If you are considering becoming a Neonatal Nurse Practitioner (NNP), there are many aspects of the role that you should examine. First, you will want to be sure that you are passionate about working with this very specific patient population and their families. You should also consider the other requirements of the role, such as leadership, administrative responsibilities, research, multidisciplinary collaboration, and more. You will also want to pursue the educational program that will best prepare you for all aspects of the role of the neonatal nurse practitioner. If you are asking yourself, “What does a neonatal nurse practitioner do?,” it will help you to have some facts at hand. Read on to learn about the healthcare landscape you will face as an NNP.
What does a neonatal nurse practitioner do?
The primary role of a neonatal nurse practitioner is to care for healthy neonates and high-risk newborns. Often, this takes place in a hospital within a Level I Well Newborn Nursery, Level II Special Care Nursery, Level III Neonatal Intensive Care Unit (NICU), or Level IV Advanced NICU; or in a specialized clinic that provides follow-up care.
Strictly speaking, a neonate is a baby aged birth to 28 days. However, depending on the extent of illness, NNPs may care for infants beyond the 28-day mark, and in some cases, up through 24 months of age. In most instances, though, an NNP’s care ends when these young patients are discharged from the hospital.
For newborns with health problems, care can span a wide range of treatments. In addition to close monitoring, assessment of vital signs, and physical examinations, NNPs may have to work with specialized equipment (ventilators, dialysis, heart-lung machines), start and maintain IV lines and implement specific procedures (intubation or placement of a central line).
Neonatal nurse practitioners: Statistics
In 2018, there were 5,433 NNPs according to information from the National Certification Corporation (NCC), the body that certifies neonatal nurse practitioners. By 2020, the number of NNPs increased to 6,558, representing just over 2% of the more than 325,000 licensed nurse practitioners in the U.S. that year. The growth rate for the number of NNPs has remained consistent at around 2% year-over-year.
Periodically, the National Association of Neonatal Nurse Practitioners (NANNP), in cooperation with the NCC, surveys all NNPs in the U.S. Its report for 2020 revealed essential data about America’s NNPs.
The NNPs who responded to the survey (n=845) presented a fascinating picture of this critical healthcare role. Salary surveys showed that those with five years experience or less earned a mean annual salary of $109,000, while those with much longer service—30 years or more—earned $134,000 on average. According to Salary.com, NNPs are among the highest paid of all nurse practitioners with an average annual salary of $132,112 (as of December 2022). Other factors affecting salary were educational attainment—NNPs with Doctor of Nursing Practice (DNP) degrees earned $7,000 more than the average wage, and NNPs in administrative roles earned $9,000 more than the average.
Of course, salaries will vary depending on the region and type of institution where the NNP works. For example, the 2020 NNP Workforce Survey reported a mean salary of $122,000 for NNPs in Texas, Arkansas, Louisiana, and Oklahoma. Nationally, NNPs working for children’s hospital systems earned slightly more on average than their next-highest earning counterparts in multiple hospital systems: $124,653 vs. $124,304.
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Neonatal Nurse Practitioners: Practice Environment
As mentioned above, Neonatal Nurse Practitioners frequently work in hospital settings and primarily in infant care units that are ranked according to patient acuity. NNPs work at all levels to care for these youngest patients. The following descriptions of levels of newborn nurseries and neonatal intensive care units can be found on the American Academy of Pediatrics publications website:
Level I – Well Newborn Nursery
- Provide neonatal resuscitation at every delivery
- Evaluate and provide postnatal care to stable term newborn infants
- Stabilize and provide care for infants born between 35–37 weeks
- Stabilize newborn infants who are ill and those born at <35 weeks’ gestation until transfer to higher level of care
Level II Special Care Nursery (offers Level I capabilities plus:)
- Provide care for infants born ≥32 weeks’ gestation, weighing ≥1500g who are moderately ill and are not expected to require subspecialty services urgently
- Providing care for infants convalescing after intensive care
- Provide mechanical ventilation for 24 hours or less or positive airway pressure or both
- Stabilize infants born before 32 weeks/weighing less than 1500g before transfer to NICU
Level III — Neonatal Intensive Care Unit (offers Level II capabilities plus:)
- Provide sustained life support
- Provide comprehensive care for infants born <32 wks gestation and weighing <1500 g and infants born at all gestational ages and birth weights with critical illness
- Provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide
- Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric ophthalmologists
- Provide advanced imaging (MRI, CRT, echocardiography) with urgent interpretation
There are also Level IV centers, which provide advanced intensive care services, generally in support of complex surgical procedures and for a large geographic region.
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Neonatal nurse practitioners: Patient load, schedules, and NNP shortages
Full-time NNPs have recently reported that they care for 13 patients per day and prefer to work day shifts or 24-hour shifts.
As is true for other nursing roles, the average age for NNPs is trending upward; 57% of the 2020 survey respondents are age 50 or older compared to 53% in 2016. While these years of experience are valuable, it does cause worry among administrators who foresee a rising wave of retirements. As it stands, more NNPs are needed not only to offset losses from retirement but to shoulder the increasing workload as fewer pediatric and medical graduates spend time in NICU rotations.
Neonatal nurse practitioners: Care units and patient population stats for Texas
Future NNPs who plan to practice in Texas will have a large number of facilities to apply to. The state boasts 80 Level I nurseries, 52 Level II nurseries, 73 Level III NICUs, and 22 Level IV advanced NICUs. And while the infant mortality rate in Texas has seen a steady decline, the percentage of preterm births has been climbing. Because of this, demand for NNPs will remain steady or climb as the number of fragile infants requiring care increases.
How to become a Neonatal Nurse Practitioner
Neonatal Nurse Practitioners are advanced practice registered nurses (APRNs) licensed by their state board of nursing and certified in neonatal care by the National Certification Corporation (NCC). While there are many NNPs with master’s-level education, the number of NNPs with Doctor of Nursing Practice (DNP) degrees is increasing. The NANNP Workforce Survey indicates that the percentage of NNPs with a DNP has risen from 9% in 2016 to 12% in 2020.
Since 2004, when it was first proposed by the American Association of Colleges of Nursing, a doctorate of nursing practice (DNP) has been recommended as the entry level degree for nurse practitioners, including neonatal NPs. This recommendation was also adopted by the National Organization of Nurse Practitioner Faculties in 2018, with a goal of having this as a standard by 2025.
Employers may view DNP-prepared NNPs as stronger candidates for administrative and research-intensive positions. Educational preparation in neonatal nursing theory, assessment, clinical care, program planning, diagnostic reasoning, and patient management will form a lasting and valuable foundation for care delivery in or management of neonatal intensive care units. Educational levels may vary among NNPs based on job responsibilities. NNP in roles involving leadership and translational research typically have a DNP level education.
Learn more about Baylor's Online DNP-NNP program
Pursue a Doctor of Nursing Practice Online through Baylor University
Baylor’s Louise Herrington School of Nursing offers an online Doctor of Nursing Practice degree with a Neonatal Nurse Practitioner focus. RNs with a BSN or MSN degree seeking the highest level of preparation will find that they can solidify their authority and autonomy by completing a doctorate in nursing practice.
Choose to protect the future by caring for neonates and high-risk infants while accelerating your career and earning potential as a DNP-prepared Neonatal Nurse Practitioner.
The Louise Herrington School of Nursing at Baylor University is:
- Fully accredited by the Commission on Collegiate Nursing Education (CCNE)
- Recognized by the Southern Regional Education Board, Council on Collegiate Education for Nursing
- Accredited by the American Association of Colleges of Nursing (AACN)
Baylor’s online DNP Neonatal Nurse Practitioner program conforms to educational guidelines for:
- State of Texas and the National Task Force Criteria for Nurse Practitioner Programs
- The National Association of Neonatal Nurses (NANN)
- The National Organization of Nurse Practitioner Faculties (NONPF)
For more information about the online DNP programs Baylor offers, visit our program page.