because if you make goals you actually have to complete them

At least when it comes to annual performance goals. It seemed so simple, so easy, so attainable…well perhaps not so easily attainable…but, as my thirteen year old son now says pretty much every day: well then YOLO. He then will carefully explain that YOLO means you only live once; and he’s right. YOLO. So I decided to make for my goal for my annual review to attend a nursing conference some time this year.

Tick tock, tick tock…

Still attainable with some planning and saving and juggling…lots of juggling. YOLO! So I put that down for my professional development goal and submitted it and did not think much of it until two months later at my annual performance review when I was reminded of the goal that I made for myself.

Still might be attainable.

Then distractions…family, a health crisis, kids schools…easy to convince myself there wasn’t a good time to work on this goal. Then the right time to go and there was literally nothing going on.

Then finally, the right time, the right conference and YOLO! So much learning going on. So much the last three days that it’s a wonder my head did not explode.

It almost did.

But now, three days later, I am looking forward to a glass (or perhaps more) of this lovely petit sirah while I reflect on the final statement as the conference adjourned:

There’s room for evidence based medicine & there’s room for clinical expertise.

Because YOLO!

the people that you meet each day

As a NICU nurse, nothing gives me more joy than seeing “my babies” grow and thrive and grow up outside of the NICU. Actually that is kind of a universal joy felt by all NICU nurses, respiratory therapists, unit coordinators and neonatologists. Moments like this:

OMG! I’m crying again. Seriously.

After over 25 years and more patients than I can keep count, I can tell you there are the ones I will never, ever forget…ever. And some I have remained close to through the years because sometimes you do become much more than just the nurse and patient and patient’s family. Hurray for Facebook (after my tiny human patients are officially discharged) for that. Truly.

Then there are the moments when you are in your neighborhood at the mall, the movie theater, the local farmers’ market, the grocery store, or even while at play at a Pumpkin Fair Carnival and you find that you are being stared at…literally. I check to make sure nothing is amiss…spinach stuck in my teeth, a bra strap showing, or worse…and then I smile, perhaps a little awkwardly because what if they are not smiling at me? What if they are smiling at the old man behind me; or perhaps the kid flying down the Giant Slide ride before my kid.

Excuse me, is your name Laura?

She looks familiar to me, but Im not sure why or from where. But she has a stroller with a sleeping toddler so maybe…

I nod my head yes and confess that she looks very familiar but I’m not sure where we have met.

You were my baby’s nurse.

Oh! That’s where I met you, lovely lady with the most striking, velvet dark eyes. I peek at her sleeping little one and honestly I don’t remember him at all. Then again, he was oh so much smaller as mom catches me up on life this first year after leaving the NICU.  It’s clear that it hasn’t always been easy.

I recall a late night conversation in the NICU where I promised her that it wouldn’t always be easy after the NICU…speaking as a NICU mom myself.

I nod my head, understanding. Understanding much too well.

It’s then that my son comes running up to me breathless after flying down the giant slide ride for the umpteenth time. I introduce her to my very excited and eager to take on the next carnival ride, thirteen year old son.

Wait! He was a 24 weaker too! Right?

She reaches out to shake his hand. Daniel, graciously, yet shyly, shakes her hand as he flashes his brace-faced, dimpled smile  before he heads back up to the giant slide ride because he tells us that it is actually that amazing.

Thank you, son!

I peek one more time at her sleeping toddler and I hug her good-bye as I quietly tell her:

It’s hard work but you are doing great mama! 

We both wipe away tears as we say goodbye until we meet again here in our neighborhood.


Not to brag or anything, but I am a pretty talented person. It’s not bragging when I repeat  back what people have told me over the years. I can sing. I take great pictures. I have beautiful handwriting. I’m a good writer. Oh, and I am a nurse.

Wait, nursing is not a talent?

True, Miss Colorado did not sing or dance or twirl a baton with fire or play a musical instrument. Still her monologue was quite moving; moving enough to be selected in the top ten of the Miss America Pageant.

Yes, I watched it. I was on call Sunday night and just trying to pass the time so why not? I got paid to do it being on call. Again, why not?

Perhaps Kelley Johnson’s talent wasn’t the most talented. Then again, some of the vocalists made bad karaoke at Torii’s sound great…and don’t get me started on the crazy smile while dancing to Bridge Over Troubled Water or the pointe dancer who couldn’t even relevé because once a dance mom always a dance mom. Original, yes. Spoken with a lot of heart and soul. But, yes, perhaps not the best talent performance. The ladies of The View seemed to think so.

Oh Dear Ladies of The View…are y’all enjoying the blow up today on social media? I sure hope so. Please allow me to educate you on a few things because that is one of the many things nurses do…we educate. We even have to document when we educate.

First of all, that is not a costume that we wear. We wear scrubs. We wear scrubs because they are designed to move with us as we go about our duties caring for our patients for 12 or more hours a day or night. They also provide a barrier from blood, poop, vomit and all kinds of body fluids. Kind of. Sort of. They are designed to clean up pretty easily because they are laundered a lot…A LOT…because of blood, poop, vomit and all kinds of body fluids.

Now about that stethoscope…

This is not a doctor’s stethoscope. This one in particular is a nurse’s. Nurses don’t wear them. We USE them. We use them to auscultate or listen….listen to all kinds of things: heart rates and rhythms, clicks and whooshes that might indicate problems with the valves in the heart, air flow that indicates the lungs are working or the endotracheal tube to help a patient breathe is in the right place along with wheezes and crackles that might indicate problems with a patient’s lung function, blood flow through arteries like the carotid, renal, iliac, femoral and the aorta, bowel sounds or perhaps the absence of bowel sounds. We use them as a percussion instrument when measuring the span of the liver. They also can help to check reflexes and can be used as a hearing aid in a pinch. In the NICU we most definitely don’t wear our stethoscopes. We don’t even carry them as each of our tiny patients have their own at their bedside because of infection…so that means it is not a doctor’s stethoscope or a nurse’s or a respiratory therapist’s, it’s the BABY’S!

Being a nurse requires a lot of education (which never does end), skill, intelligence, patience, civility, wisdom, guts, a very strong stomach and talent. It is something that a lot of people can not do…much like some people can’t sing…or perhaps should not sing…ever…just saying.

I won’t lie, I was a little pissed off at the dismissive, mocking tone the ladies of The View had regarding Ms Johnson sharing her passion which was no different than other contestants sharing their passions in the talent portion of the pageant. Okay, fine. I was a lot pissed off. What Ms Johnson does, what any nurse does every day (or night), what I do is amazing. We save lives…each and every day.

Today is National Neonatal Nurses Day and I was reminded all day today by families of some of my most favorite patients of that truth…and how damn lucky I am to be a part of their lives…lives I cared for.

To the ladies of The View, like Miss Colorado, and like the more than 19.3 million women and men all across the globe, my talent is nursing.

I save the lives of tiny humans for a living…and what is it you do?

me reflecting on the art of practicing the finest of Fine Arts

Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts

~ Florence Nightingale.

A little more than twenty-five years ago this happened.

It’s true we actually shouted “SMEGMA” as the photographer got this shot. New grad nurses, actually nurses in general can be kind of gross, sick and twisty in our humor, especially when tired, hungry, frustrated, grossed out, ready to cry or just about to lose our shit. The reality is posed in proper, starched nursing whites under a 90 something degree hot sun we were just about to lose our shit as it seemed to take forever to get this shot of my graduating class. Kick-ass, rockstar nurses we were all destined to be; but being able to line up and pose together as a group….not so much. So when the photographer directed us to say “cheese“, “SMEGMA” it was.

Literally a week later, two fellow classmates and I entered the NICU as new grad registered nurses. Dressed in the NICU’s pink scrubs, we walked through the double doors shoulder to shoulder to shoulder scared and excited all at once. Our NICU nurse educator ran up to us exclaiming, “Oh good! You’re here. We’re admitting a 27 weaker right now. You need to come and see this.

My first thought as she led the way was she seemed just a little too excited about admitting a baby born 13 weeks too soon. My second thought, as we approached the bedside and as the four caregivers stepped aside so that we could see was what in the world had I got myself into. That baby seemed to be no bigger than my hand. Her skin was translucent. I could see some of her blood vessels. She looked like a broken baby bird that had fallen from her nest.

Just a week later, I picked up her less than 2 pound body and flipped her from her tummy to her back, breathing tube, monitor wires and multiple IV lines all still attached to her impossibly tiny body. “You need to breath.”, my preceptor whispered into my ear…quite possibly the best advice I have ever received from an RN who helped to train and educate me; second only to always, always take a break when offered.

Twenty-five years later, I received a card from that baby girl’s mama that she, Baby Bailey, was expecting her first child.

Yeah, that seals it. I’m one of the old nurses.

Twenty-five years of always doing what I love to do…taking care of the tiny humans and their mommies, daddies, brothers, sisters and grandparents. Lots of babies. So many babies. So much love. So much laughter. So many tears. Learning so much…always learning…always….as one does when one is practicing one of the finest of Fine Arts. Always appreciating the opportunity to do what I love…enjoying the grateful hugs from a mommy and daddy as we together pack up their baby to finally go home from the NICU after literally weeks and weeks and then only a few hours later hugging a tearful mama who is literally experiencing the worst day of her life as she hears that her baby is dying.

Twenty five years. Some days are worse. Some days are better. Some days are frustrating and exhausting. But rewarding, exhilarating and wonderful all the same. Some days are hard….horribly hard. But most days are good…the goodest of good which literally saves you from the most heartbreaking, pain-filled days. Then years later receiving a card like Bailey’s mama sent me reminds me again the good my practice has done because Bailey is soon going to be a mommy. That, my friends is indeed Fine Art, Fine Art that I can lay claim to as is each and every tiny, mighty human and their families I have had the privilege to lay hands upon for over the last twenty five years in the NICU. Here’s to many more years, for as long as my mind, my heart, my eyes and my body allows me to.

parenting NICU style

Wa-ay back when I was a nursing student, one of my professors shared a cautionary tale about patients and medical abbreviations. A nurse, preparing to assess her patient, sets down her clipboard. While she is carefully assessing her patient, the patient spies his name on her clipboard with the word “SOB” next to it. What followed, the professor shared, was more than awkward for nurse and patient.

In case you didn’t already know, “SOB” is a medical abbreviation for shortness of breath. The nurse’s patient had emphysema and indeed was struggling with shortness of breath. He might have also been an SoB too…then again, he might have been an all around nice guy. Who knows?

There were many takeaways for us to learn from that scenario that the professor shared. For me, the biggest one was to not let my patients or loved ones see my shift notes. I keep them in my pocket.

This lesson came to mind the other day while reading through one of the micropreemie parenting forums I participate in. A parent shared her frustration of over-hearing her baby’s nurse share with the nurse taking over her baby’s care that she had been crying. Not understanding what that had to do with anything, she vented that they should not be worried about her because their job is to take care of her baby. Who cares if she was crying? The NICU nurse in me wanted to comment as to why the nurses might have been talking about her during their hand-off report. The NICU parent in me knew that she just needed to vent because for many micropreemie parents, there are few, if any, safe places to vent off some of the tears, fears, pain, frustrations and anger that is life as a parent in the NICU.

As a parent in the NICU, I know too well that feeling of being watched over, scrutinized even. In the NICU where Daniel was, where I also worked, parents had access to the bedside chart and were more than welcome to look at it. It was not uncommon to see a note or more about Bill or myself visiting Daniel. Weird to be under a microscope and analyzed in that way…especially because we already felt intense pressure from social workers, family and friends who questioned our motives to want to be Daniel’s family. Stir in the fact that a number of my own colleagues were against our plans (and quite vocal about it) and my being called into my manager’s office a couple of times because staff and administration had a number of concerns about my wanting to adopt a patient in the unit because something like this had never happened at that hospital before. “People might think we are ‘giving babies away at Good Sam’!” 

The horror of such a thing! 

Not fun it was.

If only there was a forum like the one I participate in thirteen years ago!

With most NICUs in the US focused on Family-Centered Care and many hospitals keeping an eye on overall patient and family satisfaction, odds are families are going to be right there during change of shift hand-offs and rounds…unlike the “old” days when I was a baby NICU RN and the unit was closed to family visits and calls during change of shift so that we could focus on the hand-off of patient care.

Being a parent in the NICU is hard. Other people seem to know more about your own baby than you do. They tell you when you may touch them, when you can hold them, feed them, change their diaper. You feel guilt that your baby was born early, that you can’t be at their bedside 24/7, that your other children need you, that your husband needs you, that everything else going on in your life is being ignored. You deal with questions…questions all the time as to why the baby was born early, what did YOU do to cause that, what’s going on currently with the baby, why isn’t the doctors and nurses doing what your co-worker’s nephew’s baby had done to her, why aren’t you at the hospital right now, why aren’t you spending time with your other children because they need you too….and on and on and on. Doctors and nurses and staff either seem to act as though you’re not even there or are hovering not giving you just a quiet moment alone with your baby. And god help you if you break down and cry or yell and scream in the NICU, at home, in church, at the school drop-off, in front of your parents or your in-laws.

NICU parents, am I close?

For what it’s worth, speaking as a NICU RN, when we share with colleagues that mom was crying today, or dad keeps asking the same question repeatedly or the family’s only car broke down or almost anything else family-related it is because the care we give is Family-Centered Care. Our role is to care for the baby first but we also are caring for and supporting the family during one of the most stressful times in their lives as a family…until their baby is a moody teenager. It helps the staff to know that mom is having difficulty producing breast milk or that her mother in law doesn’t want to drive her to the NICU anymore or dad just got laid off or little brother is sick with the flu so that we can better address what the family and the baby needs right now…and what they need to be ready for discharge because, god-willing, discharge will happen sooner than a NICU parent can hope to imagine.

What an amazing day that is when your baby is finally free of every single wire, tube and tape that is attached to his body and you pick him up and hold anytime you want to!

It’s a day that every NICU parent and NICU nurse, doctor, respiratory therapist, social worker and unit coordinator looks forward to as well.

Meanwhile, dear fellow NICU parents, cry if you want to, vent away too, but most of all, hang in there. Your journey is just beginning and this right now is preparing you for the weeks, months and years after the NICU.