Welcome to Synapse Spotlight where we feature an interview with an inspiring NICU healthcare professional.
Today we are sharing an interview with Jennifer O’Malley, BSN, RNC-NIC about transitioning her NICU to nontoxic skin products.
Tell us a little bit about you, your training, and what first inspired you to work in the NICU?
My twin sister and I were born premature at 27 weeks. My mom always stressed to us how important a role the nurses played during our 3 months in the hospital. I knew almost immediately once I started nursing clinical that adults weren’t for me! During nursing school, I had an externship at Thomas Jefferson University Hospital in Philadelphia, PA, in their Level IV NICU, where I was responsible for 3-4 patients each shift. After graduating with my BSN, in 2006, I started my nursing career there. I later took a travel nurse position for a year and a half before I moved back home to NJ. I’ve been at Nemours Alfred I duPont Hospital for Children in Wilmington, DE, since 2015 in their Level IV NICU.
What are some of the most surprising places that nurses will find potentially harmful ingredients in the NICU? What are some of the health effects of these ingredients?
I was shocked how awful the ingredients were in the wipes and skin care products our unit was supplied. The typical skin care supplies we had in my NICU contained ingredients such as Sorbitan Laurate and Ethylhexylglycerin. Both are known to be abrasive and irritating to the skin. Depending on the brand and ingredients, some infants suffer extreme diaper and contact dermatitis from their exposures to these chemicals and others may have long-lasting effects from exposures to these potential carcinogens.
Other commonly stocked items in the NICU (or the hospital in general) such as soaps, lotions, and wipes contained Sodium Laureth Sulfate (SLS). Although SLS helps products get “foamy,” it doesn’t really do anything to help “clean” the skin, and even worse it often can cause skin irritation.
Our skin cleansing products also contained DMDM Hydantoin, a formaldehyde-releasing, antimicrobial, agent, which is a known skin toxicant and allergen, which can cause skin irritation. Another chemical, propylene glycol, which is a skin conditioning agent found in lotions, has been associated with allergic contact dermatitis as well as urticaria.
We also noted that many products also contained a common preservative, methylparaben, which poses a high concern for endocrine (hormone) disruption and a moderate concern for biochemical or cellular level changes (i.e. a potential carcinogen).
The artificial fragrances found in many of the skin care products in the hospital, and at home, can be really strong and unpleasant after long-term exposure. We were receiving complaints from our nursing staff, but also our baby’s parents too.
These products and their harsh ingredients really became an issue when our hospital CLABSI initiatives forced us to alter our bathing policy. To comply with the new skin care policy, any infant with a corrected age of 40 to 47 6/7 weeks and who has a central line (PICC, UV, UA, CVL) was required to have a daily bath. We noticed right away how dry and irritated our patient’s delicate skin was when we started giving daily baths using our standard baby skin care products.
Even when we were offered alternative products by the hospital, they were no better. For example, we were offered a no-rinse bath wipe to trial. This product, like the old ones we were trying to do away with, contained Ethylhexylglycerin and propylene glycol, along with other ingredients known to be skin irritants. After many conversations about the risk posed by the ingredients in these skin wipes, and with the support of our nursing leadership and medical team,our NICU was able to be exempt from trialing and using this product. (Win!!!)
It became clear after this experience that we really needed to research other options for our babies!
Tell us more about transitioning your unit to environmentally friendly products. What challenges did you face? What tips do you have for nurses who want to drive similar change in their unit?
As chair of our NICU Products committee, I was able to submit a request through our hospital’s Value Analysis Committee (VAT), educating them on the toxic ingredients found in skin care products and the risks to our NICU patients. Ultimately, I was successful in persuading them to change our products to more natural and environmentally friendly options.
Everyone in the NICU or who had any NICU knowledge was on board, but we needed to educate our hospital leadership in order to bring them on board as well. We first had to compile data on all of the ingredients in the current supplies and then present to an organization-wide committee to receive approval to trial the less noxious products.
It was a hard fought battle to receive approval even to trial these products, as the more environmentally friendly products were more expensive. We explained that yes, initially it would cost more, but we pointed out that from an infection control standpoint the products were single use and long term we would be improving the quality of our patient’s skin, and potentially their long term outcomes. Once we received their approval, our unit was able to trial the new skin care products.
Once our new product trial began, our parent response was immediate and overwhelmingly positive. They loved the organic, natural options. Within a couple days, our group received feedback from nursing that some of our patients with diaper rashes had experienced complete relief after regularly using the BEB diaper balm and WaterWipes for just these few days!
We blew through our trial stock quickly because everyone wanted some! After our trial was complete, I submitted our results to the VAT and we received final approval for our new environmentally friendly products.
The process of educating our leadership and going through the hospital process of approval took quite some time. We started our product trial in late 2018. We received final approval for the products in June 2019, and received our first supply just a few months ago, in August 2019.
Are there any online resources for other nurses to learn more about this topic and your work?
For product ingredients https://www.ewg.org/ is an invaluable resource. I use it frequently.
I also try to stay active in NANN and use my contacts on social media to see what is new or what education is available. If you are interested in products specifically reach out to your vendors; they are all very well informed and can be a great resource.
As for me, you can find me coordinating the night shift chaos here in the NICU at Nemours or chat with me at the ONE Conference in February!
What is your current role in the NICU – and what is the most rewarding part of your job?
I’m “just” a bedside RN. I’m regularly the charge nurse. I’m the current chair of our NICU Products Council and NeuroNICU Council. I co-chaired the planning committee for the 2nd Annual NeuroNICU Symposium, here at Nemours/Alfred I. duPont Hospital for Children. I am also a member of the NICU Practice Council, NICU scheduling committee, NICU leadership council, NICU Mentor group, and NICU mock code team.
Our unit recently opened the new Advanced Delivery Program this month and I am a nurse on that team as well. It is our version of a special delivery unit for infants with known anomalies that need urgent NICU or Cardiac ICU care.
Along with all of that, I created and maintain an education platform for the unit entitled the “Hopper News.” (The education lives on the bathroom bulletin boards) The “Hopper News” features new products, how to maintain neurodevelopmental positioning and general facts and education. With expanding our unit and so much change, I try to focus on what questions I’m asked frequently as a resource or charge and create needed education from there.
What is your biggest struggle at work and how are you working through it?
My current struggle is the lack of NICU knowledge and skill base on night shift. We’ve had a big influx of staff as our unit has expanded in the last year and some more senior staff have transitioned to days. There are some shifts I work where I am the only staff that has been a nurse for more than a year, let alone a NICU nurse.
I love educating and mentoring our newer to practice staff but some nights it’s hard to feel like it’s all on you. I try my hardest to make everything a learning opportunity and encourage them all to advocate for their patients and take the time to further their NICU knowledge.
How do you stay on top of the latest trends and technology coming to the NICU?
Social media. I follow people in the NICU world that inspire me and through them find out about new advances and education. I’m also a NANN member and follow their boards. I love travelling for conferences and finding out new info from networking there.
What advice would you give to new nurses just starting their career in the NICU?
I’d tell them to take it all in. Use everything as a learning opportunity but make sure not to let their own feelings or insecurities get in their way. It’s easy to feel overwhelmed but use it to grow, don’t let it stifle you.
What is one thing you do every day to keep you sane in the midst of NICU chaos?
When I have a bad day or shift, I try to remind myself why we do what we do. I also love to cuddle my dogs and hang out with my nephew. There is nothing better than a laughing 1 year old to cure your blues. If all else fails, there is always drinks with the girls!
What neuro-related projects will you work on next?
We have committed to a date for our 3rd annual NeuroNICU symposium, November 20, 2020. We’ll start planning for that early next year. (Hope some of you will come!!)
I’m handing over the NICU products baton this coming January and focusing on NeuroNICU and overall unit education. Our next big project will be making sure that our IVH rates don’t go up (now that we are a delivery hospital) and focusing on publishing our standard of care based on the Neonatal Integrative Developmental Care Model and its seven core measures.
We’re also working on revamping our feeding supplies to align with our infant driven feeding initiatives and to support our Speech Language Pathologists recommendations and preferences.
Why should nurses attend the next ONE Conference or watch the 2019 recordings? What makes the ONE Conference unique?
The ONE conference is a great experience. It’s educational but also motivational. Hearing the changes this conference has produced in other units around the country, and witnessing first hand how it’s affected my unit, never ceases to amaze me. It’s 3 days of education, fun, networking and inspiration.
I initially went for a conference and to explore San Diego but it’s so much more than that. Everyone in the room is engaged and wants to learn and do better. It motivates you to be the best NICU nurse you can be.
Jen started her time in the NICU as a patient. She and her twin sister were born at 27 weeks and spent 3 months in the NICU. Jen has worked at Nemours/Alfred I. duPont Hospital for Children since 2015 and has been a NICU nurse for 13 years. She’s passionate about mentoring and educating her colleagues. She is focused on instilling the core measures of neuroprotective family-centered developmental care on her unit. Jen is the chair of our NeuroNICU Council, as well as our Products/Value Analysis council. She is the co-chair and organizer for the annual Nemours AIDHC NeuroNICU Symposium.
Jennifer is on the left and her twin sister, Candace, is on the right.