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Roles and Responsibilities for a Neonatal Nurse

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The neonatal period is the first 28 days of an infant’s life. Neonatal nurses work in nurseries that provide different levels of care to babies who range in condition from healthy newborns to premature babies or babies who have serious birth defects, severe illnesses or other life-threatening problems. A neonatal nurse is a registered nurse who may have an associate, baccalaureate, master's or doctoral degree, or a diploma from a hospital-based school of nursing. Neonatal nurses may also be certified in their specialty.

Nursery Care

Neonatal nurses may work in Level I, II or III nurseries. Although the nurses provide direct care in each nursery, their duties differ according to the condition of the infants. Level I nurseries are less common than they once were, as many babies share a room with their mothers, but where they do exist, they are for healthy newborns who need minimal care such as feeding, baths or changing diapers. Level II nurseries provide an intermediate level of care -- babies in these nurseries may need oxygen, intravenous fluids or specialized feedings. Level III nurseries are for very sick infants. Nurse in these nurseries may manage ventilators, take care of babies who have had major surgeries or provide other technically complex care.

Basic Skills

Each institution establishes practice skills for neonatal nurses, but most expect the nurse to be able perform math calculations -- an infant often needs a fraction of the dose of medication an adult would require. Other basic skills are management of intravenous lines, cardiopulmonary resuscitation and the use of specialized equipment such as ventilators and incubators. A neonatal nurse must be technically proficient with skills such as starting intravenous lines or using feeding tubes on very tiny infants.

Other Duties

Nursing infants is very different from nursing adults. Infants cannot communicate verbally when in pain, their bodies respond differently to medications and treatments and they must be protected from potential dangers. In addition, the neonatal nurse must educate and support the infant’s parents, who may be stressed or frightened. A neonatal nurse should have excellent interpersonal skills, with the ability to establish rapport and provide compassion and empathy to parents. She must also understand and be vigilant to prevent harm from risks that specifically affect newborns, such as temperature changes or excess oxygen.

Advanced Practice

Many neonatal nurses are staff nurses, but others may be advanced practice nurses such as nurse practitioners or clinical nurse specialists who also work in the neonatal arena. These highly educated nurses have a least a master’s degree and are authorized to provide physician services such as medications, or to order treatments and diagnostic tests. A clinical nurse specialist, for example, might assume responsibility for the care of ventilator-dependent infants or assist with special procedures such as the use of heart-lung bypass machines.


Beth Greenwood is an RN and has been a writer since 2010. She specializes in medical and health topics, as well as career articles about health care professions. Greenwood holds an Associate of Science in nursing from Shasta College.

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