I am privileged. I have been to the other side and experienced that the grass is greener. The majority of my career as a Neonatal Nurse Practitioner (NNP) has been in a Level 3 NICU with all the bells and whistles of high acuity, ECMO, high-risk deliveries, transport, and high patient volume. However, I then gained the privilege to also work as a NNP in a Level 2 Special Care Nursery (SCN). What a difference! But also, how similar!
The job tasks are identical … morning signout, collection of data from the medical record, physical exams, and writing notes. I touch base with the bedside nurse, case management, social worker as needed, and any ancillary staff. Consults are typically by phone. Sporadically, we may physically see an ophthalmologist, ENT, or cardiologist; but these occasions are not usual and customary. In addition, I can stand in one spot with full visual assess to all patients; as long as the census does not exceed 7 in the ‘main unit.’ The unit has evolved from a one room unit with one light switch, where either all lights were on, dimmed, or off equally. The SCN now is a state of the art unit of 7 individualized spaces to offer developmentally appropriate care, more patient privacy, and family-centered care. It is phenomenal!
Now, one may be thinking what a piece of cake. Well before we slice the cake, the grass really is not always greener. You see, regardless of the nursery level, the families are all experiencing a crisis. Acuity and level of nursery does not matter! The hopes, dreams, and vision these families had for their pregnancy, birth, and hospital experience are all shattered in the blink of an eye. The level of medical acuity has no direct correlation to the level of crisis for families. Due to lower medical acuity and lower patient volume, I am afforded the privilege of being able to take more time with families. I have the pleasure of sitting next to them, listening with my ears and eyes, to be in the moment with them. I can truly experience what the crisis or fears are. I feel a great sense of connection with the families. Regardless of the nursery level, these families become our family during their infant’s hospitalization. The communication, both active and passive, are vital for these families to emotionally survive this experience.
I have never experienced cross-trained nurses prior to working in a Level 2. This certainly is another privilege! This has positively enhanced my perceptions of the significance of the staff nurse presence in the delivery room, nursery, and postpartum area. In a Level 2, there is a staff of one NNP per 24-hour shift with attending back-up. The attending does rounds and meets with us daily, is present for all high-risk deliveries, and is always just a phone call away. This was a change coming to a Level 2. I realized how much I depend on my colleagues by just randomly shouting out to a fellow practitioner … ”What do you think?” Here, there is no one to just ‘bounce’ something off. However, it does afford me the opportunity to strengthen my knowledge by needing to know the answer ‘why’ and utilizing resources to confirm, learn, or discover answers. Because of the lack of colleague presence, the cross-trained nurses are a life-saver. They have a different level of competency, assessment, and confidence. It was awkward at first coming from a staff of 20 nurses per shift to having only 1 or 2 nurses. It truly reinforces the impact of communication and establishing rapport with others. Since there are fewer nurses, you work with people more infrequently, so communication, planning, and evaluating are essential—especially when those emergent situations do occur.
I still have the privilege of experiencing transport in a Level 2. The exception is that instead of going to receive the infant, I am sending them out. What an eye opener! This is where experience, confidence, and collaboration are vital. I remember my first meconium that clinically decompensated and overhearing, ‘I can’t remember a baby being this sick here.’ What a powerful lesson! This has afforded me another privilege of truly understanding the significant impact on providers and staff in managing these infants in an environment where resources may be more limited or staff may not be routinely used to managing these infants. I feel I have gained a level of inner strength, confidence, and resilience in handling distress in the clinical setting. It also reinforces the magic of nursing. Just like a Level 3, in a Level 2 the level of teamwork is there with everyone pulling together to do what is needed. Though a sick patient who requires transport is not usual and customary, the nurses are able to stabilize and do what is needed to optimize patient outcome. As a NNP, it is a humbling experience. Typically, as I stated previously, on transport I would pick up these infants to ‘give them what they needed.’ Recognizing you can’t fix this and need help is a character builder and essential professional trait.
In summary, I am privileged to experience the green grass on both sides of my world. I am so appreciative for my Level 2 experience because I am more proficient in looking outside of the box. I am not only a better practitioner, but a better listener, communicator, and mentor as well. I certainly have gained more than I can ever give back. And with that …I will go slice that piece of cake!
- Working as a NNP in a Level 2 Special Care Nursery - May 21, 2018
- The Life of a Neonatal Nurse Practitioner (NNP) - January 11, 2018