If there is an error on one girls’ part, and the rest of the team reacts with negativity, it’s contagious. If the same error is taken in stride, the team swoops in, recovers, and the play continues, sometimes with even better results.

It’s also obvious that not everyone can have the same role. You can’t have a team of 3-point shooters and no one to rebound. And most obviously, no matter how skilled the player, she cannot play the game alone.

So why the heck am I talking about basketball?

Because sports rule in defining the notion of team.

And we need a little more team in the NICU.

When I began writing this article, I had a whole section on how incredible it is when all disciplines in the NICU collaborate. NICUs that have great teams deliver amazing care. And it’s obvious to anyone who walks in the door.

But as therapists, I hope we already understand that our survival in the NICU depends on our ability to work as a team. Our very access to our patients depends on our communication with nursing. And we can thrive, or not, with mutual support.

But I want to talk about us. About being a team with other therapists. Yes, even though territory, history and charge codes can cloud our vision.

No One Likes a Ball Hog

If you’ve ever played sports or watched your kids play sports, you know how painful it is to watch someone hog the ball.

Or maybe you’ve attended a conference or meeting where a speaker runs over her allotted time by 30 minutes? Yep, ball hog. This sort of attitude never serves a team.

So here’s the thing:

Do OTs own rights to the sensory system? And PTs the motor system? And do SLPs own space north of the suprasternal notch?

Are we bored with that mindset yet?

Our neonatal SLP works PRN in our unit right now, primarily due to her responsibilities to other populations. She was amazed when our PT and I first approached her with the idea of taking advantage of her previous neonatal experience to expand our coverage in the NICU.

She said, “I can’t believe you’re going to let me work up there! Usually OTs don’t want SLPs up there in their territory.” We both laughed out loud. Being territorial has never been my thing. But I also know her statement to be true (and vice versa) in many places, and between OTs and PTs as well.

I’m not implying that we should minimize or dilute our discipline-specific skills, just our boundaries about sharing knowledge and ideas, and access to the NICU itself.

A New Vision

Consider this: There is room for everyone. Our differences make us stronger and deeper as a team.

There isn’t room for numerous non-specialized therapists who ‘cover the NICU’ without extensive training. BUT there is room for specialized, knowledgeable, collaborative practitioners from each discipline.

The units that exemplify teamwork will shake their heads and think I’m making this up. But I’m not going to pretend this isn’t an issue. It’s one that needs to be resolved as we move forward as a clear and focused group. There’s so much work to be done.

Let’s begin here.

We are so excited to host this historic event where we will continue to define and lead the future of this field. I love the fact that we will meet in person, share new ideas, mentor, and be mentored!

Interested in contributing to this national conference?  Click here for more information for the Call for Speakers and the Call for Posters. Submissions are due October 1st, 2010..

So many of you have emailed already saying you’re coming to the conference!

Can’t wait to see you there!

Sue Ludwig

Last summer my kids and I joined friends at a large nearby amusement park. It was there I had a Piglet moment. And it wasn’t even about the hundreds of rides that propel my kids at Mach 5 into the stratosphere.

We were walking down a wide shaded path when we heard a loud, “Boom!” Startled, we turned to see that a wooden sign about 5 feet in length had fallen off a storefront facade. My inner Piglet said, “What if one of you had been standing there? That could’ve really hurt someone.”

As usual the kids nodded saying, “Yeah, wow,” and moved on.

However my brain was now thinking, “Ok, I was fine with them riding big roller coasters, but signs? I’ve never even thought about signs!” Suddenly they were everywhere, these ominous signs.

My inner Piglet was on a roll.

We have all been Piglet. We see big things looming. We imagine what could happen IF. (We see staff and parents doing this all day at work.) We spend precious energy and time being anxious about the question marks in our lives. From falling signs, to our health, to the job market, to what could’ve happened if the guy behind us hadn’t slammed on his breaks.

What’s helpful about this Piglet triangle of fear, worry and anxiety is…well…

Nothing.

Sometimes we think we MUST worry about things because if we stop worrying then that’s EXACTLY when something’s going to happen. Right when we’re peacefully unaware.

We become so lost in our thoughts and fears we couldn’t respond to an opportunity or situation if we had to. It is another way we remove ourselves from the present. We’re not actually living our lives anymore. We’re all up in the future’s business or in what could’ve/would’ve/should’ve happened in the past.

Pooh’s response above is classic Pooh. The simple, wise thought of someone who sees the situation for what it is, and what it is not. This is Pooh as sage.

Why do Piglet moments matter?

We all get a little Piglet-y at times, so what’s the big deal?

The big deal is when that anxious voice becomes the soundtrack to our lives. We unconsciously create the fear-filled life we thought we were avoiding with all our worrying.

Because what we habitually think, becomes.

How to Let Go of your Inner Piglet

Dr. Jill Bolte Taylor, a Harvard-trained brain scientist and author of My Stroke of Insight, stated that when emotions like fear, anxiety and anger are triggered, they produce a set of physiological responses in our body. You know the feelings: shallow breathing, tightness in the chest, upset stomach and so on.

Our body’s physiological response to these emotions only lasts 90 seconds. Yes, just 90 seconds. So, in the absence of any true fearful situation, our bodies are over this stuff in a minute and a half.

Meanwhile our brain continues to run the familiar loop: “Oh no, more danger, bad things happening, must be on guard.” We make that loop in our brains deeper and deeper by feeding it these thoughts. It literally becomes a neural rut. Default mode.

The great news is we can rewire our brains to do this instead:

Triggering event occurs

Physiologic response (90 secs)

Quick assessment/no actual danger

Discard feeling

Look how quick that was!!!  Much like Pooh saying, “Supposing it didn’t.”

It is the stories we keep telling ourselves, our neighbors, and families that keep the anxiety alive long after the event. And while on the phone recounting our fears, the 10 year olds in our lives are waiting for us to help them with homework. We are not present except to our stories.

We’re off living in the past or future, but not in our very own kitchen, with the people who want and need us.

Try this today:

1. Practice being your own observer. Find yourself in a Piglet moment (this will probably happen today if you pay attention!)

2. Observe how long your body feels uncomfortable. Let it feel that way for a minute or two.

3. Resist the urge to tell 10 people what could’ve or may happen. Literally tell your brain you have no need for those thoughts anymore. Let go.

4. With practice, watch your anxiety plummet and the space and productivity you experience multiply.

5. Repeat this like a ritual when negative thoughts appear and watch your brain rewire itself with better thought patterns.

Your inner Piglet will visit now and again. But he will no longer take up residence.

Pooh, however, is always available for counsel.

Announcement: Don’t forget to ask for your time off for the First Annual NANT Conference, May 5-6, 2011- Texas!!

Originally written for Donna Ranker on the occasion of her first retirement from the NICU

Neonatal nurses are a difficult group to describe. I have a bird’s eye view of them, working with them yet not being one of them.

I entered their world cautiously, knowing they would eat me for lunch if I so much as looked the wrong way. Forget that I had any knowledge or even a personality. I knew that first I must just exist in their world and do no harm for a very long time, and if that plan worked out, maybe I could start treating some patients. I respected their protectiveness. I couldn’t think of any group of patients in greater need of protection.

And slowly, they allowed me to be.

If you’ve never seen a NICU nurse work it’s quite amazing. They can bundle a baby as tight as any burrito in 3 seconds flat, especially if showing a new resident how to properly perform this task. Seemingly regardless of their age and/or eyesight they can start an I.V. in a vein that’s no wider than a thread or fishing line while blocking out all surrounding distractions.

And don’t kid yourself if you’re a friend of one of these nurses and you visit her with your new baby. You may think she’s just admiring his adorable face when really she’s trying to control her excitement about how good his scalp veins look in case he ever needs an I.V. in his noggin.

I’m telling you, they’re just not right.

They are meticulous about the state of the baby’s bedside and the baby himself, and are so anal that they typically revamp the entire area when they come on shift because the nurse before them wasn’t quite anal enough. This is all in the best interest of the baby of course, and for that nurse’s state of mind for the rest of the shift.

They have the ability to discern when a little 1-pound person just doesn’t seem like herself from a mile away. They will do everything in their power to convince the docs of this and will likely not let them leave for the day unless they get what they want for that baby.

NICU nurses have known forever that these babies feel pain, even though it was difficult to ‘prove’. They think about the babies on their days off, come in from home if they are dying. They provide a baby with lots of love one minute, and run to code another one the next.

They are expert at what they do.

Now that I’ve been working with them for well over a decade and they trust me not to do anything too stupid, I must say I understand them. This little world in the NICU is unique. It is at once a place of celebrating new life and the grasping for it. It has been noted to be a place of intense parental love or at times abandonment; parents sometimes lost in their own set of horrible circumstances. It is mostly happy. It is mostly positive. It can be devastating.

We tuck years of that pain into a place we pretend doesn’t exist in health care. We go home and kiss our children.

I can’t say enough about the dedication of this group of people. They make me laugh hysterically with the sarcasm and humor that comes with the territory. They stun me with the level of skill they take for granted and the patience with which they teach the unending line of new doctors, new nurses, and people like me.

It is an immense responsibility to dedicate your work to a place that never closes, which needs you for its smooth and competent running, where fragile babies living and dying can just be part of your day’s work. All of that for a six figure salary…………

Thank you to the NICU nurses, for your expertise, your example, and your friendship. May there be a place in heaven for you with a coffee pot, good Chinese food, and the perfect schedule!

Stay tuned for more details!!

But as always, our members get the scoop first. So members, keep an eye on an email from NANT in the next week. Once you get the news, we’ll add it here and to our Fanpage on Facebook. Are you a fan yet?http://www.facebook.com/neonataltherapy

NANT is growing quickly and this is another way we can serve neonatal therapists. So  keep checking back!

Neonatal Therapists: Team or Territory? by Sue Ludwig

I’m sitting at my 10 year old daughter’s basketball practice and one thing is crystal clear. There is no one-most-important person on this team. If they don’t communicate and have a sense of each others’ abilities, they aren’t effective.

If there is an error on one girls’ part, and the rest of the team reacts with negativity, it’s contagious. If the same error is taken in stride, the team swoops in, recovers, and the play continues, sometimes with even better results.

It’s also obvious that not everyone can have the same role. You can’t have a team of 3-point shooters and no one to rebound. And most obviously, no matter how skilled the player, she cannot play the game alone.

So why the heck am I talking about basketball?

Because sports rule in defining the notion of team.

And we need a little more team in the NICU.

When I began writing this article, I had a whole section on how incredible it is when all disciplines in the NICU collaborate. NICUs that have great teams deliver amazing care. And it’s obvious to anyone who walks in the door.

But as therapists, I hope we already understand that our survival in the NICU depends on our ability to work as a team. Our very access to our patients depends on our communication with nursing. And we can thrive, or not, with mutual support.

But I want to talk about us. About being a team with other therapists. Yes, even though territory, history, and charge codes can cloud our vision.

No One Likes a Ball Hog

If you’ve ever played sports or watched your kids play sports, you know how painful it is to watch someone hog the ball.

Or maybe you’ve attended a conference or meeting where a speaker runs over her allotted time by 30 minutes? Yep, ball hog. This sort of attitude never serves a team.

So here’s the thing:

Do OTs own rights to the sensory system? And PTs the motor system? And do SLPs own space north of the suprasternal notch?

Are we bored with that mindset yet?

Our neonatal SLP works PRN in our unit right now, primarily due to her responsibilities to other populations. She was amazed when our PT and I first approached her with the idea of taking advantage of her previous neonatal experience to expand our coverage in the NICU.

She said, “I can’t believe you’re going to let me work up there! Usually OTs don’t want SLPs up there in their territory.” We both laughed out loud. Being territorial has never been my thing. But I also know her statement to be true (and vice versa) in many places, and between OTs and PTs as well.

I’m not implying that we should minimize or dilute our discipline-specific skills, just our boundaries about sharing knowledge and ideas, and access to the NICU itself.

A New Vision

Consider this: There is room for everyone. Our differences make us stronger and deeper as a team.

There isn’t room for numerous non-specialized therapists who ‘cover the NICU’ without extensive training. BUT there is room for specialized, knowledgeable, collaborative practitioners from each discipline.

The units that exemplify teamwork will shake their heads and think I’m making this up. But I’m not going to pretend this isn’t an issue. It’s one that needs to be resolved as we move forward as a clear and focused group. There’s so much work to be done.

Let’s begin here.

Mostly the babies are quiet. There are monitors, pagers, and ventilators beeping. Phones ringing. Staff and parents talking. But a noticeable lack of fussing coming from the babies. It’s hard to cry loud with small lungs.

So how is it that these fragile, nonverbal, babies have so much to teach me?

Well, like any of us, I learn in direct proportion to how much I pay attention. And by how much I intentionally engage in my work versus just going through the motions.

When you pay attention, these babies speak volumes.

Here are 10 lessons I’ve learned from the babies in the NICU:

1. Being born early does not mean less human, less valuable, less worthy – ONLY less prepared.

Pregnancies are full term by 37 – 40 weeks. So when a mother has her baby at 25 weeks gestation, no matter what I tell her, she often feels shame that her baby is still “in the process” of developing.

Well, who isn’t?

A few years ago I was writing up research for publication. I thought I was a decent writer. After spending countless hours writing this paper, my mentor came back and basically told me to start over.

I sobbed on the spot from exhaustion and the shame of feeling inadequate for this work. I was ashamed to still be developing as a writer.

Here’s the thing. We’re always in process! We are each starting over and over again in an endless cycle of learning and development.  No guilt, no blame, no shame. (Especially when you’ve done all you can to bring your baby safely into the world!)

2. We each communicate differently.

It’s easy to judge another person when she communicates differently, slower, or in a different dialect than you.

The babies have taught me to listen first, assume nothing, and leave judging for the Olympics. And more importantly – that I am responsible for half of every interaction with someone. So if I am busy thinking about what the other person should be doing or saying, I am likely not present for my end of the communication.

3. Small and feisty goes a long way!

Visit a NICU sometime to watch this one in action!

4. Environment Matters.

Loud noises are stressful. The babies respond to this stress by being startled frequently, spending less time in a deep sleep, and having changes in their heart rate and other vital signs.

What about your environment?

When you walk into the door to your home, do your surroundings add to your stress or decrease it? Is it cluttered, do you have space, do you have freedom to move? Are the sounds pleasant, or are they just noise?

The environments we create for ourselves directly affect our mood, our productivity, and our well-being. The babies have taught me that we thrive in an environment that serves us.

5. Connection heals.

There’s nothing better for a baby than loving connection with her mother and family.

Recently a mother in our NICU held her tiny baby on her chest. The baby was still on a ventilator. This is known as “Kangaroo Care” or “skin to skin” holding.  This mother, like so many before her, said that this was the only activity that truly allowed her to feel like a mother since her baby was usually in an incubator. Babies breathe and sleep on their mothers amazingly well even in this fragile state.

We are meant to be in connection with others.

Separation from that connection leaves us more vulnerable and less likely to maintain health. When our connections are loving and consistent, we thrive. Often when we feel vulnerable, angry or sick it’s because we’ve stepped away from the connections that heal us.

6. Eating Should Be Enjoyable!

In the NICU we’re obviously concerned with how much weight babies are gaining. In our quest for improving weight gain, we often overlook the significance of the actual experience the baby has while eating.

We pay too little attention to the fact that feeding is a bonding experience – social and nurturing. But we know that many premature babies nationwide have issues with feeding long after they’ve left the NICU. I believe that part of the problem is that hospitals often view feeding more like a medical intervention than a nurturing experience.

We should enjoy eating! But we often forget it’s a nurturing experience for our bodies and feed only our emotions or are completely distracted while we eat, giving no attention to the experience or the food.

Babies have taught me that eating should not be automatic. It should be intentional and engaging.

7. Tenacity is an inside job.

About a decade ago a boy in our unit was born weighing just about a pound. He had significant lung disease months later when he was discharged home. Now, at age 9 he is the fastest boy on his soccer team.

Who’d have thunk?

He taught me that tenacity isn’t definable at the surface. It’s something deeper, more elusive than brawn and background. It comes from inside. You know you are stronger than anyone would guess. Even when you weigh just a single pound!

When I reflect on that boy’s strength I think, “Who am I to think I can’t achieve something?”

8. Comfort and sleep are crucial to healing.

9. There are times for fighting and times for letting go.

For a premature or sick baby, most days are about fighting and growing.  They are about one more hurdle, one less tube, one more step toward home. And most babies win that fight.

At other times, when all that medicine and love have to offer is not changing the tide, the nurses and doctors do the impossible job of helping a family lovingly let go.

On the letting go days, I know only to go home and hug my own children in humble gratitude. Loss is a powerful instructor. Life is precious, yes.  And the babies teach me that it is hard to comprehend the gravity of that truth until we are asked to let it slip away.

10. Fragility and strength are not necessarily opposites.

If you look around the NICU and witness these tiny babies defying what seems reasonable for such a small person, you observe that fragility is often just strength’s first teacher.

I have rarely witnessed a population of patients that inspire such loyalty in their caregivers. Across the country I’ve noted that the NICU team appears, in my experience, to love this work.

Maybe because we have the best teachers.

Other disciplines were excited to see the formation of NANT as well. Many nurses said they are in desperate need of great neonatal therapists!

Members: If you weren’t present for the live call, I hope you have since  listened to the Special Topic Call Extreme Self Care by Bev Barnes! It was a fantastic call filled with practical ways for us to take care of ourselves while going about our busy multifaceted lives. Visit www.bevbarnes.com for more information about Bev!

Check back here often, as the Save the Date and other information regarding the 2010 Developmental Therapists in the NICU Conference will be posted here very soon!

Have a great week!

You’ll receive information for the February Special Topic Call next week in the February newsletter. Members, we have an amazing speaker lined up for that call!! Can’t wait to share that time with you.

If you’re a member and did not receive an email with your Username and Password for the Member Area of this website, please send us an email at: info@neonataltherapists.com and let us know.

Visit our booth at the 23rd Annual Graven’s Conference February 3-6 in Clearwater Beach, Florida! This is a great conference for all those passionate about “optimizing infant physical, psychological and developmental outcomes.” http://www.cme.hsc.usf.edu/gravens10/ 

Visit the Professional Support Network in your Member Area! This is a place for you to share resources with your fellow members. We should no longer have to recreate the wheel!

Have a wonderful week everyone!

Just send the event information to info@neonataltherapists.com and we will post it here for you.

Your copy of Kara Ann Waitzman’s DVD, The Listening Touch Massage, will be mailed to you by the end of November.

Your Expert Guidance Package calls begin in January! Details about those calls will be sent to you via email in December.

Thanks to all the members who have sent such enthusiastic emails in regards to NANT. Your energy is contagious!