Introduction
Interdisciplinary collaboration is a cornerstone of effective healthcare, yet misalignment between healthcare professionals can hinder patient outcomes (Hanna et al., 2024). In the Neonatal Intensive Care Unit (NICU), inconsistent adherence to infant-driven feeding (IDF) protocols, caused by conflicting practices between Speech-Language Pathologists (SLPs) and Registered Nurses (RNs), highlights the need for improved teamwork and communication. This paper focuses on identifying the impact of these inconsistencies on patient care, exploring change theories to address the issue, and emphasizing the role of transformational leadership in fostering collaboration. By addressing these factors, we aim to enhance adherence to IDF protocols and improve outcomes for infants and their families.
Interview Summary
A NICU nurse at Baptist Health was interviewed to discuss interdisciplinary issues in the workplace. She has been a NICU nurse for four years and has worked in a level two and level three NICU. She is currently part of the employee engagement team in her unit. Target questions were created in preparation for the interview, and the situation, task, action, and result (STAR) model was the basis of this interview. When asked about an interdisciplinary issue she has faced recently, she responded that there were some issues with feeding babies. Loren said, “I think a lot of times nurses can be more volume-driven and change nipples more frequently and when nurses schedule SLP consults it can interfere with true IDF protocols” (personal communication, January 19, 2025).
I inquired about why nipple changes can be harmful and how these consults can interfere with IDF protocols. Particularly when assessing the need for nipple flow changes. The SLPs in the NICU address feeding issues and assist mothers with breastfeeding. An SLP will be consulted, and they will feed the infant to address these issues and set a plan, such as a particular nipple to use for the infant; however, nurses in oncoming shifts will often change the nipples based on their opinion. This can mean that an infant will use a different nipple every shift, and evaluating how the infant is progressing is difficult. With IDF protocol, babies are cue-based feeders, which means if they give feeding cues, we feed them during that care time and otherwise let the feed infuse into their NG tubes (L. Johnson, personal communications, January 19, 2025).
I then asked if these issues had been addressed and what the results were. She claims that the issues have not been addressed aside from talk among coworkers around the unit and potentially affecting the length of stay. It is important to prioritize and implement better collaboration between SLPs and RNs in the NICU to maintain consistency in IDF protocols and reduce patient length of stay. The interview utilized the STAR model to guide the discussion and provide a structured framework for the nurse’s responses. Targeted questions were developed to address specific interdisciplinary issues related to feeding protocols in the NICU (Hamnøy et al., 2023). Additionally, personal communication allowed for in-depth insights into the challenges of implementing consistent IDF protocols, particularly regarding the roles of RNs and SLPs.
Issue Identification
Collaboration conflict between RNs and SLPs in the NICU interferes with the implementation of IDF, which may bias patient length of stay. In an interview with a NICU nurse from Baptist Health, it was discovered that the plans by SLPs are often negated by uncoordinated practices such as constant nipple change by RNs depending on their preference. The IDF protocols advocate for cue-based feeding, where an infant is fed based on the cues, or if the cues are not present, the infant is given nutrition through NG tubes. However, failure to adhere to these protocols interferes with assessing an infant’s feeding progress (Hanna et al., 2024).
SLPs are useful in handling aspects of feeding, providing feeding goals, and helping mothers with breastfeeding. When nurses change the rates of the nipple flow or feeding plans independently, it brings inconsistency that interferes with the success of such plans. Some of these issues involve matters that have been discussed among the staff but are left unresolved, therefore suggesting that there could be a failure in effective communication and consultation (Schlome et al., 2025). This misalignment affects the care of infants and may also cause babies to be in the NICU for more days. Solving this problem will need structure in improving interdisciplinary communication and compliance with the IDF protocols in care delivery.
An evidence-based, interdisciplinary approach to solving the irregularity of care interfering with IDF protocols will be beneficial if all staff and collaboration can implement these changes. The practice needs to shift from the idea of a volume-based provider-driven protocol to proper infant-driven feeding protocols. Volume-based approaches are often believed to mean progress (Schlome et al., 2025). This means that the more volume the infant is eating by mouth, the better the infant is getting and closer to going home, but this does not guarantee consistent progress or overfeeding. 14 days’ average reduced infant length of stay by changing the feeding culture within the NICU. While the unit has established this protocol change, practices between RNs have not. Feeding is one of the most difficult tasks an infant must learn and is the most frequent reason for an infant’s extended NICU stay. IDF protocols cannot be met without collaboration between disciplines, and infants’ length of stay will be longer than necessary. We will look at how change theory and collaboration strategies can work in this case to reach these goals.
Theories of Change for Implementing IDF Protocol
One strategy that supports behavioral change is motivational interviewing. This strategy focuses on improving motivation and the participants’ commitment to change. Motivational interviewing has successfully fostered collaboration and overcoming resistance in healthcare teams in settings requiring behavioral change (Leite et al., 2025). Behavioral change theories emphasize what to do but often lack guidance on how to implement change.
Motivational interviewing is one strategy that improves motivation and commitment by addressing resistance to change. This approach could help RNs and SLPs feel more involved in transitioning to IDF protocols over volume-based practices. If a team was created to improve IDF practice within the NICU, they could evaluate the education of staff, speak to staff to figure out their views and feelings on IDF, educate as needed, and create a culture within the unit that can meet this goal to achieve compliance with IDF protocol.
Another theory that supports the implementation of IDF protocols is the UNICEF UK Baby Friendly Initiative (BFI). This approach emphasizes creating an environment that supports breastfeeding and infant-driven feeding by promoting evidence-based practices and continuous staff training. The BFI model encourages hospitals and healthcare providers to integrate family-centered care, focusing on the needs of both the infant and the parents, which aligns with IDF protocols (Fair et al., 2024). By adopting BFI principles, NICUs can strengthen their commitment to infant-driven care, improve staff competency, and enhance collaboration between RNs and SLPs in promoting optimal feeding practices.
Transformational Leadership and Inspiring Change
Effective leadership is vital in addressing the interdisciplinary issue in the NICU, especially when aligning RNs and SLPs’ practices with IDF protocols. RNs and SLPs need to work together to provide consistent care that sticks to best practices, but the challenge is often in differing perspectives on care and a lack of standardized practice across shifts. Transformational leadership has improved teamwork, communication, and adherence to best practices in healthcare settings (Tsapnidou et al., 2024).
Leaders who adopt this approach foster a shared vision, empowering staff to align their efforts with organizational goals, such as implementing IDF protocols. Transformational leadership inspires others to achieve more than expected to reach a common goal. In the case of the NICU, this leadership style would be important in creating a culture of collaboration. Research highlights that transformational leaders enhance staff engagement and motivation, creating a culture of accountability and collaboration (Hussain et al., 2022).
By adopting a transformational approach, leaders could create an environment where RNs and SLPs are motivated to prioritize the IDF protocols over volume-driven approaches. Transformational leaders can encourage staff to view the IDF protocol not as a mandate but as a vital part of their role in improving patient outcomes. A transformational leader could communicate the vision for IDF protocol, motivate RNs and SLPs by giving them a voice in the discussions about the protocols, and provide feedback and recognition to reinforce the desired behaviors. By addressing each team member’s concerns, whether the RN desires to change nipples based on perceived needs or the SLPs’ focus on setting a structured plan for infant feeding, a transformational leader would help both groups recognize their shared goal: reducing the length of stay for infants.
Improving Interdisciplinary Collaboration
Effective collaboration is essential to improving IDF protocol, especially given the challenges discussed in the interview. In the NICU, implementing a culture of collaboration must include leadership and communication between RNs and SLPs. As stated in the interview, RNs on the night shift especially have a barrier when communicating with SLPs. This can cause insufficient education and resources for RNs to ensure best practices. This could be solved by allowing time for both shifts to communicate with the SLP and for IDF to be reinforced. Additional education for all staff may also increase practices within the NICU to achieve this goal.
If communication between RNs and SLPs can be established within the unit, more consistent care and best practices may arise, and IDF goals can be met. Research supports this approach, as studies have shown that improving shift-to-shift communication and interprofessional collaboration leads to better patient outcomes. For instance, Browning et al. (2025) found that scheduled handoff meetings between shifts, coupled with interprofessional collaboration, improve continuity of care and reduce communication gaps. Implementing shared handoff tools and scheduled overlap times for RNs and SLPs can create a platform for discussing patient-specific care plans, including feeding protocols, ensuring consistency across shifts.
Another collaboration approach supported by literature is structured interdisciplinary rounds (SIRs). SIRs, which involve scheduled team meetings with RNs, SLPs, and other NICU staff, have been shown to improve communication and care coordination. Research indicates that these rounds foster shared decision-making, enhance role clarity, and improve patient outcomes by ensuring that all team members are aligned in their approach to care (Mullen & Reynolds, 2024). By integrating SIRs into the NICU routine, staff can address feeding strategies and other interdisciplinary issues collaboratively, ensuring consistency in IDF protocols and improving infant care.
Conclusion
Interdisciplinary collaboration is crucial for implementing consistent IDF protocols and reducing infant length of stay in the NICU. Transformational leadership can inspire teamwork between RNs and SLPs by fostering communication and commitment to shared goals. The unit can create a culture that supports IDF success by addressing inconsistent practices and prioritizing education and alignment. Ultimately, this approach ensures better care outcomes for infants and their families.
References
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Capella FPX 4005 Assessment 2
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Capella FPX 4005 Assessment 2
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