Wellington’s NICU cares for more than 1000 of the hospital’s tiniest patients each year, the vast majority of whom will go home with their relieved and proud parents. Behind them are devoted nurses who have worked long hours, employing the latest technology and techniques, caring their best to give these newest of New Zealanders the greatest shot at life.
Katie’s entry into this world was certainly touch-and-go. She was born at only 25 weeks gestation and Rosemary was there, caring for her, playing an essential role in the reason that tiny baby is now fit, healthy and in high school.
Katie is just one of thousands of babies Rosemary has cared for over her decades of nursing. After working through several branches of medicine in New Zealand and Australia, at 23 Rosemary moved to the United Kingdom with her husband, ending up in paediatric cardiothoracic intensive care.
‘That made me realise, yes, I enjoyed making a difference at an acute phase but I really, really enjoyed making the difference at the start of life. One of the great things about being in neonatal care is that we’re there at the beginning of a new New Zealander’s life. If it all goes well, we’re handing 80-plus years to someone, and that’s such a positive thing to do.’
While in London, every year Rosemary made sure she learned something new, stacking up courses in neonatal, intensive and cardiothoracic care, and a management course. That afforded her an exceedingly useful skill set when she returned to New Zealand. She quickly realised she wanted to stay in neonatal care – and also realised her co-workers didn’t have her education.
‘Neonatal care is really a tri-speciality; in child health, intensive care and obstetrics, and no one comes out of basic training with that,’ says Rosemary. ‘In the early to mid 1980s we were just beginning to realise nurses needed post-graduate training, so I was asked to develop the first neonatal course in Wellington, which I was delighted to do.’
For the next 12 years Rosemary worked as a nurse and an educator (while bringing up her own children), focused on neonatal care. Then, in 1999 she was appointed the NICU’s nurse manager and today runs a staff of more than 165 people, most of them neonatal nurses.
It’s a diverse group, representing all age groups and many different countries. Rosemary says one of the unit’s mantras is ‘We do family here’, meaning staff are supported as much as possible in their own lives.
‘If you work in a place where no one knows who you are, doesn’t say good morning, doesn’t know about your life or what’s culturally important to you, how can you turn around and care for a young couple who have just become parents in a situation that’s the worst time of their lives? How can your staff support them if they don’t feel supported themselves?’
The nurses work 12-hour shifts, which – as well as making it easier to organise their home-life – provides continuity of care. ‘If something is developing during the day, they’re taking that care right through to the evening. That’s really important for parents coming to visit after work because the person who’s been with their baby all day is still there to talk about what’s been happening.’
And the NICU is very much focused on what’s best for those babies. Other NICUs group babies according to their medical needs. When Rosemary was asked to redesign the NICU in the mid-2000s, she wanted to take a different approach.
`We wanted a model of care that looks after babies as the centre of the universe, with their parents closely around them, then us supporting them.’
‘Pre-term babies have very different needs to full-term babies, so we designed a gestational model of care to give these babies the best neuro-developmental care we can to help them develop in the best possible way.’
‘For a full-term baby, having a diurnal rhythm – periods of awake and asleep – is normal, so they can have brighter lights and music playing in their rooms. Whereas a baby born at 25 weeks should still be in the womb, so they need a quiet, dark room where nurses are only providing care, touching the baby, when they’re getting cues they’re awake. Because of that, we group babies in pods of six according to gestation so we can manage the light, sound and rhythms of the room.’
There are other benefits: the parents feel more comfortable because they’re alongside other parents with babies at the same stage, and new staff quickly learn to care for babies needing different levels of care, rather than starting off with less sick babies as is the traditional approach. ‘The osmosis of learning they get from being around senior nurses working with sick babies earlier has dramatically improved our learning style. On all levels – staffing, families and babies – it has been a good thing to do,’ says Rosemary.
For all these and many other reasons, the survival rate at Wellington’s NICU is among the best in the world. Now, of the 1000 or so tiny patients admitted to the hospital’s NICU each year, only between 12 and 20 can’t be saved. When Rosemary started nursing, a baby born at 28 weeks was expected to die. Now, a baby born at 25 weeks is expected to live, and most born at 24 and even 23 weeks will live, and because of advances in treatment many will have few, if any, complications.
For those who don’t go home, Rosemary is honoured she and her nurses can provide palliative care to give those parents at least some time with their babies. For those who win their battle, and regularly visit the nurses who fought for them, Rosemary is beyond delighted.
‘Working with these babies makes me feel that, while I might not have climbed Mt Everest, and I certainly have not made a lot of money, my life is well-lived in the sense that my working life has been very productive. I feel like I’ve made a difference to thousands of babies over the years, and that’s really powerful.’
Caring for premature or sick full-term babies takes courage, dedication and advanced technology. The Neonatal Trust supports families and the Neonatal Intensive Care Unit with volunteers, equipment, and research resources. Support them by giving a % via onepercentcollective.org
Words by Lee-Anne Duncan. Images by Pat Shepherd.