International Nurses Day: Meet the neonatal nurse helping bring babies home

As we mark International Nurses Day, we’re shining a light on one of our brilliant neonatal nurses, Iva, who helps Lia’s Wings bring premature babies safely closer to home.

In this Q&A, Iva shares what life is really like onboard neonatal air ambulance transfers, from caring for tiny patients mid-air to supporting families through some of the most difficult moments of their lives.

“Most people know what hospital nurses do. Few realise neonatal nurses also provide intensive care in the air.”

What inspired you to become a neonatal flight nurse?

I never thought that flight nursing was possible in the UK. In fact, at one point in my life, I considered emigrating to Australia, but even then, I thought my chances of undertaking a flight as a nurse were slim. It was merely a dream, just like neonatal nursing once was.

The opportunity to become a neonatal flight nurse was presented by chance. I worked in a team where several team members already had a connection to Lia’s Wings. Once I gained experience in road neonatal transfers, I asked if I could join a flight study day. Lia’s Wings not only agreed but also kindly sponsored this for me.

"I asked if I could join a flight study day. Lia’s Wings not only agreed but also kindly sponsored this for me."

I am an ordinary neonatal nurse who loves her job. Watching babies’ faces and their little expressions will never cease to amaze me. I am living my dream.

Can you share a moment from a Lia’s Wings transfer that has stayed with you?

There are many moments that stick in my mind, and it is quite difficult to pick just one.

There are moments when the team meets the parents and their faces light up, not just because they start believing that they are finally getting nearer home, see their other children or pets, but also that we speak the same language and can interact about even the small things.

“Their faces light up because they are finally getting nearer home.”

On arrival at the home unit, the family is often greeted by the other parent and sometimes other relatives. This is always a very joyous moment when the family gets closer to their emotional support circle.

Lastly, it is the look of relief when their baby is settled in their new unit. There is a realisation that the transfer was a success and a perception that the baby is in the last stretch of hospital stay before going home.

Most repatriations lead to family reunion, but not all. Babies with complex conditions are transferred by Lia’s Wings to hospitals that offer a higher standard of care. Those I struggle to leave behind.

How do you support and reassure parents during such a stressful time?

Listening is an underestimated tool. By which I mean really listening. Acknowledging parents’ concerns as valid and offering explanations on how I would resolve them if their concerns were to occur.

“Listening is an underestimated tool.”

If the parent is anxious, I tend to try to steer their mind towards different thoughts. I am happy to hold hands, but the best medicine for anxiety is laughter.

What does a typical day look like for you when working for Lia’s Wings?

My typical working day starts the day before, when I receive the mission briefing and have a discussion with the rest of the flight team or operational team. I also pack my bag the day before. I would not leave home without my passport, toothbrush, toothpaste, water, paracetamol and a set of smalls, in case of an unexpected overnight stay.

Fatigue can play a significant role in any clinical situation, but especially when undertaking a flight transfer. Therefore, I would never skip a good night’s sleep.

Once at the dispatch hub, I follow the checklist and collect all equipment and bags that were assigned to the mission. Loading the equipment is a several-person process, and procedures need to be followed for safe loading even without the baby.

"Loading the equipment is a several-person process"

Whilst the benefit of fixed-wing transfers is to save time in transit and patient comfort, it still includes ambulance transfers between the airports and hospitals. The challenge is not to leave any medical bags in the wrong place. The rest of the day includes multiple loading and off-loading episodes.

The actual clinical care in the air is similar to road transfers. There is one additional consideration needed. As the aeroplane rises, the air pressure gets lower, which in turn increases the volume of air molecules. Because of this, there could be implications for patient care. 

What are the biggest challenges when transporting premature babies?

From a clinical point of view, I would say that keeping the baby warm is a big challenge. We could be off-loading from the aircraft in wind and rain, or sit in a closed aircraft on a scorching hot runway waiting for a departure slot. Luckily, we have a kit we take with us that includes several different items that could help to achieve a normal temperature in the former case.

What kind of equipment and care can you provide mid-air?

Thanks to Lia’s Wings, we can transfer the baby in an incubator or a baby pod. An incubator is used for babies that need more heat and respiratory support. The baby pod is used for bigger, more stable babies. Our ventilator can provide different levels of respiratory support, including intensive care. Some babies cannot have feeds in the tummy, so we give them fluid in the vein. This has to be done through intravenous infusion pumps. This piece of equipment delivers an exact volume per hour. This is particularly useful when the infusion is mixed with medication, and the dose must be precise. Babies that are on respiratory support and intravenous fluids need to have their heartbeat, oxygenation, breathing rate and blood pressure checked. This is all done by a vital signs monitor. It is necessary because the monitor alerts us when there is a change, and we need to review if there is a need for intervention. We carry a blood gas analyser in case we need to do a more in-depth assessment.

“Our ventilator can provide different levels of respiratory support, including intensive care.”

A vital piece of equipment is a suction unit, which allows us to remove secretions that may be preventing effective oxygenation. And whilst it is unlikely that a defibrillator will be required, it would be irresponsible not to have this with us on route. All of the equipment pieces are used with single-use parts, so our bags are stocked for every eventuality.

Why is specialist nursing, like neonatal transport, so important?

There are different levels of neonatal units. To provide safe neonatal care, units must have a certain number of days per year that they care for babies with a certain level of needs. That way, they maintain their skill set and adequate funding. But if you are an expectant mum and you suddenly find yourself in early labour, you will travel to your nearest delivery centre, which may not provide the level of care your baby needs. This is when neonatal transfer teams step in. In the UK, it is doctors and nurses who have lots of experience working at NICUs.

Even the most cautious expectant mums can find themselves delivering prematurely abroad and face a long time on their own in an unfamiliar environment. In addition, even if they have a proficient level of the same language, it may not be enough to communicate nuances, which would lead to parental reassurance or informed consent.

What have these experiences taught you, professionally or personally?

It taught me that many people are alike; they thrive when surrounded by family. Unfortunately, not all parents have this support available to them, but being closer to friends and their own home will make them stronger and more resilient.

Without the fundraisers and a superb medical support team, I would not be able to use my skills to help these families. My contribution is a mere fraction of their journey.

“Without the fundraisers and a superb medical support team, I would not be able to use my skills to help these families.”

What makes neonatal flight nursing different from working in a hospital NICU?

As a nurse in the neonatal intensive care unit, I had a high workload that had to be done on a strict schedule. Otherwise, the whole chain of tasks would be delayed. For the air transfer, I essentially plan to do as little as possible. Hence, I apply monitoring and change the nappy before moving the baby to the transfer incubator or a pod.  Unless I have to feed the baby, adjust leads, check IV sites or suction, I focus on babies’ comfort.  I only have one patient and one parent. There is usually an opportunity to find out what concerns parents have, and I try to explain aspects in plain language. I also outline what the family is likely to experience in a UK neonatal unit, so that parents have realistic expectations.

“The look of relief when their baby is settled in their new unit… there is a realisation that the transfer was a success.”

When babies are born prematurely or become critically ill far from home, Lia’s Wings is often the only organisation able to help.

Nurses like Iva provide specialist care, comfort and reassurance throughout every aeromedical transfer, caring not only for the baby, but for anxious parents too. It costs £600 for a specialist neonatal nurse to support a transfer. Donate today to help more babies travel safely, and more families get closer to home.

Help bring babies home

“Those I struggle to leave behind.”