Neonatal Therapists: Team or Territory?

By Sue Ludwig | 8 comments

Neonatal Therapists Team or Territory

I remember this moment (now 6 years ago) like it was yesterday:

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

If there is an error on one girl’s 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? (Besides that fact that March Madness is right around the corner.)

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 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 – even though territory, history and charge codes can cloud our vision.

No Ones 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?

Years ago, a neonatal SLP that I worked with 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 much work to be done.

Let’s begin here.

8 comment to “Neonatal Therapists: Team or Territory?

  • Patricia Allen

    I love this post! I’m a firm believer that it takes a team with multiple skill sets to make a NICU shine. I am, however, in a bit of a pickle. I’ve been working as an OT for seven years and for the last year I’ve been training (HARD) to transition into the NICU thanks to a wonderful opportunity. I’ve taken courses, followed mentors (PT, OT, and SLP), received training in other NICUs, and even spent the last weekend at the AMAZING NANT 8! Unfortunately, our neonatologist is a little old-school and is used to working with a registry PT who recently quit. We formed a new team that includes a PT, an OT (myself), and an SLP. Our PT is a new grad who has also been working hard toward making the transition. Our neonatologist firmly believes if we have a PT, why bother with an OT? He’s brought up examples such as “OTs do little hand things” or “babies don’t need to learn how to put on their socks!” I’ve worked diligently to provide him with a multitude of articles as well as initiated conversations with him about what OT can bring to the table, however I’ve made very little progress with getting OT referrals. Our new grad PT has also been providing him with an immense amount of information on how PT will cover all aspects in the NICU , including motor development, positioning, handling, parent/caregiver training, behavioral state regulation, and sensory interventions. Of course I understand that Therapy roles and interventions will cross over in the NICU, and I don’t want to step on toes or act territorial – because I only want what’s best for our patients and families. All of our backgrounds, training, and education will allow the best outcomes for these babies. How can I convince our neonatologist that OT and PT will address different areas of growth with these patients? And how can I engage our PT in a discussion about our different roles and OT’s worth/benefits in the NICU? Thank you so much for everything, I look forward to any help you can provide!

    • Helma K

      Hi Patricia,

      We’ve reached out to you via email.
      Please reach out to us at info@neonataltherapists.com if you have any further questions and thanks for commenting!

  • Lindsay Williams

    Love this article! Since there is so much overlap, but also so much distinction between the disciplines (OT, SLP, PT); curious as to how other NICU’s staff each discipline in the NICU. Are all three present each day? Do they rotate days? Is it census based, etc.?

    • Kristie Passage

      Hi Lindsay, we’ve reached out to you via email. Thanks for your comment and questions.

  • Diane Pelant

    Looking for role delineation between OT and Speech therapist as there is confusion amongst the provides and team.
    Much appreciated!!

    • Kristie Passage

      Hi Diane, We’ve reached out to you via email. Thank you.

  • Charlotte

    I would also like information on this. The overlap and role ambiguity can be a challenge and hinderance to effective teaming at times.

    • Kristie Passage

      Hello, we’ve reached out via email.

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