A Day in the Life of a Special Care Nursery Nurse

All labor stories are a little different, but most end with a healthy baby who goes home a few days later. Some newborns, however, need extra support during their first few weeks or months, and they get it from a special care nursery nurse.

“It’s hard to leave your baby in the hospital after you’re discharged,” said Mary Engstrom, RN, a special care nursery nurse at Beverly Hospital. “We often refer to ourselves as skilled babysitters, just so parents know we’re going to love and take care of their children. We also assure them their babies are on a forward path. It can be a really slow and tedious path, but … they eventually hit their milestones and go home.”

Of course, Engstrom and her team are far more than babysitters. They’re highly trained professionals in a high-intensity job that requires a lot of energy and a lot of love.

What Does a Special Care Nursery Nurse Do?

Engstrom has spent 31 years working in special care nurseries, or neonatal intensive care units (NICU). Before coming to Beverly Hospital six and half years ago, she worked in several Level-III NICUs (the highest level of specialty) and as an in-home special care nursery nurse.

“Beverly has a Level II-B NICU, which is pretty impressive for a community hospital,” says Engstrom. “We actually triage and stabilize Level-III babies — babies born before 32 weeks or in critical condition. We can do ventilator support and resuscitation, and hold them for about two to four hours before transferring them to Boston Children’s Hospital. Most babies over 32 weeks can stay with us. We support their nutrition and respiratory status, and help them meet developmental milestones, like learning how to feed.”

Engstrom is a team leader on the night shift. Each nurse on the team is assigned one to three patients per night, depending on the condition of the babies. So, she begins each shift with an update from the dayshift nurse who treated her patients.

“We go to the bedside and meet with the families, and involve them in that information-sharing process. We’ll access the computer chart and the doctor’s orders, and make sure we’re all on the same page,” Engstrom said. “Then it’s just a process of caring for the babies and working with families. We do a lot of teaching on baby care and feeding, and get them ready to care for the infant at home.”

The special care nursery team must always be ready for new patients. “As the team leader, I’m in constant communication with the neonatologist on duty and with the labor and delivery staff. I usually meet with them shortly into my shift to assess what potential high-risk babies are down there so we can create a plan. We attend any high-risk or concerning deliveries, and on the night shift, we attend all C-sections. So, at any given point, we might be paged.”

Rewarding Labor Stories

What first attracted Engstrom to the special care nursery? What has kept her there?

“I like the intensity of high-risk nursing, and I like the patients to be little,” she says. “I also like that it’s such an ever-evolving area of nursing. So many infants survive now that wouldn’t have survived 30 years ago. The surgeries that were being pioneered then are now commonplace. The medications that we were doing drug trials on back when I started are now used readily and make a big difference. Infants that would often spend their first year of life in the NICU now go home much quicker.”

Engstrom enjoys working with the families. “We’re helping them prepare for something so fun — bringing home a new family member. We’re at the beginning of all these lives. People think our job must be so sad. It isn’t. Not all the scenarios are happy, and some are full of challenge, but most babies go home. Some might have a syndrome or obstacles down the road, and it’s rewarding to help prepare families for that. It’s not always easy, and sometimes we cry with them. We put a lot of ourselves into our work, so we also get a lot out of it.”

Engstom’s patients and their families mean a lot to her, and vice versa. Many of them keep in touch and come back to visit. One family even gave her a special honor.

“I had a little baby who was born very sick,” she remembers. “He was on ECMO, which is basically a heart-lung bypass machine that’s usually a last effort to save the baby. He was in the hospital for 11 months, and he was my primary patient. Every shift I worked, he was mine, and his family felt that I was part of his life too. They made me his godmother. We had a little ceremony at the hospital. When he left the hospital, he was vent-dependent, so I took care of him for years at home. He was just that important to me and my family. My children even got to know him.”

Circumstances separated Engstrom from the family for a while. Then, a few years ago, she got a Facebook friend request from the baby — now a 26-year-old man. They’ve stayed in touch, and this year on Mother’s Day, he sent a message saying that he thinks of her as one of his mothers.

“In this job, you touch people’s lives, they’re important to you, and you become really important to them,” she says. “Knowing that relationship really was what I felt it was means the world to me. I can’t imagine not doing this type of nursing. I’ve done a lot in my career, and I still feel my role is still just as important and just as exciting as it was back then.”

*The content on this website is for informational purposes only and is not medical advice. Please consult a physician regarding your specific medical condition, diagnosis and/or treatment.

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