Since I began blogging for the Leader, many SLPs and graduate students have contacted me about how to “get in” at the neonatal intensive care unit (NICU).
It’s true that NICU positions are hard to find. This is partly because of the NICU team’s challenging dynamics and the often “volume-driven” focus. Even when SLPs offer current research, years of NICU experience and evidence-based interventions, we get challenged daily by neonatologists and nurses to articulate our role, justify our recommendations, explain physiology and repeatedly work to change old habits that might interfere with neuro-protection. SLPs do all of this while also evaluating and treating sick, high-risk, fragile infants.
For me it has been quite a speech-language pathology journey covering nearly 40 years. For 30 of them and counting, I work as part of an NICU team. Every clinical experience builds on the next—usually more complex, but thought-provoking—opportunity to learn and grow.
These four steps can help you move into the NICU if you think it’s the right place for you:
- Solid pediatric birth-to-3 experience provides an essential foundation for NICU work. It provides exposure to and comfort with normal and disordered infant and toddler feeding, as well as with parental dynamics related to feeding. I spent about 10 of my early years with this population and received guidance from fabulous mentors. You’ll also meet and provide services for many NICU graduates when you work in a pediatric early intervention program! If you are a clinical fellow, I suggest arranging for a fellowship in a hospital—either in the NICU or an outpatient birth-to-3 program. Ask to shadow and meet both teams for future opportunities.
- Read as much as you can. I compiled a list of publications on my website, which—along with references at the end—can guide you toward salient works by neonatal nurses, occupational and physical therapist, SLPs and doctors. This area of practice requires a broad, but in-depth base of knowledge that spans many disciplines.
- Look for a wonderful mentor who serves as a role model for learning, critical thinking and evidence-based practice, and who helps you ask questions and reflect. The NICU setting requires a high level of knowledge, clinical reasoning and decision-making.
- Participate in continuing education focused on the NICU. Look for seminars that provide solid foundations for practice in pediatrics and the neonatal subspecialty. You can also network with experienced SLPs who attend the seminars to expand their clinical skills. Making these in-person connections helps build your possible job leads and provides you with deeper insight.
Know that working in the NICU requires an intense commitment. As I always say, you have to pick yourself up, dust yourself off and start again. With the right support, the NICU offers great rewards, but alongside challenging and sometimes exhausting work. If you know this at the start, you can set expectations and prepare for the extreme dedication and patience needed. I wouldn’t trade it for the world!
Catherine S. Shaker, MS, CCC-SLP, BCS-S, a clinician since 1977, works in acute care/inpatient pediatrics at Florida Hospital for Children in Orlando. She also offers several seminars on neonatal/pediatric swallowing/feeding across the U.S. Shaker is an affiliate with ASHA Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia). Find her at www.Shaker4SwallowingandFeeding.com or firstname.lastname@example.org.