As someone who is interested in pursueing a career in the NICU, I am curious to hear what some of the hardest things to deal with are, from those of you with experience. It's obvious that in an intensive care unit you deal with very sick babies but I'd like to hear about what I might encounter. I'm nervous about my reaction to some things I may encounter. I consider myself a very strong person but I am also very compassionate and I think that I will be able to overcome my emotions by keeping in mind that I am there to help these innocent and helpless little ones.
As an old NICU nurse reading over the posts above, I am reminded of many similar cases I have experienced -- and the similar feelings they gave me.
2 things strike me overall:
1. Most of the time, it's not the babies themselves who are the source of stress. NICU nurses can usually handle that most of the time. Most of the most stressful times involve families -- often dysfunctional ones, but sometimes absolutely wonderful ones who are experiencing a tragedy.
2. I hope students read this thread and perhaps get an inkling as to why nurses are sometimes a little "un-impressed" by their intense reactions to the fact that a classmate is a jerk or a test question was unfair, etc. We experienced nurses have seen so much real tragedy that these little wrinkles in a student's life just don't seem like that much of a big deal anymore. It's not that we are hard-hearted. It's just that we know the difference between the really big issues of life and the little ones that a competent adult should be able to handle.
Most of the most stressful times involve families -- often dysfunctional ones, but sometimes absolutely wonderful ones who are experiencing a tragedy.
That is spot on, I totally agree.
Of course it's sad when any baby dies or when anything bad happens to the little ones we take care of.
I sometimes feel heartless because it's rare that I cry at work when a baby dies. A lot of times it's because I'm not attached to the family and I really have no connection to the situation. Of course it's still sad, but it doesn't affect me enough to cause tears.
The ones that involve families you're close to or have the absolute nicest parents .... those are hard. A lot of times it seems like the sickest kids have the nicest parents. Maybe it's harder in those cases because I have no one to blame? When the babies that are born to drug-addicted moms or those that get no prenatal care or do something stupid ..... it's easy to blame mom. It's still sad, but at least there's someone to blame. These families that want so badly for a baby and lose EVERY single one ..... they're the nicest people in the world and you just want SO BAD to give them the chance to be a parent.
Danissa - You're right .... if it were only full of big, healthy babies! I think next time I work I'm going to ask to be in the intermediate nursery so I can love on a big grower/feeder.
For me, today, it was the beautiful HLHS baby of a 15yo mom (and 32yo gma) who got no prenatal care after the initial diagnosis. FOB in jail. When mom does show up, it's often at 2am with several friends who have had to be asked to leave 2/2 intoxication and belligerence.
And we're going to send the baby home with her. And he'll need at least two more surgeries. And he can't eat, so he'll go home on NG feeds. To this. And he's so lonely, he just cries and cries unless you're standing where he can see you. Those big beautiful eyes just stare at you. And we're going to send him home with her. And you can't even be mad at her. She's FIFTEEN. In the system herself, because she ran away so often Children's Services got involved, but she's back living with her mom and (supposedly) working and being homeschooled. So you know, he's got a stable environment to go home to, or so social services seems to think.
I need a hot fudge sundae. And a drink. And a bubble bath. Possibly all at the same time.
I also think the hardest thing for me as a NICU nurse is it always seeming that the sickest kids always belong to the nicest, first-time parents. Case in point: my last primary was a beautiful term baby born to two of the nicest people you could ask for. She ended up being dx with primary surfactant deficiency, and her parents had to choose between comfort care and moving all the way from NYC to St Louis for a non-definite lung transplant. They chose comfort care. The baby spent her entire 4 month long life, including Christmas in our unit. We listened to Christmas carols together, and her parents brought in a tiny christmas tree for her. They spent every night with her, stroking her hair, comforting her, and participating in her cares, as much as they could with an oscillator and scalp PICC....
I'm now caring for a 26 weeker born to a wonderful couple (1st born). He's got IVH, and won't tolerate conventional ventilation. She's a nurse manager, and he's a big burly construction worker, but they love their little boy so much! A lot of our time is spent trying to remove the parent's self blame. They blame their baby's suffering on their incompetent cervix, or PIH, or that trip to Mexico 6 weeks ago.
Mentioning a baby you primaried a year ago who's back in the PICU to a fellow nurse and having the cardiology fellow who happens to be around look up and go "Oh, K? She died two hours ago." Just like that. And you saw her a week ago, on nasal cannula, standing up and playing and laughing.
Specializes in Neonatal nursing (paediatric trained).
I would really, really like to know who is responsible for mental health/family support in the NICU. I am not a nursing student (although I am considering it), but I am a psychology major with an interest in mental health. I also have a particular interest in the NICU and in neonatal and pediatric medicine.
Would a nurse be able to provide family support/counseling in a certain role, or would that be the role of a different type of provider?
Thank you!
Lindsay
Well, the entire team should be involved in supporting the family. On our unit, we have coffee mornings for parents of babies that were/are on the unit so that they can offer support to each other. We also have a psychotherapist that visits once a month (she can schedule appointments outside that time to see parents, though) and can see parents seperately and/or together.
Specializes in NICU, PICU, PCVICU and peds oncology.
For me, today, it was the beautiful HLHS baby of a 15yo mom (and 32yo gma) who got no prenatal care after the initial diagnosis. FOB in jail. When mom does show up, it's often at 2am with several friends who have had to be asked to leave 2/2 intoxication and belligerence.
And we're going to send the baby home with her. And he'll need at least two more surgeries. And he can't eat, so he'll go home on NG feeds. To this. And he's so lonely, he just cries and cries unless you're standing where he can see you. Those big beautiful eyes just stare at you. And we're going to send him home with her. And you can't even be mad at her. She's FIFTEEN. In the system herself, because she ran away so often Children's Services got involved, but she's back living with her mom and (supposedly) working and being homeschooled. So you know, he's got a stable environment to go home to, or so social services seems to think.
I need a hot fudge sundae. And a drink. And a bubble bath. Possibly all at the same time.
And when he comes to PICU for his Glenn, we'll be right there feeling what you've so aptly described. In our hospital our post-op cardiacs go to PICU from the OR no matter their age. A few months ago we had three tiny girls who ended up on ECLS on right after another. The first was similar to the baby you've described: no prenatal care, really young mom, dad who has been in jail but is currently selling his artwork on the street to pay for food, restraining order against the MGF, no visible means of support. Baby has a Grade 3 bleed and was actually on comfort care but didn't die as fast as the parents thought she would so they put her back on full treatment. Second one is from a delightfully normal family who prepared themselves for the birth of a baby with HLHS, moved here from their own town so that they could be with the baby all the time and have made every effort to learn her care. The third is a kiddo whose mother 'didn't know she was pregnant' until the baby crowned... three times. Yes, you read that right, she has three children that she didn't know were coming until they were here. :smackingf The paradox of these three families is mind boggling.
If he goes home with her, he's not going to make it to his Glenn. I'm serious.
Thankfully for him, it doesn't look like that's going to happen. Things are in the works. Our SW department seems like it might actually do something this time.
preemieRNkate, RN
385 Posts
:icon_hug: