The Neonatal Nurse Practitioner (NNP) is an Advanced Practice Registered Nurse (APRN) who provides advanced intensive care for acutely ill newborns and high-risk babies, usually within their first month. These neonate patients suffer from chronic illnesses and life-threatening conditions and require constant 24-hour care.
NNPs provide care for high-risk newborns with health complications due to low birth weight, drug addiction, respiratory distress, premature birth, HIV infection, or congenital heart defects, to name a few. Neonatal Nurse Practitioners attend high-risk deliveries and perform neonatal resuscitation, and they are specialists in using advanced technologies to care for neonates.
Neonatal Nurse Practitioners practice in conjunction with Neonatologists to supervise and manage the care of high-risk newborn patients. Patient care activities may include:
- Monitoring and Assessing Vital Signs,
- Developing treatment plans after assessment and diagnosis,
- Collaborating with and referring to other specialists,
- Providing advanced respiratory treatment,
- Monitoring and Managing Equipment – Incubators, Heart Monitors, Ventilators, etc.,
- Research,
- Educating nursing staff, and
- Educating and assisting parents in proper care of the newborn.
Family education is essential to the NNP role as parents may need instruction in the proper care of these newborn infants requiring special attention. Other areas of parent education may include birth control and pregnancy.
Working with high-risk newborns and their families during periods of high emotional stress can make the NNP role emotionally challenging. However, newborns who reach adulthood and their families recognize the Neonatal Nurse Practitioner’s critical role in their lives and often remain in contact for many years.
The Neonatal Nurse Practitioner advocates for the sickest of sick newborns and their families. They must possess exceptional stress management skills and be highly flexible in dealing with patient needs that may change daily.
Visit the Nurse Practitioner (NP) job description overview for more information about NP practice.
Practice Specialties
The Neonatal Nurse Practitioner is a specialty role focusing on the special patient population of premature babies and other high-risk newborns. However, NNPs may concentrate on specific areas such as cardiology, respiratory care, or prematurity.
The NNP usually has several years of Neonatal Intensive Care Unit (NICU) experience as a Registered Nurse before beginning their NNP education.
Practice Settings
Much of the care practiced by a Neonatal Nurse Practitioner occurs in hospital nurseries, of which there are four levels:
- Regional Neonatal Intensive Care Unit (NICU) (Level IV) – provides the highest level of care to neonates, the most highly complex patients. The Level IV NICU is a referral center for hospitals in the surrounding area and accepts patients from the hospital’s Level I, II, and III care units,
- Neonatal Intensive Care Unit (NICU) (Level III) – provides care for seriously ill neonates and requires care providers with skills to work with highly complex patients,
- Intermediate Nursery (Level II) – sick and premature babies who require a higher level of care, such as assisted breathing, and
- Newborn Nursery (Level I) – is a nursery unit for healthy infants. The use of Newborn Nurseries is decreasing as it is becoming more common for newborns and mothers to share the same room.
The NICU provides prompt and urgent comprehensive care, including life-sustaining support, respiratory, medical, and surgical subspecialties, and advanced imaging equipment such as Magnetic Resonance Imaging (MRI) and echocardiography.
Neonatal Intensive Care Units provide care and monitoring for patients on a 24-hour basis, requiring the NNP to work 12-hour shifts that include weekends and holidays.
Advances in treating seriously ill or premature babies have increased the demand for Neonatal Nurse Practitioners in NICUs and Intermediate Nurseries. These units are located in larger community hospitals, academic medical centers, research hospitals or universities, and regional referral centers to provide high-risk care.
The NNP may also practice in:
- Hospital Emergency Departments,
- Specialty Practices,
- Delivery Rooms, and
- Pediatric Clinics.
In recent years the role of Neonatal Nurse Practitioners has expanded beyond the nursery and into ancillary areas such as:
- Case Management – providing a continuum of care across communities and health care settings,
- Expert Consultation – Emergency Departments, Surgical Services, Radiology, Pediatrics, Primary Care Pediatric/Family Practices, prenatal services, and
- Post-NICU Care – primary and post-discharge care for high-risk infants.
Scope of Practice
Scope of Practice refers to the degree to which a Neonatal Nurse Practitioner may practice independently of oversight by a Physician. Aspects of NNP practice independence vary by state and include:
- Practice Autonomy,
- Primary Care Provider Recognition, and
- Prescriptive Authority.
The ability of Neonatal Nurse Practitioners to practice with little or no Physician involvement distinguishes the NNP from the Physician Assistant (PA), restricted to practice only under the direct supervision of a physician. NNP Prescriptive Authority varies by state and is regulated more tightly for controlled substances.
Scope of Practice varies by state based on each state’s legislative and regulatory rules. Visit the Color Coded Map and Sortable List to view how the NNP Scope of Practice varies by state. For more detailed information, visit the Board of Nursing for the state of interest. Individual employers may impose Scope of Practice rules more restrictive than the state permits.
Education
The ability to practice as a Neonatal Nurse Practitioner requires a graduate-level nursing education. There are several degrees or certificate types:
- Master of Science in Nursing (MSN), Master of Science, Nursing Major (MS-NM), or Master of Nursing (MN) – The master’s degree has been the most commonly offered degree type and is the minimum degree required for Neonatal Nurse Practitioner education. These degree programs are offered widely by public and private schools. The master’s degree in nursing focuses on advanced nursing theory and care practice. Read more...
- Doctor of Nursing Practice (DNP) – In addition to studying advanced nursing theory and care practice, the DNP emphasizes using research results to improve the NP‘s nursing practice. DNP programs also emphasize the application of Evidence-Based Practice to improve the quality of patient care. The National Organization of Nurse Practitioner Faculties is committed to transitioning all entry-level NP programs to the DNP by 2025. Read more...
- Post-Master's or Post-Doctorate Certificates – Eligibility is limited to individuals with a graduate-level or doctoral-level nursing degree. For example, someone holding an MSN as a Clinical Nurse Specialist (CNS) would be eligible to enroll in a Neonatal Nurse Practitioner certificate program. Read more...
Prospective students should verify that the Neonatal Nurse Practitioner program they are considering is accredited. Proper accreditation ensures that graduates are eligible to sit for the certification exams required to become licensed to practice.
Use the Nurse Practitioner Search Tool to identify programs for this and other degree combinations from our survey of more than 710 schools.
Prerequisites
NNP degree and certificate programs have more stringent entry requirements than most other Nurse Practitioner programs. These prerequisites include:
- Specialized Certifications – Neonatal Resuscitation Program (NRP), Neonatal Advanced Life Support (NALS), Registered Nurse Certified in Neonatal Intensive Care (
- Clinical Experience – A minimum number of years of NICU clinical experience, usually two.
Additional prerequisites for entry into an NNP program vary by school.
Accelerated Degree Programs
Accelerated Degree Programs generally cost less and can be completed more quickly than enrolling in consecutive BSN–MSN or BSN-doctoral programs. Use the Accelerated Degree Program Search Tool tool to identify programs for this and other degree combinations from our survey of more than 710 schools.
Certificate Programs
Most schools that offer a Neonatal Nurse Practitioner master’s or doctoral degree also offer an NNP post-graduate or post-doctoral Certificate Program. These programs are open to individuals with a master’s or doctoral degree in another nursing specialty. These Certificate Programs should not be confused with certifications offered by Certification Boards or Professional Associations.
Tandem Degree Programs
Tandem Degree Programs award two degrees in the course of Neonatal Nurse Practitioner study. These programs save the student time and expense by eliminating duplicate coursework. Some schools offer NNP Tandem Degree combinations, such as:
- Bachelor of Science, Nursing Major (BS-N), followed by a:
- Bachelor of Science in Nursing (BSN), followed by a:
- Master of Science in Nursing (MSN), followed by a:
Graduates from these Tandem Degree Programs are eligible to sit for the appropriate national certification exams and become licensed as required.
Use this Tandem Degree Program Search Tool to identify programs for this and other degree combinations from our survey of more than 710 schools.
Top Degree and Certificate Offerings
This table displays a count of the Top Neonatal Nurse Practitioner degrees and certificates offered by more than 710 graduate nursing programs. This count includes degrees awarded singly or as the higher of two degrees in a Tandem Degree program.
Certification
The National Certification Corporation (NCC) offers the Neonatal Nurse Practitioner exam to graduates from an NNP degree or certificate program. Individuals who successfully pass the exam receive the Neonatal Nurse Practitioner-Board Certified (NNP-BC) credential. This certification is a prerequisite for a state license to practice as an NNP.
The National Certification Corporation offers additional Neonatal Nurse Practitioner certifications:
Core Certifications
- Inpatient Obstetric Nursing (RNC-OB)
- Low-Risk Neonatal Nursing (RNC-LRN)
- Maternal Newborn Nursing (RNC-MNN)
- Neonatal Intensive Care Nursing (RNC-NIC)
Nurse Practitioner Certifications
- Neonatal Nurse Practitioner – Board Certified (NNP-BC)
- Women’s Health Care Nurse Practitioner – Board Certified(WHNP-BC)
Subspecialty Certifications
- Care of the Extremely Low Birth Weight Neonate (C-ELBW)
- Electronic Fetal Monitoring (C-EFM)
- Neonatal Neuro-Intensive Care (C-NNIC)
- Neonatal Pediatric Transport (C-NPT)
Certifications for NNPs offered by the American Association of Critical-Care Nurses (AACN) include:
- Critical Care Registered Nurse – CCRN (Neonatal), and
- Critical Care Registered Nurse Knowledge Professional – CCRN-K (Neonatal).
NNPs often obtain additional certifications in areas of specialization and advanced knowledge. Review this site’s survey of more than 300 nursing and related healthcare certifications.
License to Practice
The Board of Nursing for each state issues licenses to practice as a Neonatal Nurse Practitioner within their state. The NNP scope of practice, including Practice Autonomy and Prescriptive Authority, varies by state.
States participating in the APRN Compact and Nurse Licensure Compact have multistate APRN and RN license agreements. These Compacts ease the transfer of NNP licenses and the ability to practice among participating states. Participation in these Compacts varies by state. Check with your state’s Board of Nursing for more detailed information.
Professional Associations
The National Association of Neonatal Nurse Practitioners (NANNP) is the primary nursing professional association for Neonatal Nurse Practitioners. NANNP is dedicated to representing Neonatal Nurse Practitioners and has state and local chapters throughout the United States.
An NNP may benefit from joining other associations such as the:
- Academy of Neonatal Nursing (ANN),
- National Association of Neonatal Nurses (NANN) , and
- Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) .
An additional national association, the American Association of Nurse Practitioners (AANP) provides representation and resources for all nurse practitioners.
NNPs often belong to associations that provide resources and representation in specific areas of practice specialization. Additional associations at the state and local levels enable members to organize with their neighboring peers to address more localized issues. These associations may be chapters of national or international associations or organized independently.
This site includes an extensive survey of more than 1,800 international, national, regional, state, and local professional associations. These associations provide professional development resources and representation in numerous nursing and affiliated healthcare specialties.