Neonatal nurses provide specialised care for the world’s littlest patients - babies (neonates) who have been born premature or full-term but are unwell.

The neonatal (‘neo’ means new and ‘natal’ means birth) period refers to the first 28 days of life. Neonatal nurses are a crucial part of the neonatal care team, caring for neonates mostly in neonatal intensive care units (NICU) in hospitals, which are also known as neonatal special care units or nurseries (SCN), as well as in postnatal wards, emergency retrieval units and in the community.

Neonatal nurses have specialised skills in the assessment and care of sick babies and they also provide essential care and support to the families of their tiny patients.

Neonatal nursing involves working in a fast-paced and highly technical environment. It also offers an exciting career that comes with its emotional challenges and also its immense rewards.

What do neonatal nurses do?

As a neonatal nurse and researcher at one of Australia’s largest maternity hospitals, The Women’s in Melbourne, Victoria, Amy Brett says neonatal nurses care for tiny intensive care patients - sometimes weighing in at just 400 grams.

The tertiary NICU, which deals with complex, high-risk pregnancies, cares for more than 1700 unwell and premature babies every year, from as early as 23 weeks gestation.

Neonatal nurses often join paediatricians and neonatologists at the unexpected or planned birth of a baby, before the baby is cared for in the neonatal unit or nursery.

“It’s a very technical job - there’s a lot of monitoring, a lot of infusions for sometimes very complex patients,” Ms Brett says.

“Here at The Women’s we deal with all medical issues, so it’s a lot of prematurity and respiratory nursing and infections.

“We deliver babies here that need to be stabilised and transferred to a surgical unit for congenital abnormalities.

“We also deliver a lot of babies that are in that stage of just being premature, so they have issues with their breathing - they just need breathing support and to grow and establish.”

Neonatal nurses also care for babies as they develop, and require less support and intervention.

These specialised nurses work with medical teams, midwives and allied health professionals to provide care for neonates, and their families.

“We support them through the special care nursery, we look at establishing breastfeeding with the mothers, creating that bonding and attachment between mother and baby throughout the whole stay,” Ms Brett says.

“We also look after the family as a whole.”

Neonatal nursing is incredibly challenging.

Neonatal nurses support families through the incredibly emotional, stressful and difficult journey with some babies, who often arrive unexpectedly early, and spend weeks or months receiving care in hospital.

Aside from the unexpected arrival of pre-term babies, one of the most challenging aspects of neonatal nursing is the provision of end-of-life care for some neonates.

“That is hard. It is part of the job and you do have to do it but I consider it as quite an honourable thing to be involved with a family who is grieving,” Ms Brett says.

“We have a lot of support services in place at the hospital to help the families and help the family grieve.

“We also have support through debriefing sessions if they are required - they promote education around reflective practice, so that we can try and assist nurses dealing with any of the stress that’s related to being involved in end-of-life care.”

At the other end of the scale, neonatal nursing is also incredibly rewarding.

“We often see these tiny babies begin to grow and improve,” Ms Brett says.

“Often they will grow and establish the feeding and the bonding with the mum and be able to be discharged to a smaller special care nursery, where they have got time to continue growing and continue establishing breastfeeding.

“You build up quite a close rapport with the families because you are seeing them on a daily basis, sometimes for many months.”

Ms Brett says neonatal nursing is an exciting career.

“If you have got an interest in it, there’s definitely ways you can get exposure into this area.

“Go for it - we’re always looking for new nurses,” she says.

How can I become a neonatal nurse?

To become a neonatal nurse, you must first become a registered nurse or midwife through study and practice.

Undergraduate study requirements can vary between states and territories across Australia.

Contact the Australian College of Neonatal Nurses for up-to-date undergraduate degree requirements for neonatal nursing in your jurisdiction.

Ms Brett obtained her Bachelor of Nursing at Deakin University and began a graduate year at Monash Medical Centre, completing a rotation in the special care nursery before up-skilling in NICU.

“I spent four years in NICU completing different up-skilling education days - breastfeeding education days and ventilation education days, and then I did a transition to specialty of practice program as part of that.”

Ms Brett has since completed a postgraduate diploma in NICU and now, in her eighth year of neonatal nursing, is studying her Masters in Research.

She advises nursing students aspiring to a career in neonatal nursing to seek a graduate year in a hospital with neonatal care, where they can experience a rotation in either a special care nursery or in a neonatal intensive care unit.

“Following that you can transition to specialty practice programs that are run often after a graduate year,” she says.

“We offer at The Women’s a complex care course that is run as an entry into the specialty for registered nurses.

“Following that career pathway you can go on to do postgraduate education - certificate and diploma - there’s a number of universities that offer it.”

Neonatal nursing can lead to career paths in clinical, educational, managerial and research areas.

“It’s such a technical area that it requires a lot of clinical experts to be working on the floor on a day to day basis,” Ms Brett says.

“There’s also a clinical pathway into management, so every shift needs shift managers and unit managers who coordinate our bed numbers, our admissions, our discharges - they also coordinate staffing and what’s happening on the floor.

“We have management teams and we have the education teams who train graduates and postgraduate students.

“We also have a big research department and many of the babies are involved in clinical trials - so you can be involved in nursing research and medical research.”

In her research role, Ms Brett thrives on being part of a research team working on several clinical trials investigating areas such as non-invasive respiratory support.

“Practices change and technology changes very quickly in this area, so you are constantly questioning your practice,” she says.

“Research is a way that we can question our practice or intervention and it gives us evidence-based research that we can then apply to practice.

“We need the research there to prove that what we are doing is being done the right way and is also the most effective treatment for these babies.”