The bad stuff

[mslinzyann]

Hi.

I am a senior in college about to graduate with a psychology major. I've thought about nursing for several years, and just recently I've thought a great deal about neonatal nursing. I do have some concerns, however.

I am a very sensitive person, probably too sensitive, and I feel like when someone is hurting I really do empathize and feel their pain. But, I am moved by what goes on in the NICU and I think it would be wonderful to get to care for babies and educate parents. Really wonderful. But what about the bad stuff? How bad does it get? Would I be going home crying every night? How often do you lose babies? What is the hardest thing about this job? Aren't the hours horrible, too?

I also have seen some people reference the idea that parents sort of force medical interventions on their baby when its probably time to say goodbye. I am wondering what the nature of these problems/interventions are.

I have worked in a vets office and seen a lot of animals die and get put to sleep, which is very sad. But for most people, that loss does not compare to the loss of a child. That raw emotion and sadness really does scare me.

I also heard that in NICU they starve babies to death. Why?

I really would appreciate any information you have!!

Love :heartbeat

Lindsay

[preemieRNkate, RN]

Well, before you can work in a NICU as a nurse, you need to go through nursing school. I'm assuming that you know that already?

I have never worked as a nurse in any other area. I can't imagine working anywhere else. I love NICU. Yes, there are bad times and babies do die. That is a reality of our job. But for all the babies that we lose, there are so many more that we send home healthy. That's why I show up for work. I don't go home crying every morning (I work nights). Have I ever? Sure. But I really think that the day I can go home after losing a baby and not cry, I should be looking for a new job.

Parents sometimes want everything done for their baby, and rightfully so. As medical professionals, and as people that are not as emotionally attached to the baby (we are, but in a much different sense), we often can see the "bigger picture." We know that there may not be much else we can do for the baby. Yes, we can save a baby born as early as 23 weeks. But along the way, they develop brain bleeds, necrotic bowel, chronic lung disease and blindness. What kind of quality of life will that child have later on? These are some things that we need to consider that the parents may not be thinking about at that moment. Death is not always the worst outcome.

I'm not sure what you mean by "starving babies to death." I have never heard of such a thing in the almost 4 years that I have worked in NICU. There are times when a baby will not be fed any formula or breastmilk due to various medical issues, but they will have a IV for hydration and nutrition.

As far as the hours, they're no worse than any other area of hospital nursing. Most hospitals around here have 12 hour shifts. I currently work 7 pm-7 am. In May I will be switching to the day shift, so I will be working 7 am-7 pm. I basically work 3 nights a week, but it's not set in stone. Sometimes I will work 4 nights one week, and then 2 the next. Like any other nurse, I have to work my share of weekends and holidays. Hospitals are a 24/7 operation. Please keep that in mind if you decide to become a nurse in a hospital.

Whew, that was long. Spend some time browsing the NICU board, there are plenty of threads that will provide further insight into the "life of a NICU nurse." Good luck!

[Sweeper933]

But I really think that the day I can go home after losing a baby and not cry, I should be looking for a new job.

Same here

[TiffyRN, BSN, PhD]

It used to be an on and off topic in medically based dramas many years ago when I was a kid (maybe shows from the 70's-80's) that some children born with Down's combined with some other birth defect which I would guess to be duodenal atresia or esophageal atresia would not be fed and "allow nature to take it's course". I don't remember how this was justified, maybe the surgeries were not yet perfected or available, maybe long-term TPN was not considered an option (is it really a good option now?). Maybe the surgeries were not considered for children with Down's? I don't know, this is all a vague memory from when I was 8 or 9 watching dramas on TV, certainly no solid source of information. Maybe some of our nurses here who have been in the practice for many decades can enlighten us?

I can with assurance say that starving children to death is not a current practice. Some children may never eat by mouth or eat through their GI tract, but they all get nutrition to the best of our ability. I have seen 1 child with trisomy 18 that the MD ordered no IV's, not NG's, only what the child (who was term) could take from the bottle. The child could nipple feed though probably not well enough. This child passed away (as was expected) from it's severe heart defect though, not from starvation.

[SteveNNP, MSN, NP]

Kate pretty much summed it up....

I've also never heard of NICUs starving babies in this day and age. Any baby that is unable to eat, whether due to medical problems or prematurity is fed with intravenous fluids. Even babies with fatal conditions are kept hydrated, and usually die from their condition LONG before starvation could take them... It's usually an all-or-nothing issue. Either the baby receives comfort care and dies shortly, or is given our full complement of care. Hopefully the decision is made ahead of time.

[hikernurse]

I think one of the hardest things is seeing parents put their babies through every misery (I wanted to use a stronger word, but am respectful of TOS ) just to keep them alive a little longer. We've got a few in our unit right now where I think parents have lost sight of what's important.

A lot of what we do hurts and if the baby is going to go home in some kind of decent shape, then it's certainly worth it. But, sometimes a good death is not a bad choice to make. Family can be there and the baby can leave this earth in loving arms instead of during surgery or in the middle of an ugly code.

It was a bad night last night, I hope I'm not coming off too harsh.

[jhatRN]

I HAVE ONLY SEEN ONE KID NOT FED OR HYDRATED. THE LITTLE GIRL HAD NO KIDNEYS AND ANY FLUID OR NUTRITION WOULD HAVE MADE HER SWELL LIKE A BALLOON AND IT WOULD BE A RACE BETWEEN THE FLUID OVERLOAD AND THE BUILD UP OF TOXINS IN HER SYSTEM THAT WOULD KILL HER. WE DID MANAGE HER PAIN AND SHE LIVED AT THE HOSPITAL FOR THREE DAYS. WE FINALLY SENT HER HOME ON HOSPICE. IT WASN'T UNTIL SHE GOT HOME WITH HER PARENTS THAT SHE PASSED QUITELY AND PAIN FREE.

[mslinzyann]

Thank you guys so much for telling me your experiences and stories.

I'm definitely going to be shadowing at my local hospital's NICU when I go home this summer so I can see a bit first hand. Overall, it sounds like an amazing field, but a difficult one as well. A lot like many fields of nursing.

Its a hard choice...the hours of nursing are not too bad; long shifts but not everyday. And the pay is good, and the work is without a doubt important. But dealing with life and death so often, especially the death of chlidren, is a pretty brutal thing. Not work to be taken lightly or engaged in without being fully committed.

In other words, I still need to think about things. But I really do appreciate your input.

[preemieRNkate, RN]

Thank you guys so much for telling me your experiences and stories.

I'm definitely going to be shadowing at my local hospital's NICU when I go home this summer so I can see a bit first hand. Overall, it sounds like an amazing field, but a difficult one as well. A lot like many fields of nursing.

Its a hard choice...the hours of nursing are not too bad; long shifts but not everyday. And the pay is good, and the work is without a doubt important. But dealing with life and death so often, especially the death of chlidren, is a pretty brutal thing. Not work to be taken lightly or engaged in without being fully committed.

In other words, I still need to think about things. But I really do appreciate your input.

Shadowing in a NICU is a great thing, and will give you a better idea if NICU nursing is for you. Good luck!