NICU Nurses Are Not Nannies

[byebyebedside, BSN, MSN, RN, NP]

I work in pediatrics because I love kids and I moved to the NICU because I love babies however, the lack of parental involvement is shocking and frustrating. 

I am leaving the bedside for good and one of the reasons is because I didn’t get into this profession to take care of the parents. Yes the NICU can be a scary place and I’ve heard every excuse/explanation in the book about parental stress, fear, etc. but at the end of the day you’re still a parent and you need to be there for your child. 

I can’t be the only NICU nurse who feels like a nanny when I’m changing a diaper on a room air kid while their parent sits on their phone. I also think it’s ridiculous that I often have to prompt parents to care for their child. If your baby eats every 3 hours, I shouldn’t have to prompt you to do that. And my favorite it when parents ask me to wake them up every 3 hours. Like grow up, be accountable, set an alarm and take your role as a parent seriously. 

I am not trying to get out of doing any work but I don’t work in a birthing hospital, I have no interest in L&D and I guess I struggle with parents relying so heavily on the nurse to provide what seems to be basic infant care when they are at the bedside and seem disinterested in participating. 

Are there any other NICU nurses that share this frustration? Do you work at hospitals that have care partnership agreements with parents to get them more involved? 

[Nurse Pompom]

Maybe try a different specialty, but regardless of the patient population, you will always have to take care of the basic needs of your patients and that includes tasks such as cleaning feces and feeding pts - only my patients are adults. 

[RNperdiem, RN]

Try seeing it in another way. For a parent, they probably don't know what is expected of them. For you NICU is everyday reality, but the parents are walking into a new situation and don't know their expectations. 

If you politely and explicitly say what you need them to do and show what you need done. Tell that you need them to participate, and that the baby will benefit from their care.

While I don't work with babies, I sometimes keep in mind that there are details about a family member's life that I do not know about. To have a family member in an ICU is a time of crisis for many, and they may not be at their best. 

[JBMmom, MSN, NP]

I know there are many differences between a NICU and an adult acute care environment, but for me I know the LAST thing I want to hear is "mom wanted to go to the bathroom so we got her up!", we usually encourage families NOT to provide care because most of it is something we need to document or be sure it done right for safety/liability.

I would imagine that if a child is on room air in the NICU they're coming to end of their stay. Is there a specific point where parents are encouraged to take over care in anticipation of going home? Is there a point where you can say "I'm happy to help if you need when you change him/her?" Maybe they really just don't know what they can and can't do yet. I was fortunate to have three healthy babies that went home on day two, I can only imagine that for parents dealing with a newborn with serious health issues there is a level of apprehension even related to normal activities.

However, I completely agree that asking you to wake them to feed a baby is ridiculous. You absolutely shouldn't have to parent the parents, so I can see where that would be really frustrating. Good luck with whatever you choose to do!

[klone, MSN, RN]

As a former NICU nurse manager, who was also a NICU parent at one point, I encourage you to try to look at it from the parents' viewpoint. 

What would you do if the parents walked in to the unit, walked over to their infant's isolette, opened it up, and started picking up their infant? I'm guessing you would be all "Whoa whoa whoa, you can't just do that." So what makes you think they would suddenly take "ownership" (for lack of a better word) when it comes to other things like feedings and diaper changes? 

When my son was in the NICU, I did not feel like he belonged to me. I felt like he belonged to the nurses, and I was just a visitor. I had to ask permission to even touch him. It would certainly not occur to me that I would be allowed to do anything like his cares, unless I was explicitly told that and encouraged to participate. I CERTAINLY wouldn't have thought that I would be expected to take the lead!

So my recommendation is to let parents know what your expectations are with regards to their child's care, and then tell them "Hey, come up here! Billy's diaper needs to be changed, why don't you go ahead and take care of that?" And have a little understanding for the fact that 99% of the time, they have not once had the opportunity to take responsibility for this child's care. This child most likely went immediately into the NICU from birth, and there has been no transition period for the mom to actually be a MOM yet.

[feelix, RN]

You can incorporate care into the teaching plan. For example, include teaching how to change diapers and letting them know the next diaper is theirs. 
Teach them how to set a timer for the next feed.

[Rogue1]

When you are changing diapers, feeding, etc, you are doing important assessments.  Think of it that way, as your opportunity to observe and chart carefully.  And try to empathize with the parents--they are in a very alien environment both physically and emotionally. 

[Kooky Korky, BSN, RN]

On 8/1/2022 at 3:22 PM, JBMmom said:

I know there are many differences between a NICU and an adult acute care environment, but for me I know the LAST thing I want to hear is "mom wanted to go to the bathroom so we got her up!", we usually encourage families NOT to provide care because most of it is something we need to document or be sure it done right for safety/liability.

I would imagine that if a child is on room air in the NICU they're coming to end of their stay. Is there a specific point where parents are encouraged to take over care in anticipation of going home? Is there a point where you can say "I'm happy to help if you need when you change him/her?" Maybe they really just don't know what they can and can't do yet. I was fortunate to have three healthy babies that went home on day two, I can only imagine that for parents dealing with a newborn with serious health issues there is a level of apprehension even related to normal activities.

However, I completely agree that asking you to wake them to feed a baby is ridiculous. You absolutely shouldn't have to parent the parents, so I can see where that would be really frustrating. Good luck with whatever you choose to do!

I was with you til the last paragraph.

On 8/1/2022 at 6:19 PM, klone said:

As a former NICU nurse manager, who was also a NICU parent at one point, I encourage you to try to look at it from the parents' viewpoint. 

What would you do if the parents walked in to the unit, walked over to their infant's isolette, opened it up, and started picking up their infant? I'm guessing you would be all "Whoa whoa whoa, you can't just do that." So what makes you think they would suddenly take "ownership" (for lack of a better word) when it comes to other things like feedings and diaper changes? 

When my son was in the NICU, I did not feel like he belonged to me. I felt like he belonged to the nurses, and I was just a visitor. I had to ask permission to even touch him. It would certainly not occur to me that I would be allowed to do anything like his cares, unless I was explicitly told that and encouraged to participate. I CERTAINLY wouldn't have thought that I would be expected to take the lead!

So my recommendation is to let parents know what your expectations are with regards to their child's care, and then tell them "Hey, come up here! Billy's diaper needs to be changed, why don't you go ahead and take care of that?" And have a little understanding for the fact that 99% of the time, they have not once had the opportunity to take responsibility for this child's care. This child most likely went immediately into the NICU from birth, and there has been no transition period for the mom to actually be a MOM yet.

Hey, come up here?????

[Kooky Korky, BSN, RN]

On 7/29/2022 at 8:17 AM, byebyebedside said:

I work in pediatrics because I love kids and I moved to the NICU because I love babies however, the lack of parental involvement is shocking and frustrating. 

I am leaving the bedside for good and one of the reasons is because I didn’t get into this profession to take care of the parents. Yes the NICU can be a scary place and I’ve heard every excuse/explanation in the book about parental stress, fear, etc. but at the end of the day you’re still a parent and you need to be there for your child. 

I can’t be the only NICU nurse who feels like a nanny when I’m changing a diaper on a room air kid while their parent sits on their phone. I also think it’s ridiculous that I often have to prompt parents to care for their child. If your baby eats every 3 hours, I shouldn’t have to prompt you to do that. And my favorite it when parents ask me to wake them up every 3 hours. Like grow up, be accountable, set an alarm and take your role as a parent seriously. 

I am not trying to get out of doing any work but I don’t work in a birthing hospital, I have no interest in L&D and I guess I struggle with parents relying so heavily on the nurse to provide what seems to be basic infant care when they are at the bedside and seem disinterested in participating. 

Are there any other NICU nurses that share this frustration? Do you work at hospitals that have care partnership agreements with parents to get them more involved? 

You really can't care for a baby if you don't realize that, thank God, the baby has parents.  What does it hurt you to care a little for the parents?

Don't you imagine that the parent might be exhausted?

[byebyebedside, BSN, MSN, RN, NP]

As a NICU nurse who has taken care of quite a few patients for the first 11-12 months of their lives and observed how their parents care for and interact with them I can make a few general comments about some of your comments. We usually know if it's the parents first child or not and sometimes it's not even their first NICU baby. We know if they're on maternity/paternity leave, working, have other kids etc. based on social work assessments and general conversation with parents. I can understand being scared, shocked or overwhelmed but I've worked in level II through level IV NICU and not every baby in a level IV NICU is hooked up to scary machines and in critical condition.

I have taken care of kids for months and their parents don't call or visit and some of those patients unfortunately pass away at home from preventable events, are admitted back to the NICU with no skin on their bottom because their parent didn't change their diaper or hypernatremia because their formula was mixed incorrectly. Obviously I do teaching and encourage parents to participate care but there have been times when a parent will say "the baby's diaper is wet" and leave the room to do something else or go back to playing on their phone and wait for you to change it. Parents love picking out outfits and linens and taking pictures of their baby and all the "fun" stuff but when it comes to poop explosion diapers and the baby being difficult to console or vomiting all over themselves they want nothing to do with it. Cleaning up poop explosions, vomiting and consoling are regular parts of parenting so I don't think a NICU environment means you can pawn it off on the nurse because they're there and you don't want to deal with it even though you'd be dealing with it at home.

As far as parents being tired, parents will usually express when they're tired, or they'll sleep at the bedside or whatever the case may be and of course I do all of the care like I usually do. At the beginning of my shift I usually have a conversation with parents about whether they want to be included in cares and feeds or if they want me to do everything. But when someone is watching videos on their phone during their child's care times and show zero interest in participating in cares, I do believe that is concerning. Sleeping through a newborn's feed times is concerning as well. I've even had parents blatantly tell me they won't wake up to feed the baby in the middle of the night when they go home. I will always be there for my patients but I can't force their parents to be there for them. Every minute they spend on this earth is precious and I know a lot of parents are angry and disengaged because things didn't go the way they wanted. I do think I have a right to be frustrated when I see a sweet innocent baby crying out and their parents don't even flinch and wait for the nurse to comfort their baby.

In my experience working in pediatrics, I have had patients with a nanny, au pair or night nurse stay at the bedside. Obviously, the NICU is a different setting visitor wise but maybe some of these patients will have nannies when they go home. 

 

[JBMmom, MSN, NP]

16 hours ago, Kooky Korky said:

I was with you til the last paragraph

That's fine. My point is that while we are responsible for many aspects of care, people do still have some level of responsibility. If patients or families want to be awake, unless they have no access to a phone or alarm of any sort, that's something they should be able to take care of themselves. 

That's being said, just last night I had a patient that was literally unable to advocate for themselves or administer their own PCA medication, I have no problem going in and helping in that situation. It's all on a case by case basis what's best for the patients, and their families.

[hppygr8ful, ASN, RN, EMT-I]

When my son was in the NICU I was coming off of a high risk pregnancy, emergency C-section and I was physically and mentally exhausted. I practically lived on that unit until the nurses made me go home assuring me that the man cub was in good hands and encouraged me to rest, shower and have a meal. I am forever grateful to those nurses. I have spent the better part of my career working with pediatric and adolescent patients and remember  that in school it was stressed that the whole family is my patient.  With this in mind I can empathize and more effectively care for my young patient.