- Email: [email protected]
The Newborn Triage Nurse: A New Perinatal Nursing Role
The Newborn Triage Nurse A New Perinatal Nursing Role
A
s the warm sun rises over the serene west hills of Portland, OR, a new mom holds her 35-week infant son in her arms as she enjoys the picturesque view from her room at Providence St. Vincent Medical Center. After a rough preterm delivery, followed by insufficient blood sugars, this barely 4 lb. newborn requires special nursing care—care that at most hospitals is only available in the Neonatal Intensive Care Unit (NICU), and away from the loving arms of his parents. With an average of 6,000 births a year, including a large portion of the state’s most high-risk patients, the family maternity unit at St. Vincent has emerged as one of the busiest and most well-respected maternity units on the
http://nwh.awhonn.org
West Coast. Despite the large size of the institution, the staff and managers of this unit have kept the focus on family and the healing power maternal-infant bonding. Out of this commitment to keep moms and babies together during the postpartum period grew a new supportive nursing role called the “newborn triage nurse.” The newborn triage (NBT) nurses of St. Vincent are a select group of postpartum and NICU registered nurses (RNs) with specialized training in caring for the high-risk newborn. There is one of these expert nurses on the unit 24 hours a day, seven days a week. This designated NBT nurse carries a cell phone and clipboard listing the pertinent information of every newborn on
the unit who may require additional care and support; this doesn’t include those who have already been admitted to the NICU. The NBT nurse acts as a resource and a “go-to” person for the mother-baby nurses caring for these neonates. If a problem arises, the NBT nurse is immediately called to evaluate the baby. This RN then makes a decision and/or recommendation as to the best course of action, whether it’s a call to the pediatrician or transfer to the NICU. These nurses provide hands-on care to neonates and support to mother-baby nurses. Neonates who are added to the NBT clipboard have a variety of issues, including being born between 35 and 37 weeks gestation, blood glucose
© 2007, AWHONN
443
Parents have responded very well to the NBT role and have stated that they feel safer knowing that there are several layers of protection for their babies.
instability, respiratory issues, need for intravenous antibiotics, elevated bilirubin levels, heart murmurs and feeding difficulties. The NBT nurse is available for more emergent issues, as well. For example, if a neonate has a low blood glucose level, the NBT nurse is called immediately and remains in close contact with the pediatrician and parents while the problem is managed. If the blood glucose is low and the newborn is lethargic and won’t feed, the NBT nurse would gavage feed the newborn and continue monitoring until the blood glucose levels are stable. If the blood glucose levels remained low and weren’t stabilizing, the NBT nurse would call the pediatrician for a transfer order for the NICU. The goal of this nurse is to keep the newborn with the parents but to also ensure that the baby’s safety is the top priority. To become a NBT nurse at Providence St. Vincent Medical Center, an individual must demonstrate excellent newborn assessment skills, judgment and communication skills. A nurse with these qualities is then selected to undergo extensive classroom and on-thefloor orientation to the role. The orientation is several months long and trains the nurse to use a higher level of critical thinking and to shift to a triage type mindset. She or he must be confident enough to make critical decisions in a short period of time as well as be a strong advocate for neonates and their parents. The development of the NBT role has undoubtedly increased the level of staff and patient satisfaction. When questioned about the role, several mother-baby nurses stated that for them it eases what could turn into an incredibly busy assignment when one of the nurse’s
assigned babies is having trouble. This role is also beneficial to the pediatricians, several of whom have commented that they can take comfort knowing that there’s an extra safety net for the babies. It also has decreased the number of unnecessary calls to the pediatricians. Having this expert nurse on the floor decreases the number of NICU admits and allows for greater family bonding. Parents have commented that they like being able to remain the primary caregivers for their new baby rather than handing this role over to NICU staff. The NBT nurse facilitates bonding by managing the medical needs of the infant in the postpartum room while at the same time involving the parents in all aspects of the care. The fact that the infant, who would otherwise be in the NICU, is able to stay in the postpartum room also facilitates success in breastfeeding since the mom doesn’t have to leave the room to walk to the NICU every time she wants to feed her baby. Parents have responded very well to the NBT role and have stated that they feel safer knowing that there are several layers of protection for their babies. The NBT nursing role has proven to be a success for Providence St. Vincent Medical Center. It has enhanced the level of safety for the infants, facilitated greater parent-infant bonding and increased patient and staff satisfaction. These specially trained nurses are perfecting what has turned out to be a groundbreaking role in perinatal nursing. NWH Jennifer N. Schiewe, RN, BSN
Portland, OR DOI: 10.1111/j.1751-486X.2007.00222.x
To learn more about the necessary qualifications and what is required of reviewers, email [email protected].
444
Nursing for Women’s Health
Volume 11
Issue 5
A
s the warm sun rises over the serene west hills of Portland, OR, a new mom holds her 35-week infant son in her arms as she enjoys the picturesque view from her room at Providence St. Vincent Medical Center. After a rough preterm delivery, followed by insufficient blood sugars, this barely 4 lb. newborn requires special nursing care—care that at most hospitals is only available in the Neonatal Intensive Care Unit (NICU), and away from the loving arms of his parents. With an average of 6,000 births a year, including a large portion of the state’s most high-risk patients, the family maternity unit at St. Vincent has emerged as one of the busiest and most well-respected maternity units on the
http://nwh.awhonn.org
West Coast. Despite the large size of the institution, the staff and managers of this unit have kept the focus on family and the healing power maternal-infant bonding. Out of this commitment to keep moms and babies together during the postpartum period grew a new supportive nursing role called the “newborn triage nurse.” The newborn triage (NBT) nurses of St. Vincent are a select group of postpartum and NICU registered nurses (RNs) with specialized training in caring for the high-risk newborn. There is one of these expert nurses on the unit 24 hours a day, seven days a week. This designated NBT nurse carries a cell phone and clipboard listing the pertinent information of every newborn on
the unit who may require additional care and support; this doesn’t include those who have already been admitted to the NICU. The NBT nurse acts as a resource and a “go-to” person for the mother-baby nurses caring for these neonates. If a problem arises, the NBT nurse is immediately called to evaluate the baby. This RN then makes a decision and/or recommendation as to the best course of action, whether it’s a call to the pediatrician or transfer to the NICU. These nurses provide hands-on care to neonates and support to mother-baby nurses. Neonates who are added to the NBT clipboard have a variety of issues, including being born between 35 and 37 weeks gestation, blood glucose
© 2007, AWHONN
443
Parents have responded very well to the NBT role and have stated that they feel safer knowing that there are several layers of protection for their babies.
instability, respiratory issues, need for intravenous antibiotics, elevated bilirubin levels, heart murmurs and feeding difficulties. The NBT nurse is available for more emergent issues, as well. For example, if a neonate has a low blood glucose level, the NBT nurse is called immediately and remains in close contact with the pediatrician and parents while the problem is managed. If the blood glucose is low and the newborn is lethargic and won’t feed, the NBT nurse would gavage feed the newborn and continue monitoring until the blood glucose levels are stable. If the blood glucose levels remained low and weren’t stabilizing, the NBT nurse would call the pediatrician for a transfer order for the NICU. The goal of this nurse is to keep the newborn with the parents but to also ensure that the baby’s safety is the top priority. To become a NBT nurse at Providence St. Vincent Medical Center, an individual must demonstrate excellent newborn assessment skills, judgment and communication skills. A nurse with these qualities is then selected to undergo extensive classroom and on-thefloor orientation to the role. The orientation is several months long and trains the nurse to use a higher level of critical thinking and to shift to a triage type mindset. She or he must be confident enough to make critical decisions in a short period of time as well as be a strong advocate for neonates and their parents. The development of the NBT role has undoubtedly increased the level of staff and patient satisfaction. When questioned about the role, several mother-baby nurses stated that for them it eases what could turn into an incredibly busy assignment when one of the nurse’s
assigned babies is having trouble. This role is also beneficial to the pediatricians, several of whom have commented that they can take comfort knowing that there’s an extra safety net for the babies. It also has decreased the number of unnecessary calls to the pediatricians. Having this expert nurse on the floor decreases the number of NICU admits and allows for greater family bonding. Parents have commented that they like being able to remain the primary caregivers for their new baby rather than handing this role over to NICU staff. The NBT nurse facilitates bonding by managing the medical needs of the infant in the postpartum room while at the same time involving the parents in all aspects of the care. The fact that the infant, who would otherwise be in the NICU, is able to stay in the postpartum room also facilitates success in breastfeeding since the mom doesn’t have to leave the room to walk to the NICU every time she wants to feed her baby. Parents have responded very well to the NBT role and have stated that they feel safer knowing that there are several layers of protection for their babies. The NBT nursing role has proven to be a success for Providence St. Vincent Medical Center. It has enhanced the level of safety for the infants, facilitated greater parent-infant bonding and increased patient and staff satisfaction. These specially trained nurses are perfecting what has turned out to be a groundbreaking role in perinatal nursing. NWH Jennifer N. Schiewe, RN, BSN
Portland, OR DOI: 10.1111/j.1751-486X.2007.00222.x
To learn more about the necessary qualifications and what is required of reviewers, email [email protected].
444
Nursing for Women’s Health
Volume 11
Issue 5