First things first. There is no such thing as a typical day! Although our work revolves around premature and sick newborn babies and their families, no two days are ever the same.
The Special Care Baby Unit is officially funded to care for nine babies including one intensive care cot. However it has the capacity for fifteen babies and it is no longer unusual to have near enough that number and on some occasions even more.
The day begins bright and early at 7o’clock in the morning. Ahead of us is a twelve and a half hour shift, and at this early hour there is often very little to warn us of what may come our way. We have 14 babies already and there are plans afoot to deliver 34 week gestation twins. There are two Sisters, one Bank Staff Nurse and a first year Student Nurse on duty. As I am ‘second on’ (a strange term referring to the second most senior nurse who holds the neonatal intensive care qualification) I am allocated the sickest babies in the hot nursery (another unofficial term referring to the ITU/High Dependency room) plus twins in the cold nursery and a baby nearing discharge who is resident with his mother in one of our parent’s bedrooms.
The rest of the babies in the ‘cold’ nursery (it’s not really cold, normally a balmy 24oC, but just a bit cooler than the hot nursery!) and single rooms are allocated to the sister in charge and the ‘third on’ nurse. It gets a bit trickier and a bit harder on the feet when we are also using our single rooms and isolation cubicles!
Once we’ve taken handover (a nursing update of the baby’s progress throughout the night) it’s time to check all our safety and resuscitation equipment. Just like Accident and Emergency we often have very little warning of admissions so we have to be prepared for the unexpected. Because of the planned delivery of the 34 week twins, we shuffle a few cots and incubators around to accommodate them in the hot nursery.
During the morning the daily ward round is carried out, during this time are babies will be examined and discussed by the medical and nursing team. It’s an ideal opportunity not only to make plans for the day but also for the longer term. We try to work towards discharge right from admission so that by the time the day arrives parents are confident and well prepared.
As well as caring for the babies we all have a role to play in the running of the Unit, so interdispersed between ventilator / CPAP care, nasogastric feeds, bottle feeds, nappy changes, phototherapy, drugs, observations etc, we can be found cleaning and checking equipment, carrying out audits, stocking up and often the most difficult task; trying to ensure we have enough staff to cover shifts. It has been highlighted recently by the national press that there is an acute shortage of Neonatal Nurses and unfortunately we too are affected by this. It is not unusual to spend a whole shift making phone calls or juggling off duty in order that we can provide good quality nursing care. Today is no exception; one of my babies needs to go to Great Ormond Street Hospital tomorrow and because it’s such late notice the Neonatal Transport Service is unable to help us. I spend an half an hour on the phone to the London Ambulance Service arranging transport and then even more time trying, unsuccessfully, to find a nurse to escort the baby. In the end the Sister I am working with volunteers to come in on her day off.
By 12o’clock the expected twins have still not appeared, on contacting Labour Ward it appears that they have delayed the delivery as a lady expecting 35 week twins is in labour and could deliver imminently. It would be extremely difficult to accommodate 18 babies so some serious rethinking needs to be done by Labour Ward!
As well as caring for the babies already on the unit, we provide support to the post natal ward. Babies requiring interventions such as intravenous antibiotics, blood pressure or oxygen saturation recordings all come to Special Care. We may also be called to Labour Ward if a premature baby is to be delivered or if a term baby is having problems at delivery. Fortunately our services are not required today.
Caring for parents is a large part of our work. A lot of our parents are ‘first timers’ and hence not only need help with all the basics like nappy changing and bathing, but also support whilst they cope with having a baby in Special Care. It can be quite daunting arriving on Special Care for the first time and seeing your baby surrounded by a sea of wires and bleeping monitors, not quite what they had envisaged parenthood to be. I spend some time with a resident mum who is nearing discharge after her son has spent 8 weeks in Special Care after being born at 29 weeks gestation weighing 1.074kg (2lbs 6oz). She is obviously excited about finally going home but also anxious and has a lot of questions for me to answer. Then it’s back to the hot nursery to update the parents of a 3 day old baby girl born at 32 weeks weighing 1.85kg (4lbs 1oz). She’s doing well; she is mildly jaundiced and is receiving phototherapy treatment but is beginning to tolerate increasing amounts of milk feeds so her intravenous fluids are being slowly reduced. They are pleased that she is doing well but are still nervous to handle her. Soon after this parents of another baby arrive. She was born at 28 weeks gestation weighing 1.310kg (2lbs 8oz). She is 2 weeks old now and has required support with her breathing since birth but is gradually being weaned off of CPAP (Continuous Positive Airways Pressure Ventilation). They are keen to be involved as much as possible so as soon as they arrive, the dirty nappy duty is handed over to them!
Today we have a first year Student Nurse on the Unit. We have to help her plan her day, supervise the care she gives and evaluate her performance.
She is keen to learn and to make the most of her time on Special Care. We spend some time talking through the histories of some of the babies and discuss some of the common problems premature babies may encounter.
Babies are not only admitted from our Maternity Unit but also some other hospitals. We are contacted by staff from the Neonatal Unit at the Chelsea and Westminster Hospital who are keen for us to take back a baby that was sent there for intensive care. Unfortunately we are unable to accept the baby today so they are advised to try again tomorrow.
As the shift draws to an end there is still no sign of either set of twins arriving soon, but there is still plenty of work to be done. A nursing evaluation has to be documented in each set of notes and SEND (South East Neonatal Data Project) has to be completed. It’s been a busy day but one in which I achieved everything I wanted to. It’s nearing 7pm and it’s all about to start again for the next shift!