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!

Twas the day after Christmas……..

You know, I do love Christmas.  I love all the decor, the music, the feeling you get only this time of year.  But.  You knew the “but” was coming, didn’t you?  When I know I have to work on the holiday, I get into a bit of a slump.  Mentally.  And yes, I was in “the slump” all day yesterday.  It started when my alarm went off at the very rude hour of 4:30am.  I am used to getting up at that horrific hour at least twice a week, but it just seemed particularly awful on Christmas morning.  I did my normal routine, gathered up my stuff, scraped the frost off the car windows, and headed into the darkness to work.  I’ve worked MANY a Christmas Day.  I always hate it.  I hated it all day yesterday.  I drove my typical 1.5 hours into work, looking at the homes as I passed by.  Some still darkened, some already bright with the excitement that only Christmas Day can bring.  Even the 24 hour Wal-Mart was deserted.  The freeway was nearly deserted…. as I trucked along.  Thank goodness I did have a delightful Christmas book I was listening to along the way! (check out my “books read 2009” tab!)  I arrived at work and while some might think that it would be an “easy” day.  It wasn’t.  To offer as many people the day off as possible, the staffing was quite tight.  In other words, I had a full load of patients and they all needed the same care they would get any other day of the year.  We’d planned a Christmas potluck at work, but several of the people who had signed up to bring stuff – got the day off! (lucky dogs)  So the potluck was… well, pitiful.  Thankfully I’d brought a can of soup to heat up, you know, the kind you can put in the microwave?  After my 12-hour shift, I began my drive home, continuing to feel quite sorry for myself all the way (despite the great book I was still listening to).  We had been able to get together with the neighbors before Christmas – which was great.  We’d been able to get together with hubby’s family before Christmas – which again was great.  But I was in the midst of a pity party, wasn’t I?  I was thinking about all MY family that I didn’t get to see.  Didn’t get to see them for Thanksgiving.  Didn’t get to see them for Christmas.  So what did I do?  I drove in the driveway.  Drug my sorry butt into the house, and had a good old fashioned cry on the shoulder of my very patient husband.  People, I am not a “crier”.  But once in a while, a good cry is pretty darned cathartic.  It was for me.  And today, well I can say I did my “duty” this year and will look forward to having the time off work next year!

I really do hope everyone had a great Christmas.  Even the people like myself who had to work on the holiday.   And the pity party.  It’s over.  For a long time, I hope!

All in a day’s work

nurse1Ever wonder what it might be like to be a nurse?  These days, jobs like mine – in the healthcare world – are among the most secure.  I do live farther away from my place of work than most people, obviously it’s my choice to drive a long way.   You know what?  For me, it’s worth it.  I love my job and especially in our unsure economy, I thank God for it daily.   So here goes, a typical day-in-the-life of this nurse. 

Wake up at a horrendous hour (4:15 am).  Quickly say a prayer… a prayer for a good day, a prayer for safety on the highway, a prayer to be a blessing to someone that day, a prayer to come back home in two days again -safe and sound.  Stumble around the house in near darkness, preparing for the day in rote fashion, thankful that you set out everything the night before – exactly what you’d need – exactly where you need it.  Efficiently pack the overnight bag, two days worth of  lunches, and run it all out to the already gassed up car.  Dash back in to kiss hubby goodbye and grab the MUCH needed cup of coffee.  Out the door in 25 minutes flat!  Not bad!  Crawl into the car; turn up the heater;  flick on the high beam lights, there’s nobody around to be bothered by them anyway.  Slip the latest audio CD into the CD player and drive like a robot while hoping it’s an interesting book this time.  Get a bit dozy along the way – switch from the book to the news or some music and turn down the heater!   Arrive bleary eyed into the parking garage after a one and one half  hours drive at precisely 6:30 am.  Scan your name tag – it’s also your parking pass.  Check how much $$ is on your parking pass as you enter while mentally deducting  the daily $12 and determine that yes, there is enough to pay for today’s parking.  Drive through the garage until arriving at the desirable parking area.  Begin the trek into the building, not far really, less than two blocks.  Wonder while walking… “how will this day go, will we be busy, will it go fast?”  Enter the brightly lit hallway – it’s always daytime inside.  Trudge up the stairs and then into the nurse’s lounge where everything gets unloaded.  Whew.  Lots of “hi, how are you’s?” bantered about inside the lounge – a few minutes to catch up with the co-workers.  And then it’s time.  Time for the day to really begin.

You know, some people say hospitals have a “smell”.  Some people are completely hospital-phobic.  I can’t relate to either.  While I won’t say a hospital with it’s smells, sights, and sounds are “comforting”, I would say that to me, it’s all “comfortable”.  Guess that’s not too surprising after spending an entire career which is approaching 30 years, in hospitals.      

I wander past the time clock, waving my name tag to clock in.  Sometimes we joke about doing our jobs “out of the goodness of our hearts” – because after all, nurses are known to be caring individuals.  Then we all laugh.  While most of us love our jobs, I know we all appreciate the compensation we get every other Friday.       At the front desk the charge nurse awaits with our assignments for the day.  If it’s the first shift of your week, your assignment could be any of the 25 to 31 patients.  To provide continuity of care, the patient you had yesterday is most always yours today too.     Sometimes 3 babies, sometimes 4.  Three is great!  Four means it’s time to lace up your roller skates and focus hard on being as organized as possible.  The patient is the baby, but caring for the family is also high priority.  Learn all about your patients for the day from the night shift nurse.  It’s how the day is planned.  When to feed, what to feed, how to feed, when to medicate, whith what, what test results are pending, what tests are yet to be done, what IV is running and where, who’s going home, who needs extra teaching, who needs discharge teaching, and on and on and on. 

For people who like to sit down and work on “Task A” until it’s done – well, nursing is NOT for you.  First off, there’s not much in the way of sitting down at all!  Completing a task in one sitting is pretty rare.  We often say to each other – “sit down when you can!”.  That means – sit when you feed a baby, sit when it’s time to chart, sit AND put your feet UP during your break. 

Most often the kiddos eat every three hours.  Four kids + 12 hour shift + 4 feeds each = 16 feedings in your day.  Sixteen patient encounters, each lasting approximately 30 minutes – but often longer.  Sixteen assessments to be charted.  Don’t forget the meds, the phone calls to/from parents-doctors-practicioners.  Updates for OT/PT, the Care Coordinators, the Social Worker.   Hang the right IV fluid.  Change the tubing.  Go to a care conference.  Stock the cribs.  Wash your hands a hundred times over!   Try really hard to have a moment or two to visit with your co-workers…. they are more than just fellow nurses — they are your friends.  They’re your suport, your extra hand, your second opinion in deciphering doctor’s orders written in “chicken scratch”.   They watch your babies when you go to the bathroom, on a coffee break, to lunch.  You return the favors when they step out.  You are a TEAM.  Thank God, most days the TEAM meshes, supports each other, and work together as the left hand helps out the right. 

As the 12 hours wind down, a check of the pedometer shows 6 to 8 miles walked.  Why am I not as thin as a broom handle?  I don’t get it!  Sometimes the 50-something ankles start to swell and the the feet get SO tired.  And then…. you see them begin to saunter in.   The night shift!  A sight for sore eyes –and feet!  The cycle starts all over again.  I share everything I know with the oncoming nurse.  I wish her/him a great night and I really do mean it.  I worked 12 hour nights for 5 years (1999-2004) — I KNOW it’s hard.  It’s really hard.

One more swipe of the name badge past the time clock – it’s time to go home.  On the nights that I drive back home I get a ‘second-wind” the minute I step outside and breathe in the cool fresh air.  Soon my car is buzzing up the freeway, CD playing, and the thought of a few days off is glorious!  By about 9 pm I pull into the driveway of my most favorite place on earth.  Forget Disneyland!  I’m HOME!!!    I’m exhausted, but I’m home.  My job is not easy, but still… after all these years… I love it. 

Some days when it’s not too hectic, I’ll find myself sitting in a rocking chair, holding and feeding a baby, and I think… “Girl!  They PAY you to do this!!!!!”

We play the waiting game

We got a call last night from our wonderful Palm Springs Realtor, telling us that one of our offers was NOT accepted.  The owners (a bank) took an offer that was higher than ours.  Oh well.  It’s ok, there are no tears shed here.  Now we wait until at least next week to hear about the other house.  By the way, the house we did not get was the “fixer upper” 3 Bedroom, 2 bath.  The one we are now waiting on is the 2 BR/ 2 Bath in the golf course community.  If both of these places fall through, we will keep on looking online – until we feel like the chance for getting a ‘great deal’ has past.  I’ve always thought of myself as a patient person, so I’m more than willing to wait and see what happens.

This week it was back to work for both of us.  Kind of a rude awakening, after two glorious weeks off!  Of course I wasn’t able to ease back in to it all gently…. no – we are having an unprecedented population explosion at work!  Every single bed in our unit was full – so full that some babies were moved to “overflow” units.  Considering we have a total of 60 beds for ill or premature neonates – and they have all been full, well that means some busy, busy days. 

I’ve just finished reading two fantastic books, and will review them today in my “Books Read 2008” section.  Ok, I will freely admit it.  While I think I have darn near the best job on earth, I LOVE MY DAYS OFF!!!!  I sat outside this morning in the lovely sunshine and finished my book, all while taking in some much needed Vitamin D.  I read somewhere that you can’t store up Vit. D  — which is a shame, since we get essentially NO sun here for 8 months a year!  Oh well.  That’s what pills are for I guess.   One thing I am determined to accomplish this summer is to make some more jam.  My dad LOVES raspberry jam, and since there are oodles of raspberry farms near here, I think it may be just about time to get busy on that task.  Yes, I think I’ll plan a “day of picking” – raspberries, blueberries, and blackberries too.  I can’t let summer get away from me like I did last year!

Snippets of life

  • It’s been a very strange “spring” here.  The constant rain and grey skies are downright depressing.  Last night there was snow falling on Snoqualmie Pass!  This is simply unheard of  in June.  For the first time that I can remember, I haven’t filled my back deck containers/pots with flowers- yet.  Digging in mud is simply not appealing to me.  I have three hanging baskets and haven’t had to water them at all — Mother Nature is doing it for me.   We are used to rain around these parts, but it’s been a daily occurrence now since last October.  Sigh.   Hovering in front of our heat dish in June is crazy!
  • When we first told people that we are going to Palm Springs for a week in July,  they thought we were nuts.  After all, we all know what the weather is like there in mid-summer… blistering hot!   Guess what?  We’ve begun to hear a few “got room for us?” comments passing people’s lips!  We’ve decided that if all the summer we get is that one week in Palm Springs, then that will be OK.  At least we’ll have had a week of sunshine, swimming, and cook outs.  Yeah…. we’ll call it our “compact summer”.
  • I love feeding the wildlife around here (except the deer which annoy me no end).  I’ve had quite an array lately of large and small creatures, squirrels, hummingbirds, and other birds of many types.  The latest being a Western Tanager.  They love the sunflower seeds and suet that I put out regularly.  The hummingbirds have been devouring the sugar syrup in the feeder lately – probably in shock at the cold temps and trying to just stay fueled! 
  • Work has been particularly difficult lately.  I LOVE my job – and I’m not just saying that.  I work at a great place with exceptional people, doing something I dreamed of ever since I was a little girl.  No, it’s true!  When I was about 10, my mom and I used to volunteer one Sunday a month in the church “nursery”.  I was crazy about babies and it was my only chance to be around them.  Who’d have known that I would spend my entire career (now pushing  29 years) taking care of babies?  I believe it was divine intervention… but I digress.  Life at work has been really tough of late.  A series of extremely unfortunate events has happened involving people from work.  One nurse died quite suddenly and unexpectedly – and that really shook us all.  Since then (that was last month), there have been at least four other really sad and difficult things happen to either one of us or our significant others.   Every day we look at each other and ask quite literally “what could be next?”  In the mean time, I think we are appreciating each other a little more, and looking at each day as more of the gift that it really is.
  • We had a fantastic weekend two weeks ago when son #2 and dear DIL were here!  The guys went golfing and the girls did a bit of shopping 🙂  It was really extra special when DIL went with me – and encouraged me – to get some of my long, wild hair chopped off.  Never having had a daughter to hang out with, it’s sure been fantastic to now have my dear DIL!  Woohoo! 
  • Speaking of my dear DIL, has anyone ever heard of Silpada jewelry?  I’ll admit that I hadn’t, and I’m not a really big jewelry lover or wearer… however – this stuff is gorgeous!  She is getting into doing the Silpada home parties and I’m hoping to have one in August.
  • While “the kids” were here visiting, I made a really yummy breakfast casserole!  I took a couple pictures which I haven’t downloaded yet, but if they turn out, I plan to do a post featuring it plus the recipe, of course.
  • On the subject of food…………. I think I’ve mentioned in earlier posts how much I like Martha Stewart’s EVERYDAY FOOD magazine.  This month they have a recipe that I want to highly recommend.  I made it on Sunday evening, and honestly, it was so delicious!  It’s from issue 52, May 2008.  “Flank steak with asparagus and snap pea stir fry”   Long name, but not too many ingredients, and super yummy.  We left out the 4 cloves of garlic because we were both going to work the next day and it still turned out to be SO flavorful! 
  • I’m thinking that may be enough ‘snippets’ for this time.   Time to have a wander outside and breathe in some of the freshest air in the world.  Yup, one good thing about the rain, it REALLY cleans the air and our air is nearly medicinal,  it’s so clean 🙂

What’s with all the Canadian babies?

I don’t normally write political posts – not that I don’t have plenty of my own political views and opinions –  so this is not a political post … or is it?  Not really.  First off I must prequel this by saying that I love Canadians!  I mean it!  I’m married to one!  And we have some really fantastic Canadian friends and relatives.   My beef concern is with the Canadian government and how they fail to deliver proper healthcare to their expectant mothers!   Last fall we had a big “run” on Canadian babies in our hospital.. and guess what?  They’re baaaack!!  Check out this news story on FoxNews written last October.  Not sure if that whole article is acurate, but most of it is.  I’m positive there is a misprint towards the end where they say that the Canadian government pays “upwards of $1000 per child” for airlifts and treatment – or maybe they just meant for the transport to an American hospital because there is unequivocally NO WAY that number is correct if you include the expense of hospitalization.   The Canadian government is paying our hospital BIG BUCKS to treat these moms and their preterm infants who require very specialized (expensive!) care.  In some cases, the babies who are born preterm, spend months here.  During that time the Canadian government help subsidize housing and expenditures for the parents who understandably don’t want to be separated from their newly born children.  Cha-ching!  They are racking up monster sized bills – paid for by the taxpaying Canadian citizens… and the big question is WHY? 

I did a little informal poll around work asking just that question – WHY are they forced to come here to deliver?  Most people say because they don’t have enough staff up there, and they relate that to Canadian nurses not being paid very well.  After looking at the April 2008 ‘wage grid’ for the BC nurses union, their wages are very much in line with ours.  The Fox News article cited above led us to believe that they simply don’t have the facilities, but then mentioned the lack of properly trained nursing staff as well.  Whatever the problem may be, it is obviously still a big issue as we are again getting plenty of unhappy Canadian families, forced to be away from their extended families and normal surroundings – just because a mom has gone into preterm labor.  It’s a shame, really. 

The bottom line for me is NOT that I resent caring for Canadian families.  Nope, I don’t mind a bit.  My fear is that someday the USA might end up living out the Canadian way of government-run healthcare.  Michael Moore thinks it’s a great system.  Hmmmmmmm, he might just change his tune if HE lived in Canada. 

Tearing my hair out

Nurse and babyYes, tearing my hair out!  An expression of supreme frustration – and it’s sure how I felt yesterday at work.  Normally I consider myself a very patient and laid back sort of person, but I hit the wall yesterday.  I don’t think anyone really knew it – not that it helps to keep things bottled up inside – but I was tearing my hair out.  In the nursing profession it’s an absolute must to be compassionate but yesterday I guess I began to literally “feel the pain” that my young patient was very apparently feeling.  One of my charges was the infant of a drug-addicted mother.  This is hardly the first time I’ve taken care of babies born to drug addicts.  Did I mention another must in the profession… being non-judgmental.  I’m really good at that, 99% of the time.  But sometimes I do get a bit ticked off at mothers who do this to their babies.  What kills me is that many of these moms pop in to see their babies only every so often, and really have NO IDEA what goes on while they are not there.  Even if we say “please don’t pick up the baby right now, he’s finally just fallen to sleep”, they didn’t see the baby when he was screaming his head off, obviously miserable, sneezing repeatedly, with seriously increased muscle tone, and oft times a killer diaper rash – so they just do what makes them happy, and pick the baby up to hold.  Yes, we treat these poor innocent babes with medication and yes, it does help, but honestly it is one of those preventable things that really shouldn’t happen!  It’s not like the mom who suddenly develops high blood pressure or who is inadvertently exposed to some sort of a bacteria or virus.  At any rate, we had three innocents in our department that were sure suffering as a result of their mother’s actions/choices.  And there were at least three nurses really feeling these babies’ pain.  It was a day filled with lots of holding and rocking, swaddling, warmed-milk feeding, and medicating.  We did all we could, yet I still left there feeling as though I wished I could have done more.