Nurses have enormous impact on lives and in ways they can probably never imagine. Although neonatal nurses care for newborns and infants, their lasting impact is often remembered over decades.
Today is National Neonatal Nurses Day and the end of National Neonatal Nurses Week, and is a tribute to the ways these nurses change the lives of the tiniest patients. But it’s not just the babies these nurses save—the families of those babies never forget the nurses who cared for their children when they were at their most vulnerable.
If you’re a neonatal nurse, today’s a good day to reflect on how your efforts have a ripple effect. As you care for your patients, think of all the families you have worked with and helped over your career. Then think of all the people who loved those babies as that child grew to a toddler, teenager, or adult and went out into the world.
If that’s an emotional thought, that’s the reason why neonatal nurses are so passionate about and committed to the sometimes joyous sometimes heartbreaking work they do. They care for the newborns who need medical care for a range of medical issues. Their life-saving work is generally done in neonatal intensive care units (NICU), but they may also work in varied level nurseries. Some of these nurses will also make home visits and work in the community to care for sick infants. The infants can range from the tiniest premature baby to a full-term baby born with a critical illness.
If you are interested in a career in this nursing specialty, the National Association of Neonatal Nurses is an excellent resource. Nurses can work as a registered nurse or as a neonatal nurse practitioner. Your educational path will include a master’s degree and potentially a PhD if you want to work as a neonatal nurse practitioner, while a bachelor’s if often sufficient as a registered nurse level. Responsibilities increase between the registered nurse and nurse practitioner levels, as do salary rates.
Neonatal nurses are expected to have a high level of technical competency, and they must remain up-to-date on the constant advances in the field. Certification, as with any nursing field, is always recommended. Certification gives you the advantage of keeping your skills and your knowledge current. The American Assocation of Critical Care Nurses offers three separate certifications for neonatal nurses: CCRN (Neonatal), Acute/Critical Care Nursing; CCRN-K (Neonatal) Acute/Critical Care Knowledge Professional; ACCNS-N (Neonatal), CNS Wellness through Acute Care. There’s no shortage of the ways you can continue your professional and academic path after you earn your degree.
Nurses in this specialty must also have a level of empathy and compassion to care for the tiny babies and the people who love them. You are, in essence, treating the entire family. Helping them navigate the scary ups and downs of daily life in the NICU isn’t easy and is sometimes distracting, but families look to neonatal nurses to guide them. The bond many nurses develop with the families they work with are often strong and lasting. Some of the biggest rewards are hearing back from families years later of the positive effect you had in their lives.
No matter how hard you try to avoid it, it happens. The nurse becomes the patient. Whether you’ve given birth, had surgery, or a horrible case of the flu, there are times in life when conditions will send you to the hospital. And being on the proverbial other side of the hospital bed, as Jenny Ang, MSN, ARNP, FNP-BC, an NP in Washington State, says. So how can nurses be good patients?
“When the caregiver suddenly becomes the one who needs care, it’s an extremely unsettling, vulnerable, and helpless feeling,” says Ang. “Nurse can be good patients by showing patience, kindness, and compassion to their caregivers, while trying not to micromanage their health care professionals.”
Over the years, Ang has cared for many doctors and nurses in the ICU for a number of diagnoses in critical situations. She says that, for the most part, these patients have been good ones. But it’s because they had their questions answered, were updated regularly on their care, and understood both the risks as well as the rationale behind what was being done for them. So what is a “not good patient” in Ang’s opinion? “Someone who requires an excessive, grossly unfair amount of time and resources from a nurse, compared to a patient in a similar circumstance,” she says. “I have had only one patient who was a nurse act this way, but countless other non-health care people behave like this.”
Ang says that as nurses, you tend to advocate for the best care for your patients. “When we become the patient, we tend to advocate for ourselves like a mama grizzly bear protecting her cubs.”
What can you do to be a good patient? Ang has some tips:
- Remember that your professional judgement is clouded when the case is personal.
- Remember that you’re in a vulnerable state.
- Don’t lash out at your health care providers out of defensiveness.
- Don’t micromanage your health care professionals. Remember they are pros, and have sworn the same oath to do no harm, just like you have.
- You are a professional. Remember to act like one.
“It makes many nurses defensive when they are suddenly in the position of being the patient. Like in any other field of work, it is not wrong to question a health care professional, but how you ask your question is key. Don’t be accusatory,” recommends Ang. “It is most appropriate to maintain positive, clear communication with the health care professionals caring for you when they come to check on you in your hospital room. Nurse know how the system works.”
The art of de-escalation is an invaluable tool developed primarily to defuse hostile individuals and situations. In its original usage, the concept of de-escalation implies the existence of both verbal and non-verbal skills and techniques which, if used selectively and appropriately, may reduce the level of an aggressor’s hostility and emotional reactivity.
Although violent incidents may come from a variety of different sources, aggressive and hostile patients appear to be the largest source of workplace violence in the healthcare setting (OSHA, 2015). In 2013, 80 percent of the serious violent incidents reported were primarily caused by interactions with patients in the clinical setting (OHSA, 2015).
Since potential aggressive incidents is an acute behavioral emergency that frequently require immediate intervention, qualified nurses must be prepared to utilize the following de-escalation skills and techniques to promote patient safety and staff protection.
1. Maintain a Calm Demeanor
Maintaining a calm demeanor and intervening early with less restrictive measures, such as verbal and non-verbal communication, reduced stimulation, active listening, diversionary techniques, and limit setting can help relax the patient and promote a culture of structure, calmness, negotiation and collaboration, rather than control. If nurses remain calm and cooperative, the patient will most likely mirror their behavior.
2. Practice Active Listening
While most nurses are often tempted to retaliate when dealing with an aggressive patient, active listening and watching for nonverbal cues may be helpful in the de-escalation process. Active listening is pivotal in pre-empting an angry outburst by looking for, or listening to paraverbal communication that is tone, inflection, and volume.
Since most patients that arrive at the hospital are fearful or anxious, it is not uncommon for some patients to utilize anger or aggression as a coping mechanism. Therefore, nurses should utilize active listening as a tool to help comfort and reassure patients that they are invested in their safety and recovery.
3. Provide Patients an Opportunity to Vent
After actively listening to the patient, nurses must be able to offer thoughtful comments that demonstrate an awareness of the patient’s unique feelings and concerns. By offering patients an opportunity to vent, it allows the nurses and patients to work collaboratively and address underlying issues.
When a patient appears to be upset or is demonstrating early signs of anger, it is imperative for nurses to substantiate what they see or hear, so that the patient feels validated. Often times, nurses are accustomed to telling patients what to do, that they forget to provide patients an opportunity to sufficiently express themselves. Therefore, when nurses provide patients a chance to vent, it not only provides patients an opportunity to voice out their frustrations but also diminishes the likelihood of physical violence to ensue.
4. Display a Non-Defensive Posture
Another important technique that must be considered when de-escalating an aggressive and hostile patient is displaying a non-defensive posture. By keeping the hands in front of the body, open and relaxed, and maintaining appropriate eye contact, it illustrates authenticity and compassion towards the individual. While proper eye contact is subjective however, it is imperative not to stare.
Since a nurse’s reaction can greatly influence the emotional reactivity of highly dysregulated patients, the nurse must maintain a neutral expression at all times. By remaining calm and sustaining a neutral appearance, patients are less likely to overreact allowing nurses to regain control of the situation.
5. Impart Empathy and Compassion
Lastly, nurses should also be able to properly express their concern by conveying empathy and compassion towards the patient. The art of empathy and compassion helps reassure patients that they are not alone. Paraphrasing can be an effective tool in de-escalating a patient because it not only communicates empathy but also demonstrates understanding. By using phrases such as “I understand how difficult this can be for you,” nurses can connect with patients much more effectively which can help facilitate the healing process by re-establishing trust and rapport.
Once the patient is successfully de-escalated, the nurse is then responsible for settling any unresolved feelings or concerns the patient may hold. During the resolution stage, the nurse should identify how the patient would like their anger to be dealt with if and when a similar situation recurs. During this time, the nurse should work collaboratively with the patient to re-establish therapeutic rapport and ensure all feelings and concerns are individually validated.
Well it has been a while since my last post, due to the “busyness” of life. Often times we let the things in our life take so much of our time, that we forget about taking care of ourselves. As nurses we are focused on taking care of others: our patients, our family, our friends, and sometimes even strangers. We have heard of the saying “Take care of yourself, so you can be there for others,” but how many of us actually practice this? This really hit home after hearing about the unexpected death of two colleagues over the past month. They both devoted so much time to their job and neglected to relax and take care of themselves.
Credit: Leslie McRae-Matthews
We have our plates so full with other people’s issues, cares, and needs, yet there is no room on the plate for us. There has to be a balance between work and relaxation. This is not new information for us—we just need to apply it to our lives. Many of us advise our patients about taking time to relax, meditating, and thinking about things they enjoy to decrease stress. These are some of the same principles that we can use.
When you start noticing that you are feeling anxious, moody, or depressed, these are signs that it is time to step back to refocus, recover, and renew. Many people relax by traveling, but you do not have to spend a lot of money to relax. Engage in simple activities, such as drawing, photography, taking a walk to enjoy nature, riding on a swing, or going for a swim. These activities are not an escape from reality or stepping into a “fantasy world,” but they will help you take your mind off of work or other issues, so that you can refocus. Take care of yourself and find that balance.
There are those who consider themselves ineligible for nursing because they are afraid of needles, shriek at the sight of blood, or believe they couldn’t handle the pressure of caring for sick patients.
So-called “squeamish” individuals need not write off nursing as a career. There are many nonclinical roles in nursing such as research and leadership, but they often require nursing experience. The following is a broad overview of careers for the squeamish nurse.
Within the Hospital
Many mental health nurses are not exposed to trauma, and depending on patient acuity, they may only administer oral medication. Similarly, nurses in narcotic detox facilities give out medication by mouth and rarely, if ever, deal with the more physically graphic aspects of nursing. Naturally, there are other considerations one would need to take into account in terms of disposition when addressing these patient populations.
There are hospital positions that require little to no medication administration. For some pre-procedure nurses, their work often focuses on preoperative interview and assessment. This may involve minimal physical contact with patients, such as assistance with surgery prep, disrobing, or preoperative skin prep. It requires well-developed assessment skills and familiarity with different surgical procedures. These positions will depend on how the facility distributes perioperative responsibilities among nursing.
Mother-baby nursing may be an appropriate position for the mildly squeamish nurse who can handle the occasional unexpected event. To the extent that mother-baby nurses are not required to rotate through labor & delivery or work with high-risk births; their role is mainly assessing newborns and managing the care of young, and mostly healthy mothers. This type of nursing involves a unique, highly specialized skill set for working with the youngest patients.
Outside the Hospital
Home health nursing positions are increasing where registered nurses oversee the work of ancillary nursing personnel, such as home health aides, and certified nursing assistants. Home health nursing may involve direct patient care where nurses assess patients, administer medications, and refer to advanced practitioners for any changes in patient regimens. Home health nurses may also work with insurance companies to protect patient coverage and advocate on their behalf.
Similarly, case management uses nursing expertise in a nonclinical setting. Nurses utilize their understanding of patient population-specific needs, but they do not provide direct patient care. More commonly, case management involves advocating for patient access to necessary services and following up with patients to ensure their health needs are being met.
Outpatient clinic and primary care nursing focus on assessment and treatment of minor illnesses. Under this umbrella are school nursing and specialized outpatient clinics, such as internal medicine, pain management, psychiatry, and orthopedics. Primary care nurses do administer medication and perform wound care, therefore, the squeamish nurse may want to investigate site-specific duties.
Aesthetic nursing may be a good choice for a nurse who doesn’t want exposure to sick patients. This is a growing skill set within nursing and nurses can generate a lucrative income. Nurses in these roles will often administer injections.
It is important to keep in mind that every employer has different expectations and policies. Each individual must understand their own personal limits and job requirements before taking a nursing position. Furthermore, even positions suitable for the squeamish nurse require highly specialized skills and critical thinking.
All nurses are trained to work with a variety of patient populations, including the acutely ill. There is no way through nursing school without exposure to situations that many would consider either upsetting or even repulsive. That being said, there are many nurses who formerly identified themselves as queasy in the face of illness who find the reality of patient care much more tolerable than they anticipated. For many nurses, the spirit of service, and perhaps a bit of repeated exposure, together outweigh the upsetting sensory experience they formerly identified with nursing.
According to The Harm Reduction Coalition, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” It was originally coined to address substance users but its implications have broadened as its application has become meaningful among other populations. Nurses are empowered to employ harm reduction techniques, whether or not they work in practices specifically dedicated to that aim. This can be done through direct care with individual patients or on an administrative level.
With Individual Patients
With experience, every nurse becomes familiar with the nature of their role as caregivers. Nurses’ responsibility is to treat, care for, and educate patients, in accordance with the dictates of advanced practitioners’ directed care. It is not, however, within the nurse’s scope to ensure that every patient lives and acts according to their prescribed treatment plan. It is not uncommon to encounter patients who are noncompliant or noncooperative with treatment. For these patients, harm reduction can be a helpful guiding principle for nurses.
Nurses can utilize the principles of harm reduction with the more salient issues of IV drug use and risky sexual behaviors but also use them for smoking, diabetes, and hypertension. Nurses can minimize the negative effects of patient choices that are counter to their well-being by offering alternatives without requiring patients to practice complete abstinence.
Patient education is the greatest technique of harm reduction that nurses always have at their disposal. For willing patients, understanding the resources that are available to them is key to taking actions that minimize their risks. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV/AIDS has led to great strides in limiting the spread of the disease. Many patients would not even know about the option to protect themselves in this way if it wasn’t for having trusted resources in their health care team. Knowing about local smoking cessation, needle exchange, condoms, PrEP/PEP, and health promotion programs is a great tool for any resourceful nurse.
On the Larger Scale
For nurses who see a trend among patients who could benefit from harm reduction programs, it is within their purview to address these issues on an administrative level. It is not uncommon for policy changes to be initiated by a brave nurse who decides to use his or her voice to advocate for patients. These nurses choose to go beyond knowing about resources and encourage their employer, or even their government to be the resource. This can be unit-wide, facility-wide, or even taken to Capitol Hill to enact change on a government level.
Harm reduction started out as a small group of providers taking action to support IV drug users. They discovered that imposing abstinence on a patient who isn’t ready can actually preclude their care. Harm reduction has become a broader term that allows patients to make the lifestyle choices that they would anyway, without severing their connection to health care resources that can protect them from potentially devastating consequences to themselves or their community.