Jade England Was Born to be an NICU Nurse

Jade England Was Born to be an NICU Nurse

It is not unusual for nursing and other healthcare professions to run in the family, but sometimes the connections that lead a new generation into nursing can be almost eerie.

Tara Wood, DNP, CRNP, NNP-BC was a NICU nurse when she gave birth to twins Jade and Taylor England. Her newborns weighed less than two pounds and spent their first 87 days in a NICU. At some point, it seems to have been written that at least one daughter was destined to return one day.

“We had central lines,” says Jade England, who is completing her BSN degree at the University of Alabama Birmingham School of Nursing. Both sisters have a permanent souvenir of the constant care they needed from birth: “We still have that scar from where they were placed. It’s just crazy to see that we have actual proof of what we’ve been through.”

That scar is the only physical reminder of their journey. England knows how lucky they are to not have any complications from being born prematurely. Growing up, she saw the pictures of their tiny bodies covered in sensors and tubes. When she decided to become a nurse, she knew she had to return to where her story started—the NICU.

“You have to have compassion for those babies. You just have to be called to do that,” England said. “I want to be able to be that nurse to let the parents know that I was in their child’s place. I just want to provide the best care possible and hopefully sharing my story will make a difference in their stay in the NICU. I don’t want to give them false hope, but I also want them to know that miracles happen.”

“She literally walked me around the entire unit and was telling everybody, ‘this is my baby, I took care of her and her sister.’”

Jade England graduated in April and now works at UAB Hospital in the Regional Neonatal Intensive Care Unit. Her mother, Tara Wood – who is a member of the faculty at UABSON hopes her daughter will be able to give families the comfort she remembered needing.

“They’re going to be told all the bad, but when you can see a living example of success, I think it’s going to be amazing. I can’t wait to see what she does,” Wood said.

England will be working with one of the nurse practitioners who cared for her at the hospital where she was born. During her clinical at UAB, they made the connection.

“She literally walked me around the entire unit and was telling everybody, ‘this is my baby, I took care of her and her sister,’” England said.

“I think I found healing by helping others.”

Wood remembers not being able to hold her children for months. During that time, her lifeline to her girls was the nurses and nurse practitioners.

“My world was rocked,” Wood said. “My babies were really sick. Both of the girls were on the ventilator for weeks. Their organs were premature, and you’re faced with all the things that can go wrong. Just knowing that every minute mattered, it really put you in a constant state of terror and panic, of not really knowing how your babies are going to survive, much less thrive.”

She had planned on becoming a teacher, but the twins’ experience in the hospital changed her life. She realized she wanted to be a nurse so she could care for other families.

After working as a NICU nurse, Wood earned her Master of Science (MSN) in Nursing and Doctor of Nursing Practice (DNP) from the UAB School of Nursing. The journey came full circle for her as well. She’s now an Assistant Professor at the School and the Coordinator for the Neonatal Nurse Practitioner Specialty Track, teaching and preparing nurses to care for infants and families.

“Being a NICU mom 22 years ago we didn’t really talk about post-traumatic stress disorder and things like that that really lingered. I think I found healing by helping others,” Wood said.

Taylor England, Jade’s twin sister, also graduated from UAB this spring with a major in psychology with a minor in legal affairs and a certificate in mental health.

Jade wants to follow in her mother’s footsteps and plans to return to school next year to start the Post-BSN to DNP Nurse Practitioner Pathway to earn her Doctor of Nursing Practice degree. One day, she hopes to teach alongside her mom.

“I’m a proud mom and I want to share them with the world because I think that they were born to do great things,” their mother says. “They have servants’ hearts, and they want to help and do good.”

Nurse of the Week: NICU Nurse Mary Lovelace Saves Grownups Too

Nurse of the Week: NICU Nurse Mary Lovelace Saves Grownups Too

One occupational hazard of being a nurse (or even a nursing student!) is that friends, family, and even brand-new acquaintances tend to buttonhole you for on-the-spot diagnoses and ad hoc consultations. And, since you are completely on board with helping people, you respond as a nurse whether you’re wearing scrubs or street clothes. So, it comes as no surprise that so many off-duty nurses save lives at accident scenes, public events, and ؅—in the case of our Nurse of the Week, Loyola Medicine NICU nurse Mary Lovelace, RN—sometimes they save the odd life while on vacation.

The pint-sized (5’2”) Lovelace is accustomed to treating tiny, premature newborns, so the encounter with her first grown-up “patient” in years gave her quite a workout. The 58-year-old was returning from dinner with friends during a trip to Scottsdale, Arizona when a stranger went into cardiac arrest and fell down right in front of her male partner’s son. Lovelace initially thought the large man was merely clowning with friends, but then, recalls, “I looked down and I’m like, ‘Oh, god. He was already really gray.” She shared a few traits with the fallen man. Angelo Valenti is also 58; he’s from Chicago as well and was visiting Scottsdale on vacation; and suddenly, both their holidays had become extremely eventful.

As Lovelace told Valenti’s companions to call 911 and seek out a defibrillator, she was already starting work on her patient. On duty in the NICU, she customarily performs two-finger CPR on neonates, but as luck had it, less than a month ago she’d brushed up on the standard, much more muscular resuscitation technique at a CPR refresher course. Like most nursing jobs, caring for preemies requires physical strength and endurance, though, and Lovelace persevered with her best two-fisted CPR for eight minutes, only stopping when the local EMTs showed up. In fact, one of Valenti’s ribs broke during her compressions, but keeping a cool head, she remembers thinking, “In my mind, I’m like, ‘Oh buddy, I’m sorry, but thank goodness you’re still breathing.’”

An ambulance arrived and sped Valenti to the nearest hospital. He was unable to respond to his name for the first couple of days but quickly recovered and flew home a week later after surgeons implanted him with a cardioverter-defibrillator to help prevent a future cardiac arrest.

The two Chicagoans have been in touch since their paths crossed so dramatically and have formed a bond. When a grateful Valenti called to thank her for her prompt care, “It was very powerful,” Lovelace says, “It was a very emotional conversation. I’m glad I was there at the right time to do what I can do and what I’ve been trained to do over the years.”

See a full account of Mary Lovelace and Angelo Valenti’s exciting Arizona journey at the Chicago Tribune.

Texas Staffing Shortage Shuts Down Rural Labor and Delivery Units

Texas Staffing Shortage Shuts Down Rural Labor and Delivery Units

Cuts to services

Transferring to larger hospitals

Vaccine misinformation impacts staff, patients

How Is the Pandemic Changing Perinatal Health Care?

How Is the Pandemic Changing Perinatal Health Care?

Nearly overnight, the coronavirus pandemic transformed health care, including perinatal care. Anticipating more and more COVID-19 patients, hospitals needed to create space quickly, both to manage the influx of patients with the disease and to protect non-infected patients from exposure to SARS-CoV-2. 

Elective surgeries were postponed, telehealth was utilized when possible, and some care shifted to outpatient with remote monitoring. One procedure that cannot easily be postponed or managed remotely, though, is childbirth. And, even as the pandemic dramatically reshapes parents’ expectations of labor and delivery, the coronavirus is colliding with crises already affecting pregnant people and new mothers and parents — namely, the struggles to reach families in rural or remote areas and to prevent the unnecessary perinatal deaths of Black people. 

Melicia Escobar, BSN, MSN, CNM, WHNP-BC, believes this complex moment in perinatal health is one that nurse-midwives, trained to move through a crisis without forgetting the client at the heart of it, are more than prepared to meet.

“This is why I think midwife leaders are really shining in this time, across academic settings, medical centers, and home birth, because that’s what we’re trained to do,” said Escobar, a certified nurse-midwife (CNM) and Women’s Health Nurse Practitioner (WHNP) and Clinical Faculty Director of Georgetown University’s Nurse-Midwifery/Women’s Health Nurse Practitioner (WHNP) and WHNP programs.

Intentional support provided by antenatal and birthcare providers is essential in helping families navigate this crisis safely — as well as mitigating the potential negative effects that the pandemic’s social and economic consequences could have on perinatal health in the future. Escobar considers these and offers action steps for supporting people in pregnancy, birth, and the postpartum period below.

Parents Have Fewer Choices About the Birth Experience

Parents tend to have better outcomes when they are empowered to make choices about their birth experiences.

“Having options, offering unbiased guidance around those options, and listening to clients is so important. When people have options for where to birth, for example, and have information to weigh pros and cons, then they know where they should be,” said Escobar. “They know what’s best for them. We just need to listen.”

Consider one key decision parents have to make: Where should I have my baby? In many rural areas, birthplace options can be extremely limited. Options for out-of-hospital care may be rare, and even when parents choose an in-hospital birth, they may only have one hospital accessible to them. Some community hospitals have discontinued childbirth services completely, forcing families who want a hospital birth to travel elsewhere for care.

A CNM in Philadelphia, Escobar set the scene of the pandemic’s early days: “People were afraid of being in a hospital and exposing themselves or their babies to COVID-19. They were also afraid of being subject to hospital policies around COVID-19.”

At some hospitals, one such regulation was limiting the number of support people allowed at the birth to reduce providers’ exposure. But there was an unintended — and unjust — effect, as detailed in the article Reflecting on Equity in Perinatal Care During a Pandemic” in Health Equity: “A policy of no support persons unduly impacts marginalized communities and implicitly reinforces the ‘sacrificial’ or expendable status of Black and Indigenous parents, who have long borne the consequences of mistreatment and abandonment in their health care experiences.”

Protecting parents’ options and respecting their choices surrounding the birth experience is especially important in a crisis. Options should be safe, affordable, and respectful — in other words, a real choice among viable options.

Whether because of the coronavirus or biased, inequitable treatment, “it’s not really a choice when going into the hospital can mean real and present danger,” said Escobar. 

Existing Risk Factors May be Compounded, Especially for Women of Color

Prior to the pandemic, pregnant and birthing people in marginalized groups were already at higher risk of complications and death, as explored in [email protected]’s “How Does Race Impact Childbirth Outcomes?” Perinatal mortality rates are highest among Black women in the United States, as are rates of severe maternal morbidity (SMM), an unexpected labor and delivery outcome that may create significant short- or long-term consequences for a person’s health.

~42 non-Hispanic Black women die for every 100,000 live births, compared to 13 deaths for non-Hispanic white women.

Source: CDC, “Pregnancy Mortality Surveillance System.” 

70 cases of severe maternal morbidity events, or “near misses,” occur for each maternal death of a non-Hispanic Black woman.

Source: The American Journal of Managed Care, “Racial Disparities Persist in Maternal Morbidity, Mortality and Infant Health.” 

~4.2% of non-Hispanic Black women experience a severe complication compared to 1.5% of white women.

Source: American Journal of Obstetrics and Gynecology, “Site of Delivery Contribution to Black–White Severe Maternal Morbidity Disparity.

Some methods of adapting perinatal care during the pandemic could ultimately prove harmful to women, especially women of color, according to the aforementioned Health Equity article. For example, some providers have encouraged early inductions and elective cesarean births (C-sections) to help manage “hospital census and staffing.”

However, these procedures often require increased close contact between patients and providers, increasing the risk of COVID-19 exposure. They can also lead to longer inpatient stays, creating a higher risk for both the parent and newborn.

“Given that women of color already experience higher rates of inductions and cesareans, these policies are likely to further exacerbate the disparities in outcomes,” wrote the article’s authors.

Traumatic Experiences Could be Worsened

Most people bring trauma into the childbirth experience to begin with, said Escobar. COVID-19 adds another layer of stress and fear that may be especially difficult for expectant parents.

~14% of women are affected by perinatal depression.

Source: National Institute of Mental Health, “Perinatal Depression.”

~9% of women experience post-traumatic stress disorder (PTSD) after childbirth caused by real or perceived trauma during delivery or postpartum.

Source: Postpartum Support International, “Postpartum, Post-Traumatic Stress Disorder.”

“Then there’s a second-layer trend where Black, Indigenous, and people of color (BIPOC), who already enter our health system at a disadvantage and carrying trauma, are forced to choose between COVID risk and a system in which they perceive they are unsafe due to racism and bias,” said Escobar. 

“The baseline level of trauma that Black birthing people in particular experience is already so high,” said Escobar. “For folks opting to stay out of care or seeking out-of-hospital birth, it is very easy to understand the logic: Why compound things by introducing either of those two factors, COVID risk and racism?”

Action Steps for Supporting Maternity Care in a Crisis

Giving birth during a pandemic can be traumatic, especially for those who have already experienced trauma in the health care system. With trauma comes fear. When people — both patients and providers — start making fear-based decisions, “that’s when you start getting bad outcomes,” Escobar said.

Still, a negative outcome does not have to be traumatizing. Listening to and empowering the person giving birth can transform the experience.

“There have been clients I’ve been caring for in labor who have had obstetric emergencies, like postpartum hemorrhages or uterine abruptions, where my perception was that the experience was probably traumatic for them,” said Escobar. 

However, the patient tells a different story. “Afterwards when we were debriefing, one of those clients said to me, ‘Thank you so much. That was the most empowering experience in my life,’” she said.

Escobar believes the difference between a traumatic childbirth and a difficult but empowering birth is in listening, sharing information, and partnering together even in the midst of a crisis. When people start from a place of listening to expectant parents, they can understand and mitigate their fears. They can work through or around the trauma to comfort the client and overall have better outcomes — even if the childbirth has scary elements.  

Below, find suggestions for providers, loved ones, and communities to better listen to and support women in pregnancy and the postpartum period during the coronavirus pandemic and beyond.

  • Adopt a midwifery-model mindset: Nurse-midwives are trained to stay calm in difficult births, create an action plan, and move through it with the person “always centered,” said Escobar.
  • Treat listening and clear communication as vital clinical skills, as essential as doing an abdominal exam or listening to heart sounds.
  • Listen to the client, especially when discussing sexual health history and gender-based violence.
  • Find ways to communicate empathy and understanding, even through layers of personal protective equipment.
  • Share information and partner with the patient throughout their care, especially in potentially traumatic childbirths.

How Can Family and Friends Offer Support When You’re Expecting During a Pandemic?

Reserve judgement and honor the choices being made around childbirth and coronavirus precautions.

  • Before visiting, ask about the family’s comfort level with in-person interactions, and again, avoid adding to guilt or shame about those precautions.
  • Identify alternative ways to be helpful, such as sending takeout meals or taking care of yard work. 
  • Consider offering financial support if needed and requested. 
  • Check in if you have not heard from a new parent and ask if they need any support or reassurance.
  • Extend compassion to new parents in the postpartum period. “We’re going through a collective grieving process in this pandemic,” said Escobar. “That loss and fear juxtaposed with the excitement, joy, and hardship of transition is a really intense nexus.” 

How Can Communities Better Preserve Perinatal Health in a Crisis?

Develop a trauma-informed approach to every level of health administration and public service, from intake to birth to discharge. 

  • Consider how to address the external factors that affect pregnant and birthing people and their families. “Pregnant people don’t exist in isolation,” said Escobar. “They have housing needs, they have food needs.”
  • Have a nurse-midwife on maternal health leadership teams. “It improves outcomes, culture, and patient satisfaction everywhere,” said Escobar.
  • Create policies that make perinatal care more holistically accessible. For Escobar, accessibility includes having a hospital to go to that offers safe, effective, unbiased, and respectful care.

Citation for this content: [email protected], the online Women’s Health Nurse Practitioner program from the Georgetown University School of Nursing & Health Studies

Nurse of the Week Diane Foxen Treats Babies in the ICU, Kittens at Home

Nurse of the Week Diane Foxen Treats Babies in the ICU, Kittens at Home

Nurse of the Week Diane Foxen has two callings. The Sunnyvale, California nurse cares for human infants during shifts lasting up to 16 hours in the neonatal ICU at Santa Clara Valley Medical Center, and works part-time at El Camino Hospital as well. After she leaves the ICU, Foxen goes on shift at home, treating newborn felines as a volunteer for her local Humane Society. Her home-grown kitten clinic has been a refuge during the pandemic: “Kittens are bouncing around, running around, jumping up in the air. There’s no way you cannot laugh if you have a kitten or puppy in your life because they are just funny. And in this time of COVID, everybody needs a little bit of funny.”

Over the past decade, she has fostered some 200 homeless kittens, occasionally making room for 13 at a time. Foxen’s first feline charge was Smudge, a young tuxedo cat who was suffering from lymphoma. Smudge was expected to live for no more than six months, but under Foxen’s care he survived for three years. Cristie Kamiya, chief of shelter medicine at the Silicon Valley Humane Society said, “Having a foster parent of Diane’s caliber taking on some of the most challenging cases has been critical to our mission. Diane has literally saved the lives of the many kittens she has taken in.”

Foxen's kittens gather for dinner.

After she had taken Smudge under her wing for the Humane Society, the Society was quick to adopt Foxen: “I started getting phone calls from the Humane Society, saying, ‘Hey, Diane, we’ve got this really sick kitten—it’s just like NICU nursing—can you take care of it?’ And so now my specialty is fostering very sick ringworm kittens.”

Although ringworm is a skin fungus, it is so contagious that many cats are put to sleep simply to prevent it from spreading. When Foxen fosters kittens with ringworm, she isolates them in a special room, where she treats them with medicated baths and oral fungicides until they are worm-free.

Tending to the rescued kittens is emotionally rewarding, and also helps to relieve the stress of working in an ICU. Foxen told the Mercury News that “They say that we’re heroes but actually, especially after that second lockdown where I sheltered away from my sister, these kittens were my heroes. They’re giving me that contact that I need. They’re giving me a safe place to cry my tears where I’m not burdening anybody else who has had a hard time with this themselves.”

Her volunteer work with animals complements her career and enriches her life: “Having this transition from a kitten that may not make it to this healthy kitten that is now running around and playing, that is just reward in itself,” she said. “Having a foster—whatever animal—I highly suggest it; it can really help people make it through tough times.”

The full story on Diane Foxen is available at Los Altos Online.

Neonatal Nurse: A Day in The Life

Neonatal Nurse: A Day in The Life

One of the most intense, yet most rewarding experiences in the field of nursing can be found in a place you may not expect: the neonatal intensive care unit (NICU). A day in the life of a neonatal nurse is never the same day twice, with patients ranging from babies who are born mostly healthy to those born with complications. It’s a profession with struggles, but the little victories that make them worthwhile.

In this article, we’ll take a look into the lives of neonatal nurses to find out what exactly their job entails, what it takes to get there, and how you can get started on the path to working in the NICU should you decide it’s the right career path for you. If you’ve ever wondered, “What is a neonatal nurse, and what do they actually do,” then read on.

THE DAY TO DAY JOB OF A NEONATAL NURSE

There are four different levels of care in a hospital’s neonatal unit, and a neonatal nurse could be assigned to any one of them, or work multiple levels. The first is the nursery, where healthy, full-term babies go until their parents can take them home from the hospital. Levels two through four are organized in escalating order of severity, with level four housing the most serious cases.

Level two is for babies who were full term but have fallen ill, infants born on the latter end of preterm but still early, and those with more minor health issues. Three is where infants born very prematurely, with major respiratory issues, or with defects. Level four is where babies born with major chronic issues requiring sustained care are placed. Some smaller hospitals will only have levels one and two, and then transfer more serious cases to larger and better-equipped facilities, while some can house all levels of care. In all cases, the duty of the NICU nurse encompasses both care for their infant patients and assisting the parents emotionally coping with the situation.

Kathleen Colduvell, a NICU nurse with a decade of experience under her belt, described the highs and lows of the job — the emotional toll it takes and the reward of seeing a patient make it through — on a blog entry for a nursing website:

“Even though there has been more heartache than I care to remember, the success stories make every single minute of my shifts worthwhile. We fight to help our patients breathe on their own, take bottles independently, and achieve their developmental milestones, and that is such a reward.”

A neonatal nurse’s shifts are often 12 hours long, and at variable times, as their tiny patients often need round the clock care. The babies are fed every three hours, and the nurse will often conduct any testing or procedures like blood draws during feedings to make sure the infant can spend the majority of their time on rest and recovery. The amount each baby can eat needs to be monitored and adjusted according to their condition, vitals need to be checked, and a plethora of other variables need attending to for each patient. In addition to these duties, a NICU nurse will often end up helping the babies’ families, explaining care and procedures to them to keep them informed.

A common saying in the nursing world, and to which the NICU is no exception, is that “there is no typical day.” Neonatal nurses have to be close by their patients to lend them the best possible care, especially since babies can’t articulate what may be happening with them. Anyone who describes the job will tell you it can be challenging, but also that they love it and wouldn’t want to be doing anything else. One nurse described helping parents care for their child for the first time as especially rewarding:

“…there are a thousand amazing great things about being a NICU nurse. You can be the first person to help a mom see, touch, or even hold her fragile little preemie. You get to help people become parents for the first time and do ‘normal’ parent things like change diapers for the 1st [sic] time while working alongside an oscillator and IV pumps. We facilitate all those early and important bonding tasks, regardless of the baby’s acuity, there’s always something the parents can do and we get to show them that.”

JOB OUTLOOK AND REQUIREMENTS FOR NEONATAL NURSES

In order to specialize in neonatal nursing, you need to already have completed a Bachelor of Science in Nursing (BSN) degree. After that, two or more years of experience working with neonatal patients and a passing score on the certification exam for neonatal nursing must be completed. Areas of care recommended for gaining those years of clinical experience include:

  • Labor and delivery nursing
  • Maternal-child nursing
  • Pediatric nursing
  • Well baby nursing

There are two main routes candidates for a neonatal nursing job usually take to become certified: a critical care neonatal nursing certification (CCRN) via the American Association of Critical Care Nursing, or an RNC Certification for Neonatal Intensive Care Nursing (RNC-NIC) via the National Certification Corporation. If you wish to further certify to gain a leg up on the competition and increase your job prospects, you can choose to get one of the following certifications:

  • Advanced Cardiovascular Life Support (ACLS) certification
  • Basic Life Support (BLS) certification
  • Neonatal Resuscitation Program (NRP) certification

Nurses can pursue some or all of the above to reinforce their professional tool kit. Continuing education programs through accredited providers like the National Association of Neonatal Nurses (NANN) are also necessary to remain at the top of your game as you progress along a career path in the NICU.

The Bureau of Labor Statistics (BLS) predicts a rise in demand and a healthy job outlook for the nursing field as a whole over the next decade, and that demand will be even higher for nursing professionals in specialized fields. As a large portion of the nursing workforce nears retirement, more will need to be recruited to replace them. The median salary for a registered nurse is around $73,500 according to the BLS, but respondents on Payscale report an average salary of $97,306.

HOW YOU CAN TAKE THE NEXT STEP

At D’Youville Online, we’ve designed our online RN to BSN program with working nurses in mind, to let you gain the knowledge and skills necessary for the next level of your career on your time. Our courses run the gambit from evidence-based practice to enhancing patient outcomes, and you can complete the clinical component of the program where you already work.

Our program is CCNE accredited and taught by passionate, highly-educated professionals actively working in the field of nursing. A rolling admissions policy means you can sign up when you want, and the program can be completed in as little as two years. If you’re ready to advance yourself and your career visit our website for a detailed breakdown of courses and credit hours required.

This Sponsored Post is brought to you by D’Youville College.

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