Exploring the many roles of neonatal nursing


Neonatal nurses primarily work at hospitals. However, if you have neonatal nursing credentials, you qualify to work as a labor and delivery nurse, well baby nurse or at a pediatric office or hospital.

Many nurses work in neonatal units providing various levels of care depending on the exact needs of each infant.

A day for a neonatal nurse can vary quite a bit. During times when there are fewer infants in need of major care, a nurse may help out more in another area of maternity care, for example.

Neonatal intensive care unit levels 

As a nurse working in a NICU unit, you will help care for infants that vary a lot in their needs.

Level I

This level is for full-term infants just waiting to be taken home. They have no known health issues and are eating and responding to stimuli at an acceptable level. Many hospitals keep infants with their mothers in a mother-baby unit, but there may be times where they are taken to the nursery if the mother needs extra care or treatments.

Level II

A baby assigned Level II care is a full-term baby that has a minor illness or may have been born slightly premature. A baby born at 36 weeks, for example, may need some extra care but, otherwise, can be quite healthy. Slightly low glucose or oxygen levels are examples of level II concerns.

Level III

Babies requiring Level III care are typically very premature, have chronic health conditions or breathing issues. Level III means that a nurse must be attentive to the infant. 

Level IV

Infants requiring Level IV care are those born extremely prematurely or with major chronic conditions that require the highest level of care. Feeding tubes and supplemental oxygen are often required full-time.

Not all hospitals offer NICU units capable of all care levels. A smaller hospital may offer Levels I and II but have an agreement with a larger regional hospital to transfer infants that need Levels III and IV. 

Some women may choose to deliver at a larger hospital that offers all levels of care if they have experienced issues with past births or their physician is concerned about underlying health issues of the mother or child.

Rewarding way to advance your nursing career.

If you already have a bachelor’s degree and your RN certification, there may be a time when you want to earn a specialization. Working as a neonatal nurse is an incredibly rewarding experience. If you love working with younger patients and new parents, then this career choice could be exactly what you need.  Baylor University offers an excellent online degree program that can be completed while you maintain a nursing position at your current facility.

So what does a neonatal nurse practitioner do?

Neonatal nurses feed babies on a schedule

All infants require feeding on a schedule. The amount fed, how often, and the method will vary by infant. Neonatal nurses will be responsible for ensuring the correct formula, breast milk or other feeding formulations are used and that the infant is handling them well. Feedings may take up a large part of a shift depending on how many infants are in a neonatal unit and how the workload is being delegated.

Infant health assessments at every shift

At the beginning of their shift, neonatal nurses assess the health status of all the infants they are in charge of and conduct any necessary feedings. An assessment means looking at all the vital signs, coloring, respiratory rates, IV sites, etc.

Infant health assessments are very important because it is critical that any problems are found and addressed as quickly as possible. Accurate and regular assessments significantly reduce infant mortality and time spent in the NICU.

Emotional support and reassurance to parents

While neonatal nurses must provide constant monitoring and care of the infants they are in charge of, they also spend significant amounts of time answering parents’ concerns. This can mean talking in person, via phone or via video chats. 

A good bedside manner and the ability to empathize and offer strong emotional support is a requirement to be a good neonatal nurse. Parents with infants in intensive care are going through a very difficult time. It is incredibly hard for them not to be able to hold their child or care for them on their own.

While many infants go home with their families and lead entirely normal lives with no major ongoing issues, there are infants that are not so lucky. Helping families deal with the trauma of being told their infant will continue to have problems or worse is the most difficult part of being a NICU nurse.

Neonatal nurses often work 12-hour shifts

Neonatal nursing typically requires 12-hour shifts. This means you may be asked to work a shift where you work overnight. This should not be surprising since infants are born at all hours and require 24-hour care. If you have been working in medicine for even a short period of time, you have probably had to work some odd hours. When you’re a neonatal nurse, this may happen more often so you should plan for working nights at least sometimes. If you have children of your own, this may mean making special childcare arrangements.


Neonatal nurses provide services that save the lives of countless infants. Besides caring for infants, they provide emotional support for parents and extended family members. 

While positions in neonatal units may be harder to get due to so many medical professionals wanting to work with infants and families, with the right experience and training, it is a great career choice for experienced RNs that want to make a change or have always wanted to work in neonatal units.

Earning a degree online is a great way to get the necessary credentials to be a serious candidate for any neonatal nursing position.

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