Guest post: "Neonatal units are at breaking point"
More staff, better training and serious investment are all needed now at the units caring for our sickest babies, says nurse Louise Parry
Posted on: Mon 19-Oct-15 14:49:38
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Neonatal units aren't meeting the standards required of them. That is the underlying message of the new report from Bliss, the UK charity for sick and premature babies. The findings aren't unexpected. But they're still shocking.
I have worked on two of the largest and most advanced neonatal units in the UK, both with a permanent staff of over 100 nurses. However, despite being expected to care for babies born on the very fringes of life, both units I have worked on struggle with staff shortages. The unit where I currently work has several shifts a week that require agency staff to fill them, even after the regular staff have swapped shifts and worked extra hours.
Staffing shortages mean that although there are always sufficient staff to safely care for the babies, we don't have much time to spend with parents. For these parents having a baby on NICU is often the worst thing that has ever happened to them; they're exhausted, frightened, often feel guilty and are sometimes hundreds of miles away from home. They worry about interfering with medical equipment and are often unable to cuddle their baby without assistance.
Neonatal nurses would ideally be able to dedicate a whole shift to just caring for one baby and their family - but even in intensive care we usually have two babies to look after and so end up trying to split ourselves between two families who would benefit from our undivided attention.
Despite being expected to care for babies born on the very fringes of life, both neonatal units I have worked on struggle with staff shortages.
The Bliss baby report 2015 emphasises that neonatal staff are dedicated and hard working, but they are being stretched to breaking point. It says 2,140 more neonatal nurses are needed in order to provide the care needed to ensure that all babies admitted to NICU have the best chance of survival and improved long-term health.
The impact of staffing shortages is clear - according to Bliss, 70% of neonatal units are caring for many more babies than is considered safe. The recommendations set out by the Neonatal Toolkit state that it is not safe for units to be running at higher than 80% occupancy. But I have yet to meet anyone who works on a neonatal unit that, if not full, has more than one or two cots available for emergency admissions.
Although my current neonatal unit always ensures that we never admit more babies than we have sufficient staff for, this means we frequently have to transfer babies who are less sick to lower level units. For parents, this means dealing with the stress of having their baby transferred to a hospital that they are unfamiliar with. It means forging relationships with new members of staff and adjusting to the new routines and procedures.
Parents need the support of neonatal staff. They need support to become heavily involved in the care of their babies. For parents to have the best chance of being able to bond with the babies, they also need psychological support from trained mental health staff - there is strong evidence that parents who have a baby on NICU are more likely to develop PND. However, the report finds that many neonatal units are unable to provide any form of psychological support.
I have worked on a unit where no psychological support was available to parents beyond what we as nurses tried to give them, despite having no mental health training ourselves. On the unit where I currently work we are lucky enough to have a dedicated unit psychologist, well trained staff and overnight parent accommodation but nothing in neonatal care (or indeed healthcare) should be down to 'luck'. The reality is though that many neonatal units (including mine) rely on charity donations to buy much-needed equipment and to keep our parent accommodation open. And so, the quality of care we can provide is often dependent upon the charity funds we are able to raise.
What needs to be done? Everything. We need more funding, more staff, better training; the list just goes on and on. Neonatal units are already stretched to breaking point and without serious investment it won't be long before some of them snap.
By Louise Parry
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