Skip to main content

How to Become a Neonatal Nurse Practitioner: 5 Steps for Nurses with a BSN

There is a tremendous need for neonatal nurse practitioners (NNPs). Neonatal nursing is the least common nurse practitioner (NP) specialization, with a certification rate of less than 1%. As a result, approximately 2 in 3 healthcare administrators recently reported a lack of NNPs.

NNPs make a significant impact on healing high-risk infants by providing specialized care in their earliest days of life. If you are passionate about helping infants, desire greater professional autonomy, and want to advance to higher levels of healthcare, you may find it fulfilling to be an NNP.

In our blog post, you will learn what to expect from this rewarding career and the process for how to become a neonatal nurse practitioner.

What is a Neonatal Nurse Practitioner?

An NNP is an advanced practice registered nurse (APRN) specializing in providing care to children from birth through two years of age.

Neonatal nursing focuses on the care of infants experiencing problems right after birth. However, some infants are sick for many months. So, NNPs may care for premature infants, term neonates, infants, and toddlers.

NNPs are educated to be autonomous healthcare providers. They are prepared to diagnose, manage, and treat various health issues from primary to critical care, including:

  • Prematurity
  • Congenital disorders
  • Infections
  • Cardiac malformations
  • Surgical needs
  • Anemia
  • Arrhythmias

Neonatal Nurse Practitioner Work Settings 

Most NNPs practice in hospital inpatient units, such as neonatal intensive care units (NICUs). NICUs have four special designations designed to provide different levels of care:

  • Level I: Basic care of low-risk neonates, stabilization and care of infants born between 35- and 37-weeks gestation, and stabilization of newborns who are ill or born before 35 weeks gestation.
  • Level II: Specialty care of infants born before 32 weeks gestation and infants recovering after intensive care.
  • Level III: Advanced care of infants born before 32 weeks gestation and infants with critical illnesses.
  • Level IV: Care and surgical repair for infants with the most complex and critical illnesses.

Level III and Level IV NICUs are the most common practice settings for NNPs, where they work rotating or 24-hour shifts. NNPs also work in emergency rooms, delivery rooms, and outpatient clinics, where the neonatal population may be present.

Neonatal Nurse Practitioner Job Duties

A full-time NNP sees an average of 13 patients per day. Their responsibilities vary by work setting and may include:

  • Collaborating with physicians, nurses, and medical staff to plan and deliver care.
  • Stabilizing and transporting infants to nurseries.
  • Performing physical assessments and collecting patient histories.
  • Ordering, performing, and interpreting diagnostic tests and procedures (e.g., resuscitation, umbilical line placement).
  • Developing treatment plans.
  • Prescribing and administering medication.
  • Supporting and educating families.

Why Become a Neonatal Nurse Practitioner?

Nurses who are passionate about infant care and want to make a meaningful difference in the lives of newborns and their families will find the path of an NNP rewarding. NNPs provide the timely, specialized care and attention that premature and ill infants need. They also support family members in times of extreme stress and play a crucial role in education–this can include making sure families are informed about the various aspects of their newborn’s care such as monitoring vital signs, communicating developmental milestones, and providing emotional support. 

Caring for young children with critical health conditions can be emotionally charged but also fulfilling. NNPs derive great satisfaction from improving and saving lives. In a recent survey, 95% of NNPs said they were satisfied with their career, so even though NNP is a less frequent specialization, professionals who choose this path are content with their choice. 

In addition to playing a significant role in children’s health, NNPs benefit from a bright career outlook. They have ample opportunities to enhance access to neonatal care, their professional autonomy, and their employment and earning potential.

Professional Autonomy

In addition to serving an essential role in neonatal care, NNPs enjoy the benefit of professional autonomy. Depending on the state where they work, NNPs practice autonomously and in collaboration with other healthcare providers.

Research shows that rural areas afford NNPs the most autonomy. NNPs who serve in rural areas are more likely than those in urban areas to practice without physician oversight and prescribe certain controlled substances.

For nurses seeking more independence in their roles, working as an NNP is a tremendous opportunity.

Neonatal Care Access

Many rural communities lack healthcare professionals. At the same time, rural U.S. counties have higher infant mortality rates than urban counties. NNPs who choose to work in rural areas help ensure critical access to neonatal care.

Employment Prospects

NNPs have excellent employment prospects because most NNP jobs are unfilled. The need for NNPs outpaces the supply.

The U.S. Bureau of Labor Statistics estimates that nurse practitioner employment will grow 45% between 2022 and 2032, a figure 15 times faster than the average for all jobs. NPs specializing in neonatal care are particularly in demand.

NNPs also have high earning potential. Though salaries vary based on experience and location, neonatal care is among the highest-paid NP specialties. The median NNP income is $140,000, almost $20,000 more than the median income of all NPs.

NP writing on a clipboard

How Long Does it Take to Be a Neonatal Nurse Practitioner?

Starting your NNP career involves becoming a registered nurse, gaining professional experience in neonatal nursing, completing graduate-level neonatal nurse practitioner education, and obtaining national NNP certification and state APRN licensure.

Generally, a nurse with a Bachelor of Science in Nursing (BSN) can become an NNP in approximately four to six years. This timeframe accounts for the professional experience and education required for NNP certification. The type of NNP degree you choose will affect the length of your journey.

Step 1: Become a Registered Nurse

NNPs must be licensed registered nurses. Most NNP degree programs require candidates to have a BSN, so baccalaureate nursing education is the ideal pathway to an NNP career.

Baccalaureate Nursing Education

The process for how to become a neonatal nurse practitioner begins by earning a BSN from an accredited nursing program. Traditional BSN programs last four years.

Generally, BSN programs focus on general education requirements during the first half and shift to nursing and nursing science during the latter. Students complete coursework and clinical rotations in health promotion, adult and pediatric care, community health, and other topics.

Professional Nursing Licensure

BSN program graduates should apply for professional nursing licensure from the state where they plan to practice. Then, they must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

The NCLEX-RN is a standardized exam that assesses decision-making skills and clinical judgment for safe and effective nursing practice. Candidates who achieve application approval and a passing NCLEX-RN score become licensed registered nurses.

Step 2: Gain Neonatal Nursing Experience

The next step is to gain professional experience in neonatal nursing, which neonatal nurse practitioner education programs require for admission.

The amount of neonatal nursing experience required depends on the NNP degree program. Generally, one to two years will suffice.

The National Association of Neonatal Nursing recommends working in a Level III NICU. The responsibilities of a Level III NICU nurse may include:

  • Assessing and caring for neonates.
  • Checking vital signs.
  • Performing screening tests.
  • Providing feedings.
  • Administering medication and IV fluids.
  • Maintaining patient records.

Some NICUs require registered nurses to have experience caring for infants, such as in a pediatric clinic or a well-newborn nursery. However, most NICUs will hire and train new RNs who want to specialize in neonatal care.

Step 3: Complete Graduate Neonatal Nurse Practitioner Education

After gaining neonatal nursing experience, registered nurses should apply to accredited NNP degree programs. Nurses with a BSN can earn a Master of Science in Nursing (MSN) or a DNP with a specialization in neonatal nursing.

MSN vs. DNP Programs

MSN programs build on the foundational knowledge acquired in BSN programs. They take two to three years to complete and educate registered nurses to provide an advanced and specialized level of direct care. 

Graduates of MSN programs can assess, diagnose, and treat patients through pharmacological and non-pharmacological measures.

The DNP is a terminal nursing degree. DNP programs expand on MSN competencies, preparing NPs to expand on their expertise as nurse leaders. NPs with a DNP have advanced training in their nursing specialty and are at the forefront of industry challenges with deepened proficiencies in critical thinking and evidence-based practice. 

DNP programs take approximately three years to complete. The coursework has additional emphasis on nursing leadership and administration, evidence-based practice, and quality improvement.

Benefits of Choosing DNP Neonatal Nurse Practitioner Education

In a recent survey of NNPs, 12% indicated they had a DNP. Why do nurses choose a DNP over an MSN NNP degree? Earning a DNP equips nurses with the highest nursing knowledge, aligns with evolving standards for NNP education, and provides additional career opportunities. By gaining a terminal degree, nurses can distinguish themselves as experts in nursing practice and leadership, highlighting a deep commitment and passion for their field. 

Terminal Nursing Knowledge

The American Association of Colleges of Nursing (AACN) describes the DNP as the “optimal pathway” for obtaining the most advanced nursing preparation. Because the DNP is a terminal nursing degree, NNPs with a DNP don’t need additional higher education.

Nursing Standards Alignment 

The nursing profession is moving towards making the DNP the entry-level educational requirement for NPs.

The AACN advocates for all APRN roles to require a DNP by 2025. According to the AACN, the nation’s increasingly complex healthcare environment requires specialty nurses to have a terminal level of scientific knowledge and practice expertise, which is earned with a DNP education.

Step 4: Obtain Neonatal Nurse Practitioner Certification

After graduating from an NNP degree program, nurses should obtain national certification as an NNP.

The National Certification Corporation (NCC) confers NNP certification via exam. Nurses must take and pass the exam within eight years of graduating from an accredited MSN, DNP, or post-master’s NNP program.

Certification Exam Content

The certification exam assesses the competence to care for neonatal patients with acute and critical health issues. It takes three hours to complete and has 175 multiple-choice questions covering five content categories:

  • General Assessment
  • General Management
  • Pharmacology
  • Embryology, Physiology, Pathophysiology, and Systems Management
  • Professional Issues

The NCC provides resources to help nurses study for the exam, including a free NNP certification exam guide and a preview test available for purchase.

Certification Exam Outcomes

Most candidates pass the NCC NNP certification exam. Between 2017 and 2022, the average pass rate was 88%.

Successful candidates become board-certified NNPs, earning the Neonatal Nurse Practitioner (NNP-BC®) credential.

Certification Renewal

NNPs must maintain their certification every three years through continuing education. The maintenance process begins by completing a continuing competency assessment.

Based on the assessment results, the NCC develops a personalized education plan for every candidate. The plan outlines the nature and number of hours of continuing education required to maintain certification, typically 10 to 50 hours.

NNPs have three years to complete continuing education and submit a certification maintenance application.

Step 5: Get State APRN Licensure

As a board certified-NNP, you can seek APRN licensure in the state where you plan to practice. This is the last step in how to become a neonatal nurse practitioner.

Every state has its own eligibility and application requirements for APRN licensure. Generally, you will need to provide evidence of your nursing education, RN licensure, and NNP certification.

Licensed APRN-NNPs must renew their credential with the state regularly, typically every three years.

For more information, contact any state board of nursing.

How to Find Employment as an NNP?

Once you’re certified and licensed as an APRN-NNP, you can begin searching for employment.

Nursing associations maintain online directories where NNP jobs are posted, including:

For NNPs seeking employment in rural areas, the National Rural Health Association also has an online career center.

Another way to find a job is by networking with other NNPs and healthcare professionals. NNPs make dozens of connections throughout their nursing education and experiences. Each contact can be a resource for employment opportunities.

Become a Neonatal Care Expert through Baylor University’s DNP-NNP Online Program

If you want to become an expert in neonatal care, consider earning the highest degree in nursing practice through Baylor University’s DNP-NNP online program. In just over three years, actively practicing nurses with a BSN gain the knowledge and skills to lead nursing care for infants through the first two years of life.

Baylor is a renowned research institution recognized among the top graduate schools for DNP programs. Baylor’s DNP-NNP online program is:

  • Accredited by the Commission on Collegiate Nursing Education (CCNE).
  • Ranked in the top 10 best NNP programs in the nation by
  • Approved by the Texas Board of Nursing.

Graduates of the DNP-NNP online program are prepared to lead change and deliver compassionate care to healthy neonates, high-risk newborns, and their families.

Back to top