In my own experience, the NICU has been a love-hate relationship.  I love working with the little ones and their families, and the mental challenge of solving sometimes difficult problems.  I hate the politics; particularly the cattiness within a specialty that is dominated by women.  Whether you have practiced two weeks or two decades, there is much to be proven before you are accepted.  You are not only judged by your skill, but how well you fit in with the personality of the unit. For those friendships that developed during my practice in the NICU, they are the most endearing.  For those relationships that were less than friendly, they were the most frustrating. 

The question is, where did this culture come from?  How can two professions that have separate, but similar goals come together? 

As we know, nurses are taught in school that they are not only the caregivers, but also the protectors of their patients. They have the responsibility to ensure that each patient gets appropriate care in a timely manner.  That means they are going to call you when there is a question regarding their patient’s respiratory treatments.  Most often this call is not to tell you how to do your job, but to make sure their patients are going to get better.

So how does a neonatal nurse differ from other nurses?  According to the National Association of Neonatal Nurses (NANN) Fundamental Professional Principles, “Neonatal nurses insure that professionals working in collaboration with them are competent to practice.  Reporting of questionable or impaired practice and concerning behavior is essential to protect patients and the profession”.  What does this mean? For the neonatal nurse this means they are not only responsible for minding their own job, but for minding yours.  

 Unfortunately, neonatal nurses, are not fully trained in all other aspects of medicine, and yet are expected to discern as to whether others are capable. While these nurses do get extra on-the-job training for the intricacies of this particular specialty, they are not trained in lung physiology and mechanical ventilation to the depth of their allied staff counterparts.   

Additionally, there are a few NICU nurses that are unable to discern the difference between being protective and being provocative.  Some therapists are met with few words and cool, lingering stares.   The result is not pretty, and many respiratory therapists forgo the opportunity of the NICU environment because of an accepted culture of intimidation.  

Are the circumstances fair?  Perhaps not for either the nurse or the therapist.  From a nurse’s perspective, taking care of critically-ill premature infants can be a daunting task.  Having to perform this job in addition to managing others in a specialty that you are not trained in is even more so.  But from the view of a respiratory therapist, a hostile work environment intensifies the stress of an already critical work area. 

Can we bridge this gap?  I think we can if we remember what our roles are, and be savvy to the knowledge and skills each has to offer.  Maybe this is a naïve view, but a walk in the other’s shoes is a beginning. 

Tammy Kane R.R.T.