NICU Transport Team Providing Critical Care to Our Smallest and Most Vulnerable Through RNSPs
Some of the most vulnerable patients in health care are those who require time in a Neonatal Intensive Care Unit (NICU). The unit is filled with tiny humans who are fighting for their lives and their family members who watch hoping for their best outcome. With the help of nurses, other health care professionals and medical advancements, these babies are given the best care so they can go home one day with their loved ones.
The NICU is an area of the hospital where pre-mature babies, and other babies that require additional care and attention, are admitted. The Regina General Hospital NICU has a Transport Team used to transport babies that may be pre-mature, in distress, sick, experiencing respiratory issues or any other number of health concerns, to the city. The team is comprised of nurses with education and certifications that provide them the competencies to be a part of this specialized team, as well as Respiratory Therapists and Paramedics. The team is trained to go out to rural Saskatchewan locations, stabilize the neonate and bring them back to the NICU in Regina. In situations where the baby may require advanced care, transport may be provided to a larger Canadian centre where the team accompanies the baby by air ambulance or ground transport. Having RNs practicing to full scope through the use of RNSPs supports this advanced care for the neonates being transported.
Carmen Chaupiak, RN, has been practicing for more than 15 years and is a clinical nurse educator and a nurse on the NICU. She has always loved babies and children and the NICU seemed like the best fit for her from the start, almost like it was where she was meant to be. She said, “I just fell in love. I can’t see myself really working with any other population. It’s definitely a calling to work with these little people, just as it’s a calling for someone to work in the Emergency Room.”
The same is to be said about her colleague Donna Morgan, RN who has been practicing for more than 25 years and is a clinical nurse educator as well as a registered nurse on the NICU and a member of the NICU Transport Team. Donna said that she knew before she started nursing school that the NICU was where she would end up, “Neonatal is what I wanted to do. That’s why I became a nurse, to be honest.” She not only loves children, but enjoys the skills the NICU requires, “I also like the ICU part. I like to have the adrenaline rush and to be able to do the necessary skills. I also love to do transports and go to deliveries.”
Together, these women have identified the opportunity to optimize the scope of practice of the RNs on the NICU Transport Team, one that will enable the nurses to be able to place Umbilical Line Catheters both, Umbilical Venous Catheters (UVC) and Umbilical Arterial Catheters (UAC), by creating an RNSP clinical protocol. A UVC and UAC allow for the central line to go in through the umbilicus vessels to a central position to be use for IV fluid and medication administration and to monitor arterial blood pressure. Donna states that this skill is incredibly important because, “You might be out there for a few hours stabilizing and you might have a two-hour drive back as well. So, to have a proper central line if you have a really sick kid is vital and to have a line for arterial monitoring and to use for arterial blood work is critical in managing care.”
A micro-prem is a baby that is under 27 weeks gestation. Donna emphasizes that, “These babies are very small. Anything under 30 weeks is usually having umbilical line insertion for access during the first 7 to 10 days of life. But for those really low gestation babies, it’s essential to have these kinds of lines because we try to do minimal handling of them once we have everything kind of settled and done in our admission because it’s very important to not over stimulate these tiny babies to provide neurological protection. They’re very fragile and the vessels in their brain are fragile so following protocols to protect against IVH is extremely important.” Previously, on transport they were only placing peripheral IVs, which then had to be replaced upon arrival to the hospital. With an RNSP for insertion of the UVC and UAC in place, less handling of these babies will be required and necessary venous and arterial access to sustain life will be placed initially during transport.
Given the premature nature of many of the babies, time is of the essence and the extra step previously required could take precious moments from their limited initial timeframe, something they call the golden hour. The “golden hour” is support by evidence and when managed well, supports better outcomes for neonates. Donna elaborates on this term and shares that, “from once the baby is born, we get into the unit, we would try to get all the admission procedures inclusive of stabilization procedures, respiratory support, x-rays, measurements, medications the IV /central lines and blood work. We want to try and get everything done within one hour of time. And the x-rays for confirming the lines because that one hour is critical to get things done. Then you want that baby left alone so you aren’t handling and overstimulating that baby so much. So it is a time constraint because the lines need to be put in right away.” These UVC and UAC lines are used to administer IV fluids, draw blood work instead of having to venously draw it, and monitor arterial blood pressures and it also allows the medical team to provide medications to the infant without multiple IVs. This RNSP aids in optimizing this golden hour and makes the transition to best possible care and practice of care more efficient.
Though the NICU has 24-hour coverage, there are instances when fewer physicians are in house, and they are also providing care to other sick neonates. The director of the NICU is encouraging the training of nurses with this skill to widen the base of the skill level and the availability of those on the unit who can perform the UVC and UAC insertions. This will allow the interprofessional team to provide the care that neonates require during the golden hour, providing an environment where the best possible outcomes can occur. Yearly training will occur to ensure competencies are met, with a certain number of successful line placements required to remain certified.
As Donna and Carmen share more about this RNSP, it is evident they are passionate about seeing it to fruition as they speak with true pride of the role they play within the unit. Donna sees RNSPs as an opportunity for best practice, and therefore best care to be provided to patients. “Being able to do any kind of higher scope of practice is fantastic because we have a huge knowledge base and experience. We’re hands on all the time. We know our patients. We know what our patients are like. A lot of our patients we have for, some of them 100 or 150 days. We know those babies so well that we can read them. It’s just a feeling you get.” She goes on to say, “The more skills, knowledge and understanding of what we do and what’s done to our patients the better off the patient is. And it really just comes down to providing the best care for them.”
Both women agree that passion is what will continue to advance the nursing profession and have registered nurses continuing to expand their scope of practice. Donna says, “If you are really passionate, those are the nurses that are going to bring the profession forward. It’s important to have a passion for the area that you pick to work in, to excel the whole profession to where it can be because it’s limitless really, of where our profession can go.” If these RNs have one thing, it is a passion for the work that they do. Carmen summarizes their feelings around the role they play in the NICU by sharing, “The best part of my job is the impact that we do have on the families and the patients we serve. It’s just unlike any other area. You’re really impacting, not just the baby’s life, but the family’s life.”