Wednesday 4 May 2011

Nicu Nurse - What makes a good one?

Yesterday I read this interesting article written by Jodi, a NICU (neonatal intensive care) nurse. It got me thinking about what makes a good NICU nurse, what qualities should they have and practices should they follow. Obviously this is very subjective, and this is just my opinion. I have a group of four friends who went through NICU together with me, and we all differed on which ones we liked the best!

However, it was pretty universal that we all loved one nurse, who I shall call Matilda. (M)  She had a way of relating to parents, she was down to earth and practical and full of good, sound suggestions. She never tried to pretend she knew how it felt to have a tiny baby, but she always seemed to understand exactly what we were going through. I remember her saying to me in about week 3 that a time would come where we really resented the staff and would feel bitter about their involvement, and she was absolutely right. By week 7 I was so, pardon the French, pissed off with the whole thing and just wanted my baby to be mine. I was sick of sharing him. The fact that she recognsied this and pre empted it really helped me understand that what I was feeling was normal. I have tears in my eyes reading that back. I was so grateful my baby was alive, and so grateful that we had such brilliant, experienced nurses, but sometimes I felt so angry, but mainly at myself, that I had failed to do my job, incubate my baby safely, and other people now had to it for me.

The picture above is of Joseph in HDU, about week 5. M had got him all settled and comfy, she had a special way with him, of getting him in just the right position, and making him feel and look so snuggly! I'll never forget her kindness and her warmth.

So here is what I think makes a good NICU nurse.

Calmness and grace - NICUs can be mad, understaffed, busy places. A good nurse, to me, treats every baby as an individual, and like a swan on a rough lake, you can't tell what's happening underneath. When Joseph was very poorly on day 5 some of the doctors were extremely concerned, but none of the nurses let on at all that they were worried, they just calmly got on with it, and that helped me stay calm too.

Communication skills - a lot of what happens in NICU is very technical, and very complex. I remember one of my favourite nurses having to explain to me that Joseph needed insulin, and being very careful to make sure I understood it was just a "preemie" problem and didn't necessarily mean anything long term. I also remember careful explanations of different drugs and potential side effects. It's a hard time, and its made easier for parents if they can explain things carefully. An example of bad communication is when Joseph needed tests for retinopathy of prematurity. A leaflet was just left on the side in his room with a post it saying "mum read this". I was terrified that he might have complications and needed it explained carefully.

Empathy, but don't over identify - No one knows what its like to be the mother of a premature baby until they have walked that path. And to be fair, everyone's experience is individual, what I feel may not be what you feel. I think it's important that a good nurse has empathy, and puts themselves in your shoes, like M did in my example above. She warned me of how I might feel later in my journey, and when it happened, took me aside and helped me through it. One of the night nurses had had a baby in that unit some years before, and I found it difficult to talk to her, because she always looked so worried about Joseph. She was almost too caring, too close, and I found it very difficult at the time, as I had so many emotions I had no idea what to do with them or what to say.

Baby skills - sometimes, and its inevitable, your baby seems like a patient, and nothing else. They have wires and lines and tubes and machines. There are medicines to work out to the 0.01 of a mil. Everything has to be measured, even wee and poo. Sometimes I'd walk into the unit, and not even be able to see Joseph for all the equipment in the way. A good nurse has good baby skills. The picture above to me illustrates that. The baby is spoken to and treated as a baby first and a patient second, its a baby focussed, family inclusive approach that I think is sometimes missing.  And a good nurse empowers the parents to focus on the baby, not on the machinery and what is happening medically. A good nurse helps you to understand what you can do to help your baby, encourage you to sing, or to read, to do "cares" - change your babies nappy, clean their face, move their probe site.

A good nurse makes you feel confident in your skills as a parent, that you are an integral part of the team, and not just a spare part. A good nurse keeps you informed, and makes sure you are as involved as you can be in your baby's life on the NICU. And a good nurse reminds you that there will come a day when this is over. One of our regular nurses later on in our journey came to me one day and said "have you got somewhere for Joseph to sleep when he comes home?" I cocked my head to one side and said "Um no, we haven't got anything yet", she looked at me with a fake stern look and said "this weekend, go shopping, get a car seat and somewhere for him to sleep" then walked off. Just over a week later and Joseph was home!


  1. Interesting post. I went through the SCBU with my baby so identify with some of your feelings but must have been so much harder for you am glad it is over and all is well! It was doubly hard and weird for me as am a Paediatrician myself so had to step back and be a mummy and not stress about the medical care!

  2. Very interesting blog, as a night nanny who sometimes works with families who's babies have not long left NICU its good to see what i can do as a professional to make parents lives easier.
    Lovely blog post!