What is a Neonatal Nurse Practitioner?
Definition of an NNP
Neonatal Nurse Practitioners (NNPs) are expert APRNs who care for high risk neonates (pre-term and full-term infants) with critical health issues. Those issues can include life-threatening conditions, chronic illnesses, genetic disorders, congenital abnormalities, and problems associated with premature birth.
Thanks to their specialized training—and their prior years as neonatal nurses—NNPs often end up “running the floor” in a NICU unit. On any given day, they might be assisting in a high-risk birth, conducting neonatal resuscitation, taking part in advanced clinical procedures (e.g. intubation, lumbar punctures, chest tubes, etc.), ordering advanced tests, evaluating lab data, monitoring equipment (e.g. ventilators, incubators, etc.), collaborating with neonatologists and pediatric clinicians, and counseling parents.
Typical work settings for NNPs include:
- Level II, III & IV Neonatal Intensive Care Units (NICUs)
- Children’s hospitals, city hospitals & large community hospitals
- Specialty/sub-specialty clinics
- High-risk follow-up clinics
- Emergency departments (EDs)
Note: Becoming an NNP is a true calling—be ready to spend your entire working life with neonates! NNPs also have leadership responsibilities, which means RNs may spend more time in hands-on care (e.g. soothing infants, feeds, changing diapers, etc.).
Neonatal Care Levels
- Level I – Well Newborn Nursery: Level I is the minimum standard for facilities that provide in-patient maternity care—think care of healthy newborns, stabilization of ill patients for transfer to a NICU, and standard postnatal follow-up. NNPs aren’t usually involved in Level I settings.
- Level II – Special Care Nursery: Level II nurseries provide care for premature and sick infants who are moderately ill and in need of constant attention. Level II nurseries also handle infants who are recovering from a serious issue that has been treated in a Level III setting (i.e. NICU).
- Level III – Neonatal Intensive Care Unit (NICU): This is where you’ll find the majority of NNPs. Level III units are designed to handle critically ill neonates or premature infants with life-threatening health issues. These vulnerable newborns may require surgical intervention, ventilation, and invasive procedures, and they must be monitored 24/7.
- Level IV – Regional NICU: Regional NICUs are responsible for the highest level of neonatal care. Level IV NICUs often handle newborns who need surgery for complex birth defects, acquired conditions, and genetic disorders (e.g. cardiac surgical repairs). They are always staffed by a clinical team of experts, including surgeons, neonatologists, and specialized nurses.
Neonatal Nurse Practitioner vs. Other Specialties
Neonatal vs. Perinatal (Obstetrics/Labor & Delivery/Midwifery)
NNPs care for vulnerable newborn infants. If you enjoying helping mothers and babies in the period around birth—including pregnancy, labor & delivery, and postpartum care—you may wish to explore other options. Those can include:
- Certified Nurse Midwife (CNM): CNMs are APRNs who support patients throughout their reproductive life, but especially during pregnancy (e.g. prenatal care, healthy home births, hospital deliveries, newborn care, etc.). Labor & delivery RNs and doulas often pursue this qualification.
- Women’s Health Nurse Practitioner (WHNP): WHNPs are APRNs who focus on the health of women & mothers. A number of WHNP graduate programs now include clinical training in prenatal & perinatal care (e.g. high-risk prenatal management, family planning, fertility, uro-gynecology, etc.).
- Family Nurse Practitioner (FNP): During their graduate program, FNPs may be able to focus on perinatal areas by choosing relevant electives or arranging for clinical rotations in ob/gyn offices. But their scope of practice is officially “family.”
- Clinical Nurse Specialist (CNS) – Perinatal: The rarest offering is a post-master’s graduate certificate or a DNP as a Perinatal Clinical Nurse Specialist. This is intended for experienced APRNs (e.g. active WHNPs) who want to become clinical leaders, educators & researchers in perinatal women’s care.
When it comes to national certification, it’s important to note that there is no specific NP credential for perinatal nurses. Most APRNs working in perinatal fields are CNMs, FNPs, or WHNPs.
Neonatal NP vs. Pediatric NP Specialties
Are you an RN who loves caring for children? You may be wondering whether to becoming an NNP or a PNP. Here are some pros and cons to consider:
- Neonatal Nurse Practitioner (NNP): NNPs only deal with neonates and infants under the age of 2. It’s an intensivist role—NNPs must be able to handle high-stakes situations, complex daily tasks (e.g. ventilation needs), medical crises (e.g. intubation), and the trauma of newborn deaths. The role often involves on-call coverage and long hours in the NICU (e.g. 24-hour shifts). Because of their specialized training & expertise, NNPs earn the highest salary among NP specialties.
- Acute Care Pediatric Nurse Practitioner (AC PNP): AC PNPs care for children under the age of 21 who have acute, critical, and chronic health conditions. Just like neonates, these pediatric patients need 24/7 care. Thanks to their expertise, AC PNPs may be responsible for medical procedures (e.g. chest tubes, intubations, etc.), case management, and teaching. You’ll often find them at all hours (days, nights, weekends, and holidays) in hospitals and ICUs. They tend to be paid less than NNPs and more than PC PNPs.
- Primary Care Pediatric Nurse Practitioner (PC PNP): PC PNPs handle outpatient primary care tasks (e.g. physical exams, immunizations, home visits, etc.). This is the world of office paperwork, regular business hours, and one-on-one time with patients & families. The job doesn’t usually involve life & death situations. And it doesn’t pay as well as the NNP or AC PNP.
If you’re torn between acute care specialties, try to shadow an APRN in the NICU. Then spend some time in a PICU or surgical unit for comparison. Talk to current NNPs and AC PNPs in your area for an unfiltered view of the job. Weigh up your outside responsibilities (e.g. family) with your career goals.
Note: You always have the option to complete an NNP graduate program and then earn a post-master’s certificate in either acute care or primary care pediatrics. Just make sure that both programs will prepare you for relevant certifications.
RN to MSN Neonatal Nurse Practitioner Programs
RN to MSN Neonatal NP: Overview
RN to MSN and RN to MS Neonatal Nurse Practitioner programs are targeted at working nurses who already hold a nursing diploma or an associate’s degree (e.g. ASN/ADN). There are also RN to MSN NNP programs for experienced RNs with a bachelor’s degree in a field other than nursing.
Our directory includes:
- Concentration/Track: RN to MSN Nurse Practitioner (NP) programs with a concentration or track in the Neonatal Nurse Practitioner specialty. These are popular, and you can have your pick of online or on-campus programs.
- Dual Concentration: Dual focus RN to MSN programs that combine pediatrics (PNP) & neonatal (NNP) training. These are rare, but they do exist. Be sure to ask how the dual program will prepare you for state licensure requirements and certification.
RN to MSN Neonatal NP: Admissions
RN to MSN Nurse Practitioner programs—in any specialty—tend to share the same prerequisites: a diploma or associate’s degree in nursing (unless you have a bachelor’s in another field), a current RN license, at least one year of RN clinical experience, a baseline undergraduate GPA (typically 2.75-3.0), and letters of professional reference. See our guide to RN to MSN Nurse Practitioner Programs for details.
There is one key difference for RN to MSN Neonatal Nurse Practitioner programs:
- Nursing Schools often want to see that you have a minimum of two years, full-time, RN-level practice experience in a Level III NICU. You’ll see this stipulation from Vanderbilt, the University of South Alabama, the University of Connecticut, and more. It’s not a hard and fast rule—Stony Brook, for example, only requires one year of relevant experience—but two years will give you more options.
- Some universities will also ask you to hold or start pursuing Neonatal Resuscitation Program (NRP) certification.
In other words, most RN to MSN NNP programs are not for inexperienced RNs or folks who suddenly want to switch from pediatrics. They are for dedicated neonatal RNs who have put in long hours in the NICU.
RN to MSN Neonatal NP: Undergraduate Phase
Remember that an RN to MSN is going to be longer than a traditional master’s program. Before you can study for a graduate degree, you’ll be expected to earn good grades on prerequisite undergraduate courses (e.g. statistics, public health, community capstone, etc.). The length of this work will vary; schools may expect 6 months, 1 year, or even 2 years.
Check out our guide to RN to MSN Nurse Practitioner Programs for more info.
RN to MSN Neonatal NP: MSN Curriculum
Once you’ve leapt that hurdle, standard MSN or MS degrees take around 1-3 years to complete. As you explore the options in our directory, you’ll find that almost every NP program contains coursework in advanced pathophysiology, advanced pharmacology, evidence-based practice, leadership, and healthcare assessment. Sometimes called the “Nursing Core,” this set of subjects meets many of the education requirements for national certification.
But MSN programs with a Neonatal NP concentration are a little different than other NP degrees (e.g. pediatrics or family). Because the NICU puts unique demands on nurses, concentration subjects often focus on specific neonatal applications. For example, an NNP curriculum could include courses in:
- Neonatal Nursing Birth Through 2 Years of Age
- Advanced Neonatal Embryology/Physiology
- Comprehensive Assessment for Clinical Decision Making of Mother and Neonate
- Advanced Neonatal Pharmacotherapeutics
- Advanced Neonatal Nursing Theory
- Neonatal Pathophysiology and Management
Overall, it makes for a few years of intense study! (This is one reason why schools insist that RN candidates have two years of prior experience before applying.)
However it is structured, the curriculum should always prepare you for NNP certification. If you have any doubts, ask.
RN to MSN Neonatal NP: MSN Clinical Hours / Practicums
Around 30% of your NNP MSN or MS will be devoted to clinical practicums, also known as clinical hours or clinical rotations. Practicums provide opportunities to improve your skills in the NICU, meet potential career contacts, and expand your range of medical knowledge. They are also required for state licensure & national certification, so Schools of Nursing will often aim to give you 600-800 total hours of direct patient care.
When it comes to Neonatal NP graduate programs:
- A lot of clinical work is going to take place in a Level III NICU (or the equivalent).
- You may also spend time in specialty clinics, delivery rooms, and newborn nurseries.
- If pediatrics is included in the curriculum, you may even have clinical hours in primary care.
Talk to alumni about their clinical experiences and how well they were organized (e.g. did the student have to find a preceptor?). You can also ask the program coordinator if the NNP program has partnerships with well-regarded children’s hospitals, city hospitals, and/or regional NICUs. Working in a high-intensity situation will give you a chance to really up your game.
Online RN to MSN Neonatal Nurse Practitioner Programs
Are Online RN to MSN NNP Programs Available?
Yes. A number of accredited schools in our directory now offer Online RN to MSN Neonatal Nurse Practitioner degrees, including Stony Brook, the University of Connecticut, the University of South Alabama, and more. Here’s how they work:
- Undergraduate Phase: To proceed to the MS or MSN part of the program, you’ll first be required to achieve good grades in upper-level undergraduate courses. These courses are typically offered online, which is great news for working RNs.
- Graduate Phase: You can usually take standard master’s courses online (e.g. nursing core & NNP concentration subjects), but you must participate in clinical practicums in order to graduate. Practicums can be completed in your own community (i.e. a local NICU). However, you may be expected to find the site and a clinical preceptor who is willing to supervise you.
We also want to point out the phrase “100% online” can be misleading. A lot of schools like to see their nursing students at least once. For example:
- The University of Alabama Birmingham requires RN to MSN students to visit the campus in Birmingham for an orientation and three multi-day intensives.
- The University of Connecticut’s NNP program includes three on-campus visits: one for orientation and two visits for leveled simulation experiences.
- The University of South Alabama has a mandatory three- to four-day orientation during the fall semester of the first practicum course. Various clinical skills workshops are held during this time.
We favor online RN to MSN NNP programs with on-campus components—all that hands-on training and networking!—but they will involve money (e.g. travel costs). Budget for every expense.
Online RN to MSN NNP Programs & State Licensure
Final caution! Before you opt for an Online RN to MSN NNP program, check with your State Board of Nursing and the NNP program coordinator about APRN state licensure. State Boards have specific rules and regulations regarding clinical learning experiences for students enrolled in distance education programs. You need to be sure your degree components will meet licensure requirements in your state.
For example, in Stony Brook’s distance NNP program, graduates who reside in New York State are easily eligible for certification and registration as a nurse practitioner by the New York State Education Department. However, because of changing State Authorization Regulations, non-New York State applicants are expected to contact the graduate program assistant before applying.
You’ll find more info about state licensure on the program’s FAQ or School of Nursing’s State Authorization page. Confused by the language? Don’t be afraid to pick up the phone or send an email to the program coordinator.
Neonatal Nurse Practitioner Certification
Overview of NNP Certification
The best job in the NICU starts with the first four steps in How to Become a Nurse Practitioner. Once you have made the choice to become an NNP and looked into APRN state licensure (Steps 3 & 4), you can start planning for national certification. Good accredited RN to MSN FNP programs will always prepare you for NNP certification. Great ones will have outstanding exam pass rates!
The most popular neonatal certification is the NNP-BC, which is offered by the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Specialties (NCC). You’ll see the NNP-BC as a requirement in a lot of job descriptions. To gain it, you must:
- Hold a current, active RN license.
- Earn a master’s (e.g. MS or MSN), post-master’s qualification, or DNP from an accredited NNP program. The program must include at least 200 didactic hours and 600 clinical hours.
- Take & pass the NNP-BC exam. The exam covers General Assessment (e.g. Maternal History Affecting the Newborn, Neonatal, etc.); General Management (e.g. Resuscitation & Stabilization, Nutrition, etc.); The Disease Process (e.g. Cardiac, Pulmonary, Gastrointestinal, etc.); and Professional Issues (e.g. Evidence-Based Practice, Patient Safety, etc.). You must take the exam within 8 years of graduation from your program.
- Keep your certification & licensure up-to-date through continuing education. The certification period lasts 3 years.
Other NCC Specialty Certifications
Interested in widening your horizons? The NNC has a range of other specialty and sub-specialty certifications in the neonatal field. These are open to RNs with relevant clinical experience—you don’t need a master’s or doctorate to earn the credential.
- Low Risk Neonatal Nursing (RNC-LRN)
- Neonatal Intensive Care Nursing (RNC-NIC)
- Electronic Fetal Monitoring (C-EFM)
- Neonatal Pediatric Transport (C-NPT)
- Inpatient Obstetric Nursing (RNC-OB)
- Maternal Newborn Nursing (RNC-MNN)
Note: The American Association of Critical Care Nurses (AACN) has a separate CCRN (Neonatal) certification open to RNs and APRNs who provide direct care to acutely/critically ill neonatal patients, regardless of their physical location. However, the NNP-BC is the industry standard for NNPs.
Neonatal Nurse Practitioner Jobs
Neonatal Nurse Practitioner Careers
Neonatal nurse practitioners with a strong graduate degree, NNP-BC certification, and solid clinical experience are always in demand. Obviously, the opportunities are going to be higher in large cities and major academic medical centers, but ask around. You want a place where you can stretch your wings.
- Happy Where You Are: If you like the NICU that you’re currently working in, and your supervisor is behind your decision, you’ll find that the NNP qualification can offer a bump in a pay and a huge expansion in responsibilities. We talked about “running the floor” or the NICU unit. That’s your future.
- Looking for a New Job: If you’re thinking of using the degree to get out of your current NICU and into a new one, plan for your career during your degree. Look for Schools of Nursing with job counseling, career development workshops, job boards, job fairs, and networking events. Would you like to work in a Level IV facility? See if the program can help you organize a clinical rotation in one.
- Aiming to Specialize: If you want to focus on specific area of neonatal care, certain pediatric hospitals (e.g. Boston Children’s, Cincinnati Children’s, Johns Hopkins, etc.) consistently appear in “Best of” lists for relevant NICU fields (e.g. cardiology). Keep in mind these can be high-stress settings in which to work.
Neonatal Nurse Practitioner Job Openings
- AANP Job Center: Filter by the job setting (i.e. Neonatal) for the best results.
- AWHONN Career Center: Job postings for WHNPs, NNPs, Nurse Managers, RNs, and more.
- National Association of Neonatal Nurses (NANN) Career Center
- Indeed: Neonatal Nurse Practitioner Jobs; NICU Nurse Practitioner Jobs; Neonatal Nurse Jobs; Medical Office Nurse Practitioner Jobs.
- Linkedin: Neonatal Nurse Practitioner Jobs.
- Glassdoor: Neonatal Nurse Practitioner Jobs.
Neonatal Nurse Practitioner Salaries
Glassdoor’s page on Neonatal Nurse Practitioner Salaries and Payscale’s page on Neonatal Nurse Practitioner Salaries will give you ballpark estimates of NNP salaries. When it comes to specialty jobs, these sites aren’t always working with a huge amount of data, so the stats may fluctuate. In 2018:
- Glassdoor put the average salary for NNPs at around $117,000.
- Payscale’s salary figures for NNPs ranged from $75,000-$125,000.
For comparison, have a look at the AANP National NP Compensation Survey report. This report is free for AANP members and available for purchase by non-members. In general, you’re going to find that the NNP is highest paying NP specialty, even beating out the base salary for Psychiatric-Mental Health NPs (PMHNPs).
Neonatal Nurse Practitioner Resources
NNP Certification Bodies
- American Association of Critical Care Nurses (AACN)
- National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Specialties (NCC)
- NCC Exam: Center for Certification Preparation and Review (CCPR)
NNP Professional Associations
- American Association of Nurse Practitioners (AANP)
- Academy of Neonatal Nursing (ANN)
- Association of Women’s Health, Obstetric and Neonatal Nursing (AWHONN)
- National Association of Neonatal Nurses (NANN)
- National Association of Neonatal Nurse Practitioners (NANNP)
NNP Conferences & Events
- Journal for Nurse Practitioners
- Journal of the American Association of Nurse Practitioners (JAANP)
- Journal of Neonatal Nursing
NNP Useful Resources
- AANP Job Center
- AWHONN Career Center
- Medscape: Pediatrics/Neonatal Care Nursing
- NANN Career Center
- National Coalition for Infant Health: Professional Resources
RNs who enter the Neonatal Nurse Practitioner MSN program at the University of Alabama at Birmingham can complete the master's degree in six successive semesters. For the first three semesters, students study core nursing classes and take introductory classes in neonatal care. For the final three semesters, each term includes didactic and clinical courses in neonatal nursing. The program is considered part-time, and classes are delivered in a synchronous online format. Students are also required to come to the campus in Birmingham for intensives where they master essential skills through simulation and lab experiences. Overall, the curriculum includes 45 graduate-level credits, including 10 credits in clinical practicums. U.S. News & World Report ranks UAB's MSN program as #18 in the nation.
The University of South Alabama has a Master of Science in Nursing in Neonatal Nurse Practitioner that delivers all the required classes online. However, students are required to attend a mandatory orientation meeting on the campus in Mobile, Alabama, the fall semester when they begin taking practicum courses. The orientation event includes clinical skills workshops and lasts three or four days. The NNP degree requires 45 graduate-level credits, including core courses, support courses, and classes in the NNP specialty. The curriculum also requires nurses to complete 600 clinical hours over three practicum classes. Students complete the clinical hours working with a qualified preceptor. The College of Nursing has contracts with qualifying agencies in many parts of the country. All students in this program must have at least two years of Level 3 or higher NICU experience before they can begin the clinical component.
Saint Francis Medical Center College of Nursing has an online Master of Science in Nursing with a Neonatal Nurse Practitioner track that students can complete in three years. Some of the specialized classes include advanced health assessment of the neonate, physiology and pathophysiology for the neonate, and advanced neonatal pharmacotherapeutics. In their final year, students take didactic and clinical coursework in neonatal management. Students complete 42 graduate credits and 640 clinical hours that are spread over two semesters. All NNP students must have at least two years of full-time RN experience in a level 2 or higher neonatal unit in the past five years before they can begin clinical courses. They must also have a current Neonatal Resuscitation Program certificate. Graduates are eligible for the national NNP certification exam.
Students in the Master of Science in Nursing Neonatal Nurse Practitioner program at the College of New Jersey complete 23 credits at the College of New Jersey and 15 credits at Thomas Jefferson University in Philadelphia. The two schools are part of a consortium that offers the NNP program, with Thomas Jefferson University teaching the specialty classes. Specialty courses include diagnostic reasoning and clinical decision making for neonatal nurses and comprehensive assessment of mother and neonate. There is no online option for this degree, but most classes are offered in the evening. In addition to the 38 credits, students complete 672 practicum hours spread over three semesters. Practicums require daytime clinical hours and the college partners with agencies and health care providers across the tri-state area for placements. Full-time students can complete the MSN in two years, including summers. Part-time students must complete all the requirements within six years.
Stony Brook School of Nursing has a Master of Science in Nursing with a Neonatal Nurse Practitioner specialty. The curriculum for this master's degree requires students to complete 45 credits. Some of the specialized courses in this track include neonatal pharmacology, health assessment of the neonate and infant, and neonatal pathophysiology. Students also complete four clinical courses. One focuses on the childbearing family, one on primary care for high-risk infants, and two focus on the high-risk neonate. Classes for this degree are presented in a distance education format with some on-site requirements. Students in the NNP program must have Neonatal Resuscitation Program certification and at least a year of recent relevant experience. Graduates of this program are prepared to take the national certification exam for Neonatal Nurse Practitioner.
The University of Rochester has a Master of Science in Nursing in Pediatric/Neonatal Nurse Practitioner. Graduates of this program are prepared to provide both primary and acute care to infants in settings such as delivery rooms, acute and chronic care units, and outpatient settings. Most graduates of this program work in NICUs. The degree requires students to complete 48 credits, with 17 credits in the professional core. The clinical specialty classes include care of well children, pediatric primary care, and nursing care of the high-risk neonate. Students also complete more than 500 clinical hours over three semesters. The College of Nursing has about 500 preceptors across New York state to oversee clinical experiences. This wide network allows the college to match students and preceptors based on clinical specialty and schedule. Clinical sites include Rochester General Hospital and United Memorial Medical Center.
The Vanderbilt School of Nursing uses a modified distance learning format for the MSN in Neonatal Nurse Practitioner. This format allows nurses to remain in their home community and take classes through online modes combined with concentrated blocks of time on campus. During the program, students must come to the campus in Nashville five times, in blocks ranging from three to seven days. The curriculum for this 40-credit program includes advanced neonatal pharmacotherapeutics, developmental/neonatal physiology, neonatal nursing birth through age 2, and neonatal health assessment. Students complete 700 clinical hours a preceptor. Vanderbilt graduates had a 96% first-time pass rate on the certification exam for Neonatal Nurse Practitioner in the most recent year reported. Students in the NNP specialty must have at least two years of current nursing experience in a Level 3 newborn unit before starting clinical hours. Vanderbilt faculty includes specialists in pediatric surgery, endocrinology, and neurology.