How Every NICU Encounter Counts

In honor of National Neonatal Nurses Day, Nurse Elizabeth (Liz) Drake, RNC-NIC, MN, NNP, CNS, CHOC, of Children’s at Mission Hospital in Mission Viejo, California, shares her experiences in spreading the word on NICU encounters across the United States, and why her work is important.

“When you meet families in the NICU for the first time, you see sadness, fear of the unknown, stress, shock, etc. Many moms have been on bedrest, some mothers have done ‘everything right,’ many families have birth plans—and then the unexpected happens. They meet us, which is something a new parent never expects. Spending time with and partnering with a family at the bedside allows you to walk alongside this roller coaster journey with them,” says Drake. “Your words, your education, your compassion can change a parent’s fear into confidence as you encourage them to learn every aspect of their infant’s personality and behavior. You develop a bond with them. They consider us as family because you are with their infant over the course of days, sometimes months. They look to the team for encouragement, education, and reassurance. Every day you leave work, you know that you have impacted a family and their infant.”

How does your teaching throughout the country help families?

The mother, especially, has developed a history with her infant, such as history of movement patterns, smells, and tastes from her diet. The infant also recognizes the redundancy of her voice and body sounds along with others in the home. This is so important to remember as we explain to families that their presence is vital to their infant. Providing skin-to-skin contact when possible, providing breast milk, quietly speaking to their infant—these are all things that are familiar to the infant in an unfamiliar NICU. Educating, role-modeling, and emotional support are all things that the NICU nurse provides to the parents to empower parents to bond with their infant. Teaching them their infant’s engagement and stress cues are important, so the parents can develop this reciprocal relationship with their infant. The infants then thrive because they have a caregiver who knows them, listens to them, and responds in kind to their needs.

What are the most important things that NICU nurses tend not to know about interaction with a premature infant?

I think with the way health care has evolved, it has placed more “tasks” for the nurse to “do.” We are professionals who assess, evaluate, process, intervene, and integrate knowledge into care. Because of how health care has changed, the nurse is often left to accomplish a lot of things.

When I first started, I was not taught about the things I’ve shared with you. So, I often reflect on the impact I may have had on infants and families early in my career. Now that I know better, I work to do better and make sure others just starting out know the importance of our impact. I believe that with education, everyone will desire to do the right thing and provide excellence in all their care.

What do the families not know that you believe is important for nurses to communicate to them?

Just because their baby is born doesn’t mean that they are ready to do what other infants can do. It’s important to share and teach that infants’ brains, especially those in the NICU, are still developing and learning. NICU nurses must protect that development as best we can, the way you would have if they were still inside: dark and quiet, with not a lot of non-relational touch.

What qualities are most unique about premature infants?

The first thing that comes to mind is that premature infants, even the tiniest and most fragile of babies, have personalities and ways of communicating with you. When you take the time to just observe them, you will see that. Every Change Matters explains that while pain in premature infants can be difficult to identify and distinguish from stress, certain indicators such as facial expressions and body movements can be used for pain assessment and management. They speak with their body movements (e.g., you may position them a certain way after care time, and they will keep moving, trying to turn their head or their own body. If you position them in the way they are moving, they will settle down. They didn’t ask to be turned verbally, but you were still able to figure out what they wanted!)

They speak with facial expressions, like a grimace when they are in pain. They do cry and let you know when they are not happy. The most beautiful thing to watch is when you show the parents how they can comfort their baby with a firm hand on their body or by the sound of their voice telling them they are there and then watching the baby settle down. Watching the parents’ faces after that melts your heart.

What are the biggest challenges of working with premature infants?

Some babies don’t survive. That never gets easier.

Another challenge is that sometimes it doesn’t matter that you provide your best technology as well as medical and nursing care. Babies born at the earliest of gestations are at risk for outcomes that will be challenging all of their life. Issues a person may experience at three, 13, or 23-years-old could be completely because they were born prematurely. Even with lifelong problems, the care and environment the parents provide can overshadow the “what ifs.” The strength and resiliency of families of premature infants is beyond anything you have ever seen. They make us better human beings for watching and experiencing their strength.

What are the greatest rewards?

The greatest rewards are knowing you do your best in understanding these infants and seeing what your impact is on their—and their families’—lives. When you get Christmas cards, Facebook messages, or hear about major life milestones (college graduations or marriages) from past families and children, your heart smiles, and it reminds you of why we do what we do.