How to become a NICU OT without experience

Becoming a Neonatal Occupational Therapist without experience can be challenging.  There’s really not a lot of NICU OTs willing to let you shadow them, and you might wonder how you get experience if you’re unable to shadow someone. 

That might leave you to ask the question, how do I become a NICU OT?

Most NICU OTs find jobs by working in acute care (hospitals) and building experience through mentorship and specialized education.

If you’re dead set on working in the NICU, here are a few ways that might help.

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What does an OT do in the NICU?

An OT working in the neonatal intensive care unit performs evaluations and interventions for premature infants. 

On evaluation, an OT may assess reflexes, range of motion, feeding, and swallowing.  

A NICU OT will also provide individualized treatments and family training for positioning, bathing, sleeping, hand to mouth, strengthening, and sensory activities.

Can an OTA work as a NICU OT?

Currently, most occupational therapy assistants do not work in the NICU.  However, this article provides a good example on how an OTA implemented an eat, sleep, console program for infants experiencing drug withdrawal. 

This might be one way to make OTAs more valuable in the NICU, but most hospitals don’t have a strong enough need for OTAs.

Are NICU OTs required to be certified?

No.  While certification can be helpful, it’s not required. Below I’ve listed 6 things you can do to get started as a Neonatal OT.

6 steps to becoming a NICU OT

1 – Get experience

Current Student

If you’re a student, you should be looking day one for a NICU OT who is willing to take you on as a student. I’ll be honest here, most NICU OTs won’t take you.

You’re better off doing your fieldwork at a hospital in acute care that has a NICU OT. During your fieldwork, you can ask to spend a day or two with the NICU OT or PT.

This might be easier if you get placed at a hospital that delivers a lot of babies.  You might also look into shadowing NICU OTs living in more rural areas.  

Rural hospitals may have less rules and regulations because of their small size.

Practicing OT

If you’re already working as an OT, the easiest way to get a job in NICU is to start working in acute care at a hospital that delivers babies.

Talk to the director about the possibility of working in the NICU during your interview. Some hospitals will pay for you to get additional training. 

If the hospital doesn’t utilize NICU OTs, explain to the director why the hospital would benefit from a NICU OT.

You might also want to start observing an OT who’s working in the NICU. This is your best way to get your foot in the door and help you feel more confident working in this specialty. 

2 – Take a course

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The single best way to start working as a NICU OT is to take a course and get certified. Some of these courses are a week long. Other courses may require 3500 hours or more and at least 3 years of OT experience.  Medbridge also has has some really great courses for anyone who is just getting started. Use my discount code OTFOCUS to save $150.

Taking a course is the best way to get the experience and knowledge you need, and can be much more beneficial than shadowing.

3 – Find a mentor

If you’re already working as an OT at an acute care hospital, find someone who can be your mentor. It’s best to have a good mentor after taking a NICU course.

A good mentor can help you see what a proper evaluation and treatment looks like. Watching someone else will give you more confidence in your own abilities, and help you see what you can do better.

4 – Network with other NICU OTs

Join a facebook group or network with other NICU OTs on linked-in, Instagram, or twitter.  Some of these social “hang out” places can provide resources that you won’t find anywhere else.  

As you network with other OTs, ask them what courses helped them the most.  Find out what helped them feel more comfortable as a new NICU OT.

Network with PTs and STs who work in the NICU.  Ask them how they got started and what helped them along their path.

5 – Read a book on NICU OT

A course can be a great way to get hands-on experience, but sometimes reading a book can be just as valuable and much less expensive.  

Here are a few books I’d recommend to get started:

6 – Become a certified Neonatal OT

The NTCB is a relatively new program that launched in 2019 for the purpose of certifying Neonatal OTs.  

It requires 3500 hours working in the NICU, 40 hours of education, 40 hours of mentorship, and a passing score on the neonatal therapy certification exam.

Remember certification requires recertification.  In the case of the NTCB, recertification is required every 5 years with a fee of $350.  You’ll also be required to have 2000 hours of NICU related care, and 60 hours of professional education.

In most cases, certification doesn’t make you a better therapist, but it will make getting the job you want much easier. 


The quickest way to get started as a NICU OT is to start shadowing and get mentorship.  You can do this by finding opportunities in rural locations or by working for a hospital that has a NICU OT.  

The next step is to educate yourself and take professional courses.  The combination of mentorship and education will help you feel more confident and help you find someone who will want to hire you.  

I hope this helped, and I wish you the best on your journey to becoming a Neonatal OT! Subscribe below.

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