When I first started in the NICU in 1985, I was excited but also concerned that I could potentially cause harm working with such fragile babies. And this was even after I already had nearly eight years of experience treating complex pediatric feeding/swallowing patients ages birth to 3.
The NICU is a different world: the medical terminology, the co-morbidities and their impact, and the fragile population. Working there, I thought of many clinical questions. Was what I saw normal feeding behavior for a preemie? A variant of normal? Immaturity? Or pathology? I started to build my knowledge base and framework for problem-solving by asking questions. I asked questions of neonatologists, nurses and respiratory therapists at every juncture. And I still do today!
So my number one tip for success in the NICU is ask questions! It paved the road for my success and will help you too.
- A question is like a flashlight that we shine into the darkness allowing us to move forward into the unknown and uncertain. We can organize our thinking around what we don’t know, as a guide.
- For various reasons, we tend to ask fewer questions as we mature. Students get graded more for their answers than their questions. Bosses get impatient when their staff ask too many questions, especially ones that challenge assumptions.
- Some often stop asking questions out of fear of looking foolish or appearing uninformed. Not asking often leads us down the wrong path, be it the wrong path for diagnosis or the wrong path for intervention.
- Advanced clinicians contemplate these two questions, repeating the cycle many times: “Why?” and “What else?” (What else do I need to consider? What else might be the etiology? What else might make a difference?)
- But who has time to pause and question? We’re so used to getting quick answers on Google, but clinical questions call for a different search. You may have to follow them into unfamiliar places, grapple with them and change them over time. Einstein said: “It’s not that I’m so smart, it’s just that I stay with problems longer.”
In the NICU, answers may become obsolete or insufficient over time. Only the questions endure.
If you are thinking about moving into NICU practice, feel free to comment below, email me or read my previous posts. And 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 firstname.lastname@example.org.