Stressful work in the NICU

Doctor attends to sick baby in the stressful NICU environment

I loved my work in the neonatal intensive care unit (NICU) because there was always some excitement, plenty of intellectual challenges, and various procedures to perform. Some days working in NICU, however, I felt like a fireman running around putting out fires – one baby deteriorating here, another baby needing resuscitation there, some terrified parents with questions waiting over there, or a high-risk delivery to hurriedly attend. The NICU required maximum energy and sustained, intense effort. The stress at work I experienced always seemed manageable to me. It was not until the very end of my career, while working in a quiet low-risk labor and delivery (L&D) unit, that I had an opportunity to better understand myself and discover how I had survived my often stressful work in the NICU environment for so many years.

A stressful case example

One afternoon, a healthy young mother presented to L&D with her baby’s little feet hanging out of her vagina. She was pregnant at full term, and her baby was breech. This mom had just ruptured her membranes and went into labor with the baby’s feet presenting first. So, the obstetrician (OB) and nursing staff quickly transported the mother with her footling breech presentation back to the operating room for delivery.

The nervous mom was given an IV sedative while the OB tried desperately to deliver this baby. However, his head became wedged in the mother’s cervix, the uterine outlet. Fortuitously for me, I stood there waiting to care for the baby with a skilled NICU nurse and a trained NICU respiratory therapist (not usually the case in this quiet unit). We had all the necessary equipment ready, which was reassuring, but we all expected a badly depressed baby.

The resuscitation begins

After an excruciating twelve minutes of watching the OB tug on the baby boy’s feet and limp, purple legs, this little guy was finally delivered—blue, limp, lifeless, and not breathing. He had a heart rate of around 100, and we proceeded to resuscitate him. The endotracheal tube went in correctly and was secured well, his ventilation was ideal, the nurse’s IV insertion was flawless, and meds were administered correctly. By five minutes of age his heartbeat was a normal 140 and he became pink, however he still did not move.

NICU doctor and nurse examine baby after stressful resuscitation.

Cord blood gases were obtained. Then he proceeded to gasp for a few minutes, and finally began to breathe regularly and wiggle around. This was a very reassuring response to our resuscitation. At about twenty minutes after birth, he looked pink and perfect, and repeat blood gases were normal. I decided to remove his breathing tube. Since he continued to look well and act vigorous, I took him to see his mom briefly, then brought him to the nursery for observation and lab checks.

My response to stress: Working at NICU

I returned to update his terrified parents and reassured them that he would be fine. After speaking with them, I walked down the chilly and empty hospital corridor alone. Then I noticed that I felt ecstatic – “high” and quite wonderful. I realized then that I had not felt that way in over a year, since I was last in the busy NICU. It was at that moment, thirty-five minutes after his birth and resuscitation, that I understood that I was on an adrenaline (epinephrine) high. Adrenaline is the hormone that regulates your fight or flight response to assist us in defending stressful or threatening situation.

It was then that I realized how intense epinephrine surges had propelled me throughout my career, always providing strength and a huge sense of accomplishment. It dawned on me that I had spent a good part of my life in the NICU as an epinephrine addict. I craved excitement and valued going from one interesting or demanding situation to another. I was addicted to busy, frenetic work and always felt that the work was thrilling and rewarding (both feelings are the result of epinephrine surges). What I had not learned until it was too late was the toll I would pay for a career-filled with this kind of unrelenting, exciting work.

Your response to stress

Young doctor or nurse overwhelmed by work-related stress.

If you have a demanding, high-stress, or uncommonly busy job, I encourage you to seek an understanding of the physiological effects of your job on your mind and body. You need to understand how your body responds to work-realted stress and how to  best recover from it. Short-lived or infrequent episodes of stress pose little risk. But when stressful work situations go unresolved, your body is kept in a constant state of activation. This situation increases the rate of wear and tear to your biological systems. Ultimately, fatigue results, and the ability of your body to repair and defend itself can become compromised. As a result, the risk of injury or disease increases.

Your symptoms of stress

Are you experiencing irritability or angry outbursts? Do you have disturbed sleep, inability to fall or stay asleep, or restless sleep? Do you feel overwhelmed or hypervigilant? Are you having difficulty concentrating? Have you noticed social withdrawal or problems with friends and family? Are you experiencing feelings of worthlessness? Even headaches, upset stomach, and indigestion are signs of stress. Are you using alcohol or other substances to cope with your stress? I experienced many of these symptoms of work-related stress off and on over the years.

Working at NICU: Methods to cope with and recover from work-related stress

If you have a stressful job, it is important to set aside adequate time to recover, restore, and replenish. There are some helpful techniques to help you cope with work-realted stress.

  • Time alone is crucial. Most of us need time to be alone, reflect, explore our feelings.
  • Writing in a journal is a great way to get in touch with your subconscious mind and your creative, right brain. Journaling distracts your left brain from thinking about your worries.
  • Take a break to escape into nature. Take the kids to the playground. Walking outside in sunshine and nature in a great stress buster. The natural environment is calming.
  • If you have a quiet moment, you could try meditation. Keeping the Calm app on your phone will provide at-the-ready calming music and guided meditations.
  • Deep breathing practice is a stress relieving technique. Triangular breathing is very helpful: breathe in deeply to a count of 4; hold this breath for a count of 7; and then exhale to a count of 8. Breathe this way several times. This 4-7-8 breathing pattern engenders relaxation and lowers stress hormones.
  • Exercise is a crucial part of self-care and stress recovery. Exercise boosts mood, lessens stress, and lowers anxiety.
  • Pleasant social interactions with good friends, telling stories, and laughing all relieve stress. Watch for opportunities to show physical affection & give your friends a hug.
  • Playing and listening to music is well known to relax you and relieve stress.
  • Confiding in your spouse or partner about your stressful work can be helpful as well. When you are ready, you might ask them to listen quieting while you unload.

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