9 Must-Have Nursing Skills for Neonatal Nurses

Neonatal nurses must possess clinical skills to provide intensive care for the tiniest babies, communication skills to care for families and passion for their profession.

“I love working with neonatal patients and their families, because I get to be part of a family’s journey at a very important time in their lives,” said Lori Williams, DNP, RN, RNC-NIC, CCRN, NNP-BC, clinical nurse specialist at the American Family Children’s Hospital at the University of Wisconsin Hospitals and Clinics, Madison, and Pediatric Perspectives section editor for AACN Advanced Critical Care. “For me, NICU nursing is special because you have this precious new life in your hands.”

Babies receiving care in the NICU may be recovering from surgery, have congenital anomalies or have been born prematurely. Babies born as early as 22 or 23 weeks are surviving with NICU care.

“You have an influence on that child’s life from the beginning,” said Gail Bagwell, DNP, APRN, CNS, president of the National Association of Neonatal Nurses and a clinical nurse specialist at Nationwide Children's Hospital in Columbus, Ohio.

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9 essential nursing skills for NICU nurses

Many nurses come to the neonatal intensive care unit (NICU) after practicing in an adult or pediatric intensive care unit. They bring those skills to help the tiny newborns. Some neonatal nurses move to the specialty from pediatrics. Bagwell said some hospitals will hire new graduates for the NICU.

Wherever one starts their training, the following skills will help NICU nurses be successful:

1. Assessment skills. “NICU babies can decline quickly,” Williams said. Neonatal nurses must pick up on those changes and take the appropriate action.

2. Critical thinking, which “can be a game of detective work as you have a nonverbal patient whose clinical presentation can be so subtle,” Williams said.

3. Effective communication for handoffs, reporting changes in condition and working with colleagues and the babies’ family members.

4. Ability to teach the family members not only about the equipment and technology, including life support and dialysis, but also how to incorporate the child into the family and achieve the maternal and paternal roles, Williams said.

“NICU nurses play an important role in helping parents feel connected to their child,” Williams added. “Often, parents feel the child is not really ‘theirs’ until the point of discharge, and we ‘allow’ parents to take their child home.”

Over time, “as we work together and practice skills, the parents move from novice to expert,” Williams said.

5. Experience teaching about breastfeeding and pumping breast milk for baby. Nurses also encourage skin-to-skin care.

“Breast milk is the best medicine for the neonate,” Bagwell said. “Babies that get mom’s milk do better.”

6. Empathy and the ability to nurture and read clues from the patient are essential to the role of NICU nurses, Williams said.

7. Responsiveness to the patient’s developmental needs as they evolve over time. Are the newborn’s emerging skills on time or delayed? Williams asked.

8. Ability to meld with the rest of the NICU team and get along with others is another key skill, Bagwell noted.

9. Understanding of palliative care. Not all babies survive and nurses have to be prepared for that eventuality and help the parents through the tough times.

Certification as a neonatal nurse

“[Certification] is evidence that the nurse has a specialized body of knowledge above that expected by the employer to do the job,” Williams said. “It shows commitment by the certified nurse to stay up to date and to practice at a higher level.”

Williams added that certification aids in establishing a culture of excellence, and boosts nurses’ confidence, which leads to better patient care.

Neonatal nurses experience the joy of providing the intensive care a baby needs to survive and thrive and educating the family members, so the baby continues to grow and blossom once home.

“Everything we do for these babies will impact them for the rest of their lives,” Bagwell said. “We get to see them born at the edge of viability to going home with their moms and dads.”

Some parents will bring their babies back to the NICU and keep in touch with the team that saved their babies’ lives.

“New NICU nurses should know their lives will be changed by being a small part of the lives of these children and families,” Williams said. “Neonatal nursing is a passion.”

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