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FOSTERING LEADERSHIP THROUGH COLLABORATION

Samantha J. Ventimiglia

NICU nursing: More than a job

by Samantha J. Ventimiglia

A small body, light ash in color mixed with green, lay on an open warmer, its skin taut and peeling from general edema. The tiny chest rose and fell as each breath of the ventilator puffed air into the baby’s lungs. As I looked at the infant, I felt hopelessly intimidated and almost as vulnerable.

She had been doing well, but there were more obstacles to be conquered. A preemie has to cross mountains to move toward recovery and life, mountains that most adults cannot comprehend, let alone survive. She did.

Her beautiful, long eyelashes that brushed her tiny cheek seemed to be the one healthy attribute that remained of her once vibrant self. Gazing at her eyes, I thought, “She will live. She wants to live. She has the will to live.”

In her progress notes, I read: “Severely, critically ill infant. If she survives the week, surgery needed, but now the infant is unstable.” No one thought she could overcome the massive infection that ate most of her bowel, but she had other plans and lessons in store for us.

Just a few days earlier, Janie* was on a path toward full recovery as a preterm newborn. She had overcome the hurdles associated with a 25-week gestation and being born at just 1 pound and some odd ounces. She was about to go home. Preemies, however, are predisposed to infections that usually don’t affect healthy term babies, infections that can occur latently in an otherwise “healthy” preemie.

She appeared to be doing very well. Then one day, a nurse noticed her color didn’t look right. Janie became septic with a decreased heart rate and periods of apnea, and her abdomen was very distended with visible bowel loops. An X-ray was done, lab work drawn and a diagnosis of necrotizing enterocolitis (NEC) made.

Surgery saved Janie’s remaining bowel from the ravages of NEC, and it was the day after surgery that I saw her in a contact isolation room. She looked breaths away from death.

A clinical perspective reveals how much Janie had to deal with in her struggle toward recovery. She was intubated on an oscillator for ventilation, and a Replogle in her mouth suctioned away brownish-green secretions. As I’ve described, her skin was ashen gray and her abdomen and body so distended that the stretched skin was tenting. A surgical dressing covered the width of her abdomen where her umbilicus would have been. A saline-locked peripheral intravenous line (PIV) transported blood products, and numerous IV fluids ran through two Broviac central lines—one on each side of her chest—to decrease pain and maintain blood pressure, electrolytes and nutrition. IVs also administered a page-long list of antibiotics to fight her widespread infection.

As a novice nurse, I simultaneously assessed her health status and my ability to care for this fragile life. It’s as if time stops when you, a new nurse, perform a visual assessment on a critically unstable neonate. All these thoughts rush into your mind. Initially, you think about the pathophysiology of each body system and various interventions. Then, like lightning striking your heart, you see a life, a very sick baby, and you want to do everything you can to comfort, care and fight for that life.

Nurses have intuition that grows with experience. This experience was my first taste of that growing intuition. Experienced caregivers can often distinguish between a baby that is fighting to live and one showing acceptance of impending death, and I sensed that Janie would recover.

There was a battle within Janie’s body to fight the infection and, with each day that passed, I watched her slowly get well. As the infection died, Janie lived and grew. Her color brightened to a healthy pink. She was extubated to a nasal cannula and then to no supplemental oxygen support. She continued to have a Broviac central line for nutrition and eventually was fed via a G-tube. But Janie had conquered what many preemies do not.

Moreover, she went through all those months of healing with one very important quality that touched me—she always smiled, with gleaming eyes. Nestled upright in her “big-girl” pedicrib, she would respond with small spurts of laughter as she watched movies. Taking care of Janie was pure joy to anyone who had the privilege. Everyone could see her bravery and hope.

It is easy to become emotionally attached to these little chronically ill patients. Some people view this attachment as a negative attribute, but my experience tells me it is a positive quality. The beauty of nursing is truly caring for your patients. I believe patients can feel care, hope and love from their caregiver.

I worked hard because I cared for Janie. I sought to be the best nurse I could be for her, to help her survive as if she were my own. I had to be confident and humble in my nursing knowledge and ability. I was not afraid to ask questions, to seek insight from more seasoned nurses. I also learned how to let go and transition Janie’s care to her parents. My goal was to put her back into their arms. There was only joy—no sadness—when she left the unit. I felt very satisfied, and I had gained confidence in my nursing ability.

Hope is the only true cure in the NICU. I often ask myself, “Why does one baby live and another die?” Every nurse, doctor and parent desires the best possible outcome. The health care team works hard to achieve that outcome. Despite fear and possible defeat, we all march on, working together to support a tiny life and protect the beauty of hope.

Five months later, a 9-pound, giggling child went home with her parents. Janie went home with a G-tube for her feedings, because it was hard for her to take a bottle after being intubated for so long, but she was a happy, interactive baby. She had exhibited a will to live beyond anything I’ve ever seen or experienced.

Her life changed me forever. She made me truly understand NICU nursing, the profession I love. Janie was the first of many little patients with whom I’ve experienced heartfelt bonding. A really wise nurse said, “NICU nursing is getting the littlest of God’s children in the midst of their creation.” As Janie went home, I realized that NICU nursing isn’t just a job—it fulfills my life. RNL

* The name and some details provided in this account have been changed to protect the baby’s identity.

Samantha J. Ventimiglia, RN, BSN, works in the neonatal intensive care unit at St. David’s Medical Center in Austin, Texas.