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Sunday, April 15, 2012

Handling the NICU Staff

At fist this might seem like a non issue. Everyone knows what they are doing, they are trained medical professionals, why would this become an issue at all?

Its true that they are trained medical professionals, and that they have dedicated their careers to helping babies and families. I am forever grateful for their expertise that saved my boys life and have given us the experiences we have today.

However as a parent, it took me a while to realise that the situation takes handling. As I said in my first post, at first I just wanted to agree with them and make their life as easy as possible. I thought their goals (my babies good health) is my goal so why get in their way?

Where it takes management is in the information and the details. Firstly, getting consistent information with so many health care providers is very difficult… we had 8 neonatologists who were on shift rotation, and maybe 20 different nurses also on shifts. Add to that the pediatric ophthalmologists, endocrinologist, cardiologist, and it’s a bewildering array of information about our son from different sources.

As things progressed, we were more and more involved in having information about what was happening. But the doctors would often have quite conflicting styles of communicating information and often quite vague responses which didn’t fill me with much confidence. For example, my son had Retinopathy of Prematurity (ROP) which is very common among premature babies. The ophthalmologists told us controlling levels of oxygenation in the blood is very important. A day later our baby was having wild fluctuations in oxygenation levels and we asked the doctor on shift about its relevance to the progression of ROP and he gave us a very vague “oh we are monitoring the situation” type response. I had to push (referencing some of the literature available) for a more detailed response, and the doctor didn’t look too happy about me questioning on this line.

In summary: Surprise! Doctors are people too and they all behave, communicate, and react differently and learning to manage them as individuals is very useful.

In terms of managing information we started writing it down. I used a format like:


This leads me to the details. Some of the doctors were hardly ever with the baby. In fact we wouldn’t see them at all unless we asked the nurses to see them. If you decide to spend a lot of time with your baby you get to know the ins and outs, and you will notice details the nurses and doctors simply won’t (but probably should). For example, I quickly learnt that when my son was red, with a high heart rate and high respiration, he was probably too hot inside the incubator.

The next time it happened there was no doctor with us, and the nurse gave me another vague response of “no its to do with his medications”. I bought that for 15 minutes till I could see my sons behavior was not what it normally is, he looked distressed and his stats were all over the place. I called for the doctor who had quite an angry conversation with the nurse about why she didn’t check the temperature. He ordered hydration for my son and the temperature in the incubator to be lowered.

This is just one example of the way small details can be missed and can impact on the care of your child in the NICU. Don’t be afraid to ask about them, trust your intuition and ask for the nurses and doctors to actually look, check and verify that everything is OK.

I don't want to be down on the staff, they do an amazing job, deal with really difficult situations and families of all sorts in their darkest hours. And I would say 99% of the time I was really happy with the staff.

1 comment:

  1. I'm a bit concerned about them missing small details as you said. Do situations like that happen a lot? I think you did a good job handling them though.

    Something to consider, what is the doctor&nurse-to-patient ratio? I know that doctors and nurses deal with a lot of patients over the course over the day, but having too many patients would of course make it easier for them to get distracted and miss out on small things (which do have some potential big impact on your child). Might be something that the hospital might want to check, too!