According to ONS, there were 657,000 live births in England and Wales (2018). Sadly, not all live births start on a high note. There are complications or cases where babies need more clinical care after they were delivered. Good thing we have professionals – doctors, physiotherapists and nurses who are specialising in providing care to these babies.
Meet Clarisse, one of our fellow Filipino Nurse working in the Neonatal Intensive Care Unit (NICU) in the UK.
I am Clarisse. I currently work as a Senior Staff Nurse (Band 6) at a Level 3 Neonatal Intensive Care Unit (NICU) in one of the NHS trusts in London. I have worked for Adult and Paediatric nursing before moving to NICU. I have been working in NICU for more than 7 years now and I am enjoying it until this day.
People would ask me why I chose NICU and I would just give them a simple answer – “I love taking care of babies.”. Caring for babies gives you the privilege of touching the lives of the purest souls in the world. These tiny humans have not known anything and anybody else apart from you, their parents, and the doctors. It is an honour to look after these innocent human beings.
Having experienced both adult and paediatric nursing, I can say neonatal nursing is also the least physically demanding. It is still stressful but it gives me a satisfying feeling seeing them get better through our care.
My Typical day as a NICU Nurse
My day in NICU varies depending on our baby patients’ situation, level of care needed by each of the babies and the role assigned to me. No two days are the same. As a Band 6 Senior Staff Nurse, I can be assigned to one of the 3 roles: Bedside Nurse, Float Nurse and HDU In Charge.
As a NICU Bedside Nurse, I look after allocated patients. Before we go to the nurse: patient allocation ratio, it is important to understand the 3 levels of care in a neonatal unit which is ITU intensive care (ITU/ICU), high dependency (HD), and special care (SC). I can have 1-2 patients if I am dealing with ITU or HDU babies and 2-4 babies if they are in SC (special care) level. It may sound a lot less than the typical adult nurse to patient ratio but as we are dealing with babies, cases tend to be more complex thus requiring more attention and care.
The activities I have in day are generally the same across all three areas but with varying degrees of acuity and demand. First, I have to take a handover/endorsement. Then, I need to assess the baby and check all the bedside emergency safety equipment. I also prepare any medications the baby needs and ensure the IV fluids are running correctly and accurately. After doing the initial checks and preparations, I create a plan of when I need to give the medications, feed the babies, change the dressing, change the stoma, change the nappy, check the gastric aspirates, change the IV fluids and take my breaks. Pheww! That was a long list and it goes on and on depending on how complex the situation of the baby is. As a NICU Nurse, we need to be very organised and carefully plan this to ensure our baby patients are given the proper care they need.
As a Float Nurse, I tend to wear various hats such as the “runner” or “transport nurse” of the group. If I am allocated to be the float nurse of the day, I would usually go around each bedside to check drugs, help the other bedside nurses and do emergency safety equipment checks for the unit like transport incubators, resuscitation bags, trolleys and CD drugs. Also, I will attend to emergency deliveries and/or crash calls and accompany a patient transfer to the theatres or to another hospital.
Aside from being a Bed side nurse and a float nurse, I also take on the role of a HDU-in charge. This is given to senior band 6 nurses who are willing to be in-charge of HDU shifts. In this role, my typical day would start with allocating the nurses to the babies after handover, then followed by checking the staffing for the next few shifts. I would attend to ward rounds and support the other HDU staff. I would also organise Levels 1 & 2 babies for potential transfer to their local neonatal units. This can be quite tricky as our patients can come from different parts of the country and sometimes, we even have patients from overseas. Checking emergency equipment and ensuring any new orders are relayed to the staff are also part of my role as HDU In-Charge. You can just see how busy and dynamic our days can be as a NICU Nurse. Exciting!
Aside from the number of checks, assessments, and tasks we need to do, there are also challenges we typically face as a NICU nurse. In an ideal world, shifts can go as smoothly as possible if I just carry out my plan and do my checklist. But no—there are a lot of factors and people we need to consider. Babies are very fragile. Their health can change dramatically in an hour to two. I need to focus and respond quickly, if needed. Aside from doing my plan, I also need to ensure that I work closely and properly with the neonatal doctors, physio therapists, pharmacists, other specialists, and the parents. The parents and the families play a big part in our day to day job. You can just imagine how stressful it is for the parents to see their baby in an intensive care unit. They are in a roller coaster ride and can be overwhelmed with so much emotions. As nurses and humans, we must show empathy to the parents/families, regardless of how difficult they can be.
Perks and Career Opportunities for a NICU Nurse
Being a NICU Nurse also has its perks, you can work your way up from a Band 5 to a 7. But you need to take the Neonatal and management courses, as you go up the ladder. In some trusts and hospitals outside London, a Band 6 means you will be in-charge of a shift/unit. But in Central London, a Band 6 means you will act as a Senior Nurse but it does not necessarily mean you have to take charge of the unit. You will be given an opportunity to be the “HDU in charge” but overall unit management will be covered by the Band 7.
Where I am currently working, there are opportunities to become practice educators, ANNP (advanced neonatal nursed practitioner) like a nurse-doctor (SHO) role, research nurse, and MRI nurse. You can also apply in some transport teams to be a Neonatal transport nurse which, I believe, pays the same salary as a Band 7.
How to become a NICU Nurse
In the UK, you can transfer to NICU regardless of the clinical area you are currently working. Once you get the role, you must complete Neonatal nursing modules. Mental agility is imperative in this job—you need to know the basics including good knowledge of drugs and its calculations.
If you are thinking of transferring, do your research. Yes, NICU nursing can be stressful at times, but it will become manageable with the right support from the management and your colleagues.
Aside from the technical knowledge and experience, having the right attitude and exhibiting the right behaviours are important to successfully do the role.
As a NICU Nurse, you have to be very organised, observant and sensitive. Our patients are the smallest, sickest, and most frail humans in any hospital setting. They need their rest and sleep to grow and get better. Critical thinking is also a must. You need to think on your feet.
You also need to be emotionally strong. Our baby patients’ conditions can change drastically and dramatically. There will be times where you will face a lot of emotional stress. You need to have the ability to work under a lot of pressure. Effective communication is also beneficial in this line of work. This is a difficult time for the parents and the baby’s family. It is key that we know how to empathise, support and communicate with them.
Being a NICU Nurse is a big job but is an honour too. I have the honour of taking care of these vulnerable yet budding lives. I have the responsibility and the privilege of seeing them improve and become better under our care. I take great pride of the job I do. I am a NICU Nurse. I am proud to be one.
About the Writer:
Clarisse has been working as a nurse in the UK for over 10 years. She is currently with one of the NHS trusts in London. Clarisse loves trying out new things especially new dishes and restaurants. She also loves to travel, especially with family and friends.
Disclaimer: Baby photo is a mere representation and not from the trust/writer's employer.