NICU: Interview with Senene Owen, RNC, MSN, CNS, CPNP
Caring for high-acuity infant patients
Senene Owen, RNC, MSN, CNS, CPNP Clinical Nurse Specialist/ Educator Methodist Hospital of Southern California
Please tell us about the arc of your nursing career.
Before I earned my nursing degree, I worked at several different homes, caring for severely handicapped infants and children with special needs. That work had a great impact on my life and goals. In my first nursing position, at another facility, I was able to float to many different areas, including ICU, NICU and labor & delivery.
When I came to Methodist, I started off in the surgical ICU, where I remained for 10 years. I loved caring for neuro patients, especially neurosurgical patients with ICP [intracranial pressure] monitoring. I also enjoyed working with post-op cardiac patients and patients requiring invasive monitoring.
When I went into premature labor with my son, he spent a month in the NICU. As I cared for him, it became clear that I needed to work in an NICU. So, when Methodist opened their own unit, it was personally and professionally exciting to be involved in getting it off the ground. I worked as frontline NICU bedside staff for 18 years.
How did you become interested in becoming a clinical nurse specialist (CNS)?
Some of my role models in the NICU were the parent/child clinical nurse specialists. They were able to promote change, educate staff and improve patient outcomes, which showed me the kind of nurse I wanted to be.
What functions do you perform as a CNS?
I provide education for the staff, teach house-wide orientations, train new staff, and plan and facilitate our Skills Day. Other responsibilities include facilitating our malignant hyperthermia drills for the OR, PACU and L & D; writing and revising policies and procedures for maternal/child and nursing; and obtaining supplies and equipment.
I also attend some deliveries and provide care for some babies in the NICU. I take part in many meetings that may involve the approval of new policies, which as well as the planning and facilitation of our neonatal mortality and morbidity conferences. In the course of my work, I collaborate with neonatologists, obstetricians and other providers. We all take part in multidisciplinary rounds.
Do you only educate nurses or do you also work with other allied professionals?
The NICU respiratory care practitioners (RCPs) and RNs complete their education and Skills Day together — they’re a team. The RCPs are very important in the care of babies during delivery and in the NICU. We do a lot of simulation so the staff can practice skills and communication. We also do education with social workers and OTs. (OTs actually feed the babies in the NICU.) Also, we have mortality and morbidity conferences for all disciplines. Another of my contributions is educating patients and their families, mostly in the context of families with babies in the NICU.
What types of patients or cases trigger your involvement as a consultant?
Difficult cases are sent to me: any patient in maternal/child; patients with perinatal loss or high potential for a poor outcome; patients requiring high-risk infant follow-up; pediatric ED patients; or babies needing a PICC line.
What are some of the challenges faced by nurses in the 21st-century acute care workplace? How do you view the growing intersection of nursing and technology?
Patients today are very sick, with complex illnesses and a lot of procedures for nurses to follow. I’m always concerned that staff will come to rely more on monitors and technology than hands-on physical assessment. Electronic charting is highly detailed and time-consuming. Even the administration of medications is entered on the computer, which takes time and mental focus.
The intersection of nursing care and technology is here to stay, but hopefully we can make it easier for staff to chart so they have more time at the bedside with patients. Also, there are so many monitors and alarms. Their purpose is to keep patients safe, so we need to teach staff how to use these systems appropriately, but we must also remain acutely aware of the risk of alarm fatigue.
Please tell us about the educational track you chose to become a CNS.
I went to a school that was conveniently located and that had tracks for both parent/child CNS and pediatric nurse practitioner. I did both simultaneously, so there were a lot of clinical hours and different rotations to take part in. I can’t imagine doing one without the other. I continued to work while going to school, while also helping care for a relative with leukemia. It was a busy time.
Interestingly, around the same time, my husband was restoring an old “woodie” (a wood-bodied car) that was going to take many years to complete. It was an ongoing family challenge to see which would be finished first: the car or the master’s degree.
Who won the competition?
He did! My husband finished the car that April and I graduated that July. My daughter Ashley attended nursing school at the same time as I, earning her BSN. We graduated on the same stage, just minutes apart, which was simply awesome. She now also works as a NICU neonatal nurse. Sadly, my husband, who was always my greatest supporter, died suddenly two years ago. We would have been married 37 years now.
What do you love about your work? What gets you out of bed in the morning?
I love caring for babies and families. Whether it’s the babies that haven't been born yet or the babies in the NICU and postpartum, they keep me coming back. I also love working with great people. Many of my peers are so much more than mere coworkers. Supporting people at the most vulnerable times in their lives is another important aspect of my work. I can help people improve and feel better. I can also help them die and grieve better when the time comes.
During my husband’s illness, my family and I were the vulnerable ones relying on the healthcare team. It’s very different being on the other side, and I truly understand how patients and their families feel. What we’re able to do really makes me proud of our profession. Something that keeps me going is knowing there is always more work to be done to improve patient outcomes.
There is so much to educate staff about. It’s gratifying to give them the tools they need to successfully and safely care for patients. Sometimes, the most important thing I can do is listen — to patients, to babies, to the staff, to physicians and to the leadership team. Only after we truly listen and hear what is being said can we make a difference.
What are your recommendations for nurses interested in the CNS path?
If a nurse is more interested in the bigger picture of healthcare, the CNS is a great role. The primary goal of the CNS is to consistently improve patient outcomes and nursing care. The CNS includes three spheres: the patient (client); the nurse; and the organization (system). The CNS is also an educator and mentor who can be involved with research. A CNS also engages frontline nurses and interdisciplinary teams to achieve optimal patient outcomes. Patient care is increasingly complex, with changing regulatory requirements and broader scope of practice, so there is much that a CNS can do.
What have you learned about teaching and educating others?
I’ve found that we learn and accomplish more through collaborating with others than we do on our own. Simulation and drills are very valuable for learning complex skills. I’ve found that involving the frontline/bedside staff in teaching and facilitating simulations and drills serves many purposes and promotes much learning and education.
The staff members who participate in conducting simulations become very proficient in the topic at hand; they become the unit experts. They do detailed preparation to teach their coworkers new knowledge and skills. It makes me so grateful for all of my mentors — whether they’re bedside nurses, patients or colleagues from other disciplines — for all they’ve taught me and all the ways they’ve influenced my life and practice.
What are your future career goals? What avenues of career growth are available to a nurse with your credentials?
I’m not really sure what my future holds. Having the CNS and NP provides such a plethora of opportunities. I still think there is more to be done in my current role: educating staff, ensuring compliance with regulatory standards and striving to improve patient outcomes. Beyond that, a CNS can work in a hospital, teach at a university, lecture for different organizations, serve as a consultant for companies or work with different disease-specific populations. There are many options!
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.