This article appears in the October issue of 400 Life.
Jaime Scott waited with the premature baby and his mom for an hour and a half hoping that nothing would happen.
Their objective was so basic but also tricky. Elijah had been born premature at 33 weeks, along with his twin sister, Collins, and so he had come to the Northside Hospital Forsyth Neonatal Intensive Care Unit. Elijah had progressed well and was close to being able to go home, but there was one more test to pass: sitting in a car seat.
For a preemie, even the ordinary can be complicated, but Northside aimed to create a NICU armed for any situation. When it opened in 2008, there were 20 staff members. Today, it has 80, a menagerie of doctors and specialists and technicians and therapists. One wing of the NICU is devoted to preparing milk for babies with individualized “recipes.” It has its own pharmacy, too.
But the heartbeat of the operation are the registered nurses standing in the Northside patient rooms watching a baby sit in a car seat. If Elijah could go home, he had to be able to maintain his airway for an hour and a half.
“Sometimes when babies are born prematurely and small, they have a hard time maintaining their airway in a car seat,” Scott said, and so mom buckled Elijah in his seat and they waited.
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Scott has been at Northside for four years, but she grew up in Michigan. Scott’s uncle is an OBGYN. When Scott got to high school, she shadowed him on deliveries. The more and more she saw, the more she became interested in the babies.
During Scott’s last year of nursing school, she chose to do final residency in a NICU. “I wouldn’t do anything else,” Scott says. There were no available full-time positions in the NICU when she graduated, so she worked in an adult cardiac intensive care unit her first year. “I just had to go somewhere,” Scott says. The next year she moved into the NICU and hasn’t left.
“I always wanted to [work with] babies,” Scott says.
Elijah passed the car seat test, so his mom took him out, changed his diaper and fed him. Meanwhile, Scott went to the next room over and fed Elijah’s sister, Collins, sticking to her most basic responsibility in the NICU.
Scott conducts a little assessment of the three preemies in her care every three hours. She checks vital signs, changes diapers, feeds them with a bottle and repositions them, filling charts and taking mental notes along the way to inform the neonatologists and other specialists during their rounds.
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“It’s kind of being the eyes and ears of the doctors at the bedside,” said Nancy West, a 30-year NICU nurse who has spent the last eight at Forsyth.
Everything else is more complicated. One moment, a NICU nurse might put a catheter into the vein of a 500-gram baby, the next they might have that first conversation with parents who are just discovering the NICU exists, a blend of technical and personal roles needed to guide preemies and their families through a journey that is at first mysterious and almost always overwhelming.
“A lot of people don’t even know about NICU until you’re thrown into it,” said Kerri Jascomb, a nurse who joined Forsyth’s NICU just after it opened in 2008. “It can be a rollercoaster ride.”
West added, “You don’t go into the desire of being a parent thinking one day you’re going to end up with a 1-pound baby. It’s so out of anything they’ve ever heard or been familiar with.”
And so, while the nurses’ technical skills are crucial, their relationships with parents are just as vital. “They’re just looking for some warm voice,” West says. “Somebody that can hold their hand and say, ‘We’re here with you. We’re going to navigate this with you.’”
Sandra Grady, clinical manager of the NICU’s Special Care Nursery, added, “They’re the ones who are there at the bedside with mom and dad and family all the time. The doctor or practitioner may come in and speak with them briefly each day, but the nurse is gonna be there 12 hours at a time.”
The journey of each baby in the NICU is different. “Unfortunately, they’re not all easy-growers,” Jascomb says, and there is an emotional toll to bear. “We take a lot home with us,” Jascomb says. “We think about it. We dream about it. Taking showers the next morning and like, ‘Oh my gosh, did I do everything I could’ve done?’ It’s constantly on your mind.”
Those outcomes are less frequent. Most are like the baby Jascomb planned to see on a recent Saturday. When she was born at 25 weeks, she weighed 1 pound 1 ounce.
Eleven months later, Jascomb and a few of the other NICU nurses had been invited to the baby’s baptism.
“People don’t forget their NICU nurses,” Grady says.