For more than 35 years, Elizabeth (Liz) Drake, RNC-NIC, MN, NNP, CNS, CHOC, Children’s at Mission Hospital in Mission Viejo, California, has worked with infants as a NICU nurse. Her time spent at the bedside of these tiny patients with families and team members have been her most meaningful—and this is one of the reasons that Drake joined Kimberly-Clark’s Huggies Nursing Advisory Council, a multidisciplinary group of experts seeking to support perinatal and neonatal nurses.
Drake took time from her schedule to answer our questions about her passion and the important work the council is doing.
Why did you become a member of Kimberly-Clark’s Huggies Nursing Advisory Council?
I am always interested in being a part of something bigger than myself and being a part of group of experts who are passionate about their specialty. I loved Kimberly-Clark’s vision for the council and was intrigued by the opportunity to share my passion for the NICU with others and to encourage care teams to strive for improved clinical practice. I love partnering with a group that is always seeking how to make things better, and I appreciate Kimberly-Clark’s desire and commitment to help babies thrive by consulting with experts in the field.
What are your tasks as a member?
The Huggies Nursing Advisory Council (HNAC) is a multidisciplinary group of experts that includes nurses, educators, a neonatal therapist, and a NICU parent advocate. Our goal is to identify opportunities to provide resources that recognize nurses’ contributions and help them perform their best—for babies, families, and communities.
Our specific tasks and engagements vary, depending on project and member. Our work ranges from speaking at conferences or webinars, to writing articles on clinical topics such as diaper dermatitis or the power of touch and hugs, to research and development of educational resources, such as Every Change Matters™: A Guide to Developmental Diapering Care, which was compiled based on the HNAC’s literature review of diapering in the context of developmental care.
Tell us about your teaching the NICU team about the power of touch and sound for premature infants.
Many of the infants in the NICU are still in the “development phase” of their lives. Their physical features are all there and complete around 6 months gestation, but the function of those organs isn’t completely developed—namely their brain development, sensory, and limbic systems. If you think about it, it’s those systems that make us human. They are part of how we will learn, feel, experience relationships, hear, and see. There is no other area of nursing/medicine where you are truly having impact in how this human being will become a relational being. I view it both as a tremendous responsibility and an incredible honor.
I have a passion for teaching others what is happening with every interaction with these very tiny—but mighty—individuals. We need to understand and learn what is happening in their bodies when they are in the NICU, including what they are saying with their movement patterns and with their silence. Though they can’t speak audibly, they have a language of their own, and when they can’t communicate we have to step in and protect them.
When drafting Every Change Matters, the HNAC wanted to communicate that preterm infants are physically taxed from the transition into the world and subsequent maternal separation, and the NICU environment contains additional stressors that could impact their development. On top of all of this, studies show that caretaking procedures that are considered standard for a full-term baby—such as diapering or tub bathing—can lead to increased pain and stress for preterm infants. Huggies, with the help of NICU nurses, developed Huggies Little Snugglers Nano Preemie Diapers, specifically for babies in the NICU weighing less than two pounds, with a narrower fit and softer fasteners to promote developmentally appropriate positioning to keep these fragile babies as comfortable as possible. They even have cute graphics to help provide parents with a sense of normalcy in a clinical environment!
The sense of touch is the first sense to develop and the last sense to fail before we die. Touch is also a powerful memory cue. The absence of loving or relational touch can result in significant growth, developmental, and behavioral deficits.
There is a gap between the womb experience and the NICU experience. The auditory system also must learn to separate meaningful versus non-relevant sound. In the intrauterine environment, noise is regulated by mom’s circadian rhythms; there are no competing noises and mom’s voice isn’t masked. In the womb, sound is non-directional and protected by the mother’s body while her voice travels inside and begins the recognition to maternal infant attachment. Purposeful sounds are needed to “prime” the brain. If we think about the small babies in our NICUs they are deprived of not only the biologic sounds from the intrauterine environment but also the low frequency tones of their mother’s voice and redundant heartbeat. When this happens during the critical period for this sense’s development, it can have a profound effect on auditory brain maturation and speech and language acquisition. Persistent background noise above 50 decibels reduces an infant’s ability to discriminate differences in pitch, intensity, tone, and pattern.
As health care teams, we need to protect REM sleep, reduce background noise levels beginning in the third trimester, provide periods of appropriate sound and of quiet, and ensure that the newborn infant hears plenty of conversational, interactive human speech from an attachment figure. Bringing parents into the NICU also provides the opportunity to bring their familiar voices closer to the baby and encourage sensory development.
Why is it important for NICU nurses to know?
The brain and limbic system is involved with many of the expressions that make us human; namely, emotions, behaviors, and feelings. That humanness also includes individuality. Infant brain development is a dynamic process dependent upon internal and external stimulation and a supportive environment. Every Change Matters describes the perfect environment as safe (providing physiologic stability and supporting optimal neuromotor development), hygienic (including ensuring hands are clean and dry before and after a diaper change), and manages stimuli (moderating bright lights and loud noises). Disruption or deprivation in the infant’s social and physical environment can create permanent deficits in the developing neurosensory and limbic system.
Educating ourselves is key. Knowledge of the experiences that play a critical role emphasizes the responsibility we have in the care we provide. The challenge is in assessing what interventions are necessary and appropriate, and if can they be performed in more protective ways. We have such a responsibility every day with every touch. With every experience as we leave a profound imprint on who they will be.
Every time you fly in an airplane, the flight attendant explains that, in a crisis, you need to put on your own oxygen mask before helping others—because you can’t help others unless you’re taken care of first. Unfortunately, with regard to their own health, nurses don’t follow this type of example.
According to a recent survey conducted at the Medical University of South Carolina (MUSC), about 75% of MUSC nurses admitted that they put their patients’ health, wellness, and safety before their own. In fact, they put their own well-being last. And even though nurses have quite a bit of knowledge about nutrition, they eat a 30% less nutritious diet than they should be.
Like they say in the air, you need to take care of yourself before you can truly care for others.
As a result, on June 13, MUSC launched a 60-day nutrition pilot that is designed to help nurses eat better and improve their eating habits with healthier food options. At three locations at MUSC, nurses will be able to increase the amount of fruits and vegetables they eat daily by getting Simply-to-Go foods, which are healthful, fresh, seasonal, as well as locally sourced.
Andrea Coyle, MSN, MHA, RN, NE-BC, Professional Excellence and Magnet Program Director at MUSC, answered some questions about this program.
Why did MUSC decide to do this?
MUSC nurses impact the lives of their patients, colleagues, families, and neighbors every day, so when we were approached by ANA Enterprise to spearhead the first HNHN pilot, the decision to participate was easy. The opportunity to collaborate with ANA and Sodexo Healthcare to offer more quality food options on our campus and serve as a model for other organizations is truly an honor.
The ANA Enterprise and Sodexo Healthcare have partnered, at a national level, to improve the health of America’s nurses through the Healthy Nurse, Healthy Nation™ (HNHN) Grand Challenge. Sodexo made a multi-million-dollar contribution to the American Nurses Foundation in direct support of the ANA Enterprise’s HNHN Grand Challenge.
Where did the idea come from?
Sodexo has operated the foodservice at MUSC for over 30 years, so it made sense that MUSC, which is also an HNHN partner, would be selected to be the first organization to participate in a HNHN quality of life program in the United States. MUSC is the only participant site in South Carolina.
Why do you think that nurses tend to put their health on the backburner?
Nurses have one thing in common; they want to help care for other people. It’s their passion. Often helping others takes priority over helping themselves.
Why do they need to take care of themselves like they do their patients?
At MUSC, our nursing shared governance and nursing leadership has made self-care a priority. One driving strategy in our nursing strategic plan is to integrate healthy living into the nursing culture. If nurses have the tools and support to care for themselves, taking care of the patients and community we serve will reap the benefits of healthy nurses.
The biggest excuse that just about everyone has when it comes to eating better is that they don’t have time to prepare foods. What advice do you give to nurses about making up their own healthful foods/snacks?
- Plan ahead: whether it’s packing up dinner leftovers to grab on the way out or getting up 10 minutes earlier to pack a lunch, have a plan for what you will eat for the day.
- Keep better choices on hand: a mix of nuts and dried fruit, low-sodium tuna packs, nut butter, microwavable soups are all shelf-stable options. If you have access to a refrigerator, yogurt or cottage cheese, cut up veggies and hummus. Hard boiled eggs will keep for a couple days.
- 2-for-1: when you purchase a grab-and-go item, pick up a second option for the next day or take turns with a friend where one person takes time to make the food run one day and you the next.
Assuming that the pilot is a success, is this something that you will market to other health care facilities or to nurses in general?
Absolutely! It would be so exciting to share lessons learned and best practices. Promoting health and wellness is bigger than MUSC; it expands into the community we serve. At MUSC we aspire to build healthy communities.
What benefits can hospitals and other similar facilities get from using this kind of program?
The biggest benefit of the program is to increase awareness of heathy food choices. Recognizing that fruits and vegetables, smaller portion sizes, and fresh food ultimately creates a healthier workforce.
Why is this kind of program so important?
The answer is twofold: Nurses must turn their passion for caring for others inward and make caring for themselves a priority. Nurses must also be role-models for healthy living and health promotion to ensure our patients and families stay well. This program provides healthy food choices, which is one way to make a difference in the lives of nurses as well as the patients and families that depend on us for health promotion and wellness.
Unfortunately, nearly everyone knows someone who has had cancer. As a result, there are many oncology nurses working to help patients get through their experiences—whether with surgery and the aftercare, chemo, radiation, immunotherapy, and the like.
We interviewed Savannah Dunivant, RN, BSN, a nurse working in oncology at the University of Maryland Upper Chesapeake Medical Center, located in Bel Air, Maryland. She gave insight into what it’s like to work with these amazing patients.
Describe a typical work day for an oncology nurse. What do you enjoy most about it?
A typical work day can be quiet or hectic, but it is always rewarding. Certain tasks must always be completed: Physical assessments, administering medications, bathing, toileting, and rounding with doctors. You may have a patient who is newly diagnosed with cancer or you may have a patient that gets to go home.
I enjoy each day I get to spend with my patients, seeing them smile or reach for my hand. I have always said that with such a terrible disease as cancer, I hope that one good and positive thing that could come from their stay is me and the care I provide.
What are the various types of jobs that nurses can get in oncology?
There are various opportunities for nurses in the oncology field, such as staff/floor/inpatient unit nurse, Infusion Therapy, and Radiation. The primary role is teaching patients and families what to expect and to monitor patients for pain, fatigue, appetite, any side effects of treatments, etc. Nurse Navigators have oncology-specific knowledge and can give individualized assistance to patients, families, and caregivers to help navigate the health care system barriers.
What kinds of changes have occurred more recently in the oncology field? Why is it a good specialty for nurses to pursue?
There are many changes within oncology. Medications are always changing as are the treatments and protocols. There is always room to advance your skills and abilities.
What have you learned from working as a nurse in oncology?
That life is a very precious thing and never take time for granted.
What are the biggest challenges of working as an oncology nurse?
The biggest challenge is the emotional involvement you can create with your patient, although it is a positive thing. I once spent many of my shifts with a patient who then passed away, which was difficult for me. Nursing practice and your patients always take up a little piece of your heart, and it hurts to let them go—especially when we have been with them from first diagnosis to first chemo and beyond, up until when the treatment has just become too much. Your team members are your family, and your regular oncology patients become like family. But when it comes time to see them go, you know that they are no longer in pain, and you learn to love your memories of them.
What are the greatest rewards of being an oncology nurse?
The greatest reward is hearing your patient’s gratitude and knowing how much they care for you as a nurse.
What would you say to a nurse considering working in oncology? What kind of training do they need?
Go for it! It takes a special person to be an oncology nurse! It’s important to be trained in difficult situations and conversations as well as chemo certification and training in order to educate the patients and families. Oncology certification is important in order to educate patients and families and knowing the side effects or reactions to treatments. It is also important to be trained in “comfort care/palliative care.”
Anne M. Cabello, RN, BSN, CRRN, was only 12 years old when she experienced a mild stroke. Luckily for her, with good, acute rehabilitative care—as well as, she says, much love, prayers, and support—she made a full recovery. This experience, though, led her to become a rehabilitation nurse when she grew up.
“Rehabilitation nursing allows me to give back what I have been given and to provide nursing care to a patient for a significant period of time, often watching them progress to a lesser dependent state than what they were at when the stroke first occurred,” Cabello says.
Since 1995, Cabello has worked for Burke Rehabilitation Hospital in White Plains, New York, and she is a staff RN on an acute rehabilitation stroke unit. “The majority of my patients have suffered some form of a stroke resulting in impaired mobility usually on one side of their body—affecting their arm, hand, and/or leg, impaired speech and swallowing ability, impaired cognition, impaired vision, and impaired bladder and bowel function,” explains Cabello.
Working the 7 p.m. to 7 a.m. shift, Cabello says that being the primary nurse for neurology patients means that she cares for people who have worked hard during the day doing intense physical, occupational, and speech therapy. Her role, she says, includes doing an ongoing assessment of their conditions and reporting the results to the physician, medication administration by oral, IV, or via feeding tube, and overseeing the care associated with activities of everyday living including: assisting patients with eating, transfers to the toilet or in and out of bed, helping them change into night clothes, showering/bathing, wound care, tracheostomy care, incontinence care, and bladder catheterizations for those who need it.
Cabello says that the greatest reward for her in her job is “job satisfaction—knowing that I have given the best care I can to a patient.”
If you’re considering this type of nursing work, Cabello says that you must be compassionate. “Care for each patient as if they were your own loved one. That is what will cause you to give special attention to all your duties.”
“Nurses are vital team members of the health care team and are the ones on the frontline in providing direct care for patients. The stroke patients on the unit are still at the phase of their illness where they are at a high risk for a stroke progression,” says Cabello. “The nurse’s strong assessment skills coupled with identification of sudden changes in the patient’s condition can lead to the quick treatment and health care management of the patient.”
When Nathan Hansen, RN, was still in nursing school at the State College of Florida, he often used YouTube videos to help him study. While watching videos one day, he saw a story about a young man who got the call to donate bone marrow to help save someone’s life. At the time, Hansen didn’t know it, but one day, he too would get that call.
Hansen, who works in the operating room at Blake Medical Center in Bradenton, Florida, says that after seeing the video, he was moved. “I regularly donate blood and wanted to immediately sign up to be on the list to donate bone marrow,” recalls Hansen. “I wanted to get the call, but I didn’t really expect to.”
After signing up to be a bone marrow donor through Be the Match, the largest bone marrow donation registry, which is run by the National Marrow Donor Program, Hansen went about his life. As he said, he didn’t think he would get called. A few years later, though, Hansen’s phone rang, and he was told that he was a match for a 13-year-old boy in Washington, DC, who needed a life-saving bone marrow transplant.
When Be the Match contacted Hansen, they still gave him a choice. Just because he signed up to be a donor didn’t mean that he absolutely had to. But for Hansen, it was a no-brainer. “I was excited to get the call and definitely wanted to help in any way,” he says.
After going through many lab draws and physicals, Hansen headed to Washington, DC in June 2017, about four months after getting that first call—and he used his Paid Time Off to do it. “Again, this was a no-brainer,” Hansen says. Be the Match covered his travel and accommodations.
Hansen has never met the recipient whose life he saved, as this information is kept confidential. He had no pain post-op, and he says that he was only a little uncomfortable, much like you would feel with muscle soreness.
Because of his compassion, Hansen was nominated to be the New Nurse of the Year at Blake Medical Center—and he won. “I was honored even to be nominated,” he says. “So I was elated when I actually won.”
“I would absolutely do it all over again, and I think that others should sign up too,” says Hansen.
For more information on becoming a bone marrow donor, go to www.BeTheMatch.org.