My Life as a Neonatal Nurse Part One

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Three years ago, I retired from my life-long career of nursing. I spent around 35 years working in various hospitals and always with infants.  Oh, there were the occasional times when I was “floated” to different areas within the hospital where I struggled to be the med nurse on the surgical ward or the “active listener” in the Psych department. I never felt comfortable with adult patients. My heart, my mind, and my expertise were always with the babies.  In later years, hospitals quit floating nurses from specialty units out to general medical floors.  I guess they realized that after so long working with only infants, we were literally “winging it” with the adults, and it just wasn’t smart or safe.

Before I actually retired, many of my co-workers would tell me, “you’re gonna miss the babies!” I’m still waiting for that to happen.  What I do miss are my nursing colleagues, and members of the ancillary staff too. Nursing in a hospital is so very much a “team sport” and I truly enjoyed getting to know everyone that was part of our team.  I don’t miss getting up at 4:15 am, the 88 mile drive in to the hospital, the long 12++ hour days, or working nights, weekends, and holidays. I DO miss the paycheck. I do miss my friends. I do miss the rare afternoon at work where I wasn’t running my tail off and could actually sit down and just hold and rock one of my tiny patients.  On those days I remember thinking, “they actually pay me to do this”. Okay, so maybe I do miss those babies, a little 🙂

My career spanned a period of time when LOTS of changes and discoveries were made in how we treated premature infants. Believe it or not, there was no oximetery back in the late 70’s and early 80’s.  We had to draw so many blood gasses to determine lung function and ventilator settings that every few days we’d need to transfuse the baby to replace what we’d taken. There were no surfactants and nobody used CPAP, either – at least at the beginning of my career. We had many ventilator dependent patients that were extremely difficult to wean off — and how many little ones ended up with severe vision problems because we couldn’t keep a super close eye on their oxygen saturation?  Seemed like we did lots more exchange transfusions (for jaundice or high bilirubin problems), and we were taught to always be attuned to a baby who began to run a low-grade fever, or suddenly was cold and couldn’t seem to warm up. Yes, this was in the days prior to all pregnant moms being tested prenatally for Group B Strep – a killer bacteria that is extremely dangerous for newborns.   All this reminds me of one of the many significant events of my nursing life.

It was about 1980. Could have been ’79 but it doesn’t matter either way. It was a LONG time ago. I worked evening shift back then, 3 – 11 pm.  My own two boys were really little – just 2 & 3, so I stayed home with them till about 2:30 pm when it was time to leave for work. Then my parents would come stay until hubby got home about 5:30 in the evening.  I was happy to work just three days a week, and on those days, I literally felt like I “worked” from morning to night. I’d be busy all day, taking care of the toddlers, doing your normal household chores, and I usually tried to have something ready for the family dinner when I wasn’t there.  Some days I’d go to work and start my shift already feeling totally exhausted.  I enjoyed my co-workers so much, even back then.  One of the other nurses was very pregnant with her third child.  “Janie” worked nearly right up to her due date, and seemed so full of energy – more than I had, that’s for sure. She was so good with parents and doctors, and of course with the babies.  Back then, in our rather small-town hospital, we had a large traditional newborn nursery and a small (3-4 bed) Special Care Nursery. We switched off working in both areas.  I loved the experience of working with normal newborns.  There was no “rooming in” in those days, so we “newborn nurses” walked literally miles every shift, carrying each baby to mommy’s room several times in an 8 hour period, and then back to pick baby up for a return trip to the nursery. Most evenings were very busy, depending of course on what the census was.  In those days, mom’s with normal vaginal births normally stayed in the hospital for 3 nights.  C-section moms were most often hospitalized for 5 nights.

My work day always began in the locker room back then. It was there that we had to change from our “dirty street clothes” into hospital provided scrubs prior to our shift. Everyone was talking about how our co-worker Janie had had her baby the day before. We were tittering on about how it was a girl and how big she was – at that time, prenatal ultrasounds were pretty much unheard of. Let me amend that.  Nobody ever got an ultrasound back then. It just wasn’t done, so we were all excited to learn it was a girl.  Janie now had a boy and two girls. Of course we were just thrilled for her. That evening, during my shift, one of the other nurses noticed that Janie’s baby had a bit of a temperature elevation. Since we were pretty cautious about that, we called the pediatrician to let him know.  Yes, nearly ALL the Peds were men back then. In an abundance of caution, the doc, who knew all of us nurses well, decided to come in and have a look at Janie’s newborn daughter. He decided just to be safe, he’d draw a CBC & blood culture (nurses were never allowed to draw blood cultures back then – at least where I worked).  None of the results were back before it was time for the evening shift to head home.  The next day upon arriving at the hospital, there was an entirely different aura.  Janie’s baby had taken a turn for the worse and was now in our small Special Care Nursery, on a ventilator with IV antibiotics going. She almost had a gray cast to her skin, she looked so unwell. It was so sad and difficult to see a baby belonging to one of our own – so sick,  and Janie, clearly very frightened as well.  Baby’s diagnosis came early in the shift. Overwhelming Group B Strep Sepsis.

Honestly, there couldn’t have been a worse diagnosis.  The neonatologist had already put little “Anna” on IV antibiotics, but it seemed like they weren’t helping.  Janie pretty much didn’t leave the Special Care Nursery at all, understandably wanting to be at her baby’s side.  Family members were in and out constantly. Still, little Anna didn’t seem to be responding to treatment.  The next day, with baby Anna getting worse instead of better, our neonatologist decided (with parental permission) to try a treatment that is normally NOT associated with Group B Strep.  Within a few hours, we were set up and doing a Double Exchange Transfusion. This entails slowly and carefully removing a few milliliters of blood from the baby, and then replacing it with new donor blood. The process can take several hours.  It was clearly and admittedly a last ditch effort to rid this baby’s body of the streptococcal bacteria.   I wish I had a wonderful, miraculous ending I could share with you, but I don’t. Janie’s baby Anna died that day. We tried everything we could to save this infant, both conventional and unconventional treatments, but nothing was effective. Words can’t describe how sad we all felt for Janie and her family.  Several months later, Janie did return to work and continued to be a wonderful, well respected nurse.

Nowadays, in the USA, all pregnant women in the care of gynecologists get a test for GBS at about 37 weeks gestation.  If it’s positive, they are treated with IV antibiotics when labor begins. This is a highly effective treatment for the prevention of transmission from mother to baby. I only wish we would have had this insight back in 1980 when Janie was expecting Anna.   On a similar note, I have very recently read online that routine prenatal GBS testing is the standard not only here in the US, but also in France, Germany, Spain, and Canada.  It is NOT available through the National Health Service in the UK. Apparently the test costs 11 pounds, and the government is choosing not to provide this as part of routine prenatal care. They are also concerned about the cost of antibiotics, should a mom test positive.  Here’s an interesting article on the subject: http://www.mirror.co.uk/news/uk-news/government-leave-700000-mothers-untested-6966169   I usually try to stay apolitical on my blog, but MAYBE the recent British exit from the EU will allow Great Britain to spend some “new found” revenue on their own citizens — it seems to me that GBS testing on all pregnant women would be an excellent and prudent use of tax money.

I have lots of memories about actual events that happened during my career as a neonatal nurse. I will never share real names to protect privacy.  Please be on the lookout for the next installment in “My Life as a Neonatal Nurse” in a few weeks!