September 30, 2019
By Sabrina Scarpa
*Beep, beep, beep*
It’s 4 p.m. when the alarm clock sounds and Tracey Jodzio, RN, BSN, who happens to be my mom, wakes up and begins preparing for her evening shift as a NICU nurse at Hackensack Meridian Health’s Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center. She quickly showers, preps dinner and hits the road.
Usually she hugs me and runs out the door with a quick, “I’ll see you in the morning,” but tonight I get to tag along and see her in action.
Arriving at the hospital, we head to the locker room where she puts on her uniform, a pair of royal blue scrubs. “Team members working in the NICU are provided with their own clean scrubs from the hospital,” Mom says “This eliminates the number of outside germs that can enter our unit.”
Once dressed, Mom heads to the conference room where she obtains her nightly assignment. The ratio of nurses to patients varies based on the acuity of the unit. Babies requiring intensive care are typically assigned one baby to one nurse. As their predicament improves, they receive intermediate care, which means three or four babies can be assigned to a single nurse.
Tonight, Mom is assigned two babies. She makes her way over to the bedside of her first patient, where she begins receiving reports from a day-shift nurse.
Together the two share a detailed report about each baby’s history, special care instructions and any issues that may have arisen during the previous shift.
“Giving and receiving a detailed report is crucial in the NICU,” she explains, “Leaving out one bit of information can be make or break for our premature babies. As the nurse taking care of this patient for the next 12 hours, I need to know if they’ve had any episodes or infection risk during the previous shift.”
They go into each patient’s room and confirm the baby’s information, IV fluids and insertion sites, discuss orders and verify endotracheal tube placement. The two of them complete their reporting process by co-signing a document confirming all the information discussed.
Not long after, evening rounds begin. A neonatologist and hospitalist visit each patient in the unit to review current orders and address any concerns.
The night continues and my mom begins her evening routine. Each baby has a schedule to follow for things like eating, bathing and receiving medication. As these tasks are completed, she updates the communication board in each patient’s room with the most current information. These status updates are useful to both staff and parents keeping an eye on the infant.
Once things settle down in the unit, I have time to ask her a few questions.
My first question, “Would you consider tonight a typical NICU shift?” receives a light chuckle.
She replies, “You’ve probably heard this before, but there’s no such thing as a ‘typical’ shift in nursing, especially the NICU. Most nights I take care of two or three babies, interact with their parents and assist other nurses as needed. But at any given moment, we could get a phone call that another baby is on its way into our unit and we won’t know how critical the situation is until we have the baby in front of our team.”
In the NICU, nurses often work as a team. They pride themselves on being supportive through thick and thin.
“Our goal is to provide optimal care for all of our patients. So sometimes that means helping other nurses who have busier assignments and relieving each other for breaks,” she explains, “Although I’m assigned only two or three babies each night, I’m actually responsible for making sure every baby in my area of the unit is cared for.”
As we wrap up this question, the parents of one of Mom’s patients stop in for a visit. She updates them on how their baby is doing and gives them some “alone time” as she heads over to her other patient.
This prompts my next question, “What advice do you have for families with a baby in the NICU?”
“We always encourage parents to take initiative to learn and be proactive because their development is different than a full-term baby,” she adds, “Simple things like holding your baby are done differently. New parents are encouraged to cup their hands around their baby to help them feel safe and comforted and speak softly to their newborn. As NICU nurses, it’s our job to educate parents what they can do to help their baby.”
Other suggestions she gave were to take time to learn how to feed, wash, and change your baby with a NICU nurse. Practicing these tasks and others while your baby is in the unit will help you feel more comfortable when it’s time to go home. For families with pets, she advises bringing a blanket home that smells like the baby, to familiarize them with the family’s new addition.
She adds, “Although my first job is to take care of the baby, I always make an effort to care for and provide support for the parents, as well.”
Having a child stay in the NICU can be emotionally draining for the entire family. The NICU at Joseph M. Sanzari Children’s Hospital offers free education and support programs for parents including support groups, craft activities and training seminars.
At this point, I’ve gained a sense of how demanding the NICU can be for both parents and the nurses. I ask, “Is there anything the nurses do to de-stress after a particularly difficult shift?”
“Yes,” Mom responds. “From time to time, you can find a bunch of us sharing breakfast at the Chit Chat diner in Hackensack. It’s a good way for us to wind down after a stressful night.
“We’ve also been hosting what we call ‘NICU Night Out,’” she adds, “where we attend a painting class or go out to dinner, which I think has definitely helped boost the morale of our staff.”
Talking about food has prompted us to take a quick break and make a pot of coffee in the break room.
“Coffee is an essential vitamin!” Mom jokes.
While staying up all night can be challenging, I imagine there are more difficult things about working in the NICU. So, I ask the obvious, “What would you say is the hardest part of your job?”
“There are two parts to answering that,” Mom says in prefacing her response. “First is probably more obvious, which is taking care of a baby for weeks and them not surviving. Most of our nurses spend 12-plus hours a day caring for these babies, and we want to see them thrive. It’s only natural that we get emotional when one of them doesn’t survive.
“There’ve been situations when I haven’t even taken care of a certain baby, and now I need to deliver bad news to the parents,” Mom says, continuing. “In emergencies we do our best to keep the baby alive so the parents can say goodbye.”
The other emotionally challenging aspect of working in the NICU is when one of the patients is doing really well and then faces setbacks.
“This happens somewhat regularly and it’s hard explaining to the parents why their baby is suddenly regressing and helping them cope with that,” Mom explains. “As you could imagine, you’ve spent at least three months in the NICU and you want to take your baby home. So anything delaying that can be difficult for parents to cope with.”
Mom begins her walk back down the long hospital corridor. As she makes her way over to her patient’s bedside, another nurse stops to ask her a question. It’s clear that some of the younger nurses look up to their more experienced colleagues with pride.
“All of our nurses rely on each other. It’s always good to have a second opinion or second set of eyes look over something before it turns into a problem,” Mom says. “No matter how experienced you are, never feel insecure about asking a coworker if you’re unsure of something you need to do. I’ve been working in the NICU for 27 years and I still ask plenty of questions!”
Mom walks over to her computer to check the time of her next feeding. She goes on to talk about one of the biggest changes in the unit that often requires collaboration: technology. Pretty much every task in the NICU is paperless.
“For years, we’ve been charting on computers, but sometimes the seasoned nurses, like myself, have to ask the younger nurses computer-related questions,” she admits.
“Don’t think that the shoe hasn’t been on the other foot though!” she adds. “Once, I was working and technology went down for an extended amount of time. So we wound up teaching the younger nurses how to do traditional paper charting.”
“The bottom line is our nurses are supportive of each other when we have a lack of knowledge in an area that someone else might be more experienced,” Mom says.
And with this statement, I’m reminded that it all comes back to being part of a team.
In the patient’s room, Mom starts prepping new bedding. While she does this, she talks to the baby in a gentle voice; complimenting her on how adorable she is and kindly asking her to “eat well for nurse Tracey tonight.” It’s clear in this moment how much she enjoys and appreciates her nursing career.
Another nurse comes in to assist in changing the bedding. Watching the two nurses work together is like watching a machine move. There’s a system to how they work—deftly handling the baby amid the many tubes and wires.
Once things have settled, Mom praises the baby for being so well-behaved during the process. And without prompting, she expresses gratitude for the rewards of her work. “I’m so fortunate that I always get to work with these small miracles,” she says. “No matter how small they are, they are perfect in so many ways.
“Everyone always thinks the worst when their baby goes to the NICU, but babies at all different stages can come here,” Mom adds. “It doesn’t always have to be a sad situation. In the end, most babies do well and go home.”
Inspired by her statements, I ask her to tell me the most rewarding part of working in the NICU.
“The milestones,” she replies. “Almost every day these babies achieve something worth celebrating.”
Mom continues, talking about how the unit hosts an annual Neofest, where graduates of the unit come back and the nurses see how well they’re doing.
“We also have a lot of families send us photos around the holidays thanking us and reminding us how much we’ll always be a part of their families,” she says.
The dayshift nurses arrive to receive report of the last evening’s happenings. Just as they did when Mom and I arrived last night, she and her replacement go over the details of each patient.
She then heads to the locker room and changes into her street clothes before getting in the car and driving home.
Upon arrival, she eats breakfast and lies down for a nap.
“If you’re still here later, can you make sure I’m up at 4?” Mom asks wearily. Thanks.” She then dozes off.
And after spending a night with NICU nurses, it’s clear to me how utterly exhausting and rewarding their job is.