Some days, weeks, even months are just crazy in the NICU. We get so busy that no one has a moment to breathe, much less pee or have lunch. We end up way over our normal census numbers and nurses get plain burnt out. We are tired. Plain and simple. It is exhausting right now. Nurses in the step-down unit are caring for as many as 5 patients at a time (normal is 3... sometimes 4) and in the ICU they are caring for up to 3 at a time (normal is 2 at the most). So, you get the picture.
When it gets crazy, we see different kinds of nurses.
THE WORK OVERTIME ALL THE TIME NURSE
She is on her 10th day straight and coming back for more! She is frazzled. Her hair is askew, her makeup isn't quite all there, and she is doing the job like a robot. But she is making BANK and is proud of it. She is talking about all the things she is going to do when her paycheck comes in. The parents come in and say, "You are here again? Do you ever take off?"
THE NEVER WORK UNLESS SHE HAS TO NURSE
She is working her one day per week as her schedule reads and you don't hear from her again. She walks out with her eyes to the floor because she worries about being asked to come back. She won't answer her phone when called either, so don't even try.
THE WORK MY SCHEDULE AND COMPLAIN THE WHOLE TIME NURSE
She comes in on her scheduled days and complains about how busy it is. She also complains that no one will come in to help when we are so busy. She talks badly about the "NEVER WORKS UNLESS SHE HAS TO NURSE." However, you will not see her on a day she isn't scheduled. She blatantly says "NO" when asked to work extra and complains that she was asked. She also makes sure everyone knows that she was overly busy because she had to care for 2 babies the whole shift and got a 34 week admission at 5pm before shift change.
THE HOPPED UP ON CAFFEINE NURSE
Ok, she is there all the time. She has drank so much coffee that we aren't sure if she has slept at all in the last few days. She also stays late and comes in early. She is so peppy that most people want to punch her in the face.
THE NURSE MANAGER
She calls, texts and emails begging for more help everyday. When it is recommended that we have an incentive pay to encourage people to come in on these busy days, she shrugs it off saying, "We can handle it! We are NICU nurses!" She also waves as she leaves at 4:30pm Monday-Friday watching the others drown.
All of these nurses are very real and maybe you can come up with your own.
But why do we keep doing it??
The other day, in the midst of the insanity, we had a visitor. This little boy was a year and a half old. He had been born at 23 weeks and spent over 5 months in our unit. He was perfect. He was on track for a boy his corrected age. He had no residual issues. He smiled big when he saw us come out to say hello and his parents hugged us and said thank you for saving him. I remembered those sweet big eyes gazing up at me while I fed him and prayed he'd survive. I remember thinking on his admission day that we'd have to say goodbye so quickly because he was so sick and so tiny. I remember countless surgeries and the days after when he should have died, but he didn't. And there he was, strong, happy, and beautiful. He is the reason we keep it up. He is the reason we keep going through the crazy. He is the reason I could never do another job!
Saturday, August 23, 2014
Monday, August 18, 2014
On death in the NICU
As a nurse, I deal with death more than most humans. As a neonatal nurse, I see death at a time no one ever thinks death should or would occur. Most people who face death in our unit were, only a short time ago, preparing a nursery, planning for sleepless nights of feedings and baby coos, looking into daycares and buying the cutest outfits at the store because, although the closet was crammed with pink or blue already they just couldn’t pass it up. They were rubbing their tummy and singing a lullaby planning for the time they’d rock that baby to sleep in that very rocking chair. Death of the newborn is something no one thinks of until it happens to them. But it is something I see all too often.
I take a particular interest in this subject, not because I am morbid, but because it happens. Death is a part of life. It occurs no matter what we do to fight it. We can prolong life. We have millions of advances in technology that helps us do just that. We have medications, equipment and knowledge that helps those who, only a few years ago, could not have had a chance of survival, not only survive, but go on to thrive. However, we cannot save every baby. We cannot fix every problem. And then we see the moments no one likes to think about. The last moments a mother holds her newborn and weeping over him tells him that she loves him and will forever. We watch as their body shuts down and they say goodbye. And those are the good deaths. Can any death be good in the NICU? Well, I don’t know, but I can tell you that death can be bad in the NICU.
An infant who has been so pumped full of medications and fluids that their skin weeps and swells to the point you worry to push to hard because it may just burst. And infant whose parent has never held him until he has already died because he is too unstable and “might die” if held. But if he is going to die anyway, what’s the point? The infant whose birth defects already pronounced her death long before birth, but are brought to our unit anyway, where she is hooked to many machines, fluids, stuck with needles and compressions are done repeatedly on her tiny heart all while her mother and father cannot be in the room because mom is recovering from the delivery. All of these, I would consider a “bad” death.
So what does a good death look like? What about an infant, whose mother, father, siblings all surround her in love while I disconnect the monitors, wires, tubes and other apparatuses then gently hand her to her family so they can sing, rock, read Goodnight Moon, and pray over her while she takes her final breaths? What about a family, friends and church who comes into a room to sing hymns while he drifts into a sleep from which he doesn’t awaken? What about a single mother without support dressing her tiny infant for the first time, bathing her, putting a bow in her hair, and making other memories while I help her, support her, remind her she is a good mother, and stay with her?
We, as medical professionals, often strip away everything from our patients’ families. We dictate when they can hold, touch, change a diaper, take a temperature and even talk to their child. And we have to. Not because we are evil people who don’t want the parents to bond with their child, but because we understand the mechanisms of brain development and risks associated with prematurity. But, there is a fine balance. This is, after all, still their child, not mine. I have to find ways to help them bond with their baby that is safe for the baby. I am a teacher, a healer, a gentle speaker. Too often this isn’t what parents feel though, and for that I am sorry. I can say that no one works in the NICU very long without a deep love of this profession. We definitely do not do it for the money (because it isn’t enough). We do it because we love the work. Seeing an infant go home after 6 months is the best feeling in the world. And so, for an infant to die is devastating on us, because we are healers…. We want to fix the problem. We push and push. We tell parents to “be strong.” We encourage further treatments and more medicines. We do more tests and draw more blood. And sometimes we get so caught up in telling parents to be strong and fight, that we don’t allow the strongest thing of all which is to allow their child to die.
I want to make the experience our families have with us as gentle as possible. A friend of mine often tells parents, “The NICU is one of those places you never want to see, but are so happy it is here when you need it.” We understand that. And when a child dies, it can be much more gentle than I’ve seen it in those “bad death” times.
When we can say, “You’ve fought so hard. You’ve done so much. It is ok to rest. It is ok to go on. It is ok to die. Your body does not have to fight here anymore.” Then we’ve figured it out.
I take a particular interest in this subject, not because I am morbid, but because it happens. Death is a part of life. It occurs no matter what we do to fight it. We can prolong life. We have millions of advances in technology that helps us do just that. We have medications, equipment and knowledge that helps those who, only a few years ago, could not have had a chance of survival, not only survive, but go on to thrive. However, we cannot save every baby. We cannot fix every problem. And then we see the moments no one likes to think about. The last moments a mother holds her newborn and weeping over him tells him that she loves him and will forever. We watch as their body shuts down and they say goodbye. And those are the good deaths. Can any death be good in the NICU? Well, I don’t know, but I can tell you that death can be bad in the NICU.
An infant who has been so pumped full of medications and fluids that their skin weeps and swells to the point you worry to push to hard because it may just burst. And infant whose parent has never held him until he has already died because he is too unstable and “might die” if held. But if he is going to die anyway, what’s the point? The infant whose birth defects already pronounced her death long before birth, but are brought to our unit anyway, where she is hooked to many machines, fluids, stuck with needles and compressions are done repeatedly on her tiny heart all while her mother and father cannot be in the room because mom is recovering from the delivery. All of these, I would consider a “bad” death.
So what does a good death look like? What about an infant, whose mother, father, siblings all surround her in love while I disconnect the monitors, wires, tubes and other apparatuses then gently hand her to her family so they can sing, rock, read Goodnight Moon, and pray over her while she takes her final breaths? What about a family, friends and church who comes into a room to sing hymns while he drifts into a sleep from which he doesn’t awaken? What about a single mother without support dressing her tiny infant for the first time, bathing her, putting a bow in her hair, and making other memories while I help her, support her, remind her she is a good mother, and stay with her?
We, as medical professionals, often strip away everything from our patients’ families. We dictate when they can hold, touch, change a diaper, take a temperature and even talk to their child. And we have to. Not because we are evil people who don’t want the parents to bond with their child, but because we understand the mechanisms of brain development and risks associated with prematurity. But, there is a fine balance. This is, after all, still their child, not mine. I have to find ways to help them bond with their baby that is safe for the baby. I am a teacher, a healer, a gentle speaker. Too often this isn’t what parents feel though, and for that I am sorry. I can say that no one works in the NICU very long without a deep love of this profession. We definitely do not do it for the money (because it isn’t enough). We do it because we love the work. Seeing an infant go home after 6 months is the best feeling in the world. And so, for an infant to die is devastating on us, because we are healers…. We want to fix the problem. We push and push. We tell parents to “be strong.” We encourage further treatments and more medicines. We do more tests and draw more blood. And sometimes we get so caught up in telling parents to be strong and fight, that we don’t allow the strongest thing of all which is to allow their child to die.
I want to make the experience our families have with us as gentle as possible. A friend of mine often tells parents, “The NICU is one of those places you never want to see, but are so happy it is here when you need it.” We understand that. And when a child dies, it can be much more gentle than I’ve seen it in those “bad death” times.
When we can say, “You’ve fought so hard. You’ve done so much. It is ok to rest. It is ok to go on. It is ok to die. Your body does not have to fight here anymore.” Then we’ve figured it out.
Monday, August 12, 2013
Never Trust a Monitor
This is the best advice I have for new nurses. Often I see the new girls in our unit so concerned about the numbers on the monitor that they forget to actually assess the baby. Most of the time the monitor is not picking up the true heartrate or oxygen saturation because of a faulty lead, or a kicked off O2 probe. Always check the baby.
For instance,
We had a little one pass yesterday. She had Trisomy 13 which is fatal, but some children linger a while with this disorder. The mom spent great time with her. She was able to snuggle with her and love on her for a long time. Then she went home to hug her other children for a bit before coming back. It was in this time that her little one decided her fight was done. We knew mom wanted no heroic measures, so we just watched her, gave her a little oxygen, and waited. As other nurses were off calling the doctor and mom to come back, myself and the charge nurse waited with the baby. Then it happened... the monitor jumped, so we listened again. There was a heart beat. It was faint and way too slow, but it was there. Then the monitor started showing that the baby was fine. Heartrate in the 140s, O2 sat in the 90s. If I had been sitting outside that room watching a monitor I would have thought that child was fine. But indeed she was not. It is a phenomenon that happens at times with these infants at the time of death. She was able to hang on until mom got there and mom was able to hold her and say her final goodbyes, which I think was good. But we did just turn off the monitor completely because it was reading completely false.
Never look only at the monitor, it is only a tool. As one of our doctors says often, "The monitor is NOT your patient." Pay attention to what the patient is doing, what he looks like, what he is telling you a whole lot more than the monitor.
For instance,
We had a little one pass yesterday. She had Trisomy 13 which is fatal, but some children linger a while with this disorder. The mom spent great time with her. She was able to snuggle with her and love on her for a long time. Then she went home to hug her other children for a bit before coming back. It was in this time that her little one decided her fight was done. We knew mom wanted no heroic measures, so we just watched her, gave her a little oxygen, and waited. As other nurses were off calling the doctor and mom to come back, myself and the charge nurse waited with the baby. Then it happened... the monitor jumped, so we listened again. There was a heart beat. It was faint and way too slow, but it was there. Then the monitor started showing that the baby was fine. Heartrate in the 140s, O2 sat in the 90s. If I had been sitting outside that room watching a monitor I would have thought that child was fine. But indeed she was not. It is a phenomenon that happens at times with these infants at the time of death. She was able to hang on until mom got there and mom was able to hold her and say her final goodbyes, which I think was good. But we did just turn off the monitor completely because it was reading completely false.
Never look only at the monitor, it is only a tool. As one of our doctors says often, "The monitor is NOT your patient." Pay attention to what the patient is doing, what he looks like, what he is telling you a whole lot more than the monitor.
Friday, August 9, 2013
OMG, we are so slow!
Slow days. This is something I'd never say at work. Never utter the words "slow" or "I'm bored" or "we need to pick up." Or anything else like that. It is the kiss of death (literally for some of our little ones I think).
However, now that I'm home and not back for a while I'll write about it. We are so very sloooooow at work right now. All our poor PRN nurses haven't worked in ages. It is a little ridiculous at this point.
And this is where it gets a little hairy being a nurse in the NICU (or I guess I nurse anywhere). Saying things like, "Ok, we need more tiny babies" sounds pretty awful to anyone who doesn't exist in our world. But really, we need more preemies. Ok, I guess the thought is, we need more babies being born in general. Because even our well-baby area in our hospital is slow. Fewer and fewer people are electing to have children right now. I guess the economy and the uncertainty of the future employment plays a big role.
It makes my employment difficult too though. Everything really is very tied together.
However, now that I'm home and not back for a while I'll write about it. We are so very sloooooow at work right now. All our poor PRN nurses haven't worked in ages. It is a little ridiculous at this point.
And this is where it gets a little hairy being a nurse in the NICU (or I guess I nurse anywhere). Saying things like, "Ok, we need more tiny babies" sounds pretty awful to anyone who doesn't exist in our world. But really, we need more preemies. Ok, I guess the thought is, we need more babies being born in general. Because even our well-baby area in our hospital is slow. Fewer and fewer people are electing to have children right now. I guess the economy and the uncertainty of the future employment plays a big role.
It makes my employment difficult too though. Everything really is very tied together.
Wednesday, May 22, 2013
Discharge Day!
One of my most favorite duties in my job is to discharge patients. Not because I don't like them, but because I'm so excited for their families. This is the day they've been waiting to reach! I got to discharge one of my favorite little girls this week. She had spent a long 98 days in the NICU and had a lot of reasons that she shouldn't have ever been able to leave, but she did. She smiled in her car seat as her mom loaded her up into their new car.
I whispered to her to have a wonderful life and I hugged her mom and I said goodbye.
I've been asked if I get attached to these little ones and the answer is OF COURSE! Especially little ones like her who have been with us for a long time. But I would never want them to stay forever. They have a family, a home, people who have prayed and hoped and wished for them to be home. I want to help them get there. That is the most fulfilling thing about being a NICU nurse. When you say goodbye, it is sad to know you probably won't get to see her again, but more than that is the hope for what will come with her!
So, goodbye, little one. Have a great life. Make the most of everyday!
I whispered to her to have a wonderful life and I hugged her mom and I said goodbye.
I've been asked if I get attached to these little ones and the answer is OF COURSE! Especially little ones like her who have been with us for a long time. But I would never want them to stay forever. They have a family, a home, people who have prayed and hoped and wished for them to be home. I want to help them get there. That is the most fulfilling thing about being a NICU nurse. When you say goodbye, it is sad to know you probably won't get to see her again, but more than that is the hope for what will come with her!
So, goodbye, little one. Have a great life. Make the most of everyday!
Monday, May 13, 2013
Observations
Observations from this past week of work...
1. Getting a handprint that looks like a handprint of a baby is extremely difficult! Babies like to ball their little hands up the minute you put it down on the paper. And trying to explain to a tiny that we're making their mommy a cute Mother's Day card does nothing to help the situation. So sorry, hospital, for the amount of printing paper I went through. But the cards did turn out super cute and a tiny handprint makes every mother tear up.
2. Sometimes Mother's Day sucks. My friend had a baby a number of months back, but her baby was stillborn. The most devastating thing in the world... to lose a child... I'm convinced. She was at work yesterday. We talked a lot, since I too have had a stillborn son. And Mother's Day for her, just a painful reminder that her arms are empty.
3. Apparently, I'm the queen of finding infants who need a blood transfusion. And it is amazing how a tiny amount of blood help those tinies perk right back up.
4. No matter the day, I still love my job.
1. Getting a handprint that looks like a handprint of a baby is extremely difficult! Babies like to ball their little hands up the minute you put it down on the paper. And trying to explain to a tiny that we're making their mommy a cute Mother's Day card does nothing to help the situation. So sorry, hospital, for the amount of printing paper I went through. But the cards did turn out super cute and a tiny handprint makes every mother tear up.
2. Sometimes Mother's Day sucks. My friend had a baby a number of months back, but her baby was stillborn. The most devastating thing in the world... to lose a child... I'm convinced. She was at work yesterday. We talked a lot, since I too have had a stillborn son. And Mother's Day for her, just a painful reminder that her arms are empty.
3. Apparently, I'm the queen of finding infants who need a blood transfusion. And it is amazing how a tiny amount of blood help those tinies perk right back up.
4. No matter the day, I still love my job.
Saturday, May 11, 2013
Funny of the Day
If you have a 9lb, full term healthy and strong baby boy and tell me you had no idea you were pregnant I'm going to wonder what you put those kicks off on all that time. Perhaps you normally have gas the size of a 9lb baby?
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