Neonatal Intensive Care Unit, IU Health Ball Memorial Hospital, USA

Written in March 2020: I am a NICU nurse and, as such, I am not on the front lines of this pandemic (yet). There is a lot of acknowledgement for healthcare workers, especially nurses, and I feel guilty for not being on the front lines. I feel guilt, and relief, and then even more guilt for feeling relief. But I also feel fear. It is always present, always looming. There is not much data on how this virus affects newborns and the virus is constantly evolving. It feels inevitable that we will be faced with it on our unit and in our population. I fear that first patient. I fear we won’t know how to help them. I fear we might not even recognize it before it’s too late. I fear what this might mean for our most vulnerable patients – the patients born so early and so frail, with no immune system to speak of and already fighting the greatest battle of their lives. I also fear the added trauma my patients will experience by having their earliest days, weeks, and months of life with caregivers whose faces are half covered. I fear what not having the experience of seeing facial expressions of human emotions will do to their development. I fear that they will feel and embody the pervasive anxiety that is felt by every healthcare worker. Stay home. Stop the spread. The babies I take care of fight so hard every day. Do your part in keeping them from having to fight even harder.

Figure 2: Source: Brittany Kyle, with permission

Written later in May 2020: As a NICU nurse in the pandemic, I continue to worry for my patients. I feel less fear, but I still have concerns. The fear has decreased, not because the risk to our immunocompromised patients has decreased, but rather because I recognize that this is the scenario; we’ve trained for during our entire NICU career. Anyone who has ever been in a NICU knows about strict hand hygiene and screening for early signs of illness. We have existed on the frontlines of every illness that could affect our neonatal patients for the past 100+ years.

I am concerned for the increased stress that parents of babies in the NICU feel. Having a child in the NICU is already an extremely stressful situation. If parents are allowed to visit, it is only one at a time. This creates an extremely isolating experience. The stress of the NICU is made even more traumatic in this time of uncertainty. I continue to be concerned for what seeing only half a face in a baby’s earliest experience might mean for their development. I see looks of confusion on my patients’ faces, but I know that the care I provide and the tone of my voice and compassion through touch is felt by my patients. I still see smiles from the babies and that gives me hope.

I have taken care of an infant with a COVID-19 swab pending. I’ve spent shifts being mindful of donning PPE in response to my patient. I’ve heard the mantra of “there is no emergency in a pandemic.” This does not feel possible when you see a baby with a decreased heart rate and oxygen saturation, which is why you become as efficient as possible in the donning of PPE. As has every other healthcare professional, I’ve experienced the effects of carbon dioxide retention. Nobody feels good at the end of a 12-hour shift spent in a face mask, but we step up to the occasion when an emergency arises.

This is Nurses’ Week and some restrictions are beginning to lift. I just want to encourage everyone to continue to be mindful, compassionate, and conscientious when beginning to reintegrate into the public. Wear the masks when you are out, maintain distance, and keep the household members going out to a minimum. Everything we can do to protect each other also protects the most vulnerable patients.