Neonatal Nurse Practitioner (NNP) Career Guide (2023)

Nurse Practitioners deliver advanced care to a variety of patients in clinical settings. According to the American Association of Nurse Practitioners (AANP), NPs work “autonomously and in collaboration with healthcare professionals and other individuals, to provide a full range of primary, acute and specialty health care services.” Neonatal Nurse Practitioners (NNPs) are a specialty within the Nurse Practitionerfield.

Neonatal Nurse Practitionersdeliver care to preterm and sick infants with neonatologists in acute and nonacute settings. They also can assist in delivering patients in certain settings. NNPs care for patients suffering from conditions including:

• Prematurity
• Genetic disorders
• Drug addiction and withdrawal
• Surgical birth defects including Myelomeningocele, Omphalocele, Cardiac defects, Gastrointestinal disorders, and Birth Trauma

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According to the Bureau of Labor Statistics, the median pay for nurse practitioners in 2021 was $123,780 per year, with salary ranges from $79,870 to $200,540. Unfortunately, the BLS does not differentiate between different types of Nurse Practitioners. However, Salary.com reports that the average salary for an NNP as of August 2022 was $131,393.

As with any employment situation, NNPs should think about many factors when looking at a job offer, such as local cost of living and total benefits package, including health and dental insurance, retirement benefits, and tuition reimbursement options. Search for positions in the location where you want to work to find out more about the specific NNP salary ranges in your area.

Highest Paying Cities and States for Nurse Practitioners

The BLS reports that in May 2021 the highest paying states for nurse practitioners were:

• California: $151,830
• New Jersey: $137,010
• New York: $133,940
• Washington: $130,840
• Massachusetts: $129,540

The top five states with the highest concentration of jobs and locations for CRNPs include:

• Alaska
• Connecticut
• New Jersey
• Illinois
• West Virginia

The BLS also reported that the top five metropolitan cities for nurse practitioner pay were:

• San Jose-Sunnyvale-Santa Clara, CA: $197,870
• Napa, CA: $184,700
• Vallejo-Fairfield, CA: $180,380
• San Francisco-Oakland-Hayward, CA: $177,160
• Yuba City, CA: $159,260

The top five non-metropolitan cities for nurse practitioner pay, according to the BLS, were:

• North Valley-Northern Mountains Region of California nonmetropolitan area: $136,510
• North Coast Region of California nonmetropolitan area: $136,150
• Southeast Minnesota nonmetropolitan area: $129,340
• Middle Georgia nonmetropolitan area: $129,210
• Connecticut nonmetropolitan area: $128,980

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Neonatal Nurse Practitioners perform a variety of duties relating to providing care to sick and premature newborns. Specific duties include:

• Order, perform and interpret diagnostic and laboratory tests
• Order and perform specific procedures such as intubation and central line placement
• Diagnose and treat acute and chronic conditions
• Record and examine the medical history, diagnoses, and symptoms
• Educate patients and family on the disease process and plan of care
• Monitor specialized equipment, including incubators, ventilators, heart/lung bypass machines, total body cooling, and dialysis equipment
• Conduct neonatal resuscitation in collaboration with other team members
• Communicate with other frontline clinicians and bedside nurses
• Start and maintain IV lines, specifically central catheters and umbilical lines
• Design treatment plans and prescribe medications (independently or in a collaborative agreement with a physician)
• Assess vital signs
• Perform physical examinations and patient observations
• Admit and discharge patients
• Participate in post-discharge primary care management
• Participate in high-risk newborn transport if this service is available
• Provide staff development by participating in educational programs
• Collaborate with other healthcare professionals
• Detect changes in a patient’s health and change the treatment plan if necessary

>> Related: Neonatal Intensive Care Nurse Career Guide

4 Levels of Care for Newborns

In general, the setting in which NNPs work determines the tasks they perform. In the United States, there are four different levels of care for newborns. Most hospitals have three specific levels of care that group infants according to their needs, with only the most advanced hospitals having Level 4 NICUs.

Level One, Newborn Nursery Care: This is for healthy, full-term infants. As such, the need for NNPs in level one care is limited.

Level Two, Intermediate Nursery Care: This is generally where premature and sick babies who are in need of constant attention are assigned.

Level Three, Neonatal Intensive Nursery Care: This is intended for the most seriously ill neonates with critical health issues who must be constantly monitored (usually referred to as the NICU).

Level Four, Neonatal Intensive Care Unit: To be in this level, this must meet all level III capabilities, plus have the ability to care for infants born earlier than 32 weeks gestation and weighing less than 1,500 grams, provide life support, perform advanced imaging including MRI and echocardiography, and provide a full range of respiratory support.

Neonatal NPs can work in a variety of settings. Most commonly they work in Neonatal Intensive Care Units but they can also work in the following healthcare settings,

• Medical Evacuation and Transport Services
• Outpatient settings
• Private homes providing health care services
• Hospice and palliative care services
• Government and community health agencies
• Universities and research agencies
• Healthcare or health industry businesses
• Private practice
• Phone triage centers
• Rural care facilities
• Nurse-managed medical centers

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If you want to become a neonatal nurse practitioner, you’ll need to complete the following steps:

Step 1: Earn a BSN degree

To become an NNP, you must first have your Bachelor’s Degree in Nursing (BSN). If you only have an Associate’s Degree in Nursing (ADN), you must first obtain a bachelor’s degree. This is a must before any graduate program can be started.

If you’re working as an RN with an ADN, there are two programs that would help you achieve your goals. They are an RN-BSN bridge program and an online BSN program. Each program has its own requirements and it’s important to determine which programs you qualify for before applying. Furthermore, decide if you are a distance education learner or need hands-on classroom instruction.

• RN-BSN bridge programs: These are ideal for nurses who completed an ADN program or are diploma RNs and now need to further their education. This program is ideal for working individuals with families and life commitments because it provides more flexibility with a heavy emphasis on online learning. Prospective BSN bridge program students should first reach out to their Human Resources department to inquire about tuition reimbursement through the healthcare system. Some hospitals have strong associations with certain online universities. This will allow employees to have a direct point of contact for the program, a streamlined application process, and may receive a higher level of tuition reimbursement.
  • Basic requirements: The applicant must possess an RN license in good standing with no disciplinary action. An ADN degree is required. Working a minimum of 30 hours per week or pass an equivalency exam. Pass a criminal background check.
  • Online RN-BSN programs are great for busy, working professionals. These programs allow the student to work when their schedule permits and can be completed at their own pace.

Most programs have a progression they like their students to take. This is because each course builds upon the previous course. Programs are generally expected to be completed within two to three years. It is suggested to take two courses per semester. Some programs will allow students to take up to three courses in one semester but special consideration may need to be given.

If you know that you want to become a NNP, it is important to start classes for your BSN as soon as possible. This education will take several years to complete, depending on the program and will ultimately delay applying for your NNP courses.

Step 2: Get An RN License

Once you are deemed eligible by the state board of nursing you are seeking a license from, you must sit for and pass the NCLEX in order to earn your RN license. Once you pass the NCLEX and meet all additional requirements, you will receive licensure in your state.

Step 3: Gain Experience

You’ll likely need at least two years of experience in a neonatal intensive care unit or comparable clinical experience in order to be accepted into an MSN or DNP graduate program.

Step 4: Earn an MSN or DNP

Next, you’ll need to earn either your MSN or DNP from an accredited program with a specialty in Neonatal Nursing. There are two main types of NP programs offered both in-person and online:

• MSN-NP: One of the most common options for NP programs, the MSN-NP is for students who already have their BSN and enroll directly into the program at the graduate level.
  • Basic requirements: Applicant must possess a BSN degree.
• DNP: Doctorate Nurse Practitioner programs allow students to receive their doctorate degrees while meeting the requirements to become an NP. The DNP is generally suited for nurses who plan on working more in an academic or research-based setting,
  • Basic requirements: Applicant must possess a BSN degree.
• Post-graduate certificate: If you have a graduate degree that is different from the area that you wish to specialize in now with your NP, you can search for a school that offers a post-graduate certification option to allow you to enroll directly into the program.
  • Basic requirements: Post-grad certificate programs require you to either possess your Master’s Degree of Science in Nursing (MSN) or have a Nurse Practitioner qualification in another specialty.

Neonatal Nurse Practitioner Program Overview

NNP programs will adhere to the Nurse Practitioner framework and core competencies established by the American Association of Colleges of Nursing for Nurse Practitioners. Those nine competencies are:

• Scientific Foundation
• Leadership
• Quality
• Practice Inquiry
• Technology and Information Literacy
• Policy
• Health Delivery System
• Ethics
• Independent Practice

>> Related: Top Neonatal Nurse Practitioner (NNP) Programs

NNP Program Curriculum

The Neonatal Nurse Practitioner's curriculum is very different from other NP programs because it is about a very specific population. Total credit hours are between 33-45, depending on the program. A program can take 2-3 years to complete and most can be completed on a part-time or full-time basis. Students are encouraged not to work during the program; however, it is feasible with the exception of during practicum.

Neonatal program coursework may include:

• The Child with Special Health Care Needs
• Advanced Pharmacology
• Advanced Pathophysiology
• High-Risk Neonate, Theory
• Neonatal Seminar
• Pediatric Physiologic Development
• Utilization of Research in Evidence-Based Practice
• Essentials of Human Genomics for Nurses
• Neonatal Practicum (600 hours including delivery room, Level I, II, and III)
• High-Risk Neonate II, Theory
• Neonatal & Infant Assessment and Neonatal Health Promotion

Neonatal Nurse Practitioner Program Requirements

Though every Neonatal Nurse Practitioner degree program is different, most have similar entry requirements, which generally include:

• A minimum of two years of nursing experience in a Level III NICU
• Satisfactory completion of an accredited baccalaureate program with at least 3.0 GPA on a 4.0 scale
• Submission of official transcripts from all postsecondary schools attended
• Unencumbered, active RN license in state of practice (Some programs will require an RN license in the state of the program)
• Two or three professional references
• Completion of undergraduate statistics with a grade of C or better
• Written statement of professional goals for graduate study and nursing career
• Professional resume or curriculum vitae
• Successful completion of a personal interview with the Nursing Admissions Committee
• GRE if applicable
• TOEFL test if applicable

Step 5: Get your NNP Certification From the National Certification Corporation

After successful completion of an accredited program, individuals must sit for their boards.

• Neonatal Nurse Practitioner (NNP-BC) Certification

This is an entry-level examination that tests the knowledge of students regarding the care of critically ill neonates. In order to sit for the exam students must fulfill the following requirements:

• • Current U.S. nursing licensure
  • Successful completion of an accredited graduate nurse practitioner program that meets NCC program requirements and prepares neonatal nurse practitioners. The program can be a master's DNP or post-master's. NCC no longer accepts certificate prepared applicants.
  • Examination within 8 years of completion of program.

Additional information regarding the examination includes,

• $325 testing fee
• Exams must be scheduled within the first 30-days of the eligibility window
• Computerized exam at a designated testing facility
• This exam is a 3-hour test consisting of 175 multiple-choice questions. Of the 175 questions, 150 are scored and 25 are used to gather statistical data on item performance for future exams.

After completing the specialty certification exam, individuals will have to become board certified in their specific state of practice. Requirements for certification will vary state by state. It is highly advisable to contact your local state’s board of nursing.

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Methodology

This list is based on a number of factors including:

• Reputation
• Tuition
• Acceptance rate, when available
• Only ACEN or CCNE accredited schools are eligible

Neonatal nurse practitioners can earn either a master's or doctoral degree, so this list takes into account both degree options.

Nurse Panel

Our selection panel is made up of 3 Registered Nurses with years of experience and multiple degrees:

• Tracy Everhart, MSN, RN, CNS
• Tyler Faust, MSN, RN
• Kathleen Gaines, MSN, BSN, RN, BA, CBC

There are numerous programs that prepare students to become neonatal NPs and our panel of nurses ranked them based on factors mentioned in the methodology. Because individual nursing pathways and careers take various forms, the top 10 programs are ranked in no particular order.

1. University of Pennsylvania

• Annual Tuition: $51,094
• Online: No
• Program Length: 2 years

Created for RNs with some neonatal nursing experience, the University of Pennsylvania's neonatal nurse practitioner program prepares nurses for a variety of areas, including intensive care nurseries. Students get to complete clinicals at some of the best healthcare facilities in the region, including the University of Pennsylvania Health System and the Children's Hospital of Philadelphia. Full-time students take two years to finish the MSN, but Penn also offers the program part-time for nurses who plan on working while earning their master's degree.

2. University of Texas Arlington

• Annual In-State Tuition: $15,814 Annual Out-of-State Tuition: $35,054
• Online: Hybrid
• Program Length: 2 years

The University of Texas at Arlington is a top-rated public research school and one of the largest schools in the University of Texas System. UTA has an MSN for current NICU nurses looking to take the next step and become neonatal NPs. The program consists of 42 semester hours and takes two years to complete. Nurses in the program complete courses online, though they need to attend two simulations on campus in Arlington. Students also earn at least 600 clinical hours which can only be completed onsite. For Texas residents, the low in-state tuition makes UTA an excellent option.

3. Regis University

• Annual Tuition: $20,020 (based on per-credit tuition rate)
• Online: Hybrid
• Program Length: 2 years

Located in Denver, Colorado, Regis University is a private school with a Christian background. While students can't take advantage of in-state tuition rates, Regis does offer a low per-credit tuition rate, making it easy to budget for the NNP program. This master's-level program uses synchronized web-based courses, though students do complete clinical in-person. After graduating from the program, students can immediately enter Regis' online DNP in neonatal nursing, bumping potential pay rates even higher. Overall, Regis offers a great mix of quality and affordability.

4. Duke University

• Annual Tuition (estimated): $22,056
• Online: No
• Program Length: 2 years

Often considered one of the best schools in the nation for graduate-level nursing programs, Duke University boasts one of the best neonatal NP degrees. This MSN emphasizes a family-centered approach, teaching students to remain mindful of patients while saving lives. Nurses complete 43 credit hours and 616 clinical hours over the two-year program, and students benefit from one-on-one experiential learning. Duke estimates the total tuition cost for most students, though specific costs vary.

5. Northeastern University

• Annual Tuition: $32,440 (based on per-credit tuition rate)
• Online: Yes
• Program Length: 1-2 years

With a well-connected global network of business partners and alumni, Northeastern University helps its students and graduates secure some of the best positions available in their fields. Northeastern's neonatal NP program comes in a one-year full-time option and two-year part-time option, both of which cover topics including early assessment, clinical roles, and pharmacology specifics. All courses in the program come entirely online, though students do complete their residences at facilities like Boston Children's Hospital, Massachusetts General Hospital, and UMASS Memorial Health Care.

6. Rush University

• Annual Tuition: $26,818 (based on per-credit tuition rate)
• Online: Yes
• Program Length: 2.5-3.5 years

Created for seasoned neonatal nurses looking to become nurse practitioners, Rush University's NNP DNP is an online program that only comes in a part-time format. The university offers the program for both BSN and MSN graduates, with BSN graduates taking 3.5 years to finish the DNP. Of course, non-NP applicants still need to complete clinicals, and Rush connects students with healthcare facilities in the Chicago area. Graduates of the program enjoy stellar first-time pass rates on national exams for neonatal NP licensure, too. Nurses looking for a flexible neonatal degree with great outcomes should strongly consider Rush's program.

7. Baylor University

• Annual Tuition: $27,500
• Online: Yes
• Program Length: 2-3 years

Baylor University, a private Christian school located in Waco, Texas, has started to embrace online education over the past decade, adding programs like the neonatal NP DNP. Designed for current RNs with NICU experience, the neonatal DNP has nurses complete courses online and clinicals in the greater Waco area. Baylor also offers entry options for BSN and MSN holders, with the BSN entry option taking just over three years to complete. This route also has nurses complete over 1,125 practicum hours, and graduates enjoy a 100% certification pass rate.

8. University of Missouri Kansas City

• Annual Tuition: $5,680 (based on per-credit tuition rate)
• Online: Hybrid
• Program Length: 2 years

As the largest university in the Kansas City area, the University of Missouri Kansas City has close connections with local hospitals and facilities, giving neonatal MSN students plenty of locations to complete their clinicals. UMKC's neonatal NP program uses a hybrid format, letting students complete most of their coursework at their own pace online. Nurses do need to commute to Kansas City for clinical courses, though. Also, all students in the neonatal NP program receive in-state tuition, making this an affordable option for all applicants.

9. Creighton University

• Annual Tuition: $21,597 (based on per-credit tuition rate)
• Online: Yes
• Program Length: 3 years

A private, Jesuit school located in Omaha, Nebraska, Creighton University ranks among the best private schools in the region. Creighton's robust graduate school gives students plenty of options, including RNs looking to become neonatal NPs. The online DNP in neonatal nursing has students complete courses online, though clinical experience needs to be earned in-person. The BSN-DNP route takes three years to complete when nurses study full-time, and applicants should first earn several years of NICU experience. Current NPs can also choose the post-master's DNP route.

10. The Ohio State University

• Annual In-State Tuition: $26,865 (based on per-credit tuition rate)
• Online: Yes
• Program Length: 2 years

The Ohio State University, one of the best public research schools in the nation, lets nurses earn their neonatal NP degree either part-time or full-time, and nurses complete the entire MSN coursework online. While most students choose to earn an MSN in neonatal nursing, OSU also offers a BSN-DNP route that leads to APRN certification. Applicants should have at least two years of NICU experience, and OSU does require students to commute to campus for clinicals. But aside from clinical experience requirements, nursing students earn this degree entirely online and at their own pace.

Neonatal nurse practitioners are granted the same rights as all other NPs throughout the country. Specializing doesn’t exclude them from any of the laws for this profession.

In 23 states, nurse practitioners have “full practice authority” which means they do not have to work under the supervision of a doctor. Full practice states include Oregon, Maine, Alaska, Hawaii, Washington, and Iowa.

In states with reduced practice (Ohio, Pennsylvania, and Utah) and restricted practice (Texas, California, and Florida), NPs must have a medical doctor sign certain medical patient care decisions. NPs have prescriptive privileges in all 50 states and can administer controlled substances in 49 states.

Nurse Practitioners evaluate their patients holistically, including both the emotional and mental aspects of the patient’s condition and not just the physical. For this reason, a great deal of time is spent on the education aspect of patient care.

CRNPs provide teaching and supportive counseling and refer patients and families as appropriate. They focus on health education, health promotion, and disease prevention.

While the BLS does not separate the potential growth of different types of NPs, one can safely assume that the need for NNPs will always be in need as long as there are babies being born.

The idea of working independently of physicians is a great incentive for some people to move into the nurse practitioner career. In fact, the profession rates #1 as the best job in health care and No. 2 job overall in the top 100 jobs, according to the U.S. News & World Report 2022.

The U.S. Bureau of Labor Statistics (BLS) reported that employment opportunities for all nurse practitioners would grow by 40% between 2021 and 2031. This is much faster than the national average of other healthcare-related professions including Registered Nurses. As of 2021, there were 300,000 advanced practice nurses with an expected need of an additional 118,600 by 2031. Additionally, as the healthcare industry continues to change there will continue to be a need for CRNPs.

Check out these organizations for additional information and resources:

National Association of Neonatal Nurse Practitioners

Advances in Neonatal Care

National Certification Corporation

American Academy of Nurse Practitioners

Academy of Neonatal Nursing

American Association of Colleges of Nursing

1. General Nurse Practitioner
2. Family Nurse Practitioner
3. Aesthetic Nurse Practitioner
4. Psychiatric Nurse Practitioner
5. Pediatric Nurse Practitioner
6. Acute Care Nurse Practitioner
7. Women's Health Nurse Practitioner
8. Orthopedic Nurse Practitioner
9. Emergency Nurse Practitioner
10. Adult-Gerontology Nurse Practitioner
11. Oncology Nurse Practitioner

• What do neonatal nurse practitioners do?

  • Neonatal nurse practitioners care for premature and sick newborns including diagnosing them, providing treatment plans, and prescribing medication.

• How much do neonatal nurse practitioners make?

  • According to Salary.com, the median salary for an NNPs is $131,393.

• How do you become a neonatal nurse practitioner?

  • Earn an MSN or DNP with a Neonatal Nurse Practitioner specialty from an accredited program, then get your NNP certification from the national certification corporation.

• How long does it take to become a neonatal nurse practitioner?

  • If you already have your bachelor's degree, it will usually take another two years to complete your Master’s degree, or three to four years to complete your DNP.

• How many hours does a neonatal nurse practitioner work?

  • This depends on the type of facility they are working in. Working hours for a neonatal nurse practitioner can range from 36 to 40 hours per week.