Home Health Care 5 Things You Need to Know About Working in the Neonatal Intensive Care Unit

5 Things You Need to Know About Working in the Neonatal Intensive Care Unit

by Catherine Shaker

If you answered yes to any of the questions in my first post about wanting to work with acute care infants, then read this follow-up featuring five more tips for success!

  1. The NICU is an intensive care unit: Infants in the NICU are critically ill or were in the recent past. These most fragile patients can become physiologically unstable at any time—and it might happen during your therapy. The emotional roller coaster of NICU leaves families fragile, too.
  2. It’s not easy to practice in the NICU environment: Quick and constant losses and triumphs cause emotions to run high. An infant’s status can change at any time. Caregivers are highly skilled and passionate, which sometimes leads to strong opinions and respectful disagreements. The SLP needs to thoughtfully collaborate, yet at times take a stand.
  3. The NICU SLP requires advanced practice skills: It’s not just knowing what to do, but what not to do. We often support feeding/swallowing, so the risk for compromising an infant’s airway is significant. Essential skills include solid critical reflective thinking, the ability to complete a differential, and broad, multi-system knowledge about preterm development and swallowing/feeding. Your preparation should include solid experience with the birth-to-3 patients, as well as continuing education, mentorship and guided participation with many infants in both the newborn nursery and the NICU. The NICU is too demanding to be an initial independent placement after graduate school.
  4. The NICU evidence base is rapidly evolving: Read, read, read as much professional neonatal literature as possible. Sources are not just within our field but also in medical, nursing and OT/PT journals. Our role is not only to understand the evidence base, but to bring it to the NICU team. Neonatologists and neonatal nurses will ask “why?” and we must be able to discuss the research-based evidence along with our clinical wisdom: For example, if you recommend changing from “volume-driven” to “infant-guided” feeding.
  5. The NICU is rewarding: After almost 30 years working full time in the NICU, not a day goes by that I don’t learn something, make a difference in an infant’s life or experience the joy of a grateful “thank you!” from a family. The appreciation from nurses and neonatologists when an infant can now feed safely and, therefore, go home, makes your day. With such rewards, however, comes great responsibility. In our hands lies the potential to influence parent-infant relationships through positive neuro-protective feeding experiences that wire the brain toward feeding and build future connections.

If you are thinking about moving into NICU practice, you will find lots of information on my website. Stay tuned for more tips to guide your journey!


Catherine S. Shaker, MS, CCC-SLP, BCS-S, works in acute care/inpatient pediatrics at Florida Hospital for Children in Orlando. She specializes in NICU services and has published in this practice area. She offers seminars on a variety of neonatal/pediatric swallowing/feeding topics across the country. Follow her at www.Shaker4SwallowingandFeeding.com or email her at pediatricseminars@gmail.com.


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Jessica June 2, 2015 - 9:06 pm

What do SLP’s do in the NICU?

Catherine S Shaker, MS/CCC-SLP, BCS-S June 6, 2015 - 1:42 pm

Hi Jessica. It’s Catherine Shaker. That is the topic for my next post! Much of our focus in the NICU is feeding/swallowing but we also support parents and other caregivers in understanding and responding contingently to infant communication, both during care and during feeding attempts. Our role can be multi-faceted, including direct assessment and intervention, family/caregiver education, bringing the evidence base and participating in research and committees. Stay tuned for more.

ms. eli June 2, 2015 - 9:44 pm

Can #6 be you have to have good people skills? My oldest spent time in the NICU, and most of the nurses were great. We had one nurse that was great with him, but had no compassion for what my husband and I were going through, and no patience to explain what was going on with our son. NICU nurses see sick babies every day, so while things may become common place and even mundane for them, having a sick baby is scary, new, and high stress for the families. While the baby is really your patient, a great NICU nurse helps the parents through the ordeal. Our best nurse even advocated for us with the doctor (who we never met) to stop forcing formula and only give him the breast milk I was pumping and my son stopped vomiting at every feeding and quickly gained back the pound he lost.

Catherine S Shaker, MS/CCC-SLP, BCS-S June 6, 2015 - 2:11 pm

Hi. It’s Catherine Shaker. I am so sorry to hear that that nurse’s clinical expertise seemed far greater than her compassion for your NICU journey. How very sad. While those of us privileged to work in the NICU take care of the infants entrusted to us, we also care for their families. The emotional toll of having an infant in intensive care, whether a preterm or a sick newborn, begins a rollercoaster ride that is so hard to barely comprehend and understand unless you have seen it up close as NICU caregivers do. I have heard a mother cry as her infant’s life is gone and have shared cries of joy when a mother first realizes her infant communicates during feeding. If one’s work in the NICU becomes a task, versus relationship-based care with both the infant and his family, then the NICU is no longer a place for us. I wonder sometimes how the mothers and dads get up each day and arrive to visit so kind and thoughtful, given their heavy hearts. Most NICU nurses I have had the pleasure to work with are wonderful, value the family and build a strong relationship. I am so glad that along the way you were blessed with the wonderful nurses you remember so fondly. The gratitude I feel everyday to be a part of the NICU comes with the great responsibility to be thoughtful and caring with every interaction. Thanks for sharing your story with us.

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