Close this search box.

Partner Highlight Cowbirds and the NICU – Seriously?

As a Neonatal Therapist, do you ever feel like a bird in another mama bird’s nest, like the Cowbird Effect? The female cowbird “Momma Bird” lays her eggs in the nests of other birds and allows the other mother bird to do the nurturing.

Are you the only therapist in the NICU, or at least one of just a few, among a unit full of nurses? Is your ‘mother’ the NICU Nursing Manager, who becomes your surrogate leader/boss? Working in someone else’s ‘nest’ can often be challenging when attempting to create productive relationships and teams. In many ways, this situation is typical for most neonatal therapists.

Thanks to the intended efforts of nursing and therapists, who recognize the importance of developing strong, cohesive relationships, this situation advocates for a more acceptable culture. A recent survey was distributed to 184 NICU therapists to assess challenges and garner ideas for successful relationship-building. Some key findings are the following:

Looking closer at the survey data, one of the main challenges and an area of opportunity is developing a strong relationship between the therapists and the Nursing Manager or ‘Momma bird’ of the NICU. Even though therapists feel they are diligently working on strengthening relationships with staff nurses, the survey results show therapy relationships with the NICU Manager are not as involved or intentional. Given that the Nurse Manager typically sets the tone for the entire unit, building this relationship will be of benefit to all – the staff, the parents and most importantly to the fragile patients.

What will work? ……

-Collaborate with the nursing manager and clinical educator

  • Establish regular weekly meetings times
  • Establish a plan to offer formal education opportunities with nursing staff (skills day, computer-based learning, therapy education as part of new hire nursing orientation)

-Collaboration between the Nursing Manager and Therapy Manager

  • Discuss time spent, billable hours, increased opportunity for QI projects, staff education, hours on unit
  • Therapy time is essential, although true change is created with a culture change
  • Presence
  • Education
  • Relationships.

-Therapist and Nurse Manager relationship-build

  • Consider including the Nurse Manager in the therapists’ yearly performance review, especially if the therapists spend most of their day in the NICU. The Nursing Manager has a direct view of therapy interaction in the unit and the relationship with parents and staff, as well as the liaison between nursing and therapists. Many thrive in a NICU where the ‘rehab supervisor’ infrequently or never joins the therapists in the NICU, which indicates performance evals are often solely presented by word of mouth.

Finally, as you attempt to implement these relationship-building concepts to improve team outcomes/goals, the suggestions below from therapists who completed the survey will help you accomplish/share your goals:

Highlighting one creative idea:

“Therapy implemented an education carnival – nurses, aides, Nurse Practitioners – all walked through the ‘booths’ where they participated in hands-on learning experiences about positioning, sensory needs, feeding, hearing, and skin to skin. This placed the nurses in the infants’ position to allow them to feel and see what the infants were experiencing. It was FUN and there was candy and prizes!”

Creating positive relationships with staff is essential for all disciplines working in a challenging environment. Building strong relationships impacts the delivery of optimal care, which improves outcomes for babies and families. This IS what it is all about!

As Henry Ford once said, “Coming together is a beginning. Keeping together is progress. Working together is success.”

Thank you to all who responded to the survey.

Article written by Lisa Kleinz, Director of Education for Dr. Brown’s Medical™. For more information on Dr. Brown’s Medical™ products, including the Infant-Driven Feeding™ program, go to

Enjoyed this topic? Click here to listen to a recording of a webinar presented by Lisa Kleinz and Elizabeth Jeanson, DPT, on the flip side of this from the Nursing Leadership perspective.