After 40 long weeks, experiencing the birth of a healthy, full-term infant can be very exciting and overwhelming for expectant parents and families. Unfortunately, the outcomes in pregnancy are not always predictable, and newborns can come into the world prematurely or with ailments that require nursing care that is of a league of its own. Neonatal nursing is specific to the care of infants in the first 28 days of their life. The provision of nursing care is not limited to the physical care of frail infants, it often requires specialized understanding of the psychosocial and emotional needs of the family unit as a whole.
Advancement in medical technology and research over the past 50 years has allowed critically-ill newborns to survive the fight for their lives. This factor has attributed to the complexity of responsibilities involved in the modern day neonatal nurse’s scope of practice. Newborn infants that are premature (< 37 weeks gestation), have low birth weight, birth defects, heart trouble, lung problems, or other life-threatening conditions are cared for in neonatal intensive care units (NICUs). The neonatal RN uses the nursing process to formulate a plan of care for the neonate. Not only does the neonatal nurse work autonomously with the newborn, they also function as an integral part of an interdisciplinary team. This team of therapists, aides, physicians and other support staff work together to ensure the delivery of patient-center care for the neonate and families. Depending upon the severity of the neonates’ condition, care may be provided in lower acuity special care nurseries or in facilities of higher level of care known as Level III NICUs.
There are key requirements that every nurse (RN) should have when practicing in any area. RNs must have an active licensure in the state they opt to practice in. A RN license is obtained after an individual successfully completes an accredited nursing program. This program can be a two years Associate’s degree (AND) or a four year, Bachelor’s degree (BSN). Once the coursework is completed, the graduate may sit for the NCLEX-RN exam. Passing this exam is the first step in becoming an active RN.
In addition to their RN license, NICU nurses need BLS/CPR certification, PALS certification and other CEUs
Nurses who work in NICUs are required to have a current Basic Life Support (BLS)/CPR certification, Pediatric Advanced Life Support (PALS) certification, and meet other core competencies on an annual basis as required by their facility. Most specialty units require nurses to complete a minimum amount of Continuing Education Units (CEUs) in addition to that required by their state board of nursing. The never ending advancements in medicine means that staff must possess key clinical skills, but also participate in lifelong learning.
Other requirements that neonatal nurses may face include shift work, precepting, working weekend rotations, and taking mandatory call. The needs of the patients and unit must be covered, and these expectations can ensure the delivery of safe, quality patient care.
Neonatal nursing can be a very rewarding career, however, leveraging clinical knowledge with the heart’s compassion can be challenging. There is great satisfaction in knowing that what we do as nurses make a difference in the lives of others. Most neonatal nurses would agree there is no greater reward when they witness critically-ill children get better, or come to a more optimal level of wellness. Perhaps the most pronounced benefit of being a neonatal nurse is that through clinical care, the unintentional brokenness of maternal/fetal bonds can be restored or strengthened. Another advantage of being a neonatal nurse is the job security. The outlook for the nursing profession is promising. As new graduates move out of the bedside into specialty areas, experienced nurses can move into leadership or management roles. Neonatal nurses are in high demand because of the delicacy of the patients they are able to provide care for. Some nursing professionals are intimidated by the acuity of neonates and opt to leave that care “to the professionals”.
As with most professions, there are some negative factors that come with specializing in neonatal nursing. The most prominent would be the unending amount of pressure that is faced every day. The nurse is not only faced with burdens to be an expert in caring for a neonate, but also with meeting the needs of the anxious parents and families. Caring for critically-ill newborns require keen assessment skills and clinical knowledge. However, despite our efforts to never miss a beat, sometimes the outcomes of sick neonates are not controllable. Because all nurses are human, it can be disheartening to face these situations. Another challenging variable being a neonatal nurse is the physical demands the job requires. Sometimes the acuity of a sick baby means that the primary nurse or the whole team does not get a lunch or even a bathroom break. It is not uncommon to be on your feet all day, stooping over incubators and pushing and pulling equipment. Combine the physical demands with the emotional demands and this could be a specialty in nursing that calls for those who can practice proper self-care.
Neonatal nursing is a specialty within nursing that carries a stigma of respect and courage. Most nursing professionals appreciate that there are individuals who are brave enough to care for critically-ill, undersized and disadvantaged patients. The skills of neonatal nurses are very impressive in comparison to other nursing specialties. Even experienced trauma nurses or ICU nurses cringe at the thought of mastering I.V. insertion on the tiniest of veins. What sets neonatal nursing a part from other specialties is the depth of knowledge of anatomy & physiology. Not only does a neonatal nurse have to understand general principles of the human body, they also have to grasp the concept of how underdeveloped body systems effect disease processes and outcomes. The organs and systems of the neonate are not like those of term newborns, and this means a nurse must understand how these factors change simple nursing interventions like blood draws, oxygen administration and medication modalities. Neonatal nurses are often utilized in other areas if needed because of their skill sets. For example, if the census is low in the NICU, they may be able to float to Labor & Delivery or the regular newborn nursery. In times of a catastrophic community event, neonatal nurses can be utilized in the emergency room and trauma units. Neonatal nursing is vastly different from other specialties because of the versatility and demands.
Most nursing professionals appreciate that there are individuals who are brave enough to care for critically-ill, undersized and disadvantaged patients.
Nurses who practice in neonatal medicine have the opportunity to advance in education and careers paths. The American Nurse Credentialing Center (ANCC) offers specialty certifications in neonatal nursing. Nurses must work a number of clinical hours in the neonatal specialty before they can take a test to receive specialty certification. Once a nurse is certified in neonatal nursing there is often a merit increase and credibility associated with that nurse. Neonatal nurses may opt to further their education and become advanced practice registered nurses (APRNs). APRNs in NICUs are often specialists in the clinical setting and practice as educators, leaders, practitioners, and mentors. APRNs also can leverage their clinical experience in neonatal nursing within community and public health. This may allow the APRN to operate a women’s clinic, oversee postpartum and pregnancy programs that focus on the health of newborns.
So far, the information has obviously eluded that neonatal nursing can be a lucrative career path for nurses. The professional outlook for all RNs is predicted to grow by about 26% until at least 2020. The Centers for Disease Control and Prevention reports that one out of every eight babies born in the US is affected by prematurity, so there is no shortage of work for neonatal nurses.
Because of their ability to handle fragile newborns who are critically-ill, neonatal nurses are in high demand. More medical facilities across the nation operate children’s hospitals and house specialty practitioners. If a nurse is looking to have more flexibility in scheduling, higher pay, and enjoy other incentives, travel nursing may be a great option.
Travel nursing agencies can help place a nurse who meets requirements in various contract assignments across the nation. While landing a contract in a particular region, the nurse can also travel and actually enjoy life. Travel nurses who are specialized in neonatal nursing are generally expected to provide care wherever they are assigned and do not get a lengthy orientation. One must remember that contracts are usually placed in order to meet specific needs of a facility.
Whatever the case, neonatal nurses are in high demand. Whenever the supply of such caregivers dips below the demands patient care, assignments can be very attractive. The pay is more than fair, travel needs are taken care of, and housing stipends can be very beneficial. If nurses can learn to play their cards right, and find a reputable travel agency, the opportunities are endless and can pay off.
By Jennifer Petrea, RN
Jennifer Petrea is a Registered Nurse from Concord, with clinical experience that includes critical care, ER, trauma, hospice & palliative care and case management. Jennifer is currently pursuing a Master’s Degree in Nursing and certification as a Clinical Nurse Leader. Jennifer also works as a freelance writer for various medical, health and fitness projects.