Neonatal nursing

Neonatal nursing is a specialized nursing practice of caring for newborn infants (neo meaning new, natal meaning birth) up to 28 days subsequent to birth. There are three different levels of working as a neonatal nurse: Level I consists of caring for healthy newborns, Level II caring for either premature or ill newborns, and Level III caring for newborns who cannot be treated in the other levels and are in need of high technology to survive. It is the neonatal nurse’s choice whether they wish to work in the Intensive Care Unit (ICU) with the healthy born babies or with the ill and/or premature babies.

Levels I, II, and III
Level I nurses are no longer in such great demand because the mother and newborn baby now commonly stay in the same room together. In addition, the mother's stay tends to be very short compared to the historical duration of the stay after giving birth. In the 1950s a stay consisted of 8 to 14 days. Nowadays, it is common for a mother to leave between 12 and 24 hours after giving birth, providing that the vaginal delivery had no complications.

Level II nurses are more common than Level I because babies that are born prematurely or ill needing constant attention. They are responsible for making sure the newborn receives the care it needs. It may include anything from giving supplemental oxygen to intravenous therapy to the newborn.

Level III neonatal nurses specialize in the Neonatal Intensive Care Unit (NICU). Level III specialists provide direct patient care for the newborns. These nurses are in charge of monitoring the ventilators or incubators, making sure the baby is responding well, and checking for complications. The nurse must check on the infant every hour on the hour and record the information taken by the ventilators, blood pressure, etc.

Neonatal nurses are required to be highly diligent because a failure in their duty of care can lead to dire consequences. Neonatal nurses also work under the eye and direction of neonatologists (specialists that have additional training in newborn intensive care for neonatology). The nurses also work with other NNPs (Neonatal Nurse Practitioners), so teamwork is critical. The majority of the neonatal nurse's working hours involve teamwork; therefore, it is critical that the nurse is able to cope with stressful situations and work irregular hours. NICUs are more commonly found in large hospitals and in children's hospitals, rather than basic family physician hospitals. It is the nurse's job to not only care for the infant, but also to have good communication skills with people, in particular with parents. The nurse's responsibility is to teach the parents how to care for their infant in the correct manner. The nurse's role is to explain how to watch for signs or symptoms indicating something is wrong with the infant. This allows the parents to assess whether their baby may be in need of hospital attention.

History
The introduction to the title of Neonatal Nurse Practitioner took place in the 1970s. The ability to gain this title was influenced by higher care requirements for ill newborns, the nurse practitioner movement, and medical staff shortages. After nearly 30 years of technological advancement, NNPs are now members of the neonatal health care team worldwide. However, this occurred after many years of practice restrictions and restraints. NNP had to overcome isolation, title ambiguity, variable educational preparation, and underutilization. Since the foundation of NNP, neonatal care has allowed long-term outcomes for premature and ill neonates and reduced mortality rate. NICUs and neonatologists had been in high demand and have risen drastically over the past 30 years. Over the past 20 years, the number of preterm births has risen by 27% and over the past 10 years the number of multiple births has increased by 45%. However, with the increase in NICUs and neonatologists, there has been a shortage and demand for more NICU specialists to care for the infants. 90% of NICU members are nurses and in 2020 the nursing workforce is predicted to be more than twenty percent lower than required. Reasons for this are staff cuts, overtime, and unlicensed nurses providing nursing care. To make up for the shortage, the NICU does rotations between residents and NNP, which has proven very effective.

Qualifications and requirements
The entry-level requirements to become a neonatal nurse are different for each location. Most hospitals require that the nurse is a graduate of an accredited RN (Registered Nurse) program and also from an accredited school of nursing with a BSN (Bachelor of Science in Nursing) or MSN (Masters of Science in Nursing). Many require a three year minimum of clinical experience in a hospital setting. It is required specifically for neonatal nurses that he or she has certification as a Neonatal Resuscitation Provider and/or certification in either Neonatal Intensive Care Nursing or Neonatal Nurse Practitioner. The NICU, for instance, requires a certification. For all of these qualifications, there must be a CNS (Clinical Nurse Specialist) or RN certification of the state in which the nurse wishes to work. Some hospitals insist that the nurse has shown clinical competence and leadership skills. The most important qualifications include the ability to administer medications, other knowledge needed for patient care, cardiopulmonary resuscitation, and math calculations, as well as demonstrating knowledge of the equipment and its use.

Salary
The pay for neonatal nurses varies from state to state, but, as of 2007, the range lies between $30 and $80 per hour. Salaries are dependent on the local cost of living, experience in the field, and the amount of advanced training. The wide-ranged salary in this field varies throughout the world. Usually the annual pay for beginner neonatal nurses is between $30,000 and $48,000. However, the higher status neonatal nurses' salaries range from $30,000 to $50,000 and for a neonatal nurse practitioner they lie between $50,000 and $190,000. The salary range varies depending on experience and how much advanced training the nurse practitioner has received. There are also benefits, such as bonuses, valued up to $5,000.