My working life... Neonatal nurse
Monday, December 14, 2015
Ten per cent of babies need some form of neonatal care. Gabriella Jozwiak finds out about a career that has challenges and rewards in equal measure
Doreen Crawford is a neonatal nurse and senior lecturer in nursing and midwifery at De Montfort University in Leicester. She focuses on care for newborn babies born premature or sick.
‘Some babies arrive at about 23 weeks of gestation – just half a pregnancy. They cannot breathe independently, tolerate feed, or keep themselves warm – about 80 per cent will die. Of those that survive, the majority have some sort of impairment, which could be minor, such as a learning difficulty.
‘For these reasons, neonatal nursing is seriously hard work. You’d think it was all cuddling and feeding, but the role is technologically advanced. We manage a lot of machinery, such as respiratory support. It also involves many calculations as the babies have very small circulation – less blood in volume than the amount of coke it takes to fill a can. With drips you must not overload the baby with fluid. When administering drugs, even a gram of paracetamol is too much for a tiny baby, so we work in decimals and fractions.
‘A neonatal nurse will typically do two to three 12.5-hour shifts a week. This provides good continuity of care day and night. Some hospitals run seven-and-a-half-hour shift patterns. A shift begins with a full assessment – the “benchmark” against which we measure improvement or deterioration. We also check equipment.
‘If you’re looking after a particularly unstable baby, you might care only for them with another nurse. For example, if you’re running an extracorporeal membrane oxygenation system, which provides cardiac and respiratory support, one nurse might look after that circuit and another the baby and family.
‘A nurse can care for a baby on a standard ventilator by themselves. Or you might look after two reasonably stable babies at the same time. Once babies are stable, we move them to the nursery until they are strong enough to go home. By this stage they may only need a bit of oxygen or be learning how to feed. This involves introducing bottles or supporting a mother with breastfeeding. A neonatal nurse could look after up to four such babies simultaneously.
‘Nursery nurses support neonatal nurses in the nursery. They provide a bridge between sickness and normality because they help the parents start to see their baby as normal. Many nursery nurses retrain into neonatal nursing.
‘Supporting parents occupies at least half a daytime shift. It’s a particularly anxious time and we encourage parents to play an active role in the baby’s care. Communication can be challenging as even people with good English can find the technology difficult to understand. This takes much patience.
‘The role also requires us to document everything, particularly as we work under principles of implied family consent. As well as in hospitals, neonatal nurses go into the community to support babies at home. This involves preparing families to care for their child, followed by outreach visits.
‘There are low days when we lose too many babies. It zaps you, particularly when a mother loses twins or triplets one after another. It is also difficult when a mother you have worked with before returns with another ill baby.
‘Because the job is so demanding, staff turnover is high. Some nurses take career breaks or go into children’s nursing, but often they return. There is much camaraderie on the wards. And there are also highs. Sometimes a baby is so sick we give it zero chance of surviving; but against the odds, it goes home. Those are the days you walk out on air.’
1999-current: Senior lecturer, nursing and midwifery, De Montfort University, Leicester
1995-1999: Lecturer in child health and social care programme manager, NVQ/GNVQ hospital and residential care, Charles Keene College, Leicester
1999-2010: Bank nurse, Neonatal Units, central region
1987-1995: Staff nurse, progressing to sister then senior clinical nurse, Neonatal Intensive Care, Leicester Royal Infirmary
1984-1987: Staff nurse, progressing to junior sister, children’s ward, St Cross Hospital, Rugby
1978-1981: Teacher, Cross Hands Primary School and YMCA, Wales
2008: MA in health studies, De Montfort University, Leicester
1998: Post Graduate Certificate of Education, Charles Keene College, Leicester
1995: BSc (Hons) nursing science, King’s College, London
1989-1996: English National Board Certificates
1986: Registered Sick Children’s Nurse education and training, North Staffordshire School of Nursing
1984: State Registered Nurse training and education, Warwickshire School of Nursing
1978: Certificate of Education, Callendar Park, Falkirk
Only those qualified to degree level and registered with the Nursing and Midwifery Council can apply for jobs as neonatal nurses. After six months’ on-the-job training, employers expect neonatal nurses to undertake professional development.