How to get a job working with babies

[NeoNatMom]

Hi everyone! I wanted to know if anyone out there could lend me some advice. I start my program this Fall at Gwinnett Tech. I have wanted to play a role with babies (neonatal, newborns, NICU, L&D, etc). I was wondering what steps I should take to getting a position in one of those areas of a facility. I should probably add that I am pro life so I don't want to play a role in elective abortions.

Also, I understand that certain situations can occur during a wanted pregnancy that forces us to make hard decisions. Do we risk the mother's life for the child, or vise versa? Or do we leave it all up to the mother and family? How do we weigh out what to do in such situations? I know there are bound to be some sad cases in my future, especially since this area is full of sad occurrences.

Any testimonials would be appreciated as well on how to cope when you start out. I have a feeling I will have a lot of break downs where I'll wanna cry my eyes out. How do you stay strong for the families? Thanks in advance for all the advice!!! :)

[klone, MSN, RN]

Idk why many on here are comparing things that are on vastly different substrates of immorality. ...And now, you are comparing the situation of abortions to a circumcision? You have to use things of equal measure if you are going to try to justify ignoring a conscious telling you that you are doing something wrong. saying killing and circumcisions are the same is like like saying Polar bears are the same as stuffed teddy bears. One kills, the other doesnt...lol (Case by case basis logic).

According to YOUR opinion. But my opinion is different (as is every single person's here, because you know what they say about opinions). To me, routine infant circumcision is actually MORE immoral than elective abortion (because frankly, I don't find TAB immoral in the slightest). So yes, to me, it is a VERY valid comparison. But you could substitute any number of situations. The point is simply that as nurses, we are confronted with ethical and moral dilemmas regularly. The key is realizing that everyone is at different places (or using the phrase my husband loves....NAPALM....not all people are like me). Nursing isn't about you, it's about your patient, and advocating for your patient, giving them all the information, and then allowing THEM to make the decision. And respecting them, even if that's not the same decision you would make personally.

[NeoNatMom]

According to YOUR opinion. But my opinion is different (as is every single person's here, because you know what they say about opinions). To me, routine infant circumcision is actually MORE immoral than elective abortion (because frankly, I don't find TAB immoral in the slightest). So yes, to me, it is a VERY valid comparison. But you could substitute any number of situations. The point is simply that as nurses, we are confronted with ethical and moral dilemmas regularly. The key is realizing that everyone is at different places (or using the phrase my husband loves....NAPALM....not all people are like me). Nursing isn't about you, it's about your patient, and advocating for your patient, giving them all the information, and then allowing THEM to make the decision. And respecting them, even if that's not the same decision you would make personally.

I see what you are saying. Do nurses even perform them? It sounds like a special type of position with training seperate from the nursing process. But what do I know cus i don't know exactly what that entails yet lol thanks for the advice guys.

[NeoNatMom]

A high acuity NICU is not the place for you.

Why not? People will die regardless which area I go in.

[NeoNatMom]

In the NICU do they not try to save sick premies?

[TiffyRN, BSN, PhD]

NeoNatMom:

Abortions just aren't that common in hospitals; at least not the ones I've worked in. I've never worked L&D but people know these things. I think possibly my current hospital does "selective reductions" as we are a perinatal referral center and get numerous fertility patients. I'm sure the L&D/OR area has a policy much like our unit of giving the nurse the option to sign some form that documents a moral/ethical objection and be allowed to be reassigned.

Speaking of that form; ironically enough in the NICU, though I've only known a few nurses to use it, it is generally used for objecting to continuation of life as opposed to termination. Specifically, some nurses object to subjecting infants to further continuation of life support, futile care; particularly the extremely premature ones.

Having said that, I happen to know of a couple of nurses I work with that I have through the years figured out are highly pro-life. They mesh extremely well in the unit. One's view on abortion is just not that relevant to the day-to-day functioning in the NICU. I think you would be the unusual one though if you opinion on the topic didn't shift just a little after a few years there.

I will comment on something applesxoranges wrote though. About taking care of parents with a history of questionable moral choices. I actually was assigned to care for a family where the father was a convicted sex offender (offense was on a child

I won't say I didn't struggle with that one but here's an ethical situation I face off and on and deal with it with varying degrees of success: Moms on opiates (usually methadone) who are on it long-term and either don't prevent pregnancy or purposefully get pregnant (as in undergo IVF) while on these narcotics thereby sentencing their innocent child to suffer week of excruciating withdrawal they are not willing to undergo for themselves. Oh, and most of them can't handle being around their precious baby for more than about 30 minutes a day.

I just can't. . .

[JustBeachyNurse, LPN]

In the NICU do they not try to save sick premies?

Sometimes the NICU is palliative care. Sometimes the NICU is difficult as the case is, for lack of a better word, futile but the family is not ready/able/willing to accept reality (for example a 24-weeker with a grade IV IVH, zero respiratory drive and slow GI motility) but expects the team to take heroic measures. Or a 28 week emergency c/s, twin A died on day 2 d/t pulmonary hemorrhage, twin B has a congenital abdominal carcinoma taking over the abdominal organs, respiratory failure, renal failure inappropriate for peritoneal or hemo dialysis, low blood counts but mom wants baby transferred to receive active chemotherapy and dialysis (despite not being a candidate for either) and insists SOME NICU team exists that will cure her child. Refuses to listen to palliative care to attempt to increase quality of life.

[TiffyRN, BSN, PhD]

Sometimes the NICU is palliative care. Sometimes the NICU is difficult as the case is, for lack of a better word, futile but the family is not ready/able/willing to accept reality (for example a 24-weeker with a grade IV IVH, zero respiratory drive and slow GI motility) but expects the team to take heroic measures. Or a 28 week emergency c/s, twin A died on day 2 d/t pulmonary hemorrhage, twin B has a congenital abdominal carcinoma taking over the abdominal organs, respiratory failure, renal failure inappropriate for peritoneal or hemo dialysis, low blood counts but mom wants baby transferred to receive active chemotherapy and dialysis (despite not being a candidate for either) and insists SOME NICU team exists that will cure her child. Refuses to listen to palliative care to attempt to increase quality of life.

That is by far the worst part of NICU; watching the suffering infant while parents stand near cheering their "miracle child" and "what a fighter she is!". Meanwhile the child is on a vent, constantly gagging on the tube, stomach obviously hurts a lot if not all the time. But they still want to eat, baby turns bronze as its liver dies, infections happen off and on from the CVL, positive blood culture means mandatory lumbar puncture, time to go back to surgery and re-explore, time to fight the vent again, tummy hurts worse now. . . Eventually we send them home on TPN and hear a few months later they died never having made it to their gut transplant appointment. And the nurse wonders. . . why couldn't we just have let them go when they were 2 weeks old, bowel dead, vent dependent, give lots of pain meds and let mommy and daddy hold you?

OP, I am not trying to run you down. I was a very black/white thinker when I first became a nurse; part of that was age, part was an ultra-conservative upbringing. Life was so much easier then, so much clearer. I think what some of the others are trying to say is that nursing is rife with ethical dilemmas. I encourage you to stay away from clinic work if you don't want to participate in terminations, but understand that you will deal with frequent occasions when patients (or in my case, parents) are going to make morally questionable decisions. Start thinking about how you will deal with it!

[NeoNatMom]

NeoNatMom:

Abortions just aren't that common in hospitals; at least not the ones I've worked in. I've never worked L&D but people know these things. I think possibly my current hospital does "selective reductions" as we are a perinatal referral center and get numerous fertility patients. I'm sure the L&D/OR area has a policy much like our unit of giving the nurse the option to sign some form that documents a moral/ethical objection and be allowed to be reassigned.

Speaking of that form; ironically enough in the NICU, though I've only known a few nurses to use it, it is generally used for objecting to continuation of life as opposed to termination. Specifically, some nurses object to subjecting infants to further continuation of life support, futile care; particularly the extremely premature ones.

Having said that, I happen to know of a couple of nurses I work with that I have through the years figured out are highly pro-life. They mesh extremely well in the unit. One's view on abortion is just not that relevant to the day-to-day functioning in the NICU. I think you would be the unusual one though if you opinion on the topic didn't shift just a little after a few years there.

I will comment on something applesxoranges wrote though. About taking care of parents with a history of questionable moral choices. I actually was assigned to care for a family where the father was a convicted sex offender (offense was on a child

I won't say I didn't struggle with that one but here's an ethical situation I face off and on and deal with it with varying degrees of success: Moms on opiates (usually methadone) who are on it long-term and either don't prevent pregnancy or purposefully get pregnant (as in undergo IVF) while on these narcotics thereby sentencing their innocent child to suffer week of excruciating withdrawal they are not willing to undergo for themselves. Oh, and most of them can't handle being around their precious baby for more than about 30 minutes a day.

I just can't. . .

Wow that is informative. Thank you for sharing those experiences. Idk why ppl would object to a premie who is dying regardless of treatment. Just keeping them in a ventilator knowing how slim their chances are is not something I think I'd share with them. It's so sad how the world is now. I heard Obama passed a law that protects nurses from being forced to help carry out abortions. I just recently found that hospitals do them. But yeah thanks for this jnfo. I'm sure my opinions will differ to some degree once I see cases myself. I know there are some very grey areas of this issue. Like who am I to tell an 11 yr old incest victim that she is wrong to abort her fetus. Life is never black and white. I asked my husband yesterday if my life was at stake while pregnant, what would he want me to do. He ga e an answer I agree with so mu ch. That depending on if the child can be saved, we will do whatever is necessary to save my life and the fetus, bit if there was was a tougher decision that needed to be made, it was me over the fetus who would most likely die if I did. I know this area is just so grey.

[NeoNatMom]

Sometimes the NICU is palliative care. Sometimes the NICU is difficult as the case is, for lack of a better word, futile but the family is not ready/able/willing to accept reality (for example a 24-weeker with a grade IV IVH, zero respiratory drive and slow GI motility) but expects the team to take heroic measures. Or a 28 week emergency c/s, twin A died on day 2 d/t pulmonary hemorrhage, twin B has a congenital abdominal carcinoma taking over the abdominal organs, respiratory failure, renal failure inappropriate for peritoneal or hemo dialysis, low blood counts but mom wants baby transferred to receive active chemotherapy and dialysis (despite not being a candidate for either) and insists SOME NICU team exists that will cure her child. Refuses to listen to palliative care to attempt to increase quality of life.

I don't know some of your acronyms just yet, but yeah, this parent was willing to keep the baby alive regardless of what it was put through. So sad. Very traumatic for the family I bet thanks for sharing the scenario.

[NeoNatMom]

That is by far the worst part of NICU; watching the suffering infant while parents stand near cheering their "miracle child" and "what a fighter she is!". Meanwhile the child is on a vent, constantly gagging on the tube, stomach obviously hurts a lot if not all the time. But they still want to eat, baby turns bronze as its liver dies, infections happen off and on from the CVL, positive blood culture means mandatory lumbar puncture, time to go back to surgery and re-explore, time to fight the vent again, tummy hurts worse now. . . Eventually we send them home on TPN and hear a few months later they died never having made it to their gut transplant appointment. And the nurse wonders. . . why couldn't we just have let them go when they were 2 weeks old, bowel dead, vent dependent, give lots of pain meds and let mommy and daddy hold you?

OP, I am not trying to run you down. I was a very black/white thinker when I first became a nurse; part of that was age, part was an ultra-conservative upbringing. Life was so much easier then, so much clearer. I think what some of the others are trying to say is that nursing is rife with ethical dilemmas. I encourage you to stay away from clinic work if you don't want to participate in terminations, but understand that you will deal with frequent occasions when patients (or in my case, parents) are going to make morally questionable decisions. Start thinking about how you will deal with it!

Thank you and the rest for the last few posts in particular. These are very eye opening because I am learning how the situations can be. I know this will happen. It's a sad world.

[JustBeachyNurse, LPN]

I don't know some of your acronyms just yet, but yeah, this parent was willing to keep the baby alive regardless of what it was put through. So sad. Very traumatic for the family I bet thanks for sharing the scenario.

IVH= intra ventricular hemorrhage (brain bleed), grade IV being the worst.

Congenital cancer that has overtaken the abdominal cavity is one of the most devastating diagnosis for the child, family and healthcare team as if it is widespread it's often

[klone, MSN, RN]

In the NICU do they not try to save sick premies?

Some preemies should not be saved.