Hannah Bowen

They're just little, tiny warriors. Because, I mean, rightfully so, parents, a lot of times, are afraid of their babies, but they're really not that breakable. Yes, they're very fragile in a point like your skin's not developed, that kind of thing, but they're so resilient. It's phenomenal, the stuff that they go through. And, yeah, they're amazing.

Kristen Carpenter

I'm Kristen Carpenter, and this is Appalachian Care Chronicles, a podcast bringing you stories from every corner of West Virginia's health sector. Join me as we journey alongside a variety of problem solvers, change makers and daily helpers, who are all working behind the scenes and on the front lines to care for our communities.

Together, we'll explore what they do day to day, the steps that got them there and the whys that continue to draw them back. How, in the face of some of the most challenging situations possible, do they manage to keep themselves and the rest of us from falling apart? Far from predictable, the paths they've walked are full of twists and surprises, discovery and purpose. This podcast is for anyone who's ever thought about going into the healthcare field or has a passion for caring for others in times of need.

Kristen Carpenter

Let me introduce myself, the new host of Appalachian Care Chronicles, I'm Kristin, a Women's Healthcare Nurse Practitioner based in Morgantown, West Virginia. With nearly 20 years of nursing experience in both emergency and preventative medicine, I'm thrilled to be joining the show and delving into a new season of healthcare journeys. This season, we'll be exploring walks of life in neonatal nursing, gynecology and trauma medicine.

You might be able to guess where we are today. Our guest is Hannah Bowen, a neonatal, pediatric intensive care transport nurse. Hannah soothed that baby right to sleep. And by the way, this was her day off. She came in to show us around and tell us about her work, which would be challenging when she's on the clock.

Hannah Bowen

I think a lot of times with adult ICU, you're really, really sick, you've been in a wreck, you're had a surgery, you're on a ventilator. Whereas the neonatal ICU, these tinies they're not meant to be here yet, necessarily. Now, there are days that it is, you'll hear us say, oh my goodness, it's like a real ICU in here. Maybe it was just a month ago where we had, if we had 28 babies, we might have had 10 on CPAP and five or six on a ventilator, and two of them were extremely critical, where they were on eight different drips. And that's not common.

Kristen Carpenter

More than 2000 babies are born at this hospital every year, and many are high risk births. Hannah generally focuses on those little ones.

Hannah Bowen

He keeps fussing.

So for him, he was term, but he had, like an anatomical issue with his tongue, so his oxygen requirements kept increasing, and so to the point where they had to actually intubate him, put him on a ventilator. Well, then when one of our physicians went to do that, his tongue was in the way. So he actually had to have surgery to tie put a suture in his tongue, to hold it to his lip, to hold it forward, because his tongue is short and also wide in the back. I had him yesterday, I put him in the swing, and he'd do that, and then he'd go back to sleep, and then he'd talk, and then go back to sleep.

Kristen Carpenter

She is assigned one patient at a time. She meets the mother in the labor and delivery department and stays through the birth ready to shepherd them across the hall to the NICU at a moment's notice. If a baby needs care beyond the scope of what her employer can provide, Hannah will ride with them to the next stop and provide care on the ambulance or medical helicopter.

Hannah Bowen

So we need to support their breathing, support their temperatures, teach them how to eat. You might be a term baby that has an anatomical defect where your palate might not be intact, so you can't maintain your glucoses in the nursery, because you can't quite eat right. So now you have to come to us to be on IV fluids, and now we're teaching you and your parents how to eat.

Kristen Carpenter

I used to work in trauma and general surgery. So when I think of a unit at the hospital, I imagine the hustle and bustle. Monitors beeping, call lights going off, doctors rounding patients up and about. The Neonatal Intensive Unit is quite different from this traditional hospital setting. It's peaceful with dim lights and soft beeping for monitors, much calmer. That is by design. These babies are especially fragile at this stage and need as little stimulation as possible so they begin to heal. Doctors and nurses must speak in low voices.

Hannah Bowen

We don't want to wake them up if it's not necessary, so that's why we try to do everything that we can at one time and then get out of their beds. Whenever we do rounds, we'll stop at each bedside and discuss the patient, but even still, we're doing that in quiet voices. We have some babies that might be on a ventilator that even a conversation next to their bedside can make them drop their oxygen levels. It can cause a change in their vital signs and neurologically, these babies, especially 32 weeks and less, they're not ready to handle the lights and the sounds, because you have to think they're supposed to still be in the womb, where everything's muffled, everything's dark, so that we try to mimic that as best we can. In the outside world. It's extremely important to maintain their temperature. So if they're cold, then you're fighting a whole other array of issues. So whenever we get them over here, we practice what we call the golden hour. So in theory, within an hour of delivery, we want them to be tucked in, get our lines in, get our IVs started, fluids running, meds, given everything, and then we close this. For our littles, less than 32 weeks, we have the ability to put humidity in here, s o it's like they're kind of sleeping in a little sauna, like you might see the entire bed looks like you need to turn on your windshield wipers because the inside is just completely wet and dripping. But that all helps protect their skin, their heat regulation, their electrolytes, all the things.

Kristen Carpenter

The atmosphere is calm for the baby, but for the providers, it can be a race against time.

Hannah Bowen

We have what we refer to as the light. So it's a Labor Hall Emergence, essentially a Code Light for the babies. So if you hear that go off, you will see like controlled pandemonium in here, the Charge Nurse and the Transport Nurse that would be me for that day, we will take off and running and grab our labor haul bag that has all of our resuscitation supplies in it, and we take off across the hall.

As I'm then running to the exit, whoever is up at the desk for that day, they're telling us, OR one, OR two, or room 220, whatever it might be. And then we're running out here full tilt . And then the security guards are met with full blown team of people running through the doors. So when they see us approaching, they always open the doors for us. And then we're able to then go to the rooms. So for the OR I'll quickly, like, put on a mask and a hat at minimum, and then we're busting in the OR rooms to get help. So then whenever we get in there, the staff is doing what they need to at that point to resuscitate the patient. And then we get our gloves on, and then at that point we begin to take over, and hopefully the baby turns around and we're fine. I walk you down here to Mother Baby so you can see the nursery. The happy side, where they don't need us.

Kristen Carpenter

West Virginia needs great mental health professionals. If you're practicing in an underserved area and need help repaying your student loans, apply for the Mental Health Loan Repayment Program through the West Virginia higher education policy commission, visit cfwv.com to apply. That's C F W V.com

Kristen Carpenter

R ight now in West Virginia, the larger hospital systems are acquiring the smaller rural hospitals. This trend means there's an increasing demand for specialized nurses like Hannah because the rural locations are more directly connected to the larger systems. The word transport in Hannah's title means she is on the move outside the hospital too. Babies arrive at her hospital unexpectedly all the time from accident scenes, or more often, from a rural hospital that has fewer resources for the care of at risk newborns.

Hannah Bowen

So that facility, the physician will call us a lot of times, we will talk to them, put them in touch with our neonatologist or a resident if they're busy, and then they'll give us a brief rundown of what's going on. And then from there, everything's handed over to me. So at that point, based on how many weeks or how critical the patient is. I call Med Base , and we make the decision of whether or not I'm requesting a flight or a ground crew. So then I'm calling that facility, letting them know, Hey, I'm coming by air or I'm coming by ground. This is what my eta is. It's very important to always keep them updated. That's not their wheelhouse. The sick preterm infant or the critically ill newborn is not what they do every day.

Kristen Carpenter

There are four levels of specialized nurseries. Level Four is the highest level of neonatal care. Hannah works in a Level Three NICU, so sometimes in especially complex cases, babies have to leave her hospital for Cleveland Clinic or Nationwide Children's Hospital in Columbus, Ohio.

Hannah will travel all day with them by medical helicopter or ambulance, providing care along the way, there are different bags filled with medical supplies depending on the situation. Her blue labor and delivery bag, for instance, is used only inside the hospital and includes resuscitation materials. When she reaches for the red bag, the situation is critical.

Hannah Bowen

And then I call this red bag our save the world bag. If you thought the labor haul bag was heavy, pick that up. You weren't ready for that. So anything and everything that I would need is either going to be in my combination. This is our med bag. So every time before I leave, I'm always saying med bag, red bag, little red bag. I step bag to make sure that I have all my things, all meds that I might need are here, intubation, IV, suction, any like respiratory, albuterol treatments, all of that is maintained in this red bag. So if we're breaking out the red bag, there's something a little bit sideways that we're having to intervene on that patient's behalf.

Kristen Carpenter

In high school, Hannah considered going to medical school to become a pediatrician, but she wanted to join the workforce faster, so she chose to pursue nursing at Fairmont State University. West Virginia is a small world, and coincidentally, Fairmont State is where I also studied nursing. They have a great variation of traditional and non traditional nursing programs, so even for people that work full time, it's possible to earn a nursing degree in two years. While enrolled at FSU, Hannah also worked as a nurse aide in the NICU at the West Virginia University Hospital in Morgantown. Based on my experience in this job, I've always said that starting out as an aide makes for the best nurses. After graduation, Hannah interviewed to be an ER nurse at the hospital where she works, but she discovered that the unpredictable nature of the patient population wasn't a good fit for her.

Hannah Bowen

There had not been a position open here up until I worked in that unit for two and a half years before anything came open over here. There's just not a high turnover at that time. There were veteran staff in here that had been here, and they weren't going anywhere soon. So it took me nearly three years before I ever got a position over here, and then once I finally got my foot in the door, I just knew this is where my heart is, this is my God-given calling, to be here to take care of these tinies support, these families. And I've never looked back.

Kristen Carpenter

Earlier in her career, Hannah was on night shift. She worked six 12-hour shifts, followed by eight days off. A lot of new nurses work night shift. This is because there are usually open positions, and typically the pay is better. However, working long shifts, especially at night, can lead to a tough work life balance. Hannah works dayside now, and that schedule allows her to enjoy time with her family and better process the hard days on the job. Processing the hard stuff is not something gained in nursing school. Developing a support system can be tough, especially for those who are dedicated to caring for others, but finding that balance is an important part of the job.

Hannah Bowen

By night four, you're exhausted. For me personally, once I got through that fourth night, then the next two were a breeze. But then day one of your eight days off, you're half asleep, you're trying to stay awake and play with your kids, and you're like, oh, let's go take a nap. But it's eight o'clock in the morning, I don't care, let's take a nap! But now, where I'm on day shift, I can work my three twelves and be done. And then when I'm home, I'm home involved with my family. We're very active in our church. It provides me the opportunity to do those things so and there are days we've had some pretty heavy days here this year. Fortunately for me, my husband has had some healthcare experience. He works at one of the other facilities, so he fully understands that my day, my bad days, are bad days. Fortunately for me, our bad days in here are very few and far between. Thank goodness.

Kristen Carpenter

In a unit like the NICU, loss does happen. When a baby doesn't make it, the team turns to bereavement care. They take photos or molds or ink prints of the baby's hands and feet for parents to take home.

Hannah Bowen

If they want to be there when we give their baby a bath, we allow them to do so. Some people don't want any part of that. That's fine. I understand that. So pictures with them, like our staff, we will do pictures with you and your baby, or we will just do the pictures. However you need to be involved, we will allow that to happen. And sometimes it's really hard in here, because, as you can see, we're a big open unit. We don't have private rooms, so it is a little bit tricky sometimes to get that seclusion and that privacy to our families, if we even think we're getting close to that point, we literally shut the unit down. At that point too, if we're approaching end of life, we will allow that family to bring in whoever that they want, grandparents, aunts, uncles, pastors. We do our best with what we have to just create that time and space for you to spend time with your baby and your family and to try to cope and manage how you need to.

Kristen Carpenter

Sometimes it requires nurses to step into roles they aren't formally trained for.

Hannah Bowen

Not everybody is comfortable with death. We have some nurses that are like, this is not my wheelhouse, you know, and that's fine. You have people that that's very much in their wheelhouse. We have one of our nurses. She'll baptize babies. I have prayed over families myself, and you know, their pastor can't get here, or for whatever reason, our chaplain can't make it like they're tied up in something else. So the families approach me, hey, come. Our family wants you to pray for them. I'll gladly do that.

We had a really hard case, probably about a month ago. Quite honestly, I came back from that delivery and went to the break room, and I was just sobbing, because it was not the outcome we wanted and not expected by any means, and it bothered our staff for weeks. We always do a debrief after something like that happens. So we meet as a team. It's us, it's Labor Hall, everybody involved. Okay, what happened? What could we have done to change? Is there anything that we should have done? And in those cases, I feel like it's very, very rare that we miss something. If something's missed, it might be more of like an anatomical issue that we can't see or can't tell. And a lot of times, in those cases, what we do our interventions won't change anything anyway,

Kristen Carpenter

Unless people have experienced it, the NICU can be hard to wrap your mind around the juxtaposition of the excitement of brand new life, while also supporting scared, tired parents. Takes a very special person. It's not just treating one patient, it's a whole family. In addition, the whole department works as a team to maintain the best environment for these babies. Like Hannah said, quiet, peaceful atmosphere around here isn't solely an esthetic choice. It's crucial for the baby's healing, but restraint doesn't come easy. For new parents, they want to hold and feed their baby.

Hannah Bowen

Those can be hard conversations to have, so at the end of the day, this little, tiny human you're taking care of, they don't have a voice. They have ways to say no and stick up for themselves, but people don't always know those signs or tells. I feel like me coming in not having any medical experience as a parent, would be completely freaked out by all of this. But again, you have some people that don't necessarily see that. So when I have a baby that is on the ventilator, laying here at rest, I don't want them interrupted, and don't want you stimulating this patient, because if you wake them up and they get agitated, they're going to have a negative effect to their vital signs. And there's a way to approach it like, Okay, I know you want to be involved. Let me show you how to interact with your baby

Speaker 2 19:17

on our visit. The number of babies in Hannah's unit was a bit lower than usual, but just a month ago, they were completely full and there weren't enough nurses working. According to the American Association of Colleges of Nursing, nursing school enrollment is not growing fast enough to meet the projected demand. West Virginia is seeing the impact of this shortage and with larger hospital systems consolidating healthcare locations across the state, the need for specialized nurses will continue to grow.

Speaker 1 19:46

We've had a little bit of an upswing in surgical cases so the patients are more complex, so that requires more nurses as a whole. So we've been working maybe, hey, we could really use two up. To five more people, and so then that's when we're floated help from mother baby the nursery nurses will come help. We have an excellent team.

Speaker 2 20:10

One of Hannah's proudest moments came in December of 2022 when a parent of twin preemies nominated her for a national award recognizing her compassionate approach to nursing.

Speaker 1 20:22

We were busting at the seams, very, very busy, and they actually pulled me out of transport into a regular staffing role. So I had one of her twins, and I think the baby we were pushing on a week old, if not maybe a couple days past, and she had never touched one of her sons. And I said, Well, we're changing that today,

Speaker 2 20:45

the parent wrote, this incredible woman has gone above and beyond far too many times to count helping and caring for my nano preemie son. From the moment our son came into the NICU, she was a superhero. When he was a week or two old, she asked if I had gotten to change his diaper yet. I sighed and told her, No, seeing the disappointment in my face, she said, smiling under her mask, we're going to change that today. That was the very first interaction I had with my son. She will never know how much I treasure that moment, she truly helped us see a light at the end of the tunnel that is something for which I cannot thank her enough. I can see the love and compassion she has for her job and her tiny patience it radiates off of her. You.

Speaker 2 21:55

The Appalachian care Chronicles is a production of the West Virginia higher education policy commission Health Sciences Division, which is solely responsible for its content. Guest opinions are their own. Special thanks to vindalia health for more information about educational opportunities related to health care in West Virginia. Visit app, carepod.com that's a P, P carepod.com I'm Kristen Carpenter, and you've been listening to Appalachian care Chronicles. Next time, we're hitching a ride with a pair of providers from Cabell County's Quick Response Teams, Larisa Barker and Whitney Maxey, a community paramedic and emergency medical technician who work as a team to provide both medical and behavioral health solutions to those who need it most.

Transcribed by https://otter.ai