Day in the life of a NICU nurse

Inside Main Line Health
Women's Health
Morgan Graziano and twins

When Morgan Graziano began her role as a nurse in Main Line Health's neonatal intensive care unit (NICU), she didn’t realize it would also be the place where her daughter — who is now 3 years old — would be cared for in her first weeks of life.

For five years, Morgan has learned the ins and outs of the NICU. She witnessed the challenges that parents face and the hurdles that tiny babies must overcome. As a nurse, she provided the kind of care that only nurses of fragile newborns can give.

When her daughter was born at 29 weeks — well before the expected 40 weeks of pregnancy — she gained a new perspective on what the parents of babies in the NICU experience. "It was challenging for me because I was walking into the same unit, but also rewarding because she's home and healthy," she says.

While difficult, her experience helped her to connect with parents on another level. "They have every right to sit there and tell you that you don't understand what it's like," she says. "But now I can say I do understand. I get it."

As someone who bridges the gap between parent and nurse, Morgan has a unique perspective into the ongoings of the NICU — a place where babies, parents and health care providers face some of the toughest and most rewarding moments of their lives.

A day in the life of a NICU nurse

Morgan’s role in the NICU comes down to one primary responsibility — caring for babies. This includes providing respiratory support, managing central lines, taking temperatures, feeding through a tube, changing diapers and taking on many other tasks that support babies in the NICU.

Babies need extra special care in the NICU. Many are born preterm (before 37 weeks of pregnancy), and they need help adjusting to a world they weren’t quite prepared to enter.

"The preterm baby is very different from the full-term baby because they've missed a number of weeks in the womb," Morgan explains. "If they're preterm, we try to mimic the mom's womb. We try to decrease overwhelming stimuli because that can truly affect how they progress. Sometimes, if you're talking too loud next to a preterm baby, you can see their heart rate shoot up or their pulse drop down because it stresses them."

Limiting noise in the environment is just the beginning. "We dim the lights. We teach parents that their scent is enough and not to wear perfumes. If you happen to be a smoker, try to change before you come in because all of that is very overwhelming. Even laundry detergent scents can be very overwhelming for baby," Morgan says.

Too much physical touch can also be stressful for babies in the NICU. "Usually, you have a baby and you want to cuddle them or stroke them. That is way too much for a preterm baby," explains Morgan. "We teach parents the proper kind of touch that these babies need. We call it containment holding, and it's kind of light to moderate pressure. It really calms them down."

At the same time, the right kind of physical touch is extremely beneficial for the babies. This is something that Morgan says some caregivers are hesitant about. "Sometimes, the parents question whether or not they know Mom or Dad, and they truly do," she explains. "We encourage them that their touch is very important."

In addition to limiting stressful stimuli, NICU nurses are also in charge of promoting helpful factors, like sleep. "We really protect the baby's sleep in the NICU," Morgan says. "When they're sleeping, they're conserving their calories and using them to grow."

Amidst it all, NICU nurses prioritize education for the parents. "It’s non-stop education working with the parents," Morgan says. "We talk through everything we do with them."

Tube feeding, bottle feeding, breastfeeding: Nutrition in the NICU

Babies in the NICU get their nutrition differently compared to babies in the maternity department. "Babies don't typically learn to suck and swallow until about 32 weeks. The brain isn't wired to do it yet," Morgan explains. Milk isn’t usually produced until around 34 weeks of pregnancy.

Fortunately, there are tricks to help babies develop this skill. For instance, caregivers might hold their babies and give them a pacifier while they are being tube-fed. "That kind of tells their brain, ‘Okay, I'm sucking in. My belly is getting full right now,’" says Morgan.

Eventually, this practice will help them transition to bottle feeding, breastfeeding or both.

As moms begin to produce milk, NICU nurses help promote the breastfeeding bond by putting droplets of milk on a cotton swab for the baby. "Some parents are very scared. But some others — you can see how excited they get when it's one small thing they can do for their baby," she says.

Breastfeeding can be particularly challenging for moms of babies in the NICU, as it can throw a wrench in their plans to exclusively breastfeed. "A lot of the moms come in, and it's their goal to breastfeed the baby, and that's not the case," Morgan explains.

In fact, that’s what happened to her. "I just wanted to breastfeed my baby, and I had to be an exclusive pumper. Pumping is breastfeeding, but it's still so hard to come out of that mindset when that was your plan and that's not the plan anymore."

After two years of exclusively pumping, she has personal insight to share with moms. "It's so nice to be able to help moms with any little tips and tricks that worked for me," she says.

Main Line Health’s affiliation with CHOP

At Main Line Health, not only do parents of babies in the NICU have dedicated and caring nurses like Morgan, but they also have access to Children’s Hospital of Philadelphia (CHOP).

"The affiliation with CHOP has been wonderful. It makes the parents more comfortable knowing that providers can connect with CHOP physicians for second opinions," Morgan says. "We now have better access to additional testing and more coordination with specialty services while the babies are in our NICU. Overall, it has felt like quicker and better access to the resources we need for our babies."

Beyond physical care: Supporting the emotions of caregivers

The physical tasks of the NICU are only the beginning. Parents of babies in the NICU are navigating a range of emotions from worry to confusion to hope. Because of her own experience, Morgan is familiar with the ups and downs of this wing in the hospital.

"One of the biggest feelings as a mom if you have a preterm baby or even a full-term baby that ends up in the NICU for one reason or another — you truly feel like your body has failed this child you're supposed to protect. That feeling is so hard to overcome," she says.

Her job is to remind moms that this isn’t the case. "You didn't fail. Your body saved your baby," she says. "It’s helpful being able to connect with moms on that level."

Morgan also encourages parents to focus on the positives. "I try to help the parents celebrate the tiny milestones because it's not a sprint — it's a marathon," she explains.

This can be tough, especially when some days are more challenging than others. "Sometimes it can feel like you're taking two steps forward and some days about 20 steps back," she says. "It’s important to show the parents that there are things to celebrate."

A personal and professional connection to Main Line Health’s NICU

Since having her baby in the NICU, Morgan has played two roles — a skilled nurse and a caring companion who has walked a similar path.

In addition to her daughter serving as a reminder of the miracles that occur in the NICU, former patients continue to inspire her. "We had a mom bring twins back that were born around one pound. To see them walk through the doors — it was amazing," she says. "Even seeing the babies that weren't born as early but still were so sick, seeing them come through the doors and how well they're doing — it's just so exciting."

The NICU is a place full of challenges, celebrations and a wide range of emotions. As a mother and as a nurse, Morgan is here for it all.

Next steps:

Learn more about maternity care at Main Line Health
5 tips for a healthy pregnancy and avoiding preterm birth
The breastfeeding diet: Your guide to nutrition while nursing