Placement on the Neonatal Unit

How can I begin to to tell you about this placement?

Inspirational?

Frightening?

Thought provoking?

Yes- to all of the above and more.

So let me start by describing the different levels of a neonatal unit:

Level 1: Special Care Baby Unit (SCBU)- I suppose you could call this the 'basic care' neonatal unit, where babies are establishing feeding and growing before going home. Most babies within this setting are being fed orally or have had a long term feeding method (such as a gastrostomy) fitted and parents are receive training in regards to this. Some babies may be going on on oxygen and tolerance to this is being monitored and parents are given training concerning going home on 02. This is a lovely place to work as parents can see the light at the end of the tunnel (if they have had a long stay) and babies are awake and being babies (ie crying happily, pooing happily, looking around happily...). Babies also had to be a certain weight or age to be in this unit- the specifics of this vary from hospital to hospital however. This was also a busy unit as you could be looking after 3/4 babies on your own and all sorts of professionals are coming in to either visit parents offering them their services or advice for when they go home.

Level 2: High Dependency Unit (HDU)- I LOVED this unit, it was intense but not terrifyingly so and I was able to learn so much from the nurses in there because each patient had a totally different need from another. This unit is a step up from SCBU where babies are not quite as well. They could still be on a method of ventilation (such as CPAP) or have a stoma as a result of NEC or be fitted with a short term enteral feeding method such as a NG tube. I spent most of my time in this setting while on placement and was able to observe and nurse babies that continued down the scale to SCBU and babies that had to be admitted to NICU because their condition was worsening. In fact I was looking after my patient one day (who I had worked with previously on numerous occasions) and I just had this feeling that they were not right, they weren't presenting with symptoms or misbehaving obs wise, I just felt that something in them had changed- and not for the better. Later that day they crashed, right in front of me. I did everything that I had been taught, I didn't panic, I flipped them onto their back, begun bagging, pulled the crash buzzer and then began to empty their stomach via the NG tube when help arrived and took over. It wasn't until they had stabilised and been admitted back to NICU that the panic started: Had I done everything right? Had I missed anything? Should/could I have done something differently? My mentor was amazing and told me that she would have done the exact same- which made me feel mountains better!!!

Level 3: Neonatal Intensive Care Unit (NICU)- this unit is very scary as a second year- and I'm sure qualified nurses with years of experience will say the same. Things on this unit can go bad very quickly and with no warning. I spent about 15% of my placement here and in all honesty at times I really did feel out of my depth because these babies are SO ill. Looking after my own patient on this unit was like walking on egg shells- you are very aware that this baby is clinging to life by a very thin thread and you have to make sure that thread is holding. One patient of mine was born at 23 weeks gestation weighing 450g- to put that into perspective, the abortion cut off in this country is 24 weeks and 450g is less than a lb...... this baby could fit comfortably in my hand, they were tiny. They were being nursed on a ventilator set on HFOV mode (air goes in and out extremely quickly- the baby vibrates its that quick) and also in an incubator to maintain a therapeutic temperature, with all sorts of tubes and lines inserted into their umbilical cord (Umbilical line), mouth, arms and legs. IT WAS TERRIFYING!!!! I also unfortunately witnessed deaths on this unit. Everybody deals with this differently- for me I was fine until I got home, then I was overwhelmed with all the effects of what a baby dying meant for family and life.... my advice? write it down (no names!)- how you feel, what you remember, how it must be for the parents, what life will be like for the family- then look at it a couple of days later. Your mind will have processed it, analysed it and can now see it in a different way and you can comfort yourself -of sorts- because you understand it a little better. If you find yourself in this situation and feel that you need to talk about it with somebody there will be measures put into place for you, just talk to your mentor or uni :)

 While I was on this placement I was given the opportunity to go and see the birth of a baby who will be admitted to the unit. 

WOW!!!!

 If you want an account of that let me know! I'm hesitant to include it in this post as it would be very long and (sorry) very graphic, because....well.... OHMYGOD!! lets just say when people announce that their baby came out the 'sunroof' (Cesarean) I now quietly say to myself 'no they didn't, they came out a plane crash, in a fiery building, in a city on fire, on an island crashing apart'.... my utmost respect to those who have had a Cesarean!

Overall my experience on this placement is something I will never forget and feel extremely lucky to have experienced it. It has influenced my choice in my future nursing career (Neonatal here I come!) and also brought into sharp relief how very REAL nursing is. Some people really don't like the Neonatal unit, it's just not for them, however the experience you gain from it will be hugely beneficial. 

Until my next post and feel free to comment and let me know any requests or questions you may have,

Kimbers xXx