CONVERSATIONS WITH… A Neonatal Nurse

Caring for critically ill babies can be both challenging and rewarding, admits this neonatal intensive care unit (NICU) nurse…

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When Neonatal Intensive Care Unit (NICU) nurse, Wang Xia, 32, heads to work, every day, she doesn’t know just how her day will turn out. But she always hopes to end it with a sense of accomplishment, so she gives her best to her tiny patients.

Nurse Wang belongs to a group of unsung heroes who work tirelessly behind high-security, windowless doors at the NICU floor of the National University Hospital. This is where she sees a variety of cases, from full-term infants with birth injuries and congenital health problems to preemies born too soon and fighting to survive.

Explains Wang, who has been in this field for nine years, “Neonatal nursing generally encompasses care for neonates who experience problems soon after birth and it also encompasses care for infants who experience long-term problems related to their prematurity or illness after birth.”

Because she’s dealing with fragile little beings, every move she makes is delicate. Her job scope is wide ― she keeps her little patients comfy with regular diaper changes and feeds, but also has to insert IV lines and intubate them when necessary. She also uses the power of her touch to literally nurse these infants back to health, rubbing their backs, patting them, holding their petite hands and rocking them for hours.

In short, NICU nurses are the angels who look over critically-ill babies at a point when their parents aren’t able to. “It is a great joy and satisfaction to see the preemies grow in size from 500 gm to 1kg, to 2 kg, and finally medically fit to return home,” notes Wang. She shares details of her vocation with SmartParents…

What are some challenges you face in your job?

Preemies can get sick very quickly without any obvious warning signs. Since they’re not able to tell us how they’re feeling, they depend totally on the continuous observation from nurses and doctors. Any subtle changes in their general appearance, activity and colour may be a turning point. So, observational skills are extremely important for neonatal nurses, but they can only be developed overtime, through experience.

Changing diapers and feeding babies are a small part of our daily routine. We also render critical care and do similar procedures like in other ICUs, such as intubation and central line insertion.”


What are some misconceptions people have about NICU nurses?

NICU is a relatively specialised area, outsiders may not know the nature of our work and pass general comments such as, ‘’NICU nurses only change diapers and feed baby’’. It is sad to hear such comments. Changing diapers and feeding babies are a small part of our daily routine. We also render critical care and do similar procedures like in other ICUs, such as intubation and central line insertion.

How do you work hand in hand with the doctors?

Doctors and nurses work very closely together in the NICU. Since the nurses spend a lot of time caring for the babies, they are able to provide doctors with the babies’ progress and events that doctors need to know about. As a team, we decide what intervention is needed for the baby based on our observation and physical examination. Morning rounds in the NICU are led by nurses who are also involved in the discussion of patient management with the doctors. These entail discussing holistic care for the patient, including medical management and social issues. After a thorough discussion, the team will mutually agree on the best plan for the baby.

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How do you handle the parents? Must be hard to have a baby in the NICU…

Having a baby come to the world is a joyful occasion for parents. But parents with premature babies are overwhelmed with anxiety over their baby’s health condition and survival. Doctors and nurses update the parents actively on a daily basis, so we can address their doubts and concerns. They may not be able to hold their baby for a month or more, depending on how critical the baby’s condition is. However, we encourage them to talk to their baby, touch them and sing lullabies. Mothers are encouraged to express breastmilk to feed baby in order to build up immunity and help them gain weight. Once baby is medically fit, we encourage parents to start kangaroo care [skin-to-skin contact]. Many parents share their happiness with us when they first hold their baby in their arms. It’s extremely rewarding for us when we are able to share in their joy and happiness.

What’s a typical day at work for you?

I focus on direct patient care and staff development. Every day, I’ll go through inpatients’ details, especially very sick patients and those who are heading home or transferring elsewhere. I also make arrangements for home equipment some babies might need when they are discharged. After the rounds, we’ll start with necessary procedures and patient care for all babies. Often, we also supervise newly-joined staff and conduct classes for them.

“The child hugs me every time when she visits us. She knows we are the nurses who looked after her when she was little.”

Working with fragile babies can take an emotional toll on anyone. How do you manage your feelings?

Everyone has their own way of dealing with such things. It’s emotionally challenging for us to witness our patients and their families suffering. I manage my emotions by having one-on-one conversations with colleagues or with my family when I’m at home.

How do you keep calm during an emergency?

Emergencies can happen any time in the NICU, so we need to be prepared at all times. Every time I start a shift, I will go through the reports from the previous shift and perform an equipment check for the patients under my care. I need to make sure they all have an Air-viva bag, suction machine and ventilator, so that I’m ready for an emergency. We also conduct monthly “mock codes” for both doctors and nurses. During these drills, doctors and nurses learn to anticipate and manage an emergency as a team. This is very important as we need to work closely to provide the best kind of support for our very young patients.

Tell us about a patient you will never forget.

Half a year after I joined, a tiny little girl was admitted to the NICU. She was born at 24 weeks with a birth weight of 500g. She was the smallest baby I’ve ever seen. She stayed with us for nine months and was finally discharged after a tracheostomy [a surgical incision that helps baby breathe]. We went to her house a few times to visit her after she was discharged. Her mother is still in close contact with us and they often visit us after her doctor’s appointment at the hospital. The child hugs me every time when she visits us. She knows we are the nurses who looked after her when she was little, even though she can’t remember anything else.

Photos: National University Hospital Singapore

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