10 Essential Nursing Skills for Neonatal Nurses


Nursing Skills for Neonatal Nurses

By Alana Luna, contributor

NICU nurses are entrusted with the care of the littlest and most vulnerable members of our community, so it’s crucial that their nursing skills are on point. The hours are long, emotions run high and high levels of stress are the rule rather than the exception. 

10 Skills Neonatal Nurses Need to Succeed

1. Advanced education and RN licensure

All neonatal nurses must meet all the requirements to become a registered nurse and acquire at least a Bachelor of Science in Nursing (BSN) and certification from the State Board of Nursing. Most, if not all, positions also require certification in neonatal resuscitation in addition to the neonatal critical care certification discussed below.

Anyone hoping to become a neonatal nurse practitioner (NNP) will need to complete a Master of Science in Nursing (MSN) degree, which is often offered as part of a two-year Advanced Practice Neonatal Nursing (APNN) program.


2. Certification in Neonatal Critical Care Nursing (CCRN)

Nurses charged with the direct care of neonatal patients who are critically ill generally need to obtain their CCRN certification. Candidates must already have their RN or APRN license, be in good standing with the state board of nursing, and complete one of two required options for clinical practice hours:

  • Two-Year Option: The candidate spends two years as an RN or APRN providing 1,750 hours of direct care for acutely and/or critically ill neonatal patients
  • Five-Year Option: Similar to above, but the candidate is responsible for a minimum of five years and 2,000 hours of direct care

3. Basic medical nursing skills

What do neonatal nurses do? Pretty much everything other nurses do and then some, including:

  • Taking general vital signs including heart rate, blood pressure, breathing rate, oxygen saturation and temperature
  • Attaching leads and use monitors to track the vital signs above
  • Inserting intravenous lines and catheters for blood transfusions, medications and IV nutrition
  • Operating ventilators and continuous positive airway pressure (CPAP) machines

4. Attention to detail

Some estimates put the risk of patient misidentification in the NICU as high as 70 percent, causing errors ranging from switched laboratory specimens to maladministered drugs. For that reason alone, attention to detail is considered a fundamental nursing skill no member of the NICU team should be without.

5. A penchant for multitasking

There’s no one-task-at-a-time rule in the NICU. You’re always doing several things at once, and your to-do list can change in a heartbeat (literally). Being able to think on your feet and tackle multiple issues simultaneously is the hallmark of a great nurse. Being able to navigate emotional situations while still completing the tasks at hand is just as valuable.

6. Keen sense of observation

In the NICU, the smallest signs can mean very big things. Because babies can’t simply speak up and say what feels funny or what they need, perception is key. Expand the breadth of your nursing skills by training yourself to notice even the tiniest details. 

The way your tiny patients respond to stimuli, changes in their respiration rates, minute fluctuations in body temperature — all of these things could be early indications of serious problems or harbingers for better days ahead. Either way, spotting them is important.

7. Communication skills

In most professions, verbal communication is a priority, and it’s a must-have item on this list of nursing skills, too. Neonatal nurses need to be able to talk with their patients’ families, updating them on status changes, answering questions and coaching the parents on feeding and changing techniques. This information is vital to the baby’s well-being, especially after discharge, so communication should be gentle yet crystal clear. 

There is no room for misunderstandings when a child’s health is in the balance. Opening up the lines of communication also paves the way for parents to share history and concerns that could impact outcomes.

8. Optimism galore

Parents who have a child in the NICU are at higher risk for anxiety disorders. One study of mothers with low-birthweight infants found that 42 percent had elevated symptoms of postpartum depression, and 30 percent had higher-than-normal symptoms of postpartum posttraumatic stress. While professional screening is important and medical treatment may be necessary, there’s another factor that can have a significant impact: hope.

Optimism can help worried parents lower their blood pressure, increase circulation and boost their energy. Neonatal nurses who provide hope, positivity and even the occasional moment of levity as part of their cache of nursing skills give caregivers a respite — however brief — from the rigors of a hospital setting.

9. Physical endurance

While not technically a nursing skill, physical endurance matters when you’re pulling 12-hour shifts in one of the most demanding departments in the hospital. Your feet may ache from walking the floors, your neck may get stiff from bending over the one-pound 24-week-old baby tucked in her incubator and your stomach may be screaming for sustenance because an emergency forced you to skip your snack break. None of that matters when those precious lives are in your hands. You don’t need to be a marathon runner to work in the NICU, but stamina helps.

10. Resilience

All the nursing skills, education, technological advances, hope and miracles in the world won’t completely eliminate losses. Not every patient makes it, and in those situations, it’s imperative that you remain calm, cope as best you can and return to work the next day ready to help those patients for whom you can still make a difference.

A career in the medical field can be incredibly rewarding, but few positions are as emotionally fraught and endlessly challenging as work in the neonatal unit. Master these nursing skills and you could very well excel at your job while providing life-changing assistance to those in need.

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