Nursing placements: the not-so-little Neonatal Unit

Child Nursing student Abbi is undertaking a number of hospital and community placements as part of her training. She describes her time working with babies in a neonatal unit.

When I first walked on to the neonatal unit for my nursing placement, I expected all the babies to be very tiny and in incubators. However I was surprised to discover there were lots of babies in the unit for different reasons.

Why are babies in the neonatal unit?

Some babies were there because they had jaundice (which presents as a yellow colour), some because they had trouble breathing due to their immature lungs, and some babies were in fact there to gain weight.

I was surprised to see that sometimes full-term babies came on the ward, being admitted due to birth complications, or to visit to receive antibiotics if they needed them.

How does the ward work?

Handover on the neonatal unit started at 7.45am and each nurse took up to six babies.

There were lots of different rooms in the unit. There were the high-dependency beds which is where the very poorly babies went; they would usually get one-to-one or one-to-two care in these rooms. There was the room in which babies were a bit more stable, however still needed a bit of support from the nurses. Then there was the room in which the babies were nearly ready to go home, but just needed to meet a few milestones in order to do so – for example gain a few more pounds.

What do student nurses do on placement?

My job as a student nurse was to get involved in the normal routine of the ward. After handover, my mentor and I usually completed all of our safety equipment checks; this included checking out oxygen and suction and also our emergency buzzer (just in case it was needed). We then said hello to our babies and their families and started to organise our day.

A tip I learnt from my mentor is to have a piece of paper, fold it into four and write a patient’s name on each box. You can then write down exactly what needs to do be done throughout the day for the specific patients and prevent mistakes.

After this my mentor and started to do all the regular tasks done on the neonatal unit. These included:

• Feeding: some babies are not feed orally on the neonatal unit, instead they feed through a nasogastric tube which goes from their nose right down into the stomach. Breast milk or formula milk can be passed down the tube using a syringe. Other babies were breastfed by their mothers or bottle fed. Babies were often fed four hourly, however it could be anything down to one hourly, depending on why they were in the unit.
• 'Cares': it is important that babies are looked after like they would be if they were at home. 'Cares’ involved nappy changing, bathing/bed bathing, changing beds, mouth care, cannula care, etc.
• Breastfeeding support: mothers can sometimes struggle with breastfeeding or may have questions. It's important that neonatal nurses have good knowledge so they can answer any queries mothers may have and make it a comfortable experience for them.
• Cuddles: something I found very important in the neonatal unit was ensuring that when families came in, if it was possible, they could have a cuddle with their baby. It was often very soothing for both the baby and their families. It also ensures they are building a bond, just like they would at home.
• Medical interventions: lots of the babies on the unit were very poorly due to sometimes being premature and therefore some required oxygen or other ventilation to help their breathing. Some babies were put on specific medications to help their growth and overall health. And some babies also had to have cannulas so we looked after them too.
• Weighing: babies on the unit are weighed twice a week (usually on a midweek day and a Sunday.) This is to ensure that they are getting all the right nutrients in order to develop well; weighing can indicate to the nurses if they are not doing so.

What did I learn on this placement?

Overall I really enjoyed my placement on the neonatal unit. A few things I have learnt:

1. Always organise your time. Try and spend a few minutes at the start of the shift if possible writing down everything that needs to be done; it will ensure that nothing is forgotten.

1. Ask for help if needed. Always work within your competences and ask your mentor if you need anything; they are happy to help you.
2. Be confident. Take every learning opportunity you can and ask your mentor questions throughout the day.

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