Our day shifts start at 07:45, though often my mind is at work from the moment I’ve left the house. We’ve got an app which shows us where our vehicles and teams are, and sometimes it’s nice to see what’s going on to get a bit of a heads up as to what to expect. Will we need to go and do a team-swap if the team are out and about, or will we need to dispatch immediately if an emergency referral has just come in? Other times it’s nice not to worry about what’s been happening and find out when you open the door to the NEST Office. Most often the night team are there to welcome you, and there is some time to chat through how their shift has gone, and get an informal update on previous transfers.
We have a team briefing first thing, which runs through key safety checks and updates. It’s a really helpful way to start to the day and we often have some interesting discussions. Following this, we review the previous day’s transfers and advice calls. It’s an opportunity to look at the nuts and bolts of the transfers; checking how the referral went, and seeing if there were any communication, equipment or clinical issues that cropped up and might need reporting or following up in some way.
This can include follow up calls to check on the progress of transfers we’ve been involved with, or to explore situations that may be been particularly difficult or potentially stressful. It’s important that we can pick these up with the teams involved and check they’re ok. It’s a great opportunity to learn about different scenarios and approaches, as well as maintain some familiarity with the range of transfers we undertake. There is always an opportunity to ask questions about any elements of the care we give, and how we give it, making it a useful way to stay current with what’s going on.
After the cases are reviewed, we finish off all the equipment and bag checks, and there are usually a couple of detailed bag checks, stock checks to carry out, or deep cleans to do. Between the morning team brief, the rapid reviews, and equipment checks, there is almost always a handful of jobs to sort out!
At any point we could receive a referral for advice or transfer. As a nurse on the team, we are often involved in the process as we bring a lot of clinical, process and logistical experience to the table. Even if we might not be directly involved in giving clinical advice, it’s really helpful to be involved in the conference calls as then we can start thinking about the planning for the transfer. As a team, the sorts of things we do include gathering and making final preparations to the equipment according to the type of transfer, arranging for a vehicle, printing paperwork, signing out the medications we’ll be taking with us, and confirming the availability of a cot for the baby.
We’re also heavily involved in planning some of the logistical elements of the transfers, particularly when we have several transfers lined up. We often need to coordinate transfers with feed times, journey lengths, traffic conditions, and also need to make sure the referring units are clear on the plans and timings. This helps them to prepare the necessary paperwork, and keep the families in the loop with the plans as well.
The nursing role on the NEST team is a really interesting blend of variety and routine, of isolation and intensity.
It’s varied in that you literally don’t know what each day will hold. It might be a helicopter transfer bringing a local baby back in from another region, it might be a short local planned repatriation transfer. It might be an emergency intensive care transfer where every moment counts, or it might be a day in the office updating a guideline or working through some training and development if there aren’t any transfers needing to be done. It might be a day of planning transfers which never actually happen for one reason or another, or of having to abandon several best laid plans because an acute emergency referral comes in.
It can be routine because we try and approach our transfers in a standard and consistent way. The attention to detail of our approach to transfers means that complicated transfers generally feel calm, planned, and routine. We stick to checklists and consistent approaches to try and alert us early to situations that might be evolving in complexity, so that we can take appropriate action and minimise the unexpected events; keeping our minds free to react quickly and appropriately when the unexpected does occasionally occur.
It’s intense because you have periods where you are completely focussed on the situation you’re in, trying to absorb and monitor clinical information, the team-working of the staff around you, the family members who may be present, and other key allied health professionals who may also be involved. This information needs to be within the team to make sure we are all working from the same plan, and aware of any need to change the plan. It’s important to be aware of everything that is going on, yet not get overloaded or fixated on certain things. The intensity of arriving at a referring hospital in the middle of an emergency or complicated situation can be quite daunting. We have to work hard to get quickly up to speed with the clinical and team working elements of the situation. This can be a challenge when you’re working with a referring team who you may not know, and when the clinical picture is not yet clear. In a small team there is quite an intense responsibility to prepare and trouble shoot the equipment you’re using, as you don’t have the luxury of a memo team onsite, spare equipment, or additional colleagues to help out.
There is also the intensity of sitting with a family for the duration of a transfer, particularly a repatriation transfer where often we provide support to a nervous, tired and anxious parent. The repatriation transfers are commonly very stressful and emotional times for the parents of these infants, and it is often during these journeys that these feelings and emotions come out. The reality of taking a step closer to home brings with it positive and negative feelings which parents can often find quite difficult to verbalise. There is also a unique intensity when we sit with a family whose baby we have to transfer to another unit when the current one is too full. To be witness to the first cuddle between a mother or a father and their child, and then have to transfer the baby to another hospital can feel pretty heart breaking. Whilst we don’t have long with these families, we do have to use our skills and experience to quickly build positive relationships with them, to gain their trust, and for them to share their concerns and worries. Small things like involving them in sorting out some of the baby’s belongings, and taking a picture or two, often make a big difference in keeping the parents calm.
The isolation mainly comes from being a team which is often on the peripheries, dipping in and out of the units around the region. We don’t often hear how our involvement has contributed to the baby or family’s experience, as we don’t have the opportunity to build those sorts of relationships. It can also feel incredibly isolating when transfers don’t have the outcome that we were expecting. Sadly, some of the infants we transfer are too sick to be stabilised and we are unable to transfer them. These are the times when we often feel most isolated; we’ve been called to help, we’ve arrived to do a job expecting, and being expected to do it well, and despite this, the worst thing happens. We look around at faces we know, but we’re not fully part of the same team. And then we have to drive home, reflecting and wondering about what could have been.
So how do we deal with this range of situations, feelings and emotions? Being a small team means we can connect and understand each other, and really draw on each other’s professional and life experience and expertise. We form bonds with each other through the tough transfers, and enjoy time with each other on the more routine transfers. When we aren’t on transfers we train together and learn from each other. We work on projects together to help build the Service we provide for the hospitals we support. We build trust. In the systems and processes we work within, and in each other. Trust that someone will look out for us and catch us when we’re having an off day. Trust that if we don’t hit the mark, someone will carefully support us to understand how we could aim to do differently in the future. Trust that if we’ve been upset by a situation, that someone will probably already have noticed and will be working out how to support us, either through the offer of a timely coffee, a walk around the block, or just an understanding and empathetic comment.
Working on the NEST team gives us the opportunity to feel involved and engaged with the clinical care being delivered, to support the families and staff caring for the sickest infants, and to shape and develop ourselves, our colleagues, and the Service we provide.