Spotlight on Neonatal Outreach Education Coordinator
Karen Wald has been a nurse going on 24 years at Columbus Regional Health and Midtown Medical Center. Her entire career has been spent in some way working with those just getting started in life, often with the critical disadvantage and uphill challenge of being born prematurely.
That focus never changed when Wald, 45, took the job as the healthcare system’s Neonatal Outreach Education Coordinator in 2011, a position in which she trains and works with nurses at other hospitals to prepare them for moments such as resuscitating an infant and stabilizing them.
“Babies, they’ve just always tugged at my heart strings. They’re my passion for what I do,” said the Smiths Station, Ala., native and Phenix City resident. “My goal is just to improve neonatal outcomes so that the babies have a better chance to be the best they can be in life. I’ve watched babies go from fragile little babies to now they’re growing into young men and women. That’s the most rewarding part of my job is to follow them and see what a blessing and a miracle these babies are.”
The Ledger-Enquirer stopped by Midtown Medical Center recently to talk with Wald about her job and what it takes to stay on top of the skills demanded in a neonatal intensive care unit (NICU) in general, but also in helping others to become better at what they do in times of possible crisis. This interview is edited for length and clarity.
Q. So how did you become involved in this area of health care?
A. I’m been a nurse since 1994. I started as an LPN and worked a couple of years, then went back and got my RN in 1998. I initially was hired for the mother-baby newborn nursery. We took care of babies that needed a little support, but maybe not NICU (level). As that evolved, we saw a growing need and they developed a Level 2 nursery within the newborn nursery staffing. So I transferred into that role. I loved taking care of the more critical babies. I worked at our special-care nursery since 2004; it opened in 2000, and worked there until 2011. Then this job came open and it was very much out of my comfort zone.
Q. Why is that?
A. I’m not a big public speaker, but I can teach, and when I know what I’m talking about I have no problem communicating that. But public speaking was not something I was comfortable with, which is funny because my twin sister is in radio (in Asheville, N.C.) and has a morning show. Go figure.
Q. Tell us about the Perinatal Outreach Program with which you work?
A. Our goal is to improve outcomes with babies. What we were seeing is those smaller hospitals had limited resources, limited staff and education. So my role is to go into these hospitals and support them.
Q. How many hospitals do you work with?
A. We have nine. We’re one of the six regional perinatal centers in the state. We serve 21 counties and we go to each of those hospitals. I provide not only education resources, but support and maybe a consultation for advice. That’s because it’s not necessarily the goal to transport a baby back to our NICU. If that baby can stay at that hospital and remain with mom, sometimes that’s the best option.
Q. Do you examine babies?
A. I don’t, but we have a neonatal transport team, as well as neonatologists, so they can call us for advice, physician to physician. Or if they think a baby might need additional support, our transport team will go out and pick up that baby and bring it back (to Midtown Medical Center’s NICU).
Q. How far north do you travel to assist hospital staff?
A. Close to Atlanta, in Villa Rica, which is about 15 to 20 minutes from the Six Flags area. That’s my farthest hospital and it’s about two hours and 10 minutes away from Columbus.
Q. How far east?
A. Probably Thomaston.
Q. It sounds like a lot of time on the road for you?
A. Ninety percent of my time has to be for my referral hospitals, meaning not educating internal staff here. So I would say between two to three days a week, I’m out traveling.
Q. Tell us about your classes?
A. A lot of them are out-of-the-box classes, such as neonatal resuscitation. It’s a nationwide program. But part of that is trying to get creative and tailoring it to each hospital and making it fun and keeping the staff engaged.
Q. Explain more about that.
A. It’s tailoring it to each person and making it fun and engaging, not where (they feel like) my manager said I had to take this class. I want to make it fun and that they leave learning something. What’s really fun is that ‘aha’ moment, when you have a nurse who applies something they learned in a class in real life and they go, omigosh, this was wonderful. It’s almost a priceless moment for them. … My job, too, is to make it easy to remember when you’re in a stressful situation. And I remind my staff everyday, when you’re taking care of patients, you need to treat that patient just like this was your family member, treat them just like you would want your family treated.
Q. What does that core class you teach entail?
A. It’s how to resuscitate a baby in the delivery room that comes out (of the womb) requiring assistance. About 10 percent of all babies come out needing some type of support.
Q. But you’re not trying to encourage the hospitals to send infants to Columbus?
A. We are not. Our goal is for them to keep their babies (at their hospitals) as long as they are getting the appropriate level of care. Out of my nine hospitals, some are Level 1 and some are Level 2 and I have one that’s a Level 3 that has a small NICU. That’s Piedmont Newnan. When you’re designated by your level, it kind of gives you a range of what babies you can appropriately care for.
Q. What is the criteria?
A. Level 2 hospitals can take care of (premature) babies that are 32 weeks or greater. Level 1 hospitals can keep babies that are 36 weeks and greater, not requiring ventilator support.
Q. It’s remarkable that a couple of your hospitals are so close to Atlanta, but still part of your network?
A. That is true. A lot of our communities wonder why babies come to Columbus and not to Atlanta. The reason is Atlanta is so inundated (with population and patients). In their region, (another coordinator) has 41 hospitals. I have nine. So what we try to do is save those beds (in Atlanta) for the very critical babies that need surgical, that need ECMO (extracorporeal membrane oxygenation, a lung and heart procedure), that need a higher level than we can provide. We don’t do cardiac here in Columbus; we don’t do surgical. So those babies do have to go to Atlanta.
Q. What percentage of NICU babies at Midtown Medical Center are local versus coming from outside of Columbus?
A. We do around 350 admissions a year, and of those I would say maybe a quarter are probably transported here. We do about 10ish a month on average.
Q. Are you full now? There are 28 beds in the Level 3 NICU now?
A. We are full. There’s 28 beds in our Level 3. We still currently have our Level 2 nursery open and there are eight babies in there today. It has a capacity of 12.
Q. And you’re in the process of expanding?
A. We just acquired six additional beds. We were 40 beds between the two units and now we’re going to be at 46. It’s just going to be one unit called the NICU. We’re doing away with the term ‘special care nursery’ and what used to be known as ‘high risk.’ So 28 of those beds are private room concept, and the remaining beds are going to be more of an open concept allowing flexibility for multiples (including twins). So we’re real excited about that. They’re just beginning construction on that, and it is where our old unit was.
Q. When should that be completed?
A. The end of next year, I believe. The fall of 2018 is our goal.
Q. So what is a typical day like for you?
A. Usually half of my day or more is traveling to these hospitals. My classes range from four to eight hours. And then I travel back home the same day. I usually don’t do a lot of overnights unless it’s for conferences or something like that. … I usually save one to two days a week (in Columbus) just to do paperwork, to get ready for my next week, to do rosters.
Q. Are you a one-person show?
A. I am a one-person show. (laughs) But on a typical day I could get emails from my managers, phone calls, people asking about policies and procedures, how do we do this, what would be the best way to do that, making recommendations.
We also do a yearly visit where the maternal educator and myself do a needs assessment. Every hospital’s needs may be a little bit different. What we want to know is how do we best support you? What do you need from us? Some hospitals rely on me very heavily maybe to do all of their NRP (neonatal resuscitation) classes, and some have one or two people who teach with me. I have one hospital, they have some very strong nurses that do their own NRP classes. There I focus more on the stabilization.
Q. How many people like you are there in Georgia?
A. There’s five others ... Being part of the outreach program is a very rewarding job. We work very closely with the Department of Public Health and our goal is simply to improve neonatal outcomes. What we try to get our nurses to think about is everything that we do with that baby, from the delivery room to the stabilization, it all affects these babies for a lifetime.
Q. You’re dealing with infant patients who have entire lifetimes ahead of them?
A. Right, and we see miracles everyday, everyday.
Q. Do you bring some emotions to this? It would seem to be the type of work for that to occur?
A. Oh, absolutely. You have to be able to do your job, but there is a lot of emotion to it because when you care for the babies, you have to support the families, too. And you have to provide compassion and care and comfort to them during this time, as well as doing what’s best for this baby. And sometimes it’s being an advocate for the baby. Physicians are the ones directing the care, but sometimes we’re the ones with the babies 23 hours a day, and sometimes we know what they need and we have to be advocates.
Q. Do you try to make sure you spend a little time in the NICU occasionally to stay in touch and grounded so to speak?
A. I do. One of the things I do is try to work some PRN (as needed nursing) and take care of patients, whether they’re in the newborn nursery or wherever, just to keep my skills up and to keep my hands in it. That’s because I’m going out there (to other hospitals) and teaching evidence-based material and most hospitals want to know what are we doing. So I have to be able to share with them: this is what we do and why we do it.
Q. What’s the most challenging aspect of your job?
A. One of the most challenging things when I first started was the actual traveling piece. You go from working with a staff to being by yourself traveling and not having people to talk to and the communication. But I’ve kind of learned to embrace that over the years. That’s kind of my down time, or my relaxation time per se, because I know I’m going to be talking and interacting (with nursing staff) when I get there. So I do enjoy the travel piece much more so.
Q. What’s the most rewarding part of your work?
A. Even though I’m not at the bedside, I still have to remind myself that what I do does impact patients, that I may not be actually doing (the day-to-day nursing), but I am making a difference. So it’s that and seeing babies that I took care of when they were fragile little babies and they’re now growing into young men and women.
I have a set of twins now that are 18 that I see regularly. I have a little girl that’s 8 years old and her mom sends me messages. To me, that’s a rewarding thing. … I love my families. It’s funny, families always say you made such an impact or you touched our lives, but they have no idea how they impacted my life.
I went into nursing thinking I want to take care of people, I want to help people, and it’s so different from what you ever imagine it will be. And when you take care of babies, it’s a whole other world because you have to advocate for them and take care of the whole family unit, and you build relationships, and they become part of your family, too, your work family.
And when they go home it’s emotional. Sometimes you cry, too, because you’re going to miss them because you’ve been with them for three months and they’ve been here everyday. And there are those that go (back) to a home that you wish you could do more for them and that there were more resources out there.
Q. And not all babies make it?
A. They don’t, and that’s hard. It’s very hard when a baby doesn’t make it, no matter at what gestation. It’s very emotional.
Hometown: Smiths Station, Ala.
Current residence: Phenix City
Education: 1991 graduate of Smiths Station High School; earned her licensed practical nurse degree in 1994 and her registered nursing degree in 1998
Previous jobs: Has worked at Columbus Regional Health for 23 years
Family: Linc Wald, her husband of 22 years, and three children — Whitney, 28, Kyle, 26, and Blake, 19
Leisure time: Loves Alabama football and tailgating with friends; also enjoys shopping, decorating, going to the beach, camping and spending time with family
Of note: Serves on the Georgia Perinatal Association board and is a leader instructor with both the Neonatal Resuscitation Program and the Stabilization of Sick Infants Program; also volunteers with March of Dimes