NICU Nursing: Interview with Angela Scrivano
Caring for infants that are pre-term or in need of intervention
What drew you so passionately to a career in the NICU?
There’s an environment in the NICU that I have not experienced elsewhere. There is a sense of family, a collective feeling, and the physical layout of the unit is very open. We see and hear all of the babies on the unit, and our senses are totally attuned to this holistic atmosphere. It’s better for everyone — patients, nurses and families.
These little patients are growing and they want to live. Their bodies are reaching milestones on a daily basis, exponentially achieving physical wonders. I find it very uplifting.
What specific skills are needed for your work?
Many skills are essential in the NICU. You need critical care skills and you need to be an effective, efficient communicator with the team while providing emotional support and relevant information to families and parents. Excellent assessment skills and diligent charting are very important, since even the smallest changes in our patients can be clinically significant. Medication calculations are very crucial, and you must be proficient and comfortable starting IVs in very tiny bodies.
How do you process the hard times?
Sometimes when babies don’t make it, there can be a sense of relief. You see the struggling, and there comes a time when you feel it might be better if they were to go, sincerely wishing them to be free of the pain and suffering. Sometimes certain babies seemed destined to leave us. For the nurses, there can be a great deal of strain and pressure when you have to keep the interventions going, and it can be quite agonizing.
There are opportunities to talk about it, since we work in an environment where people understand, and WMMC embraces spiritual care and well-being of the nurses, as well. For myself, I do yoga, go hiking and focus on doing something that is physically demanding so I don’t have to be in my head. Going to the movies, laughing and being cognizant that there is a need to decompress is essential. I’ve lived many years already, so I know how to take care of myself.
How is it with the families?
The families come in and they’re often terrified, thinking that their child is on the verge of death. I try to explain what we’re doing, why the room looks the way it does and how their child is doing. I try to put them at ease and empower them to be proactive advocates for their children. About 99 percent of our population is Hispanic and I don’t speak Spanish, so we use interpreters and interpreter phones in order to provide [families] with the information that they need. Interacting with the parents, I find touching, smiling and acknowledging them helps them to feel that they are not on the outside looking in.
Are there special certifications required?
Neonatal resuscitation (NRP) is essential, as are BLS and ECG interpretation. Many nurses pursue the RNC-NIC certification in Neonatal Intensive Care after they have accumulated the required number of on-the-job hours. [See sidebar.]
Are there specialty nursing organizations in your field?
I belong to the National Association of Neonatal Nurses (NANN), and that helps me keep up to date with the latest protocols, guidelines and CEUs. I’m also a member of Sigma Theta Tau, which is a nursing organization more focused on leadership and research.
What about your work feeds your spirit?
There really is a lot of good that comes from working in the NICU. Many people think that pre-term babies won’t lead a full life and that we’re falsely propping them up. I don’t believe that. I know that many of these children that I’m helping today will eventually be people who lead very productive lives. As delicate as they are, they’re also strong. They’re little fighters. I see these little souls that we are helping to get out into the world, and I see the future.
Is there a patient anecdote you can share to illustrate your work? (Without violating HIPAA, of course.)
I remember an infant whose mom had to make the difficult decision to withdraw care. She came to me with a very peaceful smile and said, “I’m going to let my baby go to my God.” She was relieved, and she was actively comforting other family members.
It made me feel strong that she wanted this to be a positive experience, so I was able to maintain my professional demeanor and support her. She came in the next day and donated breast milk to the milk bank for the other babies. Then she gave me the longest hug, thanking me and giving me support. It was something that I’ll never forget. I’m really very fortunate to have the pleasure of working in the NICU at WMMC. This hospital allows me to practice nursing as I always believed I would: providing care to the whole patient and their family, caring not just the body, but also for the soul.
Any advice for nurses who may be interested in this area of nursing?
Get exposure for more than a day or two, especially if you can find a preceptorship. If you work in the ICU or ER, getting into the float pool in your facility is another good way to get cross-trained in the NICU.
Do you have any further career aspirations at this time?
I may want to pursue involvement in neonatal research at some point in the future, but I love patient care too much and need to always be hands-on with my work.
“One in eight babies now is born at least three weeks early, many even earlier, a rate that has increased more than 30 percent in two decades.”
— CBSNews.com Healthwatch
Neonatal Intensive Care is a subspecialty of pediatric nursing that attracts nurses who are willing to work with newborn infants at their most vulnerable. In the NICU, nurses closely monitor infants who have been born prematurely or are suffering from any number of neonatal complications, including but not limited to birth trauma, birth defects and oxygen deprivation. Nurses employed in the NICU enjoy a relatively low nurse-to-patient ratio, but the intensive nature of the work requires extreme attention to detail and decidedly close monitoring of the endangered neonate.
Levels of Neonatal Care
There are various levels of neonatal care with which nurses should be familiar:
Level I: This is where healthy newborns are cared for. These units are uncommon here in the U.S., where mothers and healthy newborns generally share rooms and are quickly discharged after birth.
Level II: This is a nursery that provides intermediate care for premature or unhealthy newborns who may need oxygen, IV therapy, special feeding or other interventions prior to discharge.
Level III: This level of care is represented by the NICU, where neonates in need of intensive nursing care and medical intervention are treated. Neonates in the NICU may include pre-term or full-term babies in need of ventilation, incubation, surgery or other interventions.
Technology and Intervention
Technology figures prominently in this specialty, and NICU nurses must have a high level of comfort and proficiency with cardiac monitoring and other devices used to track the condition and progress of neonates. Intravenous access of these tiny patients is also essential, and the NICU nurse must be highly skilled in venipuncture on fragile neonates, who often have less-than-optimal venous accessibility.
Including the Parents
In the NICU, parents are an important aspect of the care delivered by NICU nurses, and thus clear and concise communication with parents and loved ones is paramount. Fear and anxiety about the condition of a neonate is common, and the nurse must address the parents’ understandable knowledge deficit on a daily basis. Parents can also be enlisted to watch closely for any changes in a neonate’s condition. In this way, the astute NICU nurse can empower the parents to be active participants in their child’s care while also receiving encouragement, education and compassion from the staff.
Teamwork Is Key
Charting and assessment are crucial in the NICU, as are cooperation and interdependence between the members of the team. The babies are monitored around the clock, and important information must be communicated in the chart and in face-to-face interactions between team members. The care of these neonates is highly technical and nuanced, and therefore a cohesive and communicative team contributes greatly to patient outcomes.
The Emotional Side
With tiny and fragile patients sometimes hovering between life and death, this specialty carries the potential for great emotional impact on the nurse and other members of the team. Firm emotional boundaries and excellent self-care are essential for a nurse to be healthy and successful in the NICU.
Neonatal Intensive Care Certification (RNC-NIC) is offered by the National Certification Corporation: www.nccwebsite.org/Certification
Neonatal Resuscitation Certification (NRP) is offered online by the American Academy of Pediatrics: www2.aap.org/nrp
National Association of Neonatal Nurses: www.nann.org
Academy of Neonatal Nursing: www.academyonline.org
Association of Women’s Health, Obstetric and Neonatal Nurses: www.awhonn.org
Journal of Neonatal Nursing: www.sciencedirect.com/science/journal/13551841