Becoming a NICU Physical Therapist
After working in a large university hospital in a major city as an acute care physical therapist, I was exposed to an array of units including, ICUs, orthopedics, psychiatric, oncology, and the NICU.
These occasional visits to the NICU helped me find my place as a therapist. Truthfully, this population was not a focus of my degree instruction, but I learned and read about treatment options in order to provide the best-tailored care. My job became exciting and the long daily commute became more bearable.
Eventually, I transitioned to a new hospital (closer to home) with a Level III NICU. A Level III NICU facility is one that meets the following criteria:
- Infant born prior to 32 weeks gestation
- Weighs less than 1500 grams
- Babies of any weight or age who are critically ill
- Babies who may need respiratory support to breathe or stay alive
- Infants who need surgery
Physical Therapist Basics
NICU Physical Therapists, like all Physical Therapists, are required to complete 3-4 years of undergraduate education, 3 years of graduate work, and up to 4 clinical rotations. We graduate with a doctorate degree and have a variety of career paths available to us.
What does a NICU Physical Therapist do?
Many people ask me “What does a physical therapist do in the NICU?” Simply put, I strive to make the NICU and my care with infants as supportive to their growth and developmental as possible. For many of the patients, I am consulted on their vital systems, nervous system, GI systems etc. – all of which are still developing. They are no longer in the most perfect environment for this development to occur, they are now in a medical ICU with lights, noises, wires, hands-on-care, ventilator tubes, IVs, heel sticks.
While this is all necessary, if not essential, for their survival it can all have a cumulative negative effect on how they begin to grow and develop. These interventions have a lasting impact for weeks, months and years after they leave and grow at home.
It is my goal and the goal of NICU PTs to provide a standard of care focused on:
- Maximizing the positive long-term outcomes for our patients
- Providing opportunities for parents to bond in an ICU
- Educating NICU staff and families on the importance of a developmental approach to care-giving
A Typical Day
A typical day as a NICU Physical Therapist includes reviewing charts for infants on my case load. In our NICU, the census can range from as low as 1 infant to as many as 22. I make it a point to know each infants’ care time and to speak with each nurse to determine if they need my help at a certain time or when it would be best for me to complete my session. It’s important as a therapist to provide care or treatments around the infants’ care times.
Example Schedule: Infants will have cares usually every 3 hours, 8:00 am, 11:00 am, 2:00 pm, 5:00 pm and so on. It is important to protect their sleep in between, so sessions are clustered with nurses care times. Physical Therapy sessions provide developmental containment during nursing cares, assessing PO feeds, administering therapeutic touch and massage, or even assisting parents with swaddled baths. At times I may also see patients on our pediatric floor as well as the well-baby nursery for specific therapy needs. If I am not doing clinical work I attend rounds, work on NICU quality improvement projects, committee work and the continuing education requirements for my license and employer.
Working in the NICU as a physical therapist requires graduation from an accredited physical therapy program and licensure in that state. There are additional certifications and specialties that can be obtained to sharpen your skills as a NICU physical therapist, but are not required to work in the NICU.
Neonatal Touch and Massage (NTMTC) – A specialized certification for neonatal healthcare providers (therapists, nurses, and physicians) with a didactic online and hands-on course on massage and developmental care with a strong emphasis on families and nurturing opportunities. The certification aims to raise the standard of care that therapists and caregivers provide in their daily practice. It focuses on maximizing positive long-term development of the infant. Recertification is required every 2 years.
Certified Neonatal Therapist (CNT) – This is advanced neonatal therapy practice through evidence-based certification standards, including validation of clinical experience and knowledge essential for effective delivery of neonatal therapy.
National Child Passenger Safety Certification (CPS) – Earn this certification if you’d like additional knowledge and expertise on child passenger safety. Once certified, you’ll need to remain up-to-date on the latest technical information about child passenger safety through continuing education.
Pros / Cons of being a NICU PT
As with any job, there are pros and cons. Overall, I feel healthcare is a lifestyle, not a profession. I love what I do and cannot picture doing anything else as a profession. Working with infants and families is incredibly humbling and gives a great sense of purpose. I enjoy providing specialized care aimed to create an environment that is conducive to infants growth and development. It’s a special feeling being able to work closely with families to create nurturing moments. I’ve helped parents complete many “firsts”: skin to skin holding, bathing, feeding, diaper-changing etc.
- Cute babies
- Working closely with families to create important bonding opportunities
- Largely stress-free and quiet work environment
- Opportunities to work evenings and day shifts
- Many teaching opportunities with medical staff and parents
- Seeing happy, healthy babies grow into thriving toddlers. (I love bumping into families in my community who I’ve worked with in the past.)
- Death or treating babies exposed to illicit drugs
- Stubborn staff who are not willing to adopt new treatment best-practices (it’s rare, but does happen).
- Census fluctuations can lead to very busy days
For those interested in becoming a NICU Physical Therapist (or trying to figure out what area of therapy you enjoy) here are a few take-aways to help:
- Take the chance to explore all areas where physical therapists work and do your research. Ask to shadow a colleague to see if it’s something you find interesting.
- Get reading! Read scholarly journal articles, watch instructional videos and familiarize yourself with new research and best practices.
- Don’t be afraid of taking on non-clinical work. Multidisciplinary improvement projects, research opportunities and committees allow for advancement and practice improvement and can lead to better practices to be established with the unit.
Remember, a NICU Physical Therapist is an important part of the team that works to promote developmental medical care and treatment for the tiniest patients.
About the Author
Matthew Leocha, DPT, NTMTC has over 10 years in the Physical Therapy field with 5 of those spent attending to infants and their families in the NICU. He earned his Doctorate of Physical Therapy from Temple University and is currently a staff therapist in a Level III NICU at Penn Medicine’s Chester County Hospital. Matt has three children of his own and enjoys spending time with family, running ultramarathons, and watching Philadelphia sports.