They’re the smallest and most fragile patients at UTMB’s Galveston campus, and Registered Nurse Norma Salinas has the privilege of providing their care.
Some people find their calling, but as a nurse in the Neonatal Intensive Care Unit, Salinas’ calling found her.
The young nurse was unsure of what area she wanted to specialize in once she completed her nursing degree, but she was sure she wanted to be at UTMB.
As a Galveston native, also known as a BOI (born on the island), Salinas was very familiar with the hospital. Her mother, who has health issues, had been a frequent patient at UTMB as Salinas grew up. “She [Salinas’ mother] was always well taken care of, plus I know a lot of people who work here and they love it,” said Salinas.
“I applied for nursing positions in a variety of departments at UTMB, and the NICU is where I ended up — and I’m so happy that I did,” she said.
Salinas tells me this and more, as she gives me a sneak peek into the work life of a NICU nurse, which began at 7 a.m. Like many nurses, Salinas works a 12-hour shift, three or four days each week.
She begins her day by checking with her charge nurse for her section assignment for the day. Today she’s assigned to work the “growers’ nursery.” The growers’ nursery is for babies they call “feeders/growers” because they are no longer on oxygen or IV fluids and are feeding and growing.
Once in the growers’ nursery with her tiny patients, she begins reviewing the physicians’ orders.
The ratio is 4 patients to 1 nurse in the growers’ nursery of the NICU, but today Salinas has three babies because one of her patients is chronic and needs more attention. “They let us choose our patients, and I choose babies that I’ve worked with before because I’m familiar with their needs,” said Salinas.
And the needs can be many with these most precious of patients.
Like most newborns, they are fed every three hours — but unlike a baby born full-term, many NICU babies in the growers’ nursery are fed through their nose with a nasogastric tube. Some are also bottle fed.
After checking her orders, Salinas begins her assessments of her patients. She checks their vitals, gives them their multi-vitamins and medications and gets their milk ready. By 9 a.m. she’s finished with her first round of feedings.
“Most preemies are fed through the nasogastric tube until they're around 34 weeks, because that’s when a baby learns how to breathe, suck and swallow all at the same time. So 34 weeks is when we'll usually try their very first bottle,” Salinas said.
Salinas explains that bottle feeding can be difficult to start with the newborns. “We start with just one bottle a day and when they are able to drink their bottle safely and effectively, we increase their bottle intake to twice a day, three times a day, and so on.”
Not all of the babies in the NICU are born prematurely — some are full-term babies born with health complications.
Salinas stays in constant contact with the nurse practitioner, occupational therapist, dermatologists and a wide array of other health care providers who see after these patients. It takes a team to keep a baby born at only 1 lb, 14 ounces alive and well, but through it all Salinas is their mainstay. She’s with the babies as a constant contact, often more than their own mothers.
“Many of our mothers live far away and aren’t able to come visit their babies every day,” said Salinas.
Salinas says one of the misconceptions people have about being a NICU nurse is that she is just changing diapers and bottle feeding all day. They think her work is easy. However, I can attest that is far from the case.
While she does change diapers and bottle feed, she also draws blood from feet so small that she has to make her own Band-Aid to fit them. But, first she must warm their little feet to make sure they don’t get too cold when she unwraps them from their secure blanket to prick the heel.
She is constantly on her feet, between patients making sure their temperature hasn’t risen, their blood pressure is safe and their medication is administered. Hour upon hour, this is her routine. Plus she has to feed them every three hours, rock them when they cry and change their diapers. It is no picnic, but a full-day’s work that Salinas does with joy.
Before we part, Salinas shows me the front room where newborns are initially admitted before they can feed. All the babies in this area are on oxygen and IV fluids. It’s full of caring nurses keeping careful watch over these new lives.
Salinas explains that UTMB recently added a patient area for babies who are almost ready to go home, where their parents can also stay. The new area allows the parents to receive extra care and instruction from the health care team on how to take care of their babies with health complications at home.
“What I love most about what I do is how close I get to the babies and parents,” she said. “I saw a sign the other day that said, NICU nurses hold the future in the palm of their hands — and it’s true. We save lives, we make a difference. My greatest joy is when a baby can go home.” And for some babies it could take as long as a year and a half before they are released.
Salinas doesn’t go home until 7 p.m. and though she’s worn from the day’s work, she’s fulfilled because she’s found her calling. “I’m so happy to have been able to come back home after school and work at UTMB on these tiny patients who need so much care,” she said. “It takes a team to keep them alive and I truly feel like we’re working together to work wonders each day.” Keep up the good work, Norma.
And that’s a day in the life of a NICU nurse.