A day in the life of a Neonatal Critical Care Nurse

Ebony Blewer joined Mater Hospital Brisbane’s Neonatal Critical Care Unit (NCCU) team almost four years ago.

She works across two different roles in the NCCU — registered nurse in the Preterm and Medical Intensive Care and trainee neonatal Clinical Nurse Consultant (CNC).

As part of the CNC team, Ebony works across the unit to provide support and guidance to all members of the NCCU. This may include providing an expert opinion for different aspects of patient care, reviewing and developing policies, leading research projects, collaborating with other neonatal units to achieve best practice goals and facilitating developmental care rounds. The NCCU team also work closely with the Mater’s Maternal Fetal Medicine team by providing support and antenatal counselling to families whose baby may require intensive care at birth. The support for these families continues upon admission to the NCCU and up until discharge to ensure that their journey is as smooth as possible.

With 79 cots in the NCCU, including intensive care and special care cots — the unit cares for babies with congenital heart disease, anomalies requiring surgery, the spectrum of prematurity and a number of other medical conditions — Ebony never knows what her day has in store.

“The babies within our care can be very unwell, meaning that their needs and the level of care they require constantly changes,” she said.

04:30: I tend to wake up at 4:30 am before a 12-hour day shift to get to a CrossFit (gym) class at 5:00 am.

05:00: My gym class kicks off and I stay at the gym afterwards to shower and eat breakfast. I believe breakfast is the most important meal of the day when you’re a nurse because you never quite know when you’re going to have your first break. I usually have yoghurt, muesli or fruit!

06.00: I jump in my car and drive to work.

06:35: The first thing I do when I arrive at the NCCU is check my patient allocation for the day. I usually care for two babies each shift; however, this can change depending on the level of care required and their anticipated needs. If a baby is considered more unstable or critical, I will care for just one baby for the entire shift. I could be caring for a baby as small as 400 g and as young as 23 weeks gestation. The team leaders try really hard to allocate nurses with babies that they have previously cared for to ensure continuity of care. Having continuity can be safer and easier for patients and their families as you start to become a familiar face along their NCCU journey. Sometimes, I will also be allocated the role of the Code Nurse for the shift, which means I carry the emergency code pagers, attend high-risk births and provide support to colleagues.

06:45: The oncoming day shift team meets for a ‘shift huddle’. This is something that is done prior to the commencement of every shift. I use this as an opportunity to ensure that I am prepared for the day by discussing any key updates, safety concerns, identifying the team on duty and any potential admissions.

Afterwards, I head to my designated allocation to receive handover from the night duty team. A few things that usually discussed include why the baby requires intensive care, their medical history, an assessment of their current condition, any risks and expectation for future care and relevant documentation.

07:15: Once the night team has gone home, I start my safety checks and make sure that the clinical space is well stocked and tidy for the day ahead. I then sit and write a loose plan for the day, with the intention that it could change based on each baby’s cues or unexpected events and ensure there is an opportunity for family-centred activities.

08:00: If I’m feeling organised, I head out for an early coffee and morning tea. I like to eat early because the day almost always gets busy and then it becomes difficult to find time to take a break. 

08:30: Ward rounds usually begin. This is when the medical team and other members of the multidisciplinary team, like the pharmacists, physiotherapists, dieticians and social workers, will walk around to each cot and create an individualised plan for the baby. Families are encouraged to be present and involved in these discussions for their baby.

09:00–13:00: I’m carrying out the plans and decisions that have come out of the ward rounds. This could include admitting and stabilising a new patient from birth suites or theatre, assisting the medical team to place intravenous access under sterile conditions, commencing new fluids or medications, feeding babies, taking bloods, commencing or stopping respiratory support and updating documentation.

Every baby needs milk feeds, nappy changes, cleaning and moisturising of their skin, care for pressure areas, a complete head-to-toe assessment, as well as weighing and bathing — if appropriate.

My favourite part of the day is meeting with each patient’s parents and encouraging them to be involved with their baby’s care as much as possible, including changing nappies, reading and talking to them, and having lots of skin to skin.

13:30: If everything is up to date in the room and my colleagues don’t need an extra hand, I will sneak out for some lunch!

14:00–17:30: The care continues. We are a 24-hour unit and babies are born at all times of the day and night. It’s very unpredictable, so you have to be prepared for everything and anything.

17:45: I start writing my notes and finishing my documentation.

18:45: The night shift staff arrive and we begin the handover process again!

19:15: I have completed my shift so drive home, have dinner (which my partner Josh usually has prepared) and get ready to do it all over again tomorrow.