Caring For NICU Parents

[Bortaz, MSN, RN]

I've been bothered by this issue since my first week in the NICU, but lately I've been seeing it so much that I was compelled to finally write about it. Below is my first, and it comes from my heart. I welcome your thoughts on this subject.

Caring For NICU Parents

As RNs working in the Neonatal ICU, we are typically given a patient assignment ranging from 1 critically ill infant on a ventilator(s) to 3 to 4 "feeder/growers". Sometimes, depending on the babies involved, these assignments can be overwhelming and keep you running all night.

However, the baby is only one (large and important) part of our responsibility. Too often, care of the parents of our sick babies is neglected or considered unimportant. Still, one of the most common phrases you hear around the NICU is "A stressed parent leads to a stressed baby".

These parents are thrust into an environment that can be terrifying to them. They are scared for their baby. The likely don't understand what is happening with their child. The equipment, jargon, and noises are frightening. Often, they feel guilty for having their baby so early. Probably most importantly, they have had all control regarding their infant taken from them, and are dependent on strangers in scrubs to keep their baby alive and well. With the advent of Google, most modern parents will search the internet for information about their baby...and will find the worst-case-scenario which will just add to their stress and fears...and most likely doesn't even apply to their child. Lately, everyone's an instant expert.

The cliche about stress, above, happens to be true. And since it is, it only seems logical for caregivers to make an effort to alleviate as much of this stress as possible. It's an added task tossed on top of an already great list of things to do, problems to handle. But, it must be addressed.

Too many times in my NICU career, I've had parents of a 7 day old infant tell me that they haven't been given the chance to carry their baby, or Kangaroo Hold, or feed, or check a temperature, or even change a diaper. Not once in a week! Both the baby AND the parents need this contact!

There exists a multitude of excuses that we as caregivers use to try to get the parents out of the way. I've heard several recently, from parents:

• The baby's temperature is low.
  
• I don't want to risk losing the IV by wrapping the baby and carrying him.
  
• We just fed him, and he needs to sleep so he can digest the milk.
  
• The baby's "sats" have been going up and down too much lately.
  

Unfortunately, it often comes down to the fact that the nurse is busy, there's too much going on, or just pure laziness that leads us to try to set the parents aside. We have another baby to feed, or a med to give, or the other baby is de-satting. Or, it's my break time. When we use equipment as an excuse, parents become intimidated and might be reticent to hold the kid later. They're already afraid of all the accoutrements we have attached to our patients.

I choose to believe that it's a minority of nurses that do these things. Involved parents are good for the health of the baby, and we all want the babies to become or remain healthy, so we're all certainly going to do everything possible to attain this goal. Right?

Certainly, there will be times where we just can't oblige the parents when they want something. The NICU does become very hectic at times, and frankly...the parents can simply wait till their next visit to cuddle their angel. But we need to be sure we're not just putting them off because we see them as an imposition on our time.

So, my fellow NICU caregivers: Let's make a commitment to ourselves to help these parents get through the trauma of having a sick baby. Let's educate them, involve them in the care of their child, treat them with respect, and understand that they are as much our patient as is their baby.

Do it for the babies.

[FutureNurseShammie]

This made me cry..

[erinhrn]

I love this! I'm a newer NICU nurse (just under a year) and I try so hard to allow the parents to do as much as they can for their baby. It is difficult to balance though between a busy assignment and a baby that is not the most stable. I don't always get it right but I try to go the extra mile when I can. So rewarding to see the look on a Mother's face the first time she gets to hold her baby, and most of the time the baby improves while being held!

[Jolie, BSN]

I had worked in the NICU for about 6 months when I had my first "lightbulb over the head moment" of understanding from a parent's perspective. I was caring for a 28 weeker (this was over 25 years ago, so 28 weekers were the edge of viability at the time), who miraculously never required ventilation, and at a few days of age was essentially a feeder/grower in the step-down room.

I offered to bundle him up for Mom to hold during a feeding, but she declined. I peeked over a few minutes later to see her sobbing uncontrollably, and asked what was wrong. She was overwhelmed with fear for her tiny, sick little boy.

It dawned on me then, that the miraculously healthy child I saw (a 28 weeker well under 1000g who was stable on room air and gavage feedings) bore no resemblance to the tiny, helpless, wrinkled little waif that she saw. Her baby's reality, no matter how positive from my vantage point, was no where near the Gerber baby that she had fantacized about during her shortened pregnancy.

That little guy is 26 years old now and I still can picture him and his mother. I'm grateful for what they taught me.

[Bortaz, MSN, RN]

If a nurse cannot see things in the NICU from the perspective of the parents, I think they are missing a large, important part of being a NICU nurse. It just wears me out when I hear the new orientees say they came to the NICU because it's easier than m/s or they heard the pt loads were a lot smaller. This mentality is what leads to seeing the parents as an imposition rather than as a vital part of the baby's recovery (or survival!).

I am very thankful that I was allowed into the NICU as a new grad, but sometimes I think to myself "God, will they just let ANYONE who applies work on this unit?". NICU is one of those rare units where you have to "get it" to be successful. And by "get it", I don't mean learning to read a CBG or adjust a ventilator. Our specialty is like no other in nursing...we HAVE to see the whole picture, and we cannot allow nurses to pile into the NICU just so they can escape med/surg.

[klone, MSN, RN]

Awesome post! I'm an L&D nurse, but my last baby was a NICU baby. He was born at 36 weeks with RDS, and had to be vented for 6 days. I wasn't able to hold him until he was off the vent, so for the first 6 days of his life. I remember being so scared and overwhelmed. Even though I was a nurse, the NICU was a foreign land to me at the time. I remember that the overwhelming feeling I received in there was that he did not belong to me. He belonged to THEM, and I was just visiting. I remember how hurtful and offensive it was to hear them refer to him as "my baby in pod 12" when talking about him to someone else. I remember feeling like I had to ask permission to TOUCH him. And then being told NO, because it would "agitate" him. And remember, this wasn't a critically ill infant. This was a 36-week RDS baby who wasn't septic and had no other issues.

I also remember feeling overwhelming amounts of guilt because we couldn't be there at all times. I felt as though I was being judged for not being there enough (whether or not that was true). During the night, I debated whether I should call at 2am when I was awake to pump in order to check on him. I didn't know then that the nurses WANT that, and will actually chart when the parents call to inquire on the infant's welfare. I was just thinking I was disturbing the staff. So I think it's important to reiterate that it's OKAY if you want to call to see if your baby is okay. In fact, encourage it.

[Bortaz, MSN, RN]

Thanks for your perspective, Klone.

[celtchick68]

Awesome points to consider and keep in mind.

My 3rd baby was a NICU baby. She was born at 38 weeks via emergency c-section after cord prolapse. Very scary to see your child limp and blue with the NICU team performing CPR and intubating. She was the biggest baby in the NICU and fortunately had to spend only 12 hours on the vent (she extubated herself). She spent 8 days there due to needing bili blanket and them not wanting to send her home until fully resolved since the NICU only takes "clean" babies and they didn't want us to have to go to PICU if something else came up. "Luckily" for me I remained in the hospital as well due to uterine infection and a fever that would not resolve so I was able to remain with her and see her throughout the day and night. We lived over an hour away from the hospital so this was truly a blessing. The staff was incredible. They were encouraging, supportive and helpful every step of the way. As a parent I felt helpless and felt as if mother/child bonding was delayed. The staff sent pictures to me while I was in the recovery room which I thought was sweet.

As a result of my experience with the NICU I find myself wanting to work there. I'm a new grad working in the ER currently. I enjoy the ER but it's not where I want to end up. For me it's a stepping stone that will open doors to a more rewarding opportunity in a year or two. The patient ratio I see as not a lot different than in ICU or SICU where it just takes a lot more individual focus to care for sicker individuals. I don't see it as less work, if anything I see it as more challenging.

[babyNP., APRN]

Klone, most NICUs just want you to check in with a phone call once a day and visit a couple times a week, but even then we have many parents who don't do that, but are appropriate with their kids.

I learned fast as a new grad that all parents want to feel is that you are competent in the care of their baby and that you do actually care. I always introduce myself properly on the phone and let them know that they can call me at anytime. If I have time to look at the next shift assignment, I let them know by name which nurse they have. I find that when I do this, they tend to *not* call me 23908902358 times on my shift (I had a mom in my early days as a nurse who called me 15 times in my shift for a kid that was stable on vapotherm, NG feeds, and in an isolette. I was terrified of her (and it must have shown through my conversation) and didn't know what to say since I kept saying there were no changes and got my charge nurse to talk to her.

The other thing is that I find is that you should make them feel comfortable and give them an opportunity to be parents. Of course, letting them participate in cares as appropriate (even stable vented kids can have moms take temps, change diapers as long as there is nurse supervision) and kangaroo (we do stable vented kangaroos). I also ask them what the baby's name is, how they chose it, ask about their jobs/homes, that sort of thing. I feel like it helps them to take a step back from all the focus of "OMG I'm in an ICU" if I can have "normal" conversations with them. Additionally, if I'm calm and about extraneous things, it helps them to be calm.

On the flip side, if the baby starts to decompensate and I need to suction/stimulate/blow by, whatever, I calmly but firmly tell them that I need to get in there and squeeze my way in. If they argue while I'm (gently) pushing them aside, I tell them that their baby needs help and they need to let me do my job. Most parents respond well to this as they see me actually doing my job. I also let the monitor ring off deliberately so that they have something auditory to let them know that something is going wrong.

[KJRN79]

Excellent post, Bortaz. I have worked in Level II Nursery, years ago, but my best friend had her son prematurely and she is also a nurse. SHE was overwhelmed as a mom visiting her son. Your post goes right to the heart of the matter. Babies are number 1, but parents come in as close seconds for people needing our care. Thank you for your insight.

[klone, MSN, RN]

Klone, most NICUs just want you to check in with a phone call once a day and visit a couple times a week, but even then we have many parents who don't do that, but are appropriate with their kids.

But is that a conversation every NICU *has* with all parents? "Hey, please feel free to check in with the RN by phone, even in the middle of the night, to see how your kiddo is doing. It's okay." I know they never had that conversation with us.

Also, I felt like lactation COMPLETELY failed us. I'm an IBCLC, but I was first and foremost a MOM. The first thing I did when we got there was request a lactation consult. Nobody came for three days. When someone finally came to talk to me, she introduced herself by saying "I'm not an IBCLC, so you probably know more than I do!" Gosh, thanks.

[Nurse Mommy]

I give all NICU nurses a lot of credit... I could never do it, especially being a mom. Give me a dying adult any day, hand me a sick baby and I'd break down. Kudos!