A day in the life: Keeley McShane
FEATURE - 20TH FEBRUARY 2017
Keeley McShane, neonatal intensive care nurse at The Portland Hospital for Women and Children
Every baby is different. Some 35-weekers—that’s babies born five weeks early—will come out like full term babies: they’re warm, they breastfeed straight away and you’ve no worries. Then you’ll have another that needs interventions, for example, continuous positive airway pressure (CPAP)—a machine that gives positive pressure to the lungs—or full support, which is intubation and ventilation. When a baby is premature, their lungs may be immature or might not have enough surfactant, a fluid secreted in the lungs to make them more flexible. Immature lungs can be quite stiff and if they collapse it’s hard for the baby to open them up again. We’ve a baby boy like that here at the moment: he’ll need to be intubated to give him a specific medicine that will make the lungs more elastic, and he’ll need to be ventilated to compensate for the sedation administered when we insert the tube.
What I do on any given day largely depends on whether I’m the nurse in-charge, or tasked with caring for a specific patient. If a baby is in ICU, the care we provide is one-on-one. It is about monitoring constantly. For example, a little girl we looked after recently, her mum was type 2 diabetic, and couldn’t stabilise her sugars during pregnancy. The baby was producing her own insulin, but when she was born, mum’s supply of blood sugar to the baby was suddenly cut off. So, baby was producing a lot of insulin, but no longer receiving as much glucose, making her blood sugar levels low. I’ve never administered such a high concentration of glucose before: we had to go through the umbilical cord because via a cannula it could have caused serious damage to her veins and surrounding tissue.
I looked after her for those three days, and I could not leave the bedside during my shift. When you’re looking after a patient, it is all about staying with them, seeing what’s happening and updating the computer system with every sign, every change you make. During the day, the consultant is there from 8:30am to 7pm, so you chat to them as they come around.
Building a rapport
One of my favourite parts is starting a baby breastfeeding, if he or she is ready. We encourage mums to come as soon as they can to breastfeed, or hand express if they can’t do that. Sometimes it takes a bit of practice, but that’s what we’re here for. I love building a rapport with the parents, and helping new mums with their first breastfeed is one of the nicest, most amazing things you can ever do.
Our day officially starts at 7:45, morning or evening depending on what shift we’re on. That’s when we do our handover from one team to another, covering everything from the patient’s background, their mum’s background and treatments we’re administering, to stock checks, general admin and numbers of staff. I like to come in earlier than that though. We have a lot of safety checks to carry out, and because you never know what your day will be like, I prefer to do them before it all begins. We have resuscitation trollies on four different floors—for the theatres, the post-natal ward, intensive care and upstairs in the delivery suite. A crash call (that is, a baby falling sick) can happen at any time, but if I’ve done all my checks beforehand— checked the oxygen is full, the air cylinders are full, that the transport incubator is plugged in and charging—I know that when I walk through the doors I can concentrate without being distracted.
The handover lasts about half an hour. We use the SBAR tool, a standard system for going through information which ensures you focus on situation, background, assessment and recommendation around a set of circumstances. It’s a universal tool, instilled in you from day one of your nursing degree and again every day for three years. It’s nursing 101. Once we’ve done that, if I am the nurse-in-charge it’s time for the ward round, together with the consultant and the registrar. We’ll go through the SBAR, go through any chest x-rays or bloods and discuss whether we should start weaning and where we can go from here. Parents can attend as well if they like, otherwise we go and update them soon afterward. By the time this finishes, it is only just 9am.
A 12½ hour day
From then until around lunchtime, if I am the nurse-in-charge I’ll be doing the electrical equipment inventory and checking stock. We are only a small unit so we go through stock quickly, and you need to make sure you have everything you need, all in date.
We are all very hands-on here. We have a housekeeper who does the bins, floors and linen, but when it comes to cleaning incubators and the like I will be the one scrubbing it from top to bottom and putting it back together. We collect bloods, administer medicines and do routine surface swabs of the babies’ skin. In the evening, the consultant will come round again to see how things are and what’s needed: any x-rays need to be done before 7pm, as that’s when the radiologists finish. We finish at 8.30pm. Technically it’s a 12½ hour day, with 1¼ hours’ worth of breaks in total. In reality, it can sometimes end up being more like 14 or 15 hours.
We have to take our breaks when we can. If I get breakfast, it is usually porridge. And there always seems to be some biscuits in the staff area. Our new matron has been fantastic: she created this space where staff can escape to and relax a bit. Alarms are going off constantly here—bing, bing, bing, you hear it in your sleep—so it’s great to have somewhere where you just switch off for a few minutes, but that’s close enough in an emergency.
Often it is quite stressful. Sometimes there are tears. But we have a great team and we support each other, and if you come in here you will usually find matron. She is supposed to finish at 5pm, but she rarely does, and she lets you have a moan, a groan, a scream, a shout—whatever you need to do to get it off your chest. We have a psychologist in the hospital too who we have access to. How do I switch off at home? A glass of wine, some rubbish on TV and something I can cook quickly: M&S pizza, it seems to be at the moment. It’s hard, but I love it. I wouldn’t change it for the world.