I’m so ashamed to say that I once (internally) judged some of my high school friends for going into nursing programs at university. I thought they were all so smart and talented that they should have been doctors instead. I think back on this now and cringe. They may have confronted this opinion elsewhere, maybe from teachers or even parents.
I now know how wrong I was for two reasons. One, because I spent the last 15 years since high school ended submerging deep into all kinds of strains of feminist thought. Nursing continues to be a feminized profession in most cultures, and therefore taken less seriously by many of us. And two, because I had a baby in a hospital where I was attended almost entirely by nurses and midwives, and that baby needed a 72-hour stay in the neonatal intensive care (for a fairly minor issue, thankfully). I wish I could go back and slap my stupid teenage self.
The NICU nurses were beyond impressive. I don’t know how they do what they do, how they continue to do what they do day in and day out. Cliches get thrown around a lot, and some of it is condescending and maudlin, but nurses are super heroes. We should take some of that rah-rah spirit we as a country are constantly expected to show to our military, and bestow it on nurses. (This is not zero sum, and clearly there are many nurses in our military, and I don’t mean to disrespect them). This is the level of recognition I’m proposing. We are so lucky as a country that so many of the best and brightest women in my high school class went into nursing. These people save lives every single day.
NICU nurses have incredibly specialized skills. I witnessed in it during my time there. They can insert IVs and needles in the tiniest veins. They can perceive something is wrong with the tiniest changes in impossibly little bodies. I asked my friend Micheline, a nurse who spent five years working in the NICU at the only children’s hospital in the Maritimes, now studying to become a neonatal nurse practitioner to shed some light on just how NICU nurses do it:
She said: “Babies can’t tell you if something is wrong. Assessment skills are a NICU nurse’s biggest asset. You have to continually assess your patient through the day and know what their baseline was at the start of your shift or over the days of caring for them. When babies get sick in the NICU it can be very subtle. Maybe their stomach is a little more distended than before, maybe their heart rate is up a little higher for no notable reason- those tiny little things that in the adult world would be ignored could mean a baby has an overwhelming infection.”
And about the tiny IVs: “Those are skills that are gained over years of experience, we use the smallest IVs and the hardest things with babies is that the veins are fragile so they don’t last as long as you would like. Everything is small. Even isolating heart sounds with a stethoscope or listening to all the lung fields can be difficult because a chest is so tiny. The NICU is full of lots of technical skills that although they may not be specific to the area ( like said iv) they require different procedures, policy and techniques to perform safely and successfully on a baby.”
Mich is now working as an air transport nurse for critically ill babies, children and pregnant women, bringing them to the IWK. So picture doing all that in a loud helicopter in the air:
“I can tell you without my experience in NICU I would never be able to do my job . My assessment skills are key when I am in a helicopter that is too loud to use a stethoscope. They also help us decide what to do first when we get to the patient and they are in a critical condition. Also to safely transport a patient we have a policy that they must have two working IVs- it’s harder to put one back in when you are in the air and your patient is secured in an incubator or on a stretcher. Without my nicu experience two IVs on a tiny baby would be close to impossible.”
She says the job has incredible rewards and heartbreaking challenges:
“The NICU is a complex environment; it takes a lot of people, skills and technology to make it buzz. One of the best parts of working in NICU compared to maybe some other nursing areas is the multidisciplinary teamwork. RT’s, RN’s, NPs, pharmacy, physician’s, residents, OT, physio, surgery, social work and even house keeping all work together towards the common goal of optimizing a baby’s condition, empowering their family and helping them get home to live their very best life with the very best future they are able to have. Teamwork like that doesn’t always exist in healthcare. I love that. I also like being able to advocate for babies and their loved ones, especially because they are often unable to do so for themselves. I think that is a very important job considering the extremely vulnerable population. It is a challenging place to work; no baby is the same, no NICU stay mimics another. It is unpredictable, fast paced and high intensity at times but it is also filled with many special moments. I think the very best aspects of the job are those moments. Watching a new dad see his baby for the first time or helping a new mom finally have a snuggle when maybe their baby was too sick to be moved for weeks can be extraordinary experiences. Witnessing the babies and the families you have cared for reach their goals and meet their milestones is also at the top of the list. Whether it is drinking a full bottle, finally latching well during a breastfeed, having a surgery or procedure go well, having their IV taken out, breathing without assistance from a machine or even something as basic as finally having a poop after days of waiting for one- they are all things to be celebrated. At the very top of the list is seeing your patient finally going home with their family. It doesn’t matter if it was a baby who was in NICU for 2 days or 200, it is special every time. The neonatal unit is a very rewarding place to work.
The technology is impressive and not a day goes by where I am not amazed at the things we are capable of because of continued research and advancements in practice (especially considering neonatal medicine is considered relatively new medicine). That said, some of the hardest aspects of the job surround when technology fails or when it isn’t sufficient enough for a baby regardless of the advancements that have been made. For all the special and wonderful moments, there are still devastatingly hard ones. Watching a parent learn their baby may not live or that their child likely won’t function in the same ways as their peers as they grow up is very hard. Helping a parent say good-bye to child is always gut-wrenching and never gets easier. It stays with you. Luckily, those moments are far less frequent than the good ones. It is also sometimes hard watching babies experience pain, endure procedures, disrupted sleep and all of the negative things often associated with an intensive care unit. We do everything we can to keep our patients comfortable, prevent and treat pain and optimize their development but some things are unavoidable no matter how hard you try.
Honestly, I could list one hundred more things that are incredible about the job but I guess in the end, NICU is a very privileged place to work. As a nurse you share in the very best and the very worst days of people’s lives and I feel that it is truly an honor to be able to do so.”
I also discovered that some NICU nurses are experts at dealing with the fragility of brand new mothers, especially the nurses who work on the night shift. I would shuffle over the NICU in the middle of the night, careful not to aggravate my C-section incision, and feed my son while he was hooked up to the machines. The third night after having a baby is a notoriously difficult night: the vast amounts of hormones that were required for labour and childbirth now have nowhere to go, and they flood around your body making you extremely emotional. This made me cry/laugh almost in hysterics for four straight hours for no discernible reason. I couldn’t stop crying no matter how hard I tried,but when I shuffled down to the NICU for the 5am feeding, my favourite night nurse was there. She could tell I was totally overwhelmed and while I fed my baby she and I talked about everything but babies – mostly our dogs. Hers part-beagle, mine full-beagle. She showed me pictures of her dog on her phone. I showed her mine. She intuited that I just needed a mental break from the whole vast terrifying exhilarating process of becoming a mother to just look at pictures of cute dogs. An hour with her in the early morning hours was more mentally restorative than anything else at the time. I left her a thank you card when we were finally discharged.
So don’t just thank a nurse this week, although do that too: please try to fully appreciate how specialized their skills are, how they keep us alive, how they put us back together again when we are so, so fragile. It seems like the most vital work there is.