The Reality of the NICU From a Nurse's Perspective
People ask me all the time about what it’s like in the NICU (neonatal intensive care unit). They say, “It must be so hard,” “It must be so scary.” And that’s true, to some degree. It is hard, and it can be scary at times. And it’s so much more. The truth is that the NICU is an intense, beautiful, complicated world. There is a vast assortment of reasons for babies to be in the NICU. Some families know in advance they’ll need the care of the NICU, but for a lot of families, it’s a stressful, unexpected experience.
When I try to describe what the NICU is like, based on my experience as a NICU nurse, it usually goes something like this:
The NICU is hard. No doubt about it, it’s hard. It’s hard to see babies separated from their moms and dads. It’s hard to see families worried — terribly worried — about their babies. It’s hard to see parents trying to understand complex medical diagnoses and having to make impossible choices.
Some experiences can be wonderful. Seeing a baby grow from a fragile, delicate 1-pound baby to 2 pounds, and then 3 pounds, before your eyes is incredible. To see a 9-pound baby who was covered with tubes and wires, sick, medicated, alone in the crib… to see those tubes and wires go away over time, and in their place finding parents snuggling them, it’s fantastic. To see families adapting to meet the needs of their babies, and see them gain confidence as they learn and grow, is lovely. And to see the postcards and holiday cards showcasing strong little former-NICU patients starting kindergarden, graduating college, raising their own families? Absolutely beautiful.
The NICU is scary. NICUs are filled with equipment so big — for patients so tiny — that you can’t even see the babies through it all. Blue lights and plexiglass incubators, resuscitation bags and IVs and monitors at every bedside. You have to sterilize yourself before entering, and it looks like nowhere you’ve been before. Many NICUs try to make it cheerful with cute prints and happy colors, but it’s basically filled with so many complex machines and un-baby-like equipment that it can be intimidating to the newcomer. But if you stop by each bed, look past the equipment and look past the diagnosis, you’ll meet a unique and beautiful new baby with a personality all their own. Look around at the brand-new families — loving parents, siblings, grandparents — doing everything they can to trust and learn and love under such intensity. It warms your heart. The tiniest footprints, and the most precious baby smiles, all reside here.
The NICU is noisy. Equipment running 24/7, bubbling, beeping, crying babies. Nurses discussing. Doctors and therapists consulting. Alarms. The never-ending beeps and bings of alarms. It takes years to get used to the NICU noises, so while we nurses are pretty immune to it, newcomers find it overwhelming. And remember this — while chatter and background noise can be annoying, sometimes the alarm ringing means a baby has stopped breathing. When it means that a crew of medical staff need to rush in and save a baby, it’s more than noisy. It’s truly stressful, it’s overwhelming. But all of the babies are getting incredible care with remarkable technology. The noises and chaos are part of the process of saving lives.
The NICU is heartbreaking. It’s literally about life and death. Some babies there are relatively healthy and may need a small amount of extra care before going home, and yet some babies, just a few feet away, need much more care. It’s a unique environment where celebration and grief may be happening side by side. It’s a kind of tension unlike any other. Unfortunately, sometimes babies die. Nobody should ever have to experience this. Nobody. Ever. But it happens here, and what are the right words to describe it? Devastating. Crushing. Profound grief. Impossible sadness. Unbearable. It’s so hard to have to be the place of such sadness.
But the NICU is also about people coming together — families, nurses, doctors, therapists and so many more — devoting themselves to the care and well-being of our future generations and of each other. Step back and see the hugs, the smiles, the shared tears, the whispered prayers, the gratitude, and the hope. We all are doing everything we can to make a healthy and happy future for these sweet babies. It’s good work, and as hard as it is, it’s a loving place filled with hope and devotion.
It’s overwhelming. It’s all of the real world condensed into one small microcosm — babies and families, life and death, rich and poor, celebrations and grief, good and bad, joy and sadness. Everyone is profoundly changed by the experience. I’ve been working in NICUs for my entire nursing career, and I can’t imagine any kind of nursing I would rather do. I have never experienced the NICU as a parent, but I am a parent and as such I can appreciate the staggering intensity of parenting in the NICU. I am humbled every day as I witness families come through our scary doors into this weird and intense environment, and they do it for love. They do their very best, and they become participants in this journey because of love.
To NICU parents — my hat’s off to you. I’m honored to support you along the way, and no matter how you handle it, I understand the enormity of the struggle and appreciate that you’re doing your best in the hardest of experiences.
What would you add? What is the reality of the NICU to you?
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