In honor of National Neonatal Nurses Day, we interviewed five nurses in different facets of the field to give you a glimpse of what it’s like to be a neonatal nurse, including the challenges and rewards involved in caring for the tiniest patients of all.
A Day in the Life
Rebecca L. Hunt, RN, MSN, APRN-CNP, CCNS, a neonatal nurse practitioner at SSM Cardinal Glennon Children’s Hospital in St. Louis, Missouri, walks us through a typical day in the NICU:
“Generally, each workday starts off by first ‘scrubbing in.’ Then the nurses will begin getting report from the off-going shift. This report will include a brief history of the mothers’ pregnancies, the birth histories, and what occurred in the delivery room. The nurses will
discuss a brief history of the babies’ hospital courses (types of respiratory support, any feeding difficulties, surgical history, etc.). Report will also include the babies’ current clinical status and what type of support they are receiving (respiratory, nutrition, antibiotics, etc.). Finally, the nurses will double check what medications the babies are receiving as well as all infusing IV fluids, including TPN/IL, and any other continuous medications.
From report, the nurse will prioritize which of the babies will need to be cared for first. The remainder of the day will include performing complete assessments on the babies being cared for every one to four hours depending on how critically ill they are, what types of interventions and care are required, and what type of feeding schedules they are on. All assessments, feedings, and medications given are charted into the electronic medical record in real time. The nurses will also do IV fluid changes and mix feedings as requested by the NICU care team.
Throughout the shift, the nurse will continually work with parents and family members on how to properly care for their babies. Feeding a premature infant is very different than feeding a baby who is born at term gestation and healthy. The nurses will also work with families on providing care (feeding, bathing, etc.) to babies who may be on a ventilator or have a tracheostomy in place. The nurses will also educate the families on signs and symptoms to look for to help distinguish if their babies are doing well or may need to be seen by a member of the health care team once they are home. The nurses will teach families about home oxygen, home apnea monitors, and how to safely put their baby to sleep at home. They will also take photos and help the families document the small victories their babies achieve, such as the first time wearing clothes, the first time taking a bottle, the first bath, etc.
During the nurses’ shift, they will also participate in rounds. The entire medical team (neonatologist, fellow, nurse practitioner, resident, dietician, and pharmacist) will gather at each baby’s bedside and discuss the infant and the expected plan of care for the next 24
hours. The nurses are major advocates for the babies and actively participate in making critical care decisions, such as whether babies should or shouldn’t have their respiratory support weaned, receive more food, or attempt to bottle feed more. The nurses will let the team know if they believe babies are showing signs and symptoms of becoming sick. Finally, the nurses will also encourage the parents to be an active participant in bedside rounds and provide their own observations of how their baby is doing.”
One of the biggest challenges in being a neonatal nurse is maintaining the professional boundary between yourself and the family says Gail A. Bagwell, DNP, APRN, CNS, the clinical nurse specialist for perinatal/neonatal outreach at Nationwide Children’s Hospital in Columbus, Ohio. “The babies are in a NICU for long periods of time, and you get to know the parents very well. Learning to be caring and compassionate, while maintaining a professional relationship is a learned skill and difficult for many nurses,” explains Bagwell. “I learned it early on in my career when a baby I was caring for developed some severe complications that led to her death. The pain of getting close to the baby and the family taught me that in order to survive in this field, I would need to learn to be caring and compassionate while maintaining a distance.”
Kim Guglielmo, BSN, RNC-NIC, Clinical Nurse III in the Newborn Critical Care Center at the University of North Carolina’s Children’s Hospital in Chapel Hill, North Carolina, agrees that losing patients is one of the toughest experiences as a neonatal nurse. “Those are the days that hurt my heart,” she says. “At the time before, during, and after the passing, I am there to support the family however they may need it. My goal is to make this last involvement with their baby the most beautiful experience ever.”
For Taryn M. Edwards, MSN, CRNP, NNP-BC, a surgical nurse practitioner of general, thoracic, and fetal surgery in the NICU of The Children’s Hospital of Philadelphia, sharing setbacks and obstacles with families is her biggest challenge. “The reality is that some of the most vulnerable infants do not make it. Supporting families through that difficult time is always challenging,” she explains.
While there are a lot of challenges and sad times in neonatal nursing, there are lots of great times as well. “There is nothing quite as rewarding as handing a mother her premature infant, sometimes still attached to a ventilator, and helping her position the baby for skin-to-skin time on her chest,” says Sherri Brown, MSN/Ed, RN, RNC-NIC, staff nurse at the Neonatal UCU at the University of Kansas Hospital in Kansas City, Kansas. “Or in watching parents’ faces light up when their infant curls his tiny hand around their fingers or helping them give their baby a bath for the first time or change a diaper. These things are taken for granted in the healthy newborn world, but they take on extreme importance in the premie world.”
Guglielmo says she feels blessed to care for the smallest and most fragile of patients and have an impact on their lives. “I get to meet so many brave, courageous families who go through so much and teach me more than they ever know,” she says. Many NCCC units and NICUs have reunions in which former NCCC or NICU babies and their families return to the hospitals to celebrate. “I can’t wait to see them all!” says Guglielmo.