No, We Don’t Just Feed Babies all Day

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Years ago, when I started working in the NICU (neonatal intensive care unit) I was explaining to a group of non-medical people what I do. I explained that I was a neonatal nurse, that I work with babies. With that came the naive question, “what do you do then, just feed babies all day?” The answer is yes and most definitely no. While of course even the tiniest babies need nourishment, this is just a small part of an enormous job that involves a keen eye, constant reassessment, a soft touch, empathetic heart, and super critical thinking skills. We carry a very heavy responsibility. Many of us at one time or another in our career have gone home with insomnia wondering if we did everything we could for our patients. Did we miss any subtle signs of our patient decompensating? NICU nurses have to be experts at reading subtle signs of danger as our patients lack the ability to communicate when they hurt or feel sick. The following is what is expected of a neonatal nurse in a day’s work.

Part Expert Clinician

This skill takes years to hone. A typical day for a NICU nurse starts after report, also called change of shift. Each patient has different problems, needs, requirements. It requires anything from understanding the pathophysiology of a congenital heart defect to knowing that a premature baby that exhibits a large belly and feeding intolerance can be a sign of necrotizing enterocolitis, a life threatening infection. We are expected to interpret a baby’s blood work and know when to react, know if the baby is getting too much or not enough fluid, and give all medications correctly and on time. We have to know that giving certain medications too quickly can cause ototoxicity or hearing loss. We are expected to know that certain IV fluids should never be given together and never given through small veins. We have to trouble shoot IV sites, IV pumps, ventilator settings. We have to interpret a low grade or high grade temperature. We have to quickly (but safely) give blood product after blood product to keep our tiny patients alive. We have to respond quickly to a dropping blood pressure and stimulate a premature baby who has gone apneic. We are expected to be fully aware (even at 5 or 6 am) and prepared to administer CPR to an asphyxiated baby born after being stuck in the birth canal.

Part Mind Reader

This applies only to working in certain areas in the U.S. Depending on where in the country one works, there still exists a very clear hierarchy where nurses are expected to anticipate the needs of the doctors and in a timely manner. I have through the years reluctantly become a sort of mind reader. It is the nurse’s responsibility to know that Dr. So and So gives all his babies a suppository every 12 hours round the clock (premies become easily constipated).
I have worked with doctors that expected the nurse to know that they require a small towel (rolled in a precise manner) to place under the baby’s neck before intubation and who have all but written me up (instead of simply asking) because I had not charted the baby’s weight in the timely manner they required. This adds unneeded stress in an already stressful environment.

Part Therapist

Parents of NICU babies are grieving. They are grieving the normal delivery they had hoped for, the healthy baby they dreamed of, and the diagnosis they have been given instead. Though they are usually referred to a support group or therapist early on, it is the nurse that plays the role of therapist most days. They witness the most critical moments in a NICU parent’s life in real time as it happens. They are there the day the baby is born and admitted, the day the baby is diagnosed with a brain bleed or life threatening sepsis and even on the good days when baby starts eating by mouth or gets closer hopefully to going home. Through this roller coaster ride that is the NICU, the nurse is by both the parents’ and baby’s side watching, monitoring, assessing, intervening, and guiding. The parents rely on the information we give them and sometimes that information determines whether or not they have a restful night, so we learn (hopefully) to tread gently and carefully.

Always Protector

In the 8 to 12 hours that a NICU nurse has assumed responsibility of a NICU patient, it is that nurse’s responsibility to protect the baby. It’s called patient advocacy and it’s a little like a female lion protecting not only her own cubs, but all the cubs in the pride. It can be reminding a parent, family member, or coworker the most critical element of hand washing before any contact with the baby. It can be questioning a doctor’s order that may not be in the best interest of that particular patient. Whatever it is, if it is not in the best interest of the patient, it is the nurse’s job to speak up.

I recently heard one of my favorite doctors here in Sweden say something that will be forever engrained in my brain. Toward the end of a tiring night that required admission after admission of unstable patients, she said to me something along the lines of “it’s best to always prepare for the worst, that way there are no surprises.” This is a good summation of working in the NICU, always preparing for the worst while hoping for the best. At the end of a sometimes very long and emotionally trying day, we are expected to show up for the dinner parties with smiles on our faces. This takes the super human ability of separating work from non-work. Some days are easier than others and that is why it is so much more than just feeding babies. Feeding babies is actually a cherished moment for NICU nurses because this means that we have hopefully done our job and done it well.

Tools for Surviving Night Shift

Most nurses are creatures of habit. We develop routines before going to work, have routines while at work, and have routines when we get home. How many can relate to this?? This week was my first week back on the job. I’m a night shift nurse by heart.  I like the pace, people, and pay.

I reluctantly started night shift on my first travel assignment in 2006. It was not by choice, but after a week of nausea and confusion, I was hooked! There isn’t the constant buzz and whir that one experiences on day shift in a hospital. Nights are great for those of us who become easily distracted, as long as you can stay awake.

Working nights is no joke when it comes to the effects it has on the body.  More and more research is finding a connection between shift work and increased likelihood of cardiovascular disease, depression, obesity, and insomnia.  That’s why it’s so important to try to make sleeping well, eating well, and exercising a part of life.  Don’t get me wrong, I eat chips and drink soda sometimes, but it’s all about balance.  I try (keyword try) to limit the junk to one day a week.

I thought I’d share some of my routines for surviving night shift. It’s a process that is years in the making, thus time tested.

Stay hydrated

I usually have one or two cups of tea before work.  It gives a little pick me up and has the added advantage of antioxidants.  I might have a cup of tea on my first break at work too as well, but I have a rule of no caffeine too late for fear of interfering with my sleep.  I also pre hydrate with water before work in case it’s so crazy busy I don’t have time initially to drink.   Every chance I get, I drink a glass of water.

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Sleep

It’s so essential to sleep and sleep well. Whatever it takes. I know that my bedroom has to be as dark as possible and cool. If the temperature is off even by a degree or two I can sense it. I use an eye pillow filled with flax seed and lavender (highly recommend). Eye pillows block all light, can relieve headaches and eye tension, and allow for a deep state of relaxation. The weight of the flax seed in the eye pillow is said to add needed acupressure points around the eyes. The added benefit of lavender has a further calming effect.

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My homemade lavender eye pillow with flax seed. Highly recommend!!

Eat

I eat healthiest actually on the nights I work. I know my body needs the best fuel possible to stay alert. I eat dinner at home before going in. Baked salmon with a garlic yogurt sauce is my favorite. Both are high in protein and hold me almost the entire night. I bring fruit, nuts, and sometimes yogurt as well to snack on all night. The nuts and yogurt give the energy I need and hold me for a while, plus it is easy to eat quickly if needed.

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My favorite dish!!! Organic Norwegian Salmon with Couscous and a garlic yogurt sauce. Yum!!!

Exercise

I practice yoga nearly every day, sometimes it is only fifteen minutes with my legs up the wall with my eye pillow and deep breaths, sometimes it is a full invigorating practice that challenges my strength and endurance. It depends on how I am feeling that particular day.

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Viparita Karani, my favorite yoga pose. Perfect for stress relief, headache relief, and to ease into sleep. Should be a daily routine in the life of a nurse. Contraindicated for those with high blood pressure, glaucoma, or severe neck/back injury. Use your own discretion. Try for 5-15 minutes and let me know what you think!!

Stay busy

As we all know, this is usually not a problem. We are often faced with an admission or a decline in our patient’s status when we are most tired (right around 5 am). I usually have a routine of cleaning everything around my patient early in the shift. As I get more tired, if I have nothing patient related to do, I clean and stock.

What are your routines???  Would love to hear!!

Our Nurse Changed Our Lives

August 11, 2015

Posts like these remind us why we do what we do ❤

AWHONN Connections

Jessica_Familyby, Jessica Grenon

When I think back to the birth of my second child earlier this year, tears almost instantly begin to fill my eyes.

Unlike the birth of my first child three years prior, this isn’t because I am overjoyed by thoughts of holding my baby against my chest for the first time while I stare in awe at the life my husband and I created, a life that I grew in my own body and delivered into the world after many, many hours of hard labor. Instead my eyes fill with tears because I think of my labor and delivery nurse and how I believe her actions on that day affected the trajectory of my life, my son’s life, and the future of our family.

I am not a nurse, I don’t even work in the medical industry, but for the past nine years come June my work…

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Everything is Hard Before it is Easy

August 2, 2015

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Hej allihoppa (hi everyone)!!!!  Here is a nice little affirmation for those in need.  No words ring truer.  Life is a relative struggle sometimes.  Are we making the right decisions?  Why not take the path of least resistance?  What will others think?  Most of us have had to work very hard to get where we are or where we want to be.  Stay true to yourself, ignore the naysayers, stay determined and positive, and chances are you will reap the benefits ❤