Tuesday, September 3, 2013

What it means to be a NICU nurse

I've posted before about why I chose to be a NICU nurse- my sweet godson Tristan, who just started kindergarten! But I recently read a post called "Just a Nurse" by a nurse named Kateri. (Read it here.) She is a 20 something living in New York working as a pediatric nurse in the PICU. I had never heard of Kateri until I saw this blog post floating around on the internet. According to her bio and her thoughts on nursing, we seem to be very similar! But her post got me thinking. What does it truly mean to be a NICU nurse? Or even a nurse at all?

I feel as though society as a whole has a blurred perception of nurses. TV portrays nurses as gossip queens and eye candy to fellow doctors. If you show up at a doctor's office, you might think all a nurse does is take your blood pressure and temperature and asks you a bunch of questions. Occasionally they might come in and stick you with a needle. What you don't see is all that goes on behind the scenes. Nurses are responsible for answering hundreds of questions about symptoms, medications, and treatment plans. Nurses assess, assist, treat, and educate.

I knew from childhood I wanted to be a nurse. My mom, both grandmothers, and great aunt were all nurses. It was in my blood. When my dad was dying in the hospital, his nurses solidified the fact that nursing was my calling. That was the most painful and difficult time in my life, but the nurses were there for not only my dad, but also my family in a way that I can't quite explain.

In the NICU, as in all hospital units, nurses are the front-line. We work 12 hour shifts, and someone is at the bedside 24 hours a day. We use our eyes, ears, touch, and smell to constantly assess the patients we are assigned to. Our patients can range from barely over 1 pound to 14 pounds. All of our patients are hooked up to monitors that display their heart rate, respiratory rate, oxygen saturation, and blood pressure. Our sicker babies have lines placed in an artery that displays a constantly changing blood pressure with every beat of the heart. The babies can also be on one of several types of ventilators that breathe for them, and in some cases, they also have urinary catheters in place so we can keep a constant eye on their urine output. We have been trained to know what "normal" numbers and ranges are for everything we are monitoring, and as also know that while something may still be in a "normal" range, it may be abnormal for that particular patient and can indicate that something is wrong. Our babies are so small that they are measured in grams, and their medications are delivered in micrograms and miligrams.

Along with what we can see on a monitor, we also monitor labs and blood gases that let us know their respiratory and metabolic status. There are so many numbers floating around!

We as nurses have to be able to interpret those numbers to decipher what they actually mean. But even that isn't enough. Once we know what the numbers mean, we need to know how to fix it. We often have standing orders from the doctors that give us flexibility in how we treat the patients. Maybe they need sedation. Maybe they need their medications adjusted to increase or decrease their blood pressure, or need ventilator changes made to adjust their respiratory status. If we don't have orders, we call the Nurse Practitioner or Doctor. We discuss with them what the problem is, and they often ask us what we want. Why do they do this? Because a patient's status is more than just a number. There are sometimes several different things that can be done to fix a particular number or thing that is wrong, but because the nurse is the one constantly at the bedside and knows that baby better than anyone else, the nurse is allowed to make suggestions that they think are going to work best.

Sometimes the numbers don't change, but the nurse just has a gut instinct that something is wrong. Sometimes the babies just don't look "right" or act "right". The nurses intuition is a powerful tool that is more often than not a great predictor of a problem. Thankfully, our doctors recognize it. Again, we discuss with them what is wrong and they ask us what we think should be done.

The doctors at my hospital are wonderful. They give us standing orders that allow us autonomy to the point that it is safe to the patient. They ask us what we think would be best to treat our patients. They quiz us to make sure we understand why something is happening or being done without making us feel inadequate if we just aren't sure. They're patient and they educate. One of my favorite doctors was leading a procedure when I was still pretty new. He asked me to step up and go through it with him so that I could gain the experience, and he walked me through the entire thing when he could have done it a lot quicker with one of the other nurses in the room that had done it before. One of our respiratory therapists did the same thing with an intubation (placing of a tube to place the baby on a ventilator). He said "I've done this a hundred times, get up here. You're going to do this!" Our entire team from secretaries, care partners, equipment techs, nurses, physical therapists, occupational therapists, respiratory therapists, lactation consultants, social workers, nurse practitioners, and doctors is phenomenal and it couldn't function the way it does with any part of the team missing!

When you go to nursing school, you don't really learn about the NICU. I think we had a 20-30 minute lecture about it, and I only rotated through there for a half day of clinicals because I asked to. With NICU nursing, you take everything you were taught about adults and children and either forget it or adapt it to fit your unique population. NICU nursing requires so much on the job training and, as in any field of nursing, you never stop learning!

Aside from direct patient care, nurses also tend to the families. We lend emotional support to our parents who are almost always terrified that their baby is in some unknown world hooked up to all kinds of monitors and machines with lots of tubes and wires, rather than safe in their arms. They feel so helpless and scared, and they generally know nothing about medicine or what is happening to their precious baby. We talk them through every step of their baby's care. We hug them and hold their hands when they cry. Sometimes we shed tears with them. We listen to their questions, concerns, and stories. We bond with these people we've never met and will never see again. We teach parents what medications do and how they work. We discuss what their baby's diagnosis means for their future. We teach them how to change their 2 lb baby's diaper and take their temperature. We assist them in giving their baby's first bath, maneuvering around all the tubes and wires. We teach them how to safely feed their baby, weather it's from a bottle or through a tube that goes straight into their stomach. We teach the them how to calm their baby when they can't hold them, how to dress them, and put them safely to sleep. We teach them CPR and car seat safety. We make sure nobody leaves without being 100% comfortable taking care of their baby who may or may not have extra complications from being in our unit.

In the NICU, we don't just treat the baby, we treat the whole family. We give extremely small and/or sick babies a fighting chance at life that they wouldn't otherwise have. I've shed tears my fair share of time after losing a baby we couldn't save, but I've also felt great joy in watching so many babies get better and get to go home with their families, and that is exactly why I do what I do!

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