Enjoying a leisurely stroll into work, helping out a bit, and just doing whatever physicians ask is not what nurses do all day. If you spend a day with Courtney Clark you’ll see that nursing is a skilled, autonomous profession that it is not for the faint of heart. In Courtney’s practice as a neonatal nurse, she must be sharp and focused as she takes care of the smallest and often most critical patients in the Neonatal Intensive Care Unit at New York-Presbyterian/Morgan Stanley Children’s Hospital.
Courtney typically starts her day very early. “I get here a little before 7 a.m.,” she says. “The nursing team and I meet in the nursing lounge. That is where all of us get our patient assignments for that day.” Courtney points out how challenging the day is: “You have to be on your game, and it is a 12-and-a-half-hour shift. So, you can’t afford to have an off day at work.”
Courtney explains what it takes to become a nurse. “Our job is really important and you have to be smart and work hard. We are educated people. We have bachelor’s degrees and master’s degrees in nursing. The education is not easy. It is a lot of heavy science courses. Before I went to nursing school, I had a bachelor’s degree from Georgetown with a major in French and minor in biology. Obviously with my biology minor I had a lot of science classes but I still needed an additional year to complete prerequisites before starting nursing school at Columbia. Then I did it in an accelerated program, which means the school packs 2 years of college into one calendar year! Then you need to take the nursing boards when you graduate. People spend months preparing for it. And once you graduate and pass your boards, you have to find a job of course. It’s kind of a long road but well worth it!”
Courtney says she always wanted to work in health care, but she first thought she wanted to be a physician. But when Courtney was working as an EMT during college, she realized that nursing is where it’s all at. “I could see the difference between what physicians and nurses do, and when it came the time for me to apply to medical school, I just had this feeling of dread about it. I had to think about what is really important and why I wanted to go into health care, and it is bedside care that I really love. I like being the one who is here and being the one who patients know. You get to have a really special relationship with the patient. And although physicians have more authority in some areas, it’s the nurse’s job to be a double-check on their care plans and make sure all the plans are right and safe for the patient. And of course, we also make decisions and nursing care plans ourselves, and those are very important for the patient’s survival,” she says.
After getting assigned her patients for the day, which can be two to three babies, Courtney will conference with the night nurse, and “they will give me their report on the baby,” she says. “I know ‘Baby A’ well, so I just get the highlights of what has happened in his last few days.”
Courtney has been taking care of Baby A on and off since he was born prematurely. She admits that she checks on him even on those days that she is not assigned to him.
After relieving the night nurse, Courtney checks the babies’ charts. “I look at all the prescription sets, like how much they are eating or whether they have IV fluids. Then I’ll come examine the babies.” She also points out that constant care is a priority when it comes to these babies. “All the babies are monitored, so we observe their heart rate, blood pressure, respirations and oxygen saturation continually both in the daytime and in the nighttime.”
She adds, “You know I am on my feet all the time. I am in charge of keeping these babies alive and thriving during my shift. Attention to detail is so important. Definitely with such small patients. … They need so much support: temperature support, regulatory support, respiratory support and cardiovascular support.”
Baby A’s mother describes his nurse as “that person who is looking at your baby every 60 seconds.” She confesses that she considers Courtney a part of the family. “It is a roller coaster in here, a lot of good days, but the bad days are bad days. We consider Courtney Baby A’s aunt at this [point]… [She] took care of our son during a very hard and emotional time. Her care during that period changed our lives.” She adds that Courtney’s dedication to her patients also allows her to rest. “Once you are watching her take care of your baby you feel like [you have] peace of mind to go home and sleep in your own bed at least. So she doesn’t sing or read like mommy, but she does everything else that matters.”
What is this “everything else that matters?” Courtney is constantly alert to small changes in the critically ill infants that call for action. She notes her thinking: “How is the baby breathing? Does the baby look distressed? Then I’ll listen to heart and lung sounds and double check all the fluids and make sure everything is as it should be. If the baby is dropping her oxygen level, I’ll stimulate her to get her to breathe more, or if she needs to rest, I’ll just give her a few breaths with the ventilator and watch her for a while until she comes back around. I don’t want to give too much oxygen to preemies because it can damage their retinas, causing blindness. So I titrate the oxygen levels probably 10 to 20 times on any one shift to keep it as low as possible while keeping the baby healthy. I monitor the airway and suction it to clear secretions or vomited breastmilk. And I watch for signs of infection, hypoglycemia, which is low blood sugar, or a malfunction with the heart.”
As noon approaches, Courtney has been unable to eat breakfast because she has been busy helping other nurses, as well as keeping track of her own patient when the physicians come for their rounds. During this time, the physicians meet everyone who is involved with the baby’s care to discuss progress and the proposed plan of action. Nurses are an integral part of this meeting of the minds, as one physician points out: “Where is our nurse? Come with us — without you we are lost.” Courtney feels the same way about the doctors, saying: “I think we work really well as a team. I think the physicians have a lot of respect for the nurses and for what we do.” She explains, “If I express a concern about something they listen. I think it is a really nice partnership.”
Courtney says that “it’s not like what they show on TV. I would never follow a physician’s care plan blindly if I didn’t understand how it was supposed to benefit the patient. That is where you can have a really great relationship with the physician if you consult with them. You know good physicians don’t want nurses to blindly follow what they request, either. We all need to be on the same page of understanding. Mistakes can be really costly and can be life or death. I would never want people to think that we are the handmaidens to physicians or what we do is mindless work because it is not. We pay a lot of attention to detail. Smarter nurses are better nurses, just like smarter physicians are better physicians. It’s not easy what we do.”
Baby A’s mother says that she likes having Courtney there during rounds, because Courtney helps break down the medical terms and explain what the doctors are saying. She also adds, “[The physicians] said you should thank your nurse, and we now get that. We understand that is really [the nurse's] hands on [him] all day. The physicians are here, and they do rounds two and three times [a day], but [the nurse] is really the person who knows his stats from day to day to day. So she knows what he looks like; she knows his history.”
Typically nurses work a 12-and-a-half-hour shift. It’s not an easy job, but Courtney finds it very rewarding. “When I first started working here, I took care of a baby who had been born at only 24 weeks. I had admitted him in the transitional nursery and then I took care of him through his whole stay. He had a really great course of treatment, and he left. I still exchange emails with his mom sometimes. She sends me pictures. I got invited to his first birthday. But not everyone is appreciative of what we do, so it feels really nice to be complimented and appreciated. We don’t get that from everybody, but I like to think that the babies appreciate what we do.”
After Courtney’s lunchtime breakfast, she’s back on the floor ready to go, keeping the hospital’s littlest patients alive and improving so they can grow up with their families. A day that started well before the sun came up will end long after the sun goes down, but that is just a typical day for a nurse.
Photos: (Melissa Unger)
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