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Kathi Randall is a masters-prepared clinical nurse specialist and board-certified neonatal nurse practitioner who serves on Hope for HIE’s Medical Advisory Board.
Back when she was a student in nursing school, Kathi Randall always envisioned herself being a nurse in the emergency room setting, as she loved its fast-paced environment. When she had the opportunity to travel to Mexico for a nine-week summer internship at a missionary hospital, she witnessed several neonatal emergencies, transports, and deaths. This experience fostered in Kathi a realization that caring for newborns was very special to her. Then, later on in nursing school, when she was assigned to do a rotation in the NICU, she fell in love with the prospect of working in the labor and delivery setting. For her, serving in the NICU was a perfect blend of the intensity associated with labor and the warmth of taking care of babies. Since graduating from nursing school almost thirty years ago, Kathi has worked exclusively with the neonate population.
Over the years, Kathi’s career trajectory has continued to take twists and turns. After initially starting out as a bedside nurse, she became a public health nurse, following preemies at home. She then went back to the hospital setting, becoming an educator and a transport nurse. Eventually, at around the time she became a neonatal nurse practitioner, Kathi was able to connect to groundbreaking industry partners, who were bringing out novel cooling and brain-monitoring equipment. She was invited to the table to learn about these new technologies and to participate in research projects that held the promise of revolutionizing the field of neonatal neurology.
From that point forward, Kathi became more involved with industry partners. She went on to become a clinical consultant for these organizations, providing her nursing expertise to help them build educational programs. After that, she branched out and started her own organization called Synapse Care Solutions, an education and consulting company dedicated to supporting Neonatal Neuro-Critical Care Units. Now, Kathi offers on-site NeuroNICU program consultations, in-person workshops, online courses, and an annual nurses’ conference called The ONE. She has been invited to hospitals to help build NeuroNICUs across the United States and in different countries around the world, from Brazil to Thailand to the Middle East. It’s certainly been a fun, adventurous, and highly rewarding career.
Kathi likes to say that every NICU is a NeuroNICU, whether they call themselves that or not, for there are developing brains in every single unit. When she travels around the world to build out more nurturing and specialized neuro-intensive NICU environments, she uses her four pillars framework to help NICUs assess where they are and where they want to be. Those four pillars include neuro-assessment, neuro-imaging, neuro-monitoring, and neuro-protection. Often, she finds NICUs are already performing at a relatively high function for certain pillars, while major gaps may exist for other pillars. After identifying those problem areas, Kathi helps NICUs create customized solutions—both simple and more complex—designed to make the environment as nourishing for the brain and supportive for the staff, families, and babies as it can be.
Driven by the desire to make the NICU experience and beyond as smooth as it can be for families, Kathi is happy to be involved with organizations with like-minded missions, such as Hope for HIE. In Kathi’s eyes, Hope for HIE offers HIE families the most powerful tool in all of this—that of parent-to-parent connection. To her, the essence of hope is being able to meet someone who genuinely understands where you are coming from. The essence of hope is being able to see that people who have walked in your shoes, through dark tunnels, have made it out the other end, able to lead happy lives, in spite of all the adversity they have endured along the way. And even though babies with HIE may make up a small percentage of the NICU population, HIE is really a condition that impacts the baby and family’s whole life. Thus, Kathi is inspired by the efforts Hope for HIE takes to offer much-needed support to a niche, yet wonderful, community of people.
On top of being inspired by the efforts of Hope for HIE, Kathi is filled with hope when she realizes how her profession has continued to focus on involving families, empowering them to feel like partners, as opposed to visitors. Through the work she does—from teaching through her educational courses and conferences, as well as by sharing parent stories with those in her community—Kathi strives to constantly shine a light on how important family presence is to the health of a baby. Unfortunately, from the pandemic, there was a regression in this progress due to the restrictions on visitations. But Kathi hopes that, in a sense, the absence of parents in the NICU during the pandemic cemented the message that parents serve as essential workers to their individual babies, even more than nurses or physicians do.
Furthermore, Kathi notices that nurses sometimes feel overwhelmed with the effort to support parents when the trauma they experience is acute, ongoing, and often derived from multiple origins. Trauma for NICU parents comes in various forms, whether it’s the trauma of separation, of death, of seeing their children be critically ill, or of losing the future they had always envisioned. To complicate matters further, parents also enter the NICU with so many unique resiliencies and underlying stressors. Yet, while it may seem like the emotional suffering is too immense to help families work through, Kathi teaches nurses that they have more potential to meaningfully touch the lives of parents than they initially think. Nurses don’t have the power to completely alleviate the pain that parents feel, but that doesn’t mean they don’t have any control.
Ultimately, by embracing empathy in daily practice, nurses can make better choices about the things they do have control over at the bedside. Kathi would advise nurses that it all boils down to anchoring themselves in the present, placing themselves in the shoes of parents, and reflecting on what would serve parents most at the time. Even simple gestures of support, such as helping a mother pump for the first time, encouraging parents to bond with their babies by reading them stories, or holding a baby during cooling can make a huge difference.
That is exactly the philosophy that fuels the annual ONE Conference Kathi leads—ONE nurse can make a difference in the life and brain of ONE baby with simple actions. ONE word, ONE touch, or ONE action can make a difference to ONE brain and ONE family. It’s all about taking it ONE day at a time, reflecting on what special skill or experience you can draw from in this ONE moment to provide support and healing.
Not only is it important for nurses to tend to the mental health needs of parents, but they need to tend to their own well-being as well. Self-care is not necessarily a skill that nurses are explicitly taught, but regardless, it is a skill that is undeniably essential. Kathi would emphasize to NICU nurses to, number one, show self-compassion. Acknowledge that the work they do is hard, that the trauma of constantly bearing witness to the suffering of others is very much real and worthy of being treated. Continually being immersed in the service of others without taking breaks, will only lead to compassion fatigue and burnout. So, she advises that nurses make sure to seek out environments that are conducive to self-care, whether making a “Zen Den” at work where they can rest for a few minutes, attending a support group for nurses, or debriefing informally with a friend after a stressful shift. If no support is available in the workplace, nurses should find different ways to stay well. This could mean seeking outside communities to connect with others with similar experiences, attending therapy, or even practicing meditation. In addition, providers shouldn’t be ashamed to speak to their limits. If they’ve had a rough three days and are feeling overwhelmed, they should ask their manager if it would be possible to have an easier assignment the next day. Only by taking that time to recharge can they truly be present and engaged with families.
In the future, Kathi hopes that the momentum to address nurse wellness, as well as parental mental health, only continues to progress. She cannot speak more highly of NICU psychologists, and she is waiting for the day when NICUs will have universal mental health screenings for all families. It’s important to shift the culture from one in which mental health distress in the NICU is viewed as pathological, to one in which it is viewed as a natural part of the human experience. Far too often, families feel the need to put on a mask and bury their emotions inside, acting like they are completely fine, in order to fit into the mold of “good” parents. Perhaps, if intentional efforts were made to let parents know that emoting is a sign of healthy expression, they would feel more comfortable being vulnerable and reaching out for help.
In the meantime, not only can normalizing distress help parents, but so, too, can practicing consistent communication, offering resources that connect parents to others in the HIE community, and reintegrating families into the parenting journey. Even if it’s just finding ONE way to normalize the experience for parents, that ONE action can reap innumerable benefits.
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