Monday, July 2, 2007

NICU from the Nurse's Perspective - When Everything Changes in an Instant

Before the Wave CrashesThis is how it is [in the NICU]...
Everything changes in an instant.

Joni McGovern

12 year NICU Nurse
UCSF's Intensive Care Nursery

This quote sums up life for the NICU Nurse and for the NICU one minute you are going along with a normal pregnancy and the next you are in the NICU.

NICU Nurses - Providing Special Care
Chris Colin, author of the On the Job series published for the San Francisco Chronicle, emailed me about an article he had published today. It is a profile on the life of several NICU nurses from UCSF's ICN (Intensive Care Nursery) - located at the very top of the hospital on the legendary 15th floor, home to 50 tiny beds.

As any NICU Parent can tell you, NICU nurses are a very special 'breed' of nurses. We discovered this to be true in our daughter's case. To quote the article,
A [NICU] nurse can fight desperately to save the most fragile human life, and indeed do so for the time being, but turn right around and understand that resuscitation might not be the right decision when the next crisis comes.
It takes a very special medical professional to understand that "resuscitation might not be the right decision when the next crisis comes."

Understanding that Saving a Life isn't always the Best Option

Quality of life was a big issue that I dealt with as a physician caring for older patients with chronic illness, for hospice patients and for those at the end of life. Quality of life is now a major ethical dilemma in the NICU at the beginning of life.

The number of premature births has increased along with the technology to keep younger and younger babies alive. Another of the NICU nurses, interviewed noted:

Some babies aren't meant to live, and it's ultimately a good thing that they don't.
Melitta Hernandez
8 year NICU Nurse
UCSF's Intensive Care Nursery

The ethical dilemma facing neonatology (study of newborns) is that with the technology and the increased number of babies surviving the first few months means there are more children now facing "a lifetime of disability, stunted development or other health issues." So there are times when in the NICU "resuscitation might not be the right decision..." Of course these words may not be comforting to the NICU parents of the tiny premature child.

I don't know if anyone knows the right answer to this unhappy dilemma. Obviously much depends on your perspective...if you are the NICU parent or the CEO of a health care company providing medical insurance.

More Readings:
Carter BS. 2006. Ethical Issues in Neonatal Care. eMedicine.

Colin C. ON THE JOB: Saving babies: It's not a TV show but these nurses' jobs actually are life-or-death. SF Gate. July 2, 2007. Available at:

Photo Source:
Kumar Murukan. Just before. Royalty Free Use.

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1 comment:


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