preemiesxo

How in the world did I end up here?

Long, long ago (March 1981....I am smiling as I write that), I took a job on a rehabilitation floor of a local hospital.  Most of the patients were post-head injury or stroke.  I was a senior in high school, let out at noon everyday to pursue a job in my intended field.  Working as a nurse assistant on that floor was an eye-opening experience, to say the least.  I worked there until it was time to start nursing school in August.  I grew up a lot that summer.  My friends were spending the summer planning lake and concert trips, I spent my evenings feeding paralyzed patients and planning bowel and bladder training schedules.  I learned how precious life is and how quickly it can be changed forever (and to wear my seatbelt).  I watched as those hard-working nurses and orderlies lovingly cared for each and every patient.  Many of them could not communicate their needs or wishes, but you could see it in their eyes, they appreciated us.  Evening backrubs were a bedtime ritual for every patient, it took me hours, and I wasn't really happy at first at having to do that job.   But over time I realized how important that small gesture was to them.  For some, it was the only positive human touch they received after a day of therapy, IV sticks and phlebotomy.   I stood in the background as I witnessed two "code blue" events and saw those heroic nurses bring two people back to life.  I was amazed later when the patients would ask, "what happened?" and would reach to hold the hands that had done CPR on them just days before.  It was impossible not to become attached to the patients that were there for months at a time.  I treasure those memories, I think those events helped mold the nurse I am today.

As nursing school began, it was impossible to work evenings, so I became a weekend PCA.  I often worked on the maternal child unit and found a new love.  I enjoyed the work immediately.  There was such joy on that unit, and there is no better feeling than bringing a new mother her baby and helping with the first feeding or bath.  It was undoubtedly the happiest place in the hospital.  I continued there for the next three years while I earned my RN diploma.

Now graduation was just weeks away, and all the graduate nurses were placing applications for positions in the hospital.  When I started nursing school, just three years before, the hospital was offering $2,000 sign-on bonuses and begging the graduates to stay there.  Now, the climate had changed.  There was no longer a nursing shortage.  As I was interviewed I was told that the hospital only had a few openings, and I would be hired only because I had already worked there as a PCA through school.  I would not be given my choice of positions, I would take whatever was available. I later found out that only one-third of our class was offered jobs.   I really wanted to work in the unit where I currently worked, but the only opening in maternal/child was a night shift opening in the newborn nursery.  As I accepted that position, I also placed a transfer request to get to postpartum as soon as possible.

The night shift nursery position proved to be challenging for a new grad. It challenged my organizational abilities, but not really my nursing abilities.  We worked 8-hour shifts, every other weekend, so to get two days off together, we had to work 7 days in a row.  The nursery was set up as three small nurseries, overseen by one RN, working with one PCA in each nursery.  We had up to 40 babies at a time in those three nurseries.  The RN (GN in my case) was supervising the PCA's as they took vitals, did feedings and transported babies to and from the mothers' rooms. The RN had very little hands-on care, as we had 40 paper charts to open, chart on and close every night.  The only time I really had patient interaction was if the PCA heard a murmur, I would have to confirm it before I charted it, and on admissions, the RN would do the first physical assessment.    After a couple of months of this, I was feeling a little out of touch with my nursing preparations, I hadn't given a shot, started an IV or done anything really "nurse-worthy" since I graduated.  I was a little disappointed. I asked about my transfer, and was told, "not yet, no openings there yet". 

One night I was sitting at the desk with a pile of charts in front of me.  A routine Saturday night, around 1am, I was trying to get these charts opened so I could run to the cafeteria and grab something to eat.  The PCA's were busy transporting babies out for the 1 o'clock feeding and the door between the nursery and postpartum was left open slightly.  From out on the floor, I hear screaming.  A woman's voice is screaming, "@#$%, HELP, @#$%, HELP!"  I relunctantly leave my nurseries unattended to go toward the voice.  I walk into a dark room and flip on the lights.  There, standing in the middle of her hospital bed, is a new Mom, in her hospital gown, screaming and crying.  "I dropped him".  I look into the corner of the room and see her little bundle of joy, on the floor between the bassinette and her overbed table.  She had been trying to place her baby into the crib and it had rolled away from her. Her baby had landed on the foot of the overbed table.  I reached for him, he was crying quietly.  I ran my hand over the back of his head and there is a deep dent.  I reached for the panic button in her room, activated it to get her help, told her to sit down and I told her, "I am taking him back to the nursery.  I'll be back as soon as I know anything."

The next two hours I got to be a nurse.  A head to toe assessment revealed a deep skull fracture, but no other injuries, and the baby was acting fine.  Multiple calls to the pediatrician, neonatologist, lab, xray and supervisors, led to a paper chart with this entry becoming about ten pages in length.  Incident reports filled out on carbons, another ten pages.  A transfer to the NICU followed by hours of comforting this mother, who filled with grief and guilt, found it impossible to calm down and believe her baby was going to be okay.  But he was, and he went home with her two days later.  Wow, what a night.  I was sorry that such a thing had happened, but it confirmed that I was prepared to be a nurse, not just a babysitter. 

The next night I came to work, it was Sunday, the last in my long stretch.  I was so looking forward to a couple of nights off.  There was a note in my mailbox.  It said, "Report to the supervisor's office as soon as you clock off Monday morning".  Oh, great!  I'm getting fired in the morning.  I'm getting fired even before I get my state board results back.  Great!!  As I relay this information to my husband, on the phone, he says, "but that wasn't your fault, why would they fire you?'  He doesn't understand, when you are in charge of the nursery, everything that happens is your responsibility.  And a meeting in the supervisor's office......wonderful.  She is great at her job and her enormous responsibilities, but not really a warm, fuzzy people-person.  More of a military style form of leadership.  I had never felt comfort or approval from her. 

So, at 7am I clocked off and made my way to the supervisor's office.  She welcomed me by saying, "Come in, I'm sure you know why you are here.  We need to talk about your incident."  Her desk was  clear, except for a pile of papers that I recognized as my paper chart and incident reports.  My intuition was correct, she called it "MY incident", it had become "MY incident."

She began by saying, "okay, tell me what happened."  I was a 20 year old graduate nurse, not even an RN yet, still feeling a little sarcastic toward authority, and I wanted to say, "you have 20 pages in front of you that tell you what happened, do I really have to go through it again?".  But I didn't, I went through the whole story again.  She listened, nodded a few times and stared at me.  When she finally spoke, she said, "I am transferring you."  Fine, I'm getting a transfer, you can bet, it wasn't the transfer I had asked for.  No of course not.  Does this hospital also have a hospital in Siberia, is that my punishment?  Sorry, as I mentioned, I am still fighting the sarcastic "me".  I had received the "Leadership Award" when I graduated from nursing school.  My family told me at the time that it really meant that I was the most stubborn student they had.  I knew they were right. 

"I'm transferring you to NICU.  I know it's not the transfer you asked for, but give it a try for a while.  If you still want postpartum when an opening comes up, I will move you into it then."  NICU?  NICU? oh, God, not NICU.....Baby HELL.  I had spent two days in there during nursing school, two horrible heart-wrenching days.  There is no way I want to work in NICU, never, never, never.  But, I smiled, said to myself, "Meredith, you're not getting fired,"  and told my supervisor, "thank you" and left.  I cried in the car all the way home.  When I got home, my husband said, "so, did you get fired?"  I said, "No, worse, I got transferred to NICU.........."

This did not fit into my "master plan".  This was not going to work.  I would keep my transfer request in place and be out of there as soon as possible.  I had not learned to trust the insight of others.  I had no idea what was about to happen.

I began orientation in NICU.  By my second week, I found that I was  falling  in love with those preemies, and I was enjoying getting to use the nursing education that had sat idle for months while in the newborn nursery.  I began to feel like a real nurse, and still got to see some happy times.  More good days than bad, in the hospital, that really means something.  Months later, that transfer bacame available.  When I spoke to my supervisor, to decline it, I asked her, "How did you know?"  She told me that she had poured over my charts and reports from that night, and knew that I didn't belong in the well baby nursery, "I have never seen charting like that come from a NBN nurse, I needed to put you where we could see your potential."  She had seen something in me that I didn't know was there.  Thank God she did.  My "master plan" was shot all to heck, I have had to learn to trust, and have faith that doors open for a reason. It was a hard lesson for me, but I finally know where I belong.  I've been a NICU nurse for almost 30 years.

"N" is for knitting?......no, it's for NICU knitting!

I am a registered nurse, with the most precious job in the world, for almost 30 years.  I started out as a staff nurse in a NICU, then joined the Neonatal Transport Team, moved into a management position for 8 years, then on to education for 8 years.  I have loved every aspect of my career and it was been a wonderful experience, affording me uncountable opportunities for learning and personal growth.  After 26 years in the field, I made a very difficult personal decision.  I decided to go back to NICU as a staff nurse.  The decision was difficult because I loved teaching, but my first and most true love was working bedside in the NICU.  So, I went "home" to hopefully finish my career the same way I started it:  taking care of premature babies and their families.

All through my career there have been ups and downs in NICU, as I assume there are in all units.  As the assistant nurse manager in NICU it was part of my job to address those issues. Then as an educator I often felt it was my job to "fix" those issues.  There are countless hours spent listening, teaching, brainstorming to the root of those issues and seeking solutions. I'm sure nursing will always face this perpetual process.

When I came back to the unit as a staff nurse, the NICU was experiencing one of the "downs".  Not only in census but especially in morale.  The low census meant the staff nurses were floating to work outside their home unit, and taking many mandatory days off (for many employees that meant time off without pay or using their precious vacation/ETO time just to have a paycheck).  For the first time in over 16 years I began to fit into this group of women as a peer, not as management.  The level of discontent alarmed me.  As I sat at the lunch table in the back room of NICU I listened to frustrated co-workers spending their 30 minute break time expressing their feelings.  Many lunch times felt like gripe sessions.  It was no break at all.  Once I said, "Hey, you guys, we're on break.  Let's talk about something else."  You can imagine the looks I got.  I shared many of the same feelings but I was not interested in spending all my break time, everyday, talking about it.  So, I started bringing my knitting to work. 

I was working on a project that was easily picked up and put down, so I would rush through my food and spend the rest of my break time knitting.  A couple of co-workers noticed immediately and expressed an interest in learning to knit.  We made a shopping list and they got their supplies and I taught a few of them how to knit that very first week.  Then they started bringing their knitting to work.  People started to notice that they were no longer griping about work, they were showing each other their knitting, they were comparing stitches and their progress, they were sharing patterns and books they had found.

One day I was working NICU and caring for my primary baby, a tiny preemie.  Next to her in her bed lay a knitted hat that had been made by volunteers and donated to the nursery.  It was brown and tan yarn.  We appreciate the contribution volunteers make to our unit, their time and talents used so unselfishly to provide items for the babies.  But, this sweet baby was a beautiful two-pound girly girl.  I asked her mom, "Are you attached to that hat?"  She smiled and said, "Are you kidding?"  I told her, "I think this girl needs PINK!"  Mom agreed.  That evening I stopped and purchased the most beautiful, soft pale pink yarn I could find.  A couple of days later I presented my primary baby and her mommy a beautiful hand-knitted hat, soft as butter, that would fit a small lemon.  Mom took it from me, turned it over and over in her hands, and started to cry.  She said, "It's tiny."  We put it on her baby, it fit her perfectly.  She hugged me and still crying, she said, "She's never going to outgrow this, is she?"  Her baby was having ups and downs too, she was still on the ventilator, on almost maximum support, on antibiotics, IV's (PIC line) and continuous feedings--still on the critical list. 

I was surprised by her reaction.  I answered her, "Of course, she will outgrow this, we will look forward to her outgrowing this."  Mom said, "Meredith, do you really believe that?"  I said, "Yes, I do."  I went home that night and could not get that conversation to stop playing in my mind.  I knew what I had to do.  The next day I worked I gave mom another hat, "one to grow into".  It was the exact same yarn and stitches, just bigger, 3-6 month size.  Again, hugs and tears from Mom.  And she told me something that day that I will never forget.  She said, "Meredith, this hat gives me hope."  She rolled it up and tucked it into the nest that was holding her daughter. The baby wrapped her arms around it and we noticed her tiny hands feeling the softness of it.  I have a picture of this micro-preemie, nested in her bed, intubated and connected to tubes and wires, wearing her tiny hat and hugging her "to grow into" hat. 

A few weeks later, this little sweetheart got NEC.  Necrotizing entercolitis is a dreaded diagnosis in the NICU.  She got transferred to another hospital for surgery.  Her mom called us every few weeks to tell us how she was doing.  When she was 4 months old we got word that she was being transferred back to our hospital.  She would be admitted to the pediatric floor for the rest of her recovery time.  She had never been home.  The day she arrived, her mom called me to tell me they were there.  As soon as my shift was over, I ran to see them.  As I opened the door, I saw her, in a pediatric crib, still on nasal cannula oxygen, a PIC line and colostomy, wearing her "Big Girl" pink hat.  Her mom was smiling ear-to-ear.  She said, "Look, she DID grow into it!  Do you want to hold her?"  Silly question!!!

From that moment on, I knew, I would never again knit just one hat, they must come in pairs for these tiny people.  One for now, and one to grow into.  I shared this with my now-knitting friends in NICU and pairs of hats began to show up in NICU beds.  Primary nurses are knitting for their primary babies, and the parents love it. Each family has enjoyed taking photos of them in their hats and have sent me pictures of them later wearing their big hats. 

The knitting nurses began needing more attention than break time would afford, so we started meeting at a local yarn shop once a month and knitting together.  Most of the time is spent getting new knitters started and fixing problem stitches.  We spend time there picking out our next project, getting them started and dreaming about what we want to make "someday".  Conversations would drift from knitting to family, babies and life.  Very little work-gripe talk, what a big change from just a few months ago.

I have arrived at work many times, 0630, standing at the desk waiting for assignments, and nurses are arriving and greeting each other with, "I couldn't wait to get here to show you how much I got done", "look what I am working on" and "oh, no, what did I do, can you fix it?"  Yes, I said that nurses actually have said, "I couldn't wait to get to work........".   I have never heard that out of nurses, for any reason.  If you had asked me "what can we do to raise morale in NICU?"  I would have said, "I don't have a clue."  If I had said, "I'm going to teach them to knit", you (and I) would have thought "what a crazy idea."  A crazy, powerful, simple idea.  It wasn't my idea, it just happened, but the results are awesome.

To date, I have taught over 60 people how to knit.  Nurses, respiratory therapists, mothers of patients and friends are knitting, smiling and sharing.  Knitting won't fix everything in the world, but for us, it's a start.

He is one of the sweetest things I've ever seen. Not just because he is tiny and perfect, but he is just sweet, naturally patient and wise, born at 12 ounces. A wisdom in his eyes that told us that he understood all the things we had to do to him, for him, but mostly to him. He endured it and looked at us as if to say, "I know."
I was one of his primary nurses. I got to take care of him on very important days during those 7 weeks. I was there for his first bath, and I was there the day his eyes opened. I carefully placed him in her arms the first time she held him. We gently put him next to her and he knew the sound of her heartbeat. He settled in and stayed there a long time. He was kept warm by her bodyheat and a little knitted hat that I had made especially for him. It was soft wool, in a precious blue-green color. It fit him perfectly and he wore it many times.
That day I clocked in and walked through the nursery. It seemed quiet; people were quiet. His bed was empty and his belongings were packed into pink plastic bags. I looked for the night charge nurse and she immediately explained, "He got sick through the night, quickly and unexpectedly. We transferred him out at 0600." He was taken across town to a hospital who employed a pediatric surgeon. Mom and Dad had been here with him and were with him now. The doctor had ridden in the ambulance with him, something I had not seen in over 10 years. The situation was rushed, and critical. I had missed him by 30 minutes.
When the doctor returned I asked about him. She gave me the details of the night and how there was no choice but for him to go where surgery would be an option. I was sad that it was no longer an option here, where we knew him, and more importantly, where he knew us. Ten years before it had been an option: very few last minute transfers. I had trained in a full-service intensive care nursery, but now surgical services were across town, with strangers.
The doctor told me that they hadn't stopped to pack his belongings, but she saw Mom take one thing out of his bed. His little knitted hat was clutched in her hand as they rushed him out to a waiting ambulance.
It was late afternoon and we hadn't heard an update. I sat wondering about him as I fed another baby. I looked up and saw Mom through the glass door. The look on her face hit me like a punch in the stomach. A look that one mother recognizes on another and a look that a 25-year NICU nurse has seen too often.
I touched the big silver button and the glass door disappeared from between us. All I could do is hug her. After a long time she said, "He didn't make it. They did everything they could, and they were really good to us, but it wasn't "home"." The only home he had ever known was here with us, but he had to spend his last 6 hours of life in the company of strangers, loving caring strangers, but new faces, away from home.
Each time I encounter this situation I have a flash-back to nursing school. My instructors were very strict, reminding us to "be professional" which we all knew meant "don't cry".
Well, he was one of the sweetest things on Earth, and it was perfectly professional to cry.
Over the next several months I thought of him often. I reflected on how practice had changed where I was working and about how many families were starting their experiences with us, then for one reason or another would need to be transferred for services not offered here. I was sad for them; such difficulty added to an already difficult situation. I was sad for us; we wanted to keep them here, to care for them at "home". But the situation was unlikely to change anytime soon. Budgets and administrative decisions had left families with no choice but to travel during a crisis like this.
One year, to the day, after his transfer, and 28 years after beginning my career, I started a new job; across town, with the strangers.