11 Hot Tips to Become a NICU Nurse
Updated: May 13
How to Become a NICU Nurse (Neonatal Nurse)
Hi! My name is Tori Meskin BSN RNC-NIC. I have been a bedside NICU nurse for 8 years. Prior to writing this blog, I did A LOT of research. I have worked in Level III-IV NICUs in Children's hospitals, University hospitals, community settings etc. I have also been staff, travel nurse; worked days & nights, full-time & per diem positions within the NICU. And I love it. Yet, we are in crazy times, therefore landing your job right now can be nerving. After looking online for some insight I discovered A TON of DATED, and frankly INCORRECT blogs speaking on this manner. So, I thought I would set the story straight for you!
Let's start at the NICU Nurse beginning:
Newborns (preemies, neonates, well baby, etc) are a very sensitive no matter how healthy they are. Babies require attention from a specialized nurses who has the training, skills & experience to take care of them. Often times these are Labor & Delivery Nurses (who birth the babies) and then Postpartum Nurses (who care for baby & mother after birth).
However, some babies are born premature, experience birth trauma, born unhealthy & become critically ill. Some babies suffer from various congenital diseases or other conditions requiring surgical repair& are taken to the special Neonatal Intensive Care Unit (NICU). This is where NICU nurses come in. A NICU nurse is a nurse who specializes in the care of the neonate and helps these babies on their path to recovery by giving them all the care they require.
Lets Get Specific ~ NICU Style
NICU Nurses is are Registered Nurses (RN) who work in a Neonatal Intensive Care Unit (NICU) and assesses, monitors, and cares for medically fragile newborns. In addition to caring for premature newborns, NICU nurses may care for medically complex infants up to one year of age in some facilities. Like other critical care areas of nursing, this area is highly specialized, fast paced, and stressful. This specialty is notoriously difficult to break into, but there are ways to become a prepared and competitive NICU job candidate.
NICU Nurse Basics:
What NICU Nurses do: Neonatal nurses focus on the care of newborn infants (preemies, neonates, congenital anomaly diagnosis). We provide focused care for premature or ill newborns, or work exclusively with ill newborns in a neonatal intensive care unit (NICU).
Degree: Minimum degree you’ll need to practice: ADN (Associates Degree in Nursing) or Bachelor of Science in Nursing (BSN). A word about this. Bachelors (BSN) Degree is becoming preferred, and honestly at this point in 2020, the minimum expectation for New Grad Nurse Residency/Versant Programs nation wide.
Licensure: You must pass your State Board of Nursing or receive national certification from an agency such as the National Certification Corporation.
Monitoring vital signs (Heart rate, temperature, respirations, blood pressure, pain) using the high-tech machines found in most intensive care units for newborns. Charing and recording hourly changes and most relevant medical needs with the team.
Provide scheduled feedings via oral, NGT, G-Tube, or IV (TPN and IL) Despite ill states, neonates require vital nutrients and fluids to survive, and this is our responsibility.
Assess cardiac, respiratory, GI/GU, skin, labs, vital signs, closely. Lungs are the last organ to develop, and therefore, respiratory is often a high priority.
Administer medications (IV, Oral, IM, NGT or OGT, G-tube) to the newborn as directed by the medical team (MD, NP, DO, etc). In this role an NICU nurses need to be very diligent due to the sensitive nature of our patient gestation, size, sensitivity. No room for error here.
Care times include: temperature taking, diaper changes, comfort, containment, assessment, feedings, medication administration, linen changes, various tube and line assessments, all while maintaining appropriate developmental needs.
Neonatal Nurse Specialty Career Overview
Neonatal nurses (RNs) & Neonatal Nurse Practitioners (NNPs) mainly work in hospitals & the acute care settings. Some may work in clinics or community-based settings. NICU nurses may become managers, educators, conduct research, act as consultants, work in follow up clinics, provide education to staff & family members etc. This nursing career requires a high level of diligence & teamwork. You will work closely with parents, neonatologists, respiratory therapists, OTs/PTs, pharmacists & other specialists to achieve optimal results for your tiny patients.
There are four levels of Neonatal facility designated care:
LEVEL I - (Well-newborn nurseries) 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 can stabilize and care for near-term infants (35–37 weeks' gestation) who remain physiologically stable and can stabilize newborn infants who are less than 35 weeks' gestation or ill until they can be transferred to a facility at which specialty neonatal care is provided.
LEVEL II - (specialty) special care nurseries can provide care to infants who are moderately ill with problems that are expected to resolve rapidly. 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 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 - Nurseries 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 nurseries can provide mechanical ventilation for brief durations (less than 24 hours) or continuous positive airway pressure. They must have equipment (eg, portable chest radiograph, blood gas laboratory) and personnel (eg, physician, specialized nurses, respiratory therapists, radiology technicians, and laboratory technicians) continuously available to provide ongoing care as well as to address emergencies.
LEVEL III (subspecialty) NICUs are defined by having continuously available personnel (Neonatologists, Neonatal Nurses, Respiratory Therapists) 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 IIIA 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 placement of a central venous catheter or inguinal hernia repair.
LEVEL IV REGIONAL NICU - The most advanced level which may be located at Children's hospitals, have additional capabilities within the institution, including ECMO and surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass. This nursery has a full range of health care providers, including pediatric subspecialists, specialized nurses and equipment to care for very sick babies. Concentrating the care of infants with conditions that occur infrequently and require the highest level of intensive care at designated level III centers allows these centers to develop the expertise needed to achieve optimal outcomes and avoids costly duplication of services in multiple institutions within close proximity.
New Grad Nurses
New graduate nurses and even experienced nurses may have a difficult time obtaining a job in this area. A few nursing schools do offer senior semester practicums in a well baby nursery or a NICU that can give new graduates a competitive edge. But many (like myself, do not have that luxury). Nursing students should also know that many nursing instructors will advise students to work as a medical surgical nurse before specializing in any area. This is NOT necessary and quite honestly a dated opinion. While a few basic skills learned from medical surgical nursing are applicable to the NICU population, this is one of the rare areas that is so highly specialized that NICU job candidates may not be judged by their lack of medical surgical experience.
Projection for NICU Jobs
Experts expect that resident nursing positions will grow over the next decade:The Bureau of Labor Statistics projects that positions for RNs will increase by 15% between 2016 and 2026. With the steady increase in infants admitted to neonatal ICUs, the demand for NICU nurses and new NICU facilities will continue to rise alongside.
Important NICU Nurse Traits
Critical thinking: Critical thinking is ESSENTIAL. This trait is crucial as it will help you to assess, communicate, react quickly to rapidly changing situations. Information you gather as a nurse includes vital signs, changes in assessment, lab values, diagnostic imaging, and helps you as the nurse to know when the situation is deteriorating.
Stability: No lie, this can be an emotionally taxing job. As the caregiver, we come across many heartbreaking situations (babies born too early, congenital anomalies, drug abusing mothers, absentee parents, uneducated parents, deadly diseases, etc). which can be in the form of continued suffering of the baby and or severe emergency trauma situations. Working with the most vulnerable / innocent patient populations can be beyond stressful and you need to have the ability to work in stress. Emotional stability will help you, as the nurse, offer support to the affected family and most importantly remain focused on helping the newborns. Yes, I have cried in closets and utility rooms and with my co-workers. This is normal well. But overall, stability is important.
Caring: You have to have compassion to care for these tiny fighters. Many parents can not be at the bedside, therefore, much of the care and interaction is with us, the nursing staff! This is one of the most unique and special parts of our job. Whether it is holding them a little longer after a feed, teaching parents to bathe baby for the first time, calming a stressed infant post surgical repair, we have the power to heal with our caring.
Communication: When working in this area of specialization you will be the intermediary between parents, doctors, speciality teams, respiratory therapists, OT/PT, etc. Get used to being the middle man! You will also be tasked with monitoring the infant and provide all the information to other medical professionals that are also giving care to the baby. And due to this, it is imperative to have excellent communication skills to be effective in the job.
Sense of Humor: Yes, you need one of these. This is what gets us through!
How to Become NICU Nurse
Every employer is different. Every manager and recruiter is different. They will dictate the level of qualification that they will require for you to join their neonatal intensive care unit. Whereas some hospitals are very strict with their level of experience, some are more relaxed and would prefer to offer you most of the training that is required once they employ you. The qualifications may also differ from one state to the other due to the difference in bylaws and state government policies. How in most geographical locations and hospitals you have to fulfill the following conditions to become an NICU nurse.
A neonatal must be a registered nurse with at least an ADN (Associates Degree in Nursing) or BSN *Bachelors of Science Degree in Nursing). Those with associate degrees can still become neonatal nurses, but the competitive market leans to BSN and most hospitals are becoming very strict with the BSN requirement.
Even with all the necessary certifications, (NRP, BLS, PALS, STABLE) some employers will also require a nurse to have completed a minimum number of clinical experience hours in a hospital setting.
If you wish to advance your career further and become a neonatal nurse practitioner (NNP) then you have to do a Master of Science in Nursing (MSN). Typically programs require two years of bedside experience prior to application to an NNP program. Most NNP programs are 2-3 years. Check out my blog Post "NICU Nurse Resources" to learn about additional Grad school resources.
NICU Nurse Resources:
There are no specific online training programs to help you become a neonatal intensive care nurse. All NICU nurses start out as RNs by obtaining an ADN or BSN. BSN is now becoming preferred. Check out my blog post where I go MICRO on NICU Nurse Resources. (National Certification, Conferences, List of Books, etc).
Licensing and Certification
The biggest hurdle in becoming a NICU Nurse is getting a registered nurse license. Once you are through with this everything will be easier for you as you move to this field. You can apply to New Grad Nurse programs with your License pending. To become a registered nurse you must sit and pass the NCLEX-RN (National Council Licensure Examination for Registered Nurses). To maintain the license, you also have to earn the continuing education credits that are required by individual state licensing board. Even when you completely transition to a career in neonatal, you will still have to keep your registered nurse license updated. And it is also important to know that before you are given a license to practice in some states, it will be necessary to undergo an education verification and background check.
11 NICU NURSE JOB HOT Tips!
So you want to land that job? Here are a few things you can do:
What a hiring manager deems important is very selective to their needs and what they believe a nurse should be. Frustrating I know!! My advice is to tell them what they want to know. Really read the job posting and restate what they want, that you have! Many New Grad Nurses and Experienced Nurses have transitioned to NICU. You can certainly do it too.
3. WORK IN HOSPITAL SETTING: Work in the hospital setting, get your feet wet. (CNA, Summer intern, Patient care technician, Secretary, Scribe, Volunteer)
4. UPDATE YOUR SOCIAL: Update your LinkedIn account. Not 100% necessary. But you never know, make sure everything is spruced up!
5. NETWORK: The Best Way to get into NICU is to know somebody. Network! Call managers and ask if they have any needs and how you can help. Reach out to your preceptors and professors and state your intention, they make help! Network! Ask questions, get nosey. Speak with your nurse preceptors, utilize connections, per persistent with your journey.
6. SPRUCE UP THE PORTFOLIO: WOW THE RECRUITERS. If you are applying online, one needs to really target their app, cover letter and resume. Spruce up the portfolio! To get that interview make sure you have ALL of this complete in your application! Combine everything in a professional binder.
Registered Nurse License
Target your entire application to what they want!
Hot TIP HINT– The job posting will usually tell you what they require / recommend. Their website will provide other keywords and phrases you can use that resonates with you.
WRITE OR EMAIL A THANK YOU TO THE INTERVIEWER AND MANAGER!
7. READ AS MUCH AS YOU CAN. Check out my blog with a full list of NICU resources for you to check out.
8. INVEST IN A SUIT: First impressions are everything. I am a firm believer in show up looking sharp and ready to take on anything. Power suits are my jam. Professional, sharp, tailored look. I invested in a Navy Blue suit and this has been my go to for all interviews since.
9. VOLUNTEER: Thoughts including medical missions, church, homeless shelters, Children's Hospital if there's one nearby.
10. LEADERSHIP OPPORTUNITIES: Involve yourself with leadership opportunities too... Your student nurse organization is a good start.
8. LOOK FOR A MENTOR who serves as a role model for learning, critical thinking and evidence-based practice, and who helps you ask questions and reflect. (Doesn't have to be a nurse, but someone who you strive to be like, and learn from them). The NICU setting requires a high level of knowledge, clinical reasoning and decision-making. Find those vibes.
9. CONTINUING EDUCATION: focused on the NICU educational focused programs and certifications. Look for seminars that provide solid foundations for practice in pediatrics and the neonatal subspecialty. Making these in-person connections helps build your possible job leads and provides you with deeper insight.
10. PEDIATRIC RESUME BOOSTER (BIRTH-3 YEARS EXPERIENCE) - provides an essential foundation for NICU work. It provides exposure to and comfort with normal and disordered infant and toddler. You’ll also meet and care for NICU graduates when you work in a pediatric unit!
11. KEEP GOING : If you don't land your job in NICU ~ Get your experience & then transfer as an internal candidate to NICU, L&D, or Pediatrics.
NICU Interview Tips
Once you get the interview – you need to already be ready.
1. ONE MINUTE PITCH: Have your”Pitch” ready too. Why should we hire you?
2. BODY LANGUAGE: Body Language” be confident. Yes – the interview is
supposed to be a test. They want to see if you can handle the stress of their floor. Show them you can.
3. FAMILY CENTERED CARE: If you do land an interview, I suggest letting them know you will support and encourage a family-centered environment. Parents are a big part of the NICU experience!
4. BEHAVIORAL QUESTIONS: Confidence, teamwork, using your team, chain of command, safety and fitting are key in an interview. Know you answers to all behavioral based questions. I have a blog post "12 NURSE INTERVIEW TIPS & TRICKS!" with a ton of examples and have also linked a private FB group with some resources. RNInterview Tools
Yes, landing a NICU position can be frustrating in an over saturated market. But, it can be done with persistence. Know that working in the NICU requires an intense commitment. As I always say, you have to pick yourself up, dust yourself off and start again. With the right support, the NICU offers great rewards, but alongside challenging and sometimes exhausting work. If you know this at the start, you can set expectations and prepare for the extreme dedication and patience needed.
If you are seeking a more "in depth conversation" head over to check out my podcast! Episode #1 #2 and #10 are all great resources for you to hear more details about being a NICU Nurse, NNP, and the working dynamics of a level IV NICU!
Another great resource for you BELOW. I was featured on The Morning Rounds and talked all things NICU Nursing. Dynamics, my personal journey, NICU Nurse Tips & Tricks!
Tori Meskin BSN RNC-NIC 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, Nurse Practitioner student, a Barco Uniforms Ambassador, and Brave beginnings affiliate. Find her at www.tipsfromtori.com or email@example.com