One of the things to consider when advancing into the neonatal population is the training that is offered at the facility. Level 1 or level 2 NICU’s may have a short orientation where the clinician will have to be familiar with heated high flow nasal cannulas, mechanical ventilation, and nasal CPAP.

As a recent graduate or a therapist that is fairly green, the level I and II’s may require you quickly become proficient with advanced airways and deliveries. When interviewing with the hiring manager, it would be good to ask an ideal time frame to take the NRP course. 

Level III and IV’s are advanced with high risk deliveries, HFOV, HFJV, and patients that have long term congenital conditions. In addition to the NRP skill set, therapists will be trained with troubleshooting patient scenarios and equipment. NICU orientation should include an orientation manual, skills lab, and mentoring.

Being a NICU therapist is a specialization and it requires not only equipment proficiency and patient troubleshooting, but also communication with nursing, physicians, and practitioners. The new graduate should approach the NICU with a team orientated approach. You will have to coordinate with the nurses on ‘touch times’ in effort to reduce stimulation to the infant.

If you’re a person that likes to have conversation with patients and interact with them…good luck. The only adult conversations in the NICU will be with your co-workers. For some, that is ideal.

After orientation, be expected to be tested by your co-workers. The nurse may ask you if an oxygen delivery device is set up correctly. When in fact, she already knows the correct way. Or you may attend a delivery with the nurse and she may ask you what you got on the APGAR score.

Unexpectedly, the neonataologist called the NICU one evening and asked for me. Being in the NICU for 3 months, I wasn’t sure what he could possibly ask me. After the portable chest x-ray was completed on a 32 week infant, he asked how many ribs the lungs were expanded. After telling him the 8th, he said “ok, thank you”, and hung up. I assumed that answer was satisfactory to him, but for me I was unsure.

In the end, I learned that he could read the chest radiograph from his phone. He was just testing my competency.

I recommend reading journals and textbooks that relate to neonatology and advanced airways on your downtime. Education is power, but only if you use it.