical interventions.

Impact

Neonatal nursing is continuously expanding to recruit staff with qualifications in working with medications, math calculations, intravenous lines insertions, cardiopulmonary resuscitation (CPR), first aid, and other necessary medical knowledge. Carole Kenner pointed out in a 2015 article for Newborn and Infant Nursing Review that it is challenging but important to accurately measure the number of working neonatal nurses because sufficient levels of trained neonatal nursing staff are linked to positive patient outcomes. A few workforce projections based on 2023–24 data indicate ongoing regional nurse shortages in the United States, including a projected national shortfall of approximately 100,000 registered nurses by 2038. The COVID-19 pandemic brought the shortage to the forefront of society as many struggled to receive care, and medical professionals confessed to burnout. Estimates of nurse density in the United States vary, with international datasets from 2022 reporting approximately 11–12 nurses per 1,000 people.

Groups such as the AACN, American Nurses Association, the American Hospital Association, and the American Organization for Nursing Leadership (AONL) are developing new approaches in recruiting and retaining neonatal nurses. Some organizations have articulated the requirement for more nursing staff to attract potential specialists, with the emphasis on increasing employee benefits, whereas, in the past, rewards were primarily given for taking on overtime or additional shifts.

Society’s requirements for nurses have changed over time, thus requiring continual education and interventions. Neonatal nursing, like other nursing subspecialties, has a global impact given that healthcare is a worldwide concern. Neonatal nursing aims to provide dedicated specialists and medical innovations to deliver the best healthcare available for newborn babies.

Bibliography

“The Doctor of Nursing Practice (DNP).” American Association of Colleges of Nursing, www.aacnnursing.org/DNP. Accessed 20 Mar. 2026.

Hoover, Makinizi et al. “Data Deep Dive: A National Nursing Crisis.” U.S. Chamber of Commerce, 29 Jan. 2024, www.uschamber.com/workforce/nursing-workforce-data-center-a-national-nursing-crisis. Accessed 20 Mar. 2026.

“How to Become a Neonatal Nurse Practitioner.” AllNursingSchools, 2018, www.allnursingschools.com/articles/neonatal-nursing/. Accessed 20 Mar. 2026.

“Is a Career in Neonatal Nursing Right for You?” National Association of Neonatal Nurses, nann.org/professional-development/what-is-neonatal-nursing. Accessed 20 Mar. 2026.

Kenner, Carole. “Neonatal Nursing Workforce: A Global Challenge and Opportunity.” Newborn and Infant Nursing Reviews, vol. 15, no. 4, 2015, pp. 165–66.

Lake, Eileen, et al. “Improving the Lives of Fragile Newborns: What Does Nursing Have to Offer?” LDI Issue Brief, vol. 20, no. 1, 2016, pp. 1–4.

“Neonatal Nurse.” Nurses for a Healthier Tomorrow, www.nursesource.org/neonatal.html. Accessed 20 Mar. 2026.

“Newborn Health.” World Health Organization, www.who.int/health-topics/newborn-health. Accessed 20 Mar. 2026.

“Nurses and Midwives (per 1,000 People) – United States.” World Bank, data.worldbank.org/indicator/SH.MED.NUMW.P3. Accessed 20 Mar. 2026.

“Nurse Workforce Projections, 2023–2038.” Health Resources and Services Administration, Dec. 2025, bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nursing-projections-factsheet.pdf. Accessed 20 Mar. 2026.

Rogowski, J. A., et al. “Nurse Staffing and NICU Infection Rates.” JAMA Pediatrics, vol. 167, no. 5, 2013, pp. 444–50.

Stark, Ann R., et al. “Standards for Levels of Neonatal Care: II, III, and IV.” Pediatrics, vol. 151, no. 6, 2023, e2023061957. doi:10.1542/peds.2023-061957. Accessed 20 Mar. 2026.