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Abstract Objective To describe the development and validation of the Winnipeg Assessment of Neonatal Nursing Needs Tool-Surgical Complex (WANNNT-SC), a nursing workload tool for use in a surgical neonatal intensive care unit (NICU). Methods The Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) was modified to create the WANNNT-SC. Nursing staff utilized the tool over 60 consecutive shifts to determine the number of nurses needed to appropriately staff the unit. The charge nurse, based on professional judgement, also determined how many nurses were required to staff the unit on each shift. Results The WANNNT-SC determined that 1.76 fewer nurses were needed for direct patient care. The tool was reliable across multiple users (mean difference 0.003, SD 0.32). Conclusion The WANNNT-SC is valid, reliable, and can be used to determine the number of nursing staff required to provide direct patient care in a surgical NICU.