Neonatal Intensive Care Staff

An enormous number of people care for your baby in the NICU. It may take several days for you to get to know them all. The following descriptions can help you understand the different roles staff members play in caring for your baby.

NICU Staff

NICU Clerk

One of the first people you meet is the NICU clerk. This person typically sits at a desk near the entrance of the NICU. Each unit has several clerks, and they change from shift to shift. It's a good idea to get to know all of them and to become familiar with the rules about visiting the unit.

Most NICUs allow open visitation, which means you can see your baby just about any time-except when doctors or nurses are making rounds. It's best to check with the clerk when you arrive to make sure it's all right to enter the unit.

Neonatologists

Your baby is likely to have many doctors, but the chief physician is a neonatologist. A neonatologist is a pediatrician who (after pediatric training) completed three years of specialized training in caring for sick newborns.

Most NICUs have several neonatologists on staff, so that one is available 24 hours a day, 7 days a week. You'll probably see the neonatologist every day, as she makes rounds with other staff members to develop a plan of care for each baby. If the NICU is in a teaching hospital, you may also meet doctors at different levels of training including pediatric residents (doctors training to be pediatricians); residents from other fields, like obstetrics, anesthesiology, and family medicine; and neonatology fellows (doctors who have finished their three-year pediatric residency and are training to be neonatologists). Neonatology fellows supervise the other residents, and the fellows report directly to the neonatologist.

Other Physician Specialists

Neonatologists often consult with other specialists to provide the best care for your baby. These physicians have specialized in a particular area of medicine as applied to the care of newborn babies and young children. The titles of the various specialists and their areas of expertise are listed in the table below.

Neonatal Nurses and Nurse Practitioners

Neonatal nurses and neonatal nurse practitioners are the two main types of nurses you'll meet in the NICU. Neonatal nurses have usually completed either an Associate Degree or a Bachelor of Science in nursing and several years of specialized training. Neonatal nurse practitioners (NNPs) are registered nurses who have years of experience working in a NICU and who have advanced education (usually a Masters degree) and training.

Some neonatal nurses have specialized roles within the NICU. The case manager, for example, is responsible for coordinating the various aspects of a baby's care and making sure the baby makes progress toward discharge. Discharge planning nurses are responsible for teaching the family how to care for the baby at home.

Other Members of the Health Care Team

Other important members of the NICU team can provide the following kinds of help:

• social workers help families cope with the stresses of having a sick baby, refer families to financial and other community resources, and help with discharge planning;
• respiratory therapists set up and adjust respiratory equipment and perform some procedures, like suctioning and chest physiotherapy (gentle percussive movements that help clear the lungs);
• developmental specialists have expertise in infant development. In many NICUs, these specialists evaluate babies on a regular basis and consult with the staff about how to best position a baby and improve feeding skills. These specialists may also work with the family to help them prepare to care for the baby at home;
• neonatal nutritionists help ensure that the baby receives adequate nutrients; and
• neonatal pharmacists help manage the medications the baby is receiving.

Interacting with the NICU Staff

With the large number of people who are involved in the care of babies in the NICU, it's no wonder that families become confused. In addition, the staff's schedules are likely to vary and doctors in training may be in the NICU for only a short time. Thus, some of the doctors who cared for your baby at the beginning may not be there later.

To provide families with some consistency, many NICUs use a system called primary nursing. Each infant in the NICU is assigned a primary nurse who is responsible for that baby and for communicating with the baby's family. When the primary nurse is not working, another member of the nursing team covers for her. This system limits the number of nurses working with a particular baby and allows the primary nurse to establish a relationship with the family. The family, in turn, gets more consistent information about their baby from a more consistent source.

If you and your baby are new to the NICU, ask the nurse at your baby's bedside if she is the primary nurse. She can introduce you to the neonatologist, the residents, and any specialists involved in the care of your baby. She can also explain the plan of care in non-technical language. Let her know if you want to be notified of any test results, so she can bring this to the attention of the neonatologist. If you are unable to visit and must telephone to inquire about your baby's condition, ask for the primary nurse. She is the person best equipped to give you an update.

If you feel you are not getting enough information about your baby, ask the nurse to put you in contact with the neonatologist so that you can arrange a meeting and get a formal update on your baby's condition. A scheduled appointment helps because it can be difficult to catch the neonatologist during rounds-with an appointment you're more likely to have uninterrupted time to ask questions and express concerns. It helps to write down your questions beforehand. Try keeping a notepad handy while you're in the NICU so you can jot down questions whenever they arise.