Colette Cunningham, Senior NICU Nurse, UHW, Waterford, Ireland
A Reflection on Covid-19 from an Irish Neonatal Nurse Perspective

Covid-19 first hit the shores of the Republic of Ireland on the 29th February 2020, and within three weeks, it had spread to all 32 counties. By the 12th of March, the Government of Ireland had closed all schools, colleges and childcare facilities, and for the first time in the history of the Republic, St. Patrick’s Day festivities were called off. On the night of the 17th March, the Taoiseach Leo Varadkar, instead gave a nation’s address, and suddenly the severity of this global pandemic was plain to see. It’s potential for destruction to life as we knew it was all too apparent. Life as I knew it, as a neonatal nurse in a large “Level 2” NICU, meant the potential for catastrophe for the vulnerable ill term and preterm infants in my care.
In that first week after Covid-19 reached our country, and indeed our county, the management and infection control teams (ICT) in our regional hospital swung into action. The hospital was put on an “infectious disease” lock down, and only one parent of paediatric inpatients were allowed to stay with their child. No other visitors were allowed in any other area of the hospital, except in the Neonatal ICU/SCBU. In the early days of uncertainty, it was decided amongst our ICT and senior management, that the mother of each infant in the NICU could visit for one hour every day.
This hour was to be decided in advance of the visit, so the 2 metre distancing could be respected amongst staff and parents. Too many visitors at once jeopardised the likelihood of this being a reality. Mothers were asked to wear aprons and masks and to wash their hands thoroughly before entering the unit. The handwashing was something they were all too familiar with, the masks in 25 to 27 degree Celsius heat, was not. Priority was given to breastfeeding mothers, and a mother and baby room was made available for those trying to establish breastfeeding on the road to discharge home. An isolation bay was quickly turned into a receiving area for those infants at high risk of being Covid-19 positive, or of those born to a positive mother. We were in good shape for all potential isolation needs, a luxury we knew that was not afforded to the larger tertiary centres or smaller “Level 1” facilities across our region.
It has been decided in recent weeks to encourage visiting of either mother or father for one hour every day in our NICU. Those infants of breastfeeding mothers may also have a paternal visit once a week. This visiting is always carefully planned so as to not overcrowd the unit and to minimise risk to other infants, parents and staff. The visiting policy will be reviewed on a regular basis and the input of our ICT, management and Government guidelines will always be taken into consideration. The possibility of virtual visiting is also being explored, and is something we hope to achieve in the very near future.
As professionals we are striving to be ready and fully equipped to deal with the consequences of Covid-19 positive infants, positive mothers, positive colleagues and positive family members. We have designated “grab and go” sets of PPE for potential emergency and unforeseen resuscitations on the labour ward, which may involve aerosol generating procedures. This minimises the time it takes us to don the PPE before we reach the infant on the labour ward. We have a Covid-19 folder of updates on our desktop which we read during our shift to keep ourselves updated. Any immediate or new procedures that have been recommended to us are handed over at the start of every shift, to allow us to be fully informed and follow a general consensus of practices within our NICU. It has also become routine practice in our unit to decontaminate the telephone, the desktop and the external intercom after each use. We also keep personal diaries of those we have worked with, been in close contact with during a prolonged procedure, and the bed numbers of the infants we have looked after. This makes the possibility of contact tracing more reliable, should the need arise. Parents are encouraged to place their mobile phones in clear plastic bags provided by us, to allow them to take pictures of their infants, but also to reduce the risk of potential transmission of a multitude of micro-organisms to their infant and the immediate surroundings.
As a nurse in a NICU, the uncertainty of the times is palpable. Foremost on my mind is the welfare and the protection of the infants, my colleagues and indeed my own family at home. My mind is a flurry of mantras…stay 2 metres away, don’t forget your mask, are you handwashing at every appropriate opportunity? As NICU nurses, the WHO moments of hand hygiene are ingrained into our everyday practice. The social distancing and care of infants and mothers with masks and gloves however, is not. Staying 2 metres away from vulnerable mothers without any reassurance of touch, was and still is, extremely alien to me. But even more difficult is the handling and nurturing and developmental care of ill term and preterm infants with gloved hands.
The reassurance of positive touch is still there, but the warmth and love of a human hand is not. I prioritise the provision of positive touch and skin to skin care between mother and baby, wherever and whenever possible in my working day. This “visiting hour” is carefully planned, and with the infant’s permission and affirmative cues, I provide this basic nurturing and healing contact for infant and mother. Every effort by staff and parents is being given to try to diminish the possibility of the contraction of this devastating virus in our NICU. Although it is against our usual nurturing and encouragement of parental involvement, we hope and strive for this to be a short term solution to the potential spread of this virus. Our priority right now is to protect the vulnerable infants in our care, to the best of our ability, within our given resources. Reassurance is now given with exaggerated nods and thumbs up. Muffled conversation through masks is also maintained with smiling eyes…at least I hope my eyes are smiling.

I’m Lora Alexander, one of the Quality Improvement coaches in a busy Level 3 NICU. QI is all about understanding problems, thinking of solutions, implementing ideas and analysing the results.
My name is Adedoyin Yissau, also known as Dee. I am the Education and Workforce Lead for the London Operational Delivery Network. I came into post as a Network Educator in 2019 and have since developed nursing education region wide, with the current focus on developing a nursing career pathway for London.
Neonatal Network Nurse Educator
My name is Dr. Julia Petty, and I am a nurse lecturer specialising in children’s nursing with a particular interest in neonatal care. My nursing career in paediatric and neonatal clinical nursing practice began after a BSc Hons degree in Psychology at Warwick University, when I moved to Great Ormond Street Hospital, London. Here, I trained in children’s and adult nursing before working there for many years in children’s and neonatal surgical care. I then gained my neonatal nursing qualification at St George’s NHS Trust London and worked at the Whittington NHS Trust NICU before moving back to Great Ormond Street for a senior education role on NICU where I worked until 2001. I then worked as Senior Lecturer at City University, London for 12 years leading the neonatal nursing education portfolio. I studied for a MSc, a PGCE and MA in academic practice during this time, In 2013, I moved to the University of Hertfordshire where my role is Associate Professor (learning and teaching) and Senior lecturer child nursing. I teach on the BSc Hons nursing and master’s degree programmes including leadership of modules, face-to-face/online teaching, assessing and supervision of students at all levels up to doctorate level. I am also research active and have completed a Doctorate in Education. As a nurse, educator and post-doctorate researcher, my interests focus on parents’ premature birth experiences, supporting parents in the transition home from NICU, exploring communication needs of neonates and their carers and studying the educational value of digital storytelling. This combination and variety of roles enriches my working life and brings together my experience as a child / neonatal nurse, educator and researcher. My role and related activities enable me to engage in both education and research while supporting students on their nursing career and education pathway, which is a privilege to be part of.
Hello my name is Claire Richards and I’m the Lead Nurse for the Wales Maternity and Neonatal Strategic Network. This covers nursing leadership but also Neonatal transport. I also have a clinical honorary contract in one Health Board.
Hello, my name is Kim Edwards, and I am a Neonatal Nurse. I am currently the Lead Nurse and Workforce, Education Lead for the Thames Valley and Wessex Neonatal Operational Delivery Network (ODN)
Hello, my name is Jean and I am a registered children’s nurse with 27 years experience. I qualified with a DipHE after struggling academically due to dyslexia. Over my career I have worked mainly in PICU, NICU and children’s cardiac critical care. I am dual qualified in speciality (QIS) for both Neonatal and Paediatrics. The QIS program is a post graduate modular course completed at level 6/7. To be considered QIS you must successfully complete 4 separate modules, each have an academic and practical component. Only on completion of the QIS course can you apply for a band 6 role. In addition to the above qualifications it is expected you would have several years proven experience in speciality at Band 6 and 7 prior to applying for a Matron’s role.
My name is Lisa Baker, I’m a Ward Manager on a Level 2 Special Care Baby Unit in South Wales and I’ve been in this role since 2020.
Hello, my name is Wesell, and I am currently a trainee Advanced Neonatal Nurse Practitioner (ANNP) at Great Western Hospital, which is a Local Neonatal Unit (LNU). Prior to this, I gained substantial experience in a tertiary neonatal unit where I completed my QIS course at master’s level. This course, alongside my role as a senior nurse, provided me with the expertise required to develop my career further in neonatal care.
My name is Hannah Wells, and I am a Neonatal Surgical Clinical Nurse Specialist (CNS).
Hi, I am Amanda and work as the Neonatal Infant Feeding Coordinator for a NICU and a SCBU within one service. While the role is not standardised, many neonatal units now have dedicated posts.
Hello, my name is Daniela Machado, and I am proud to be a Developmental Care Specialist/Lead Nurse and a sister/charge nurse, working across two different trusts. I am originally from Porto, Portugal, and have spent 14 years building my nursing career in the UK. My role involves applying and advancing neuroprotective/developmental care practices for our preterm and neonatal patients/families.
Hello! I am Renjita Raju , a Neonatal Junior Sister working in London. After completing my BSc nursing degree in India, I moved to UK, and completed NMC OSCE to get registered and QIS course to become specialised in neonatal care. I recently qualified as an NLS instructor with the support from NNA scholarship programme. My role involves caring for premature and critically ill newborns, ensuring their safety and health with a highly collaborative multidisciplinary team. I also teach in NLS courses as an instructor following my passion in neonatal resuscitation. I love witnessing infants grow stronger each day and supporting their families through this journey. I’m grateful for the opportunity to provide meaningful compassionate care to the tiniest, most vulnerable patients.