Maggie McKay (Host): Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay. When your newborn is in the NICU, it's not only concerning, but there are so many questions.

So today we'll get them answered with Anna Haas, Neonatal Clinical Nurse Specialist. Thank you so much for being here today, Anna.

Anna Haas, MSN, CNS: Hi Maggie. Thanks for having me.

Host: Absolutely. Anna, can you please introduce yourself and explain your role as a Clinical Nurse Specialist in the neonatal intensive care unit at Community Memorial Hospital in Ventura?

Anna Haas, MSN, CNS: Yes, I can. My name is Anna Hass. I am a neonatal intensive care nurse. I've been one for 22 years, and I've been here at CMH since 2017. Thanks for asking about this because a CNS is something not a lot of people are familiar with and what we can do. Generally a CNS is an Advanced Practice Nurse. I have my graduate degree specializing in neonatology.

And I had to take a certification exam in order to get my license here in California as a CNS. So what CNSs do, I can provide direct patient care and work with the patients and their families. I also provide education and mentoring for our nurses that work here at CMH. And then we also do my favorite part, which is we help improve patient outcomes by writing policies and making sure that everything we do here in the NICU is based on the most current evidence-based practice.

Host: That's a lot. That's awesome. Community Memorial's neonatal intensive care unit is a level three NICU. Can you elaborate on some of the advanced technologies and specialized care that are available here and how they stand out from other NICUs in the area?

Anna Haas, MSN, CNS: Absolutely. A level three designation means we can provide care for almost every baby that would come through the NICU. So we have the advantage where there's very few times we would have to send a baby out for a higher level of care, and that means families get to stay together here in their own community, where they live.

So we can perform surgeries, we have access to specialists, we have access to certain technologies such as high frequency ventilation. We have cooling beds, continuous EEG monitoring, and even retinopathy cameras so that we can perform screenings for retinopathy of prematurity. I think we stand out by our nursing care.

In addition to all these technologies, our nurses are the most specialized thing that we have to provide the best care here in the NICU. Almost 45% of our NICU nurses have taken a certification exam, so additional training and knowledge and education has gone into taking this exam, and they are specialized in neonatal intensive care as well as care of extremely low birth weight infants.

So all of this allows us to provide as much care possible here so that we do not have to separate families from their babies.

Host: That would be awful to have to go through that and be separated. So that's a plus right there. Community Memorial's NICU has such a diverse and highly specialized team. From neonatologists to respiratory therapists, social workers, and volunteer cuddlers. Can you describe how this team works together to provide comprehensive care for babies and their families, and how this collaborative approach impacts the overall experience for parents?

Anna Haas, MSN, CNS: I really have to credit our maternal child health director Megan Rodarte with promoting family centered care across all areas of our department. She makes sure that we're communicating from labor and delivery to our mother baby unit to NICU. We have our coordinated multidisciplinary rounds where everyone involved in that baby's care, from dieticians to neonatologists to social workers, pharmacists are all at the bedside to make sure that we're all on top of what each area is doing, so that we make sure there is no gap left unturned. What I really do appreciate is our social workers, because like you mentioned when we first started today, no one expects a NICU stay and it is very devastating for families.

Everybody wants to have the pink happy Gerber baby. And sometimes unfortunately, that doesn't always happen. So when it does happen, our parents kind of need a moment to kind of stop and reset and adjust to what this new direction is taking for them. And so our social workers not only provide emotional support, but they get resources for parents.

So what they might need while their baby's still in the NICU, because it could be several days to several months and when their baby goes home. So one part of our team that we couldn't live without is our occupational therapists and our physical therapists. They come through and assess our babies every day, and they work together with the nurses in order to help us provide the best neurodevelopmental support for those babies.

So they have to give us ideas on how we can make the outside environment as close to possible as what the baby would be experiencing were they still inside Mom.

Host: I cannot imagine being a parent, having to go through this. Anna, what are some of the most common concerns or questions that parents have when their newborn is admitted to the NICU and how does a NICU address them? How do you support parents and families who are experiencing a high risk pregnancy and they're planning for a NICU stay?

Anna Haas, MSN, CNS: I think if you asked every single NICU nurse on the planet, we would all say the number one question parents ask is, when will my baby go home? And I learned very quickly as a new nurse, I would say, we expect X many days. I learned very quickly that those babies have a mind of their own. And if I told a parent, oh, expect five days of antibiotics and then your baby can go home, that baby was going to show me who was boss and hold its breath and get a couple extra days added and stress out mom and dad.

So after being a seasoned veteran for a while, I generally tell them, Hey, there's about four things that every baby, regardless if they're a preemie or a big term baby that they have to accomplish. And we specify, they have to be able to eat on their own enough to gain weight.

They have to be able to breathe on their own without holding their breath. And it's a couple other things and that really helps parents kind of get an idea. Because they're getting a lot of information and so it really helps in the NICU to give parents something that they're like, okay, I can come in and I can check, okay, so were their labs good?

Can we stop the antibiotics or are we going to continue? And it kind of helps empower our parents so that they're an active part of their baby's care team. And that's really important. And that's what I love so much about the family-centered care we give here. One of the most important things we do is if we have a mom that we're in our antepartum unit, which is where we basically have moms who we want to keep pregnant and we want to monitor them, they will stay there for a while until it's time for their baby to deliver.

And our neonatologists provide consults for those families. So they go over explain if your baby was born today, this is what you can anticipate. And Dr. Van Houghton and Dr. Bankston, our neonatologists, have put together a booklet with common NICU topics that are in it. So not only are these parents getting this information verbally with a conversation, but they have it to reference later so that they can look at over and they can actually ask questions or think about things as they come across it in the book and go, oh, you know what? I want to revisit this topic. Can we talk more about this? Especially as mom goes further along in her pregnancy, because it's really important for the parents to have that information so they can make decisions for their baby and their family on what's important to them.

 And when they have other questions, I can come by and if they're in our antepartum unit for a little bit, I go in and check on them and make sure that there's resources that they need, education wise, I can print up articles, I've drawn pictures for families. And if it's something that the NICU neonatologist needs to come back and revisit, then we get them to come in and talk to the parents and update them.

 Once again, communication is key in all areas of a neonatal stay, even before the baby's born. So we just want to make sure that we have enough information for the parents to answer their questions, and we understand that they're getting a lot of information, so if they ask the same questions over and over again, no problem at all. I will answer it as many times as they need in order for them to feel comfortable with that.

Host: It sounds like these parents are so lucky to have a department and staff like you and the people you work with, because it just sounds so supportive and like you've covered every base you can think of for these parents because it's gotta be one of the most stressful things they'll ever go through.

So what are some of the long-term outcomes for babies who receive care in the NICU? You mentioned it a little bit earlier. How does a NICU team prepare families for that transition when they have to go home and any ongoing care needs?

Anna Haas, MSN, CNS: Well, it's kind of hard to say exactly what the long-term outcomes are for the babies just because babies are like snowflakes. There's no two that are alike. You can have two 24 weekers. Moms had exactly the same pregnancy going along at the same pace, same experiences. And those babies could come out and have completely different experiences once they're born.

So it's very individualized and that's what we try to do, is we try to make sure that regardless of the gestational age, the diagnosis, what's going on with the family, that we make sure that they're supported specifically with what their baby needs. We have in 22 years of NICU, I can honestly say it's the families that make the biggest difference in their baby's outcomes.

We offer things like skin to skin support when the baby's stable enough to be held and when they're not stable enough to be held; then we still offer support through our Scent Cloth program, which is where mom and baby each get a soft cloth. One goes under the baby's head, one mom sleeps with the other between her breasts, and then they trade 'em out.

So baby gets to smell mom's scent. And even though they're not being held and getting to smell mom that way, they still get to smell mom's scent because that's one of the first senses that's developed. So we promote breastfeeding, and we try to get mom and dad or the entire family actually set up for what to expect when they go home.

We actually have a high risk infant follow-up clinic that we offer, so certain babies qualify for that and they check in with them. I believe it's quarterly for the first little bit of their lives when they go home and make sure they have that.

Host: That's great because I would think when you're at home, it's even scarier because you don't have the support team around you and you're not a nurse, you don't know what to do. So thank goodness they can contact you or ask you questions ahead of time. Anna, do you have a patient story that you're allowed to share that really demonstrates the NICU's commitment to supporting families through these difficult times?

Anna Haas, MSN, CNS: I have a million stories I could share, but one that sticks out just because, it's not just when your baby's here in the NICU. We all live in this community. Most of us, like I was actually born at CMH. I won't tell you how many years ago, but I was born here many moons ago and I had my children here and I work here.

So when you go out in the community and you're at the grocery store, or you're shopping, or at the farmer's market; you run into your former patients and I can't tell you how many times we get birthday cards and Christmas cards with these babies's pictures in it. So I actually kept in touch from my last hospital, I had taken care of a little girl named Teagan and couple years back I come to work one day and the night shift nurse goes, Hey, these parents really want to talk to you. So of course I'm looking through the chart to make sure I am getting a little refresher. It was a new admission, so getting a little rundown so I could answer any questions they might have about their baby.

And I looked at the last name and it was Teagan's parents. And so this was Teagan's sister. So I was able to take care of not only Teagan but her little sister Daphne. And so I love that we established these relationships, that just last forever because I've kept in touch with Teagan's mom this whole time.

I knew she was expecting another baby. So when she delivered prematurely again, I walked into the room and I jokingly looked at mom and dad and before we even said hi, I said, you know, we have to talk about your uterus. It needs to learn that early is not a good thing. You gotta last the whole 40 weeks.

And so we had a good laugh and just recently, a couple weeks back, she sent me a photo. And she said, I just want to show you a picture. And it was a picture of Daphne, the little one that was born here at CMH. And she was with another little girl and she said, I work with that other little girl's dad. And it turns out that they were both in the NICU here at CMH at the same time.

Host: Wow.

Anna Haas, MSN, CNS: Some people think, oh, you just come to work, you do your job, and you go home. And that's not the case in the NICU. It's so outreaching and so intertwined and so every part of your life. It's such a small world with such a big community, so it's really nice to have that connection and it's just a really nice kind of full circle moment for me to not only see that Daphne's doing well and Teagan's doing well, but that there's another baby that granted, I love every baby that comes to the NICU that I take care of, but sometimes you fall in love with the families too, and you just kind of bond with them.

So it was nice to see another baby that had been in the NICU doing well as well.

Host: That's gotta be so rewarding to be in the market and see these kids growing up. I love it. So Anna, where can listeners go to learn more about pregnancy and childbirth at Community Memorial Hospital Ventura?

Anna Haas, MSN, CNS: They can find all kinds of resources on pregnancy, childbirth, and more at mycmhbaby.org.

Host: Is there anything else in closing that you'd like to add?

Anna Haas, MSN, CNS: Thank you so much for having me. And honestly, I want to say thank you to all of our NICU parents because they oftentimes say thank you to us, and I know it sounds cheesy, but it really is us who need to thank the parents. They trust us with a piece of their heart and they allow us to be a part of their family, and we're always so grateful for that.

Host: Not cheesy at all. That is beautiful. Well, thank you so much for sharing your expertise on this very important topic.

Anna Haas, MSN, CNS: Thank you so much for having me.

Host: Of course. Again, that's Anna Haas, and if you'd like to find out more, please visit mycmhbaby.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wise and Well presented by Community Memorial Healthcare.