Precious Cargo

Precious Cargo

Transport and delivery room nurses jump nimbly between dual roles helping newborns

Leslie J. Sulpar, MSN, RN, a veteran of more than 25 years in the neonatal intensive care unit at The Johns Hopkins Hospital and elsewhere, was working a 12-hour shift when she received her first transport call—a sick newborn at another location needing special care. Sulpar changed into her black transport polo and rushed out with the team. Their job: bring the baby to the Hopkins NICU.

Sulpar was a bedside nurse and safety officer when she took on the new role of transport and delivery room (or TR/DR) nurse. For her, it was an exciting opportunity. “I like that urgent, spur-of-the-moment, thinking-on-my-feet kind of setting,” she says. And since its inception last July, the TR/DR nurse role has aided newborns, nurses, and the hospital in a major way.

“Just to have the TR/DR nurse available to draw up medications and document while the nurse practitioner might be doing stabilization of the airway has been a tremendous assistance.”
— Beth Diehl-Svrjcek, DNP, RN

Currently, there are 33 TR/DR nurses who help the team transport newborns to and from facilities around the state, attend births in the delivery room, or serve as an additional resource for NICU nurses.

The position addresses several particular needs. It complies with a new state law requiring a second licensed provider on the transport team, which also consists of a nurse practitioner and at least one paramedic. On the delivery room side, a concern was that NICU nurses weren’t getting enough opportunities to go to the delivery room, some only a few times a year, and therefore they didn’t feel comfortable enough when called upon, says Karen Frank, DNP, RN, a clinical nurse specialist in the NICU. The pairing of the roles seemed like a good fit.

Among the goals of the TR/DR program are thermoregulation of newborns and getting babies moved more quickly from the delivery room to the NICU. Thermoregulation means ensuring newborns are warm by adjusting the room temperature, activating thermal mattresses, and other measures. So far, Frank says, results are promising. “The mean temperatures have increased for all of our newborn admissions, and the time from when the baby is born to when the baby is admitted to the NICU is less than 20 minutes, which is really good,” she says.

On the transport side, a goal was to decrease the amount of time the team spends in referral hospitals by 15 minutes. “Just to have the TR/DR nurse available to draw up medications and document while the nurse practitioner might be doing stabilization of the airway has been a tremendous assistance,” says transport nurse Beth Diehl-Svrjcek, DNP, RN, lead neonatal nurse practitioner. A report shows having extra hands has so far led to a seven-minute reduction in the mean in-hospital time at the sending hospital.

During transports, the TR/DR nurse has also improved parent communication. “Now that we have the TR/DR, [she/he] can be talking to the family while the nurse practitioner is busy and while [she/he is] providing care to the baby,” says Diehl-Svrjcek.

TR/DR nurses must have two years of NICU experience and attend a TR/DR-specific class and a pediatric base station course. They also must complete a S.T.A.B.L.E. course (short for the six assessments: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support) and a neonatal resuscitation program and remain current while in the role. “I think it’s been a wonderful opportunity to provide advancement for NICU nursing staff to get them additional responsibility and additional education,” says Susan Culp, MSN, RN, nurse manager in the NICU.

Sulpar, who served as a transport nurse about two decades ago at a different hospital, has grown more comfortable in the TR/DR role at Hopkins, though she says she still gets the occasional knot in her stomach. “I love doing it. I love the diversity of it and that you never know what’s going to happen next,” she says.

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