Developing NICU Competencies

Just a few thoughts. Those developing the NICU competency will benefit from a period of reflective thinking to avoid the tendency to look for something already done or a cookbook, though guidelines can clearly guide and inform our own key learnings and formalized competencies. My dear friend and SLP colleague, Bob Beecher, from Children’s Hospital of Wisconsin used to say: “Cookbooks are made for cooking not for eating…use them wisely.”

SLPs mentoring new colleagues can develop very meaningful mentorship plans and identify objective SLP clinical skills for “check off” through careful reflection and application of current literature. This includes drawing from their own mentorship in the past (what worked, what was missing), or if you were not fortunate to have a mentor and came from the ground up alone, like I did in 1985 – what you now know is essential). Consider the current mentorship process in place (and feedback from recent staff mentored). Compile current literature that is essential as a foundation for NICU practice. Throughout the mentoring, it is critical to reflect that being part of an NICU is a journey, not a destination. Both the NICU’s evolution from a medical and technology perspective, as well as our own need to continue learning and growing in this rapidly changing clinical environment, are essential to an NICU practice that thrives and does so with respect and professional integrity.

Focus on providing the mentee with guided participation with and then assessing objectively (while supervised) their competency related to verbalizing and/or demonstrating the underpinnings of NICU practice during both evaluations and treatments. Even today these are rarely discussed in graduate school), and include: neuroprotection, medical co-morbdities and current technologies and their typical impact on feeding/swallowing, developmental progression of the dynamic systems (postural , state, oral-sensory-motor, respiratory, GI) that underlie feeding/swallowing for sick term infants versus preterm infants, guidelines for referral to ST (who, when, why, how to advocate), readiness factors for PO feeding and how SLP can support the progression to PO feeding (as co-morbidities permit), parameters for physiologic stability and indications of decompensation as well as how to avert and/or respond, the components of evaluation and completing a differential utilizing a wide range of data, explaining one’s differential to others (MD versus RN versus the family), instrumental assessment of swallowing physiology (why, when, how, potential intervention strategies and their benefits/risks), documenting to assist the team via your impression and plan versus only checking off boxes, strategies to support safety and their evidence-base (co-regulated pacing, resting, positioning, swaddling, state modulation, nipple selection), infant communication (signs of stress versus stability, signs of disengagement versus engagement), NICU equipment (what, why, application to SLP practice, progression of respiratory support, lines and their risks), team relationships (learning from other team members, bringing the evidence-base, difficult but respectful conversations, controversies due to the emerging evidence-base, supporting families), breastfeeding (physiology and relationship to bottle feeding, how to support as an SLP), common medications and potential impact of PO feeding. I am sure I am leaving something out but this is hopefully a start.

The depth and complexity of our work in the NICU, and the potential for these often fragile infants to decompensate, demand that both mentorship and competency assessment be carefully structured and supported. Our profession and our families deserve no less.

I hope this is helpful.
Catherine

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