NICU Nurse Stories – Heartbreaks and Triumphs of Caring for Premature Babies
By Kathleen Colduvell RN, BSN, BA, CBC
Imagine a unit with dozens of alarms beeping, babies crying, ventilators binging, ECMO circuits cutting out, x-rays being taken, and bedside surgeries underway.
Now, imagine the new mom who recently delivered a 25-week premature baby who was emergently transferred for necrotizing enterocolitis (NEC). NEC, if left untreated, can lead to almost certain death, but even with treatment, whether surgical or medical, the long-term prognosis for this baby is relatively grim. Despite the most advanced medical technology, there is only so much we as medical professionals can do.
Finally, imagine helping that mother hold her baby for the last time because there was nothing more to be done; no more machines, no more medications, no more surgeries, just a heavy heart, a box of tissues, and the reality that this mother will have scars so deep they may never heal. This is my world. This is my office. Welcome to just another shift in the Neonatal Intensive Care Unit.
Fighting for the Tiniest Patients
Most ICU nurses will say they work in the hardest unit in the hospital and with the sickest patients. While this may be the case and I might be a little biased, I truly believe that the Neonatal Intensive Care Unit, or NICU, is the toughest of the tough.
As nurses, we fight to keep the 24-weeker alive, to save the baby who was born with half a brain, the patient that was born addicted to heroin and cocaine, the baby who has their spinal column exposed; we fight every single day to keep these miracle babies alive, not only for the families, but for ourselves. Working as a nurse in the NICU is truly heart-wrenching, inspiring, and more often than not painful, but most importantly it's a truly rewarding job.
A full term baby spends approximately 40 weeks in utero. According to the Mayo Clinic, a premature birth is one that occurs prior to the 37th week of pregnancy. Within the classification of preterm baby, there is moderately preterm, very preterm, and the worst, extremely preterm. The earlier the baby is born, the less developed the lungs, brain, and heart will be; the baby is at risk for a plethora of medical abnormalities as well as the very realistic possibility of death. The earlier the baby is born, the more likely he or she will suffer from serious and often lifelong complications.
As a NICU nurse, each day is a new adventure and a new struggle. We not only deal with the emotions of the families but also our own emotions regarding these innocent and often gravely ill children. I remember during one of my first shifts in the NICU, a more senior nurse asked me if I could handle watching a baby die; of course, as a new nurse working in my dream unit, I answered without hesitation a resounding yes. I never quite grasped the significance of that question until I experienced my first patient death after orientation.
I recall walking into night shift one evening; just as report started, the nurse looked at me square in the face and told me with the utmost conviction that this patient would code tonight and that I should be prepared. Within two hours of starting my shift, this 23–weeker started to desaturate, a situation that was quickly followed by his heart rate dropping. I began to bag the patient like I had been taught by my preceptors, asking for assistance from one of the more senior nurses. Despite our best efforts to bring the patient's heart rate up, we could not maintain it above 60. The next 30 minutes were a complete blur; there were x-rays, chest compressions, medications, invasive procedures at the bedside, and a team of dedicated nurses and doctors all coming together to save a life. We were unable to bring the patient back.
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The Reason We Do It
Even though there has been more heartache than I care to remember, the success stories make every single minute of my shifts worthwhile. We fight to help our patients breathe on their own, take bottles independently, and achieve their developmental milestones, and that is such a reward.
A few years ago, I was fortunate enough to follow a 24-week baby throughout her hospitalization; she defied all the odds. She fought her way through surgeries, infections, countless procedures, and immeasurably high stakes. I held her mother’s hand as she was emergently placed on the oscillator, wiped away her tears as she went through narcotic withdrawal, and worked tirelessly to improve her oral intake so that she didn’t require a gastronomy tube for feeding. She was discharged to home after months in our NICU; she truly was the ultimate success story. Upon discharge, she was breathing without assistance and taking all of her bottles. Now three years later, she is a vibrant little girl who reminds us every single day why we fight relentlessly for the tiniest patients.
Eight years later was the night of my first patient death, and that memory still haunts me. That experience reminds me that we aren’t God, that we don’t have all the answers, and that sometimes, despite our best efforts, some babies are simply born too early and are too sick to survive. Every death still shakes me to my core; the wails from the parents haunt you during the long drive home. The steady beep of asystole makes you shiver at the thought that you failed; failed not only the patient, but their parents, family, and yourself. In our unit, death equals failure.
While death may be inevitable for some of our patients, there remains a sense that maybe, just maybe, there was more we could have done for them; perhaps we missed a key sign that would have saved their life. Even with all of my medical training, I know that’s not always the case; however, there’s a small sliver of hope that I will save a life in the end.
In the NICU, shifts are based around that small sliver of hope. Without hope, we would have nothing, and these premature babies would be without their most powerful advocates.
How Can You Make A Difference?
NICU nurses are in high demand across the country. Find the hospitals who need you the most. Important, high-paying positions need your skills now.
Kathleen Colduvell, originally with a degree in journalism, has worked in numerous hospitals over her eight years as a NICU nurse. Currently, she works at one of the leading children’s hospitals in the country in the NICU, PICU, and CICU and working as a Certified Breastfeeding Consultant.