Neonatal Nurses Week Spotlight: Layne Petrino ARNP-BC, NNP, IBCLC
According to the CDC, preterm birth affected one out of every ten babies born in the United States in 2020. Preterm birth is when a baby is born too early, which is defined by the World Health Organization as any time before 37 weeks of pregnancy.
Layne Petrino is currently a Neonatal Nurse Practitioner who lives in Florida. She has the heart to serve and some great reflections as she looks back on her career. Interested in nursing and want an inside scoop? Read on to learn more about this nurses story and advice!
What led you to work as a neonatal nurse?
Growing up I always loved babies. Maybe that's cliche but it's true. I'm an only child so I was never around babies. I started babysitting for a few of the neighborhood kids and worked in the church nursery in high school. In addition, I also always knew I wanted to do something in medicine. I was diagnosed with Type 1 diabetes in 3rd grade and I wanted to be on the other side of healthcare helping kids. Initially I thought I wanted obstetrics to be my specialty because I found pregnancy and fetal development fascinating. But as luck had it, I fell in love with the NICU in school and have been there ever since.
I think that neonatal medicine is fascinating. We deal with every system of the body, usually in great detail. I'm a classic Type A personality, and the level of detail in the NICU is unreal. Not just because our patients are literally tiny but because the tracking we do with their lab work, their fluids, etc. All the adjustments we make in our management are very calculated. We have to be very tuned into all the small things and be able to put all those tiny pieces together to see the big picture. That type of management just lights up my brain. :-)
What advice and/or motivational tip do you have for future nurses that want to pursue this field?
I think the biggest misconception (specifically for nursing) is that if you want to go into a specialty you HAVE to start with MedSurg. For my nursing degree I was actually in an accelerated BSN program. This means that I got my Bachelors in Nursing degree in 4 semesters (a little over a year total). Their main goal was to prepare us for the licensing exams and that meant only 1 semester devoted to all the specialties since traditional adult medicine is the vast majority of what the exams cover. I knew I wanted to do something in pediatrics or OB and this meant I got very little time on these floors. And our practicum (last semester of training) was required to be in MedSurg. Funnily enough, I was placed in the VA which was the furthest thing from what I wanted to do with my degree (there are no kids and largely no women, LOL).
I thought I would be unhireable in the NICU since the rumor was that IF any jobs went to GNs, it would be because the staff had gotten to know them during practicum. Since I never had my practicum on an L&D or NICU, I thought I had very little chance of getting hired since no one knew me. Well, I submitted my CV for several labor and delivery positions and there was a checklist where you could list other departments you would be interested in. So I checked a box saying that I'd be interested in NICU. I was called back by the recruiter asking me if I was interested in a NICU posotion why didn't I apply directly to the open position? I explained that I didn't think they'd seriously consider hiring a GN in the NICU. The next day she called me in for an interview and within a week I was offered the job.
If you know where your heart lies, don't hesitate to go after THAT. The great thing about nurses is that we can do anything. If you are a good fit, most specialty floors are willing to give you a slightly longer orientation to make up for any inexperience.
Don't be afraid to advocate for your patient, if your gut tells you something is off, speak up.
Do you have a memorable moment in your career you’d like to share? What has been most rewarding?
It's hard to pick just one memorable moment. After working as a NICU nurse for a few years, I went on to become a neonatal nurse practitioner. I moved away from the bedside and became part of the medical team. That puts me in a position to care for many more patients at a time and also to be there for a lot of impactful events in other people's lives (an exhausting delivery, the death of a baby, the realization that their child will not be born healthy and/or will have a long road ahead of them in the ICU before coming home to join their family). I don't take that for granted. I have bonded with a lot of my patients and their families over the years and I have patients that I still follow and talk to.
Probably, the most recent vivid experience I had was in 2021. I had transitioned to traveling all over the country to help understaffed NICU's. I briefly worked in a Level 2 NICU in a very rural town. To make a very long story short, we found that one of the babies in the normal newborn nursery had failed one of her tests required for discharge. After admitting her to the NICU for monitoring, I was called back to the hospital overnight because her condition worsened. I was concerned that she had an undiagnosed heart condition (these can sometimes be hard to see on ultrasound during pregnancy). The hospital did not have access to the equipment we needed to diagnose her. Instead, I used a very old test (called a hyperoxia test) to determine the cause of her distress. It came back profoundly abnormal.
After that, I knew that I would be telling her parents that their baby had a heart defect, which may be one of the scariest diagnoses for parents to hear. I also had to tell them that I was sending their baby on a plane 5 hours away to the nearest children's hospital that could treat her. I walked into their room deeply aware that I was about to change their lives. I desperately wanted to say the right things. Ultimately I spent what felt like an eternity in their room giving them awful news. I drew them pictures to try and explain how a normal heart works and how their baby's heart was working differently. They had so many questions that I couldn't answer because we didn't know what kind of heart defect she had. That was the only way to know what the treatment would be and what her prognosis was. They kept asking more questions and then stopped to cry. I sat right next to the mom, holding her hand, pausing to let her cry and then starting again when they were ready. In the end, when their baby was leaving with the transport team, they hugged me and told me that I had been the only calming presence around them and it made a horrible situation a little bit easier to bear. We all cried.
What keeps you motivated to continue doing this work?
There are 2 main parts of my job that I love. The first is when I get to do something that gets my adrenaline going and uses my skills and knowledge (resuscitating a baby, placing central lines, intubating). I like that my sickest patients are very medically complex and I enjoy the back and forth of seeing a problem and then fixing the problem. It's satisfying. And the second is when I get to be there for families in moments I know they will remember. When you work in intensive care you are positioned in certain moments that you know will be pivotal points in people's lives. And when this happens to me I am keenly aware of it and it can be intimidating. But I've had moments where I was the patient that were really difficult for me and during some of those moments I've had amazing nurses or doctors who I remember being angels who make a crappy experience bearable. I want to be that for other people.
In the experience I described above, I was proud of the catch I had made. Afterward, I was told more times than I can count that "I have never seen a hyperoxia test done in real life" and "good catch!" I enjoy getting to use my knowledge to solve problems or treat patients in difficult situations. But even more than that was knowing that I had been there at this hinge moment of that family's life. That moment between the "before" and the "after" of knowing their child was sick and not knowing how it would end. It was heavy but it also felt so humbling. I take those moments as a privilege. I will never forget that baby or her family.
What do you think future nurses should know when working in the NICU?
Before becoming a nurse practitioner, I was a nurse in the NICU. Having been on both sides, I can honestly tell you that nurses are the most integral part of the NICU. They are the ones that see the changes in patients before we do. They are there around the clock for these babies. Don't be afraid to advocate for your patient, if your gut tells you something is off, speak up. But also, stay curious! Ask questions during rounds, and learn how to read labs and blood gases. Ask questions if you don't understand why a provider is doing something. I love asking my nurses and respiratory therapists questions. We are all a team and we should all be teaching each other.
