The neonatal intensive care unit, often abbreviated “NICU”, is an acute care hospital unit that provides comprehensive care to newborns. A multidisciplinary team of doctors, nurse practitioners, nurses, and respiratory therapists work together to ensure positive outcomes for the infants in their care.
If you’re a nursing student or are a current RN looking to switch jobs, you may be wondering — What does a NICU nurse do, and what steps do I need to take to become a NICU RN? In this post, we provide an overview of the role, list key job duties of NICU nurses, and review the requirements necessary to get a job in the NICU.
What Is A NICU Nurse?
Newborns are vulnerable and sensitive to their new environment outside of the womb, no matter how healthy they are. These infants may require attention from specialized nurses who have the training, skills & expertise to improve their outcomes and help them live safely at home. Typically, this infant care is provided in a hospital by labor & delivery nurses (nurses who help during birth) and postpartum nurses (nurses who care for the baby and mother after birth).
However, some babies end up requiring additional care. Whether they’re born prematurely, experience birth trauma, are born with genetic diseases or become sick during the first few days of life, up to 10% of all hospital-born babies end up requiring care in a neonatal intensive care unit (NICU). This is where NICU nurses come in!
A NICU nurse is a provider who specializes in the care of neonates — the hospital term used to describe newborn babies. They provide comprehensive, 24/7 care and help the babies get to a place where their caregivers can take them home safely. Some NICU units provide newborn surgical care, while others may administer multiple IV medications and nutrition sources to help the infant grow and develop.
What Do the Different NICU Acuity Levels Mean?
Not all NICU units provide the same degree of care. In the US, hospitals use a 4 level system (with level I being the least acute, and level IV being the most advanced) to describe the complexity of their treatments and interventions. We outline these levels below:
LEVEL I - Also known as well-newborn nurseries, these units provide a basic level of newborn care to infants at low risk. They have the capabilities to perform neonatal resuscitation at every delivery and to evaluate and provide routine postnatal care of healthy newborn infants. In addition, they stabilize and care for near-term infants (35–37 weeks' gestation) who are stable and can stabilize newborn infants who are less than 35 weeks gestation until they can be transferred to a facility that’s able to provide specialized care.
LEVEL II - These special care nurseries treat infants who are moderately ill with conditions that are expected to resolve in days to weeks. These patients are at moderate risk of serious complications related to immaturity, illness, and/or their management. In general, care in this setting should be limited to newborn infants who are more than 32 weeks gestational age and weigh more than 1500 g at birth or who are recovering from serious illness that has already been treated in a level III (subspecialty) NICU. Level II units are differentiated into 2 categories, IIA and IIB, on the basis of their ability to provide assisted ventilation.
LEVEL IIA - These units do NOT have the capabilities to provide assisted ventilation except on an interim basis until the infant can be transferred to a higher-level facility.
LEVEL IIB - These units CAN provide mechanical ventilation for brief durations (less than 24 hours) or can provide continuous positive airway pressure (CPAP). They must have the equipment (eg, portable chest radiograph, blood gas laboratory) and personnel (physicians, specialized nurses, respiratory therapists, radiology technicians, and laboratory technicians) available 24/7 to provide ongoing care and to address emergencies.
LEVEL III - These NICU units are defined by having continuously available personnel and equipment to provide life support for as long as needed. Level III NICUs are differentiated by their ability to provide care to newborn infants with differing degrees of complexity and risk. Newborn infants with birth weight of more than 1000 g and gestational age of more than 28 weeks can be cared for in level III NICUs. These facilities have the capability to provide conventional mechanical ventilation for as long as needed but do not use more advanced respiratory support such as high-frequency ventilation. Other capabilities that may be available are minor surgical procedures such as central venous catheter placement or inguinal hernia repair.
LEVEL IV REGIONAL NICU - These are the most advanced NICUs, most of which are located in children’s hospitals or academic medical centers. These units perform complex procedures like ECMO catheterization and surgical repair of serious congenital cardiac malformations. These units staff a full range of health care providers, including pediatric subspecialists and specialized nurses. They also employ state-of-the-art equipment to care for their babies. Concentrating the care of infants with conditions that occur infrequently and require the highest level of intensive care allows these centers to develop the expertise needed to achieve optimal outcomes and avoids costly duplication of services in multiple institutions within close proximity.
What are the Most Common NICU Nurse Job Duties?
Each NICU will provide different treatments and interventions according to their acuity level. Despite the uniqueness of every unit, this list compiles some of the most frequently performed NICU RN job duties:
NICU Nurse Job Duties:
♡ Perform thorough physical assessments
♡ Collect and document infant vital signs
♡ Assist with diagnostic imaging (CXR, ECHO, MRI, etc.)
♡Initiate IVs
♡ Complete lab draws
♡ Assist during bedside procedures (intubations, extubations, bronchoscopies, central line placements, etc.)
♡ Manage central line care (sterile line changes, tube & cap changes, dressing changes, etc)
♡ Place feeding tubes (nasogastric and orogastric)
♡ Prepare infants for surgery
♡ Provide post-op care after surgery
♡ Tend to surgical sites (tracheostomy, ostomy, chest tube, incisions, etc)
♡ Administer medications (IV, IM, oral, rectal, buccal, etc)
♡ Collaborate with the multidisciplinary team to establish a plan of care
♡ Communicate changes in baby’s status in a timely and efficient manner
♡ Feed babies
♡ Bath babies
♡ Recommend support services (PT, OT, lactation consultant, etc.) when necessary
♡ Provide mothers with breastfeeding and pumping support
♡ Encourage patient and family centered care
♡ Educate and train parents on infant safety and newborn care guidelines
♡ Connect & provide resources for families looking for additional support
♡ Participate in NICU nursing research, evidence-based practice initiatives & quality improvement projects
♡ Precept new nurses
♡ Participate in hospital-wide collaborative teams and leadership groups
Each NICU department is different, providing its own level of care to the patients needing treatment. This makes pursuing a career in the specialty fresh, fun, and exciting. The NICU nurse job market can be competitive, but there are a few things you can do to make yourself a competitive candidate. Let’s start by answering a few frequently asked questions.
What Degree Do You Need To Become a NICU Nurse?
The minimum degree you’ll need to practice nursing in the United States is an associates degree in nursing (ADN). However, many facilities — including academic medical centers and large community hospitals — prefer or require a bachelors of science in nursing (BSN). If you’re looking to earn a spot in a competitive new graduate program, pursuing the BSN route will be your best option.
How Do You Get a Nursing License?
To get an RN license in the United States, you’ll need to graduate from an accredited nursing program, pass the NCLEX examination, and apply for a nursing license in the state you’re looking to work in. Bear in mind that some states have unique requirements for state licensure, like specific academic coursework or safety training.
Are there Any Certifications Required to Become a NICU Nurse?
The short answer is – no. Like most other nursing specialties, you’re qualified to work in the NICU as soon as you graduate nursing school and pass the NCLEX. Some facilities hire new graduates without previous experience!
However, once you have experience working at the bedside, earning a certification will certainly make you a more competitive and hireable candidate. Some hospitals will even pay you a shift differential or monthly bonus for holding a specialty certification.
The two most common NICU nursing certifications are the RNC-NIC and the CCRN (neonatal). You’ll be qualified to sit for each of these certification exams after getting a few years of experience in the field.
Take the First Step In Pursuing the Career of Your Dreams
If you’re a nursing student or recent graduate looking to start in the NICU, you have an exciting journey ahead! At NICUity, we’ve got you covered with a full array of NICU nurse educational materials to prepare you for the role and nursing merchandise to help you look the part! Visit us at www.nicuity.com to see all we have to offer — we can’t wait for you to begin!
Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN student, a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com
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