NICU transport nurses ensure a safe arrival for Mayo’s tiniest patients

Every day, teams throughout Mayo Clinic do incredible things behind the scenes. Teams like the NICU transport nurses, who stabilize babies before transferring them to Mayo Clinic's Neonatal Intensive Care Unit in Rochester.

Thirteen years ago, a Mayo Clinic Neonatal Intensive Care Unit transport nurse flew with Tami Omdahl's son from Baton Rouge, Louisiana, to Rochester, Minnesota.

Julie Mai.

Today, Omdahl is the nurse administrator who oversees the team of transport nurses she calls "vigilant guardians."

"They transport Mayo Clinic's smallest, most fragile patients," Omdahl says. "They give families hope."

That's a responsibility and privilege these nurses don't take lightly.

"I always say to the parents, 'Thank you for letting me be a part of your journey,'" says Julie Mai, who's been an NICU transport nurse for nearly a decade. "Being with these families on one of the hardest days of their lives really pushes you to do a great job."

Bringing compassion and expertise every day

To bring infants to the NICU at the Saint Marys Campus in Rochester, transport nurses sometimes travel by ambulance to nearby facilities. Other times, they fly in a helicopter or fixed-wing aircraft to community hospitals as far away as North Dakota. 

Though a flight or ambulance ride is critical, the NICU transport nurses bring their expertise to every stage of a patient's journey to Mayo Clinic, ensuring these brand-new babies' needs are met.

They're members of the Mayo Clinic Ambulance Services team, which includes paramedics and pilots, dispatchers, physician advisers, mechanics, nurses and EMTs. The critical care teams are specially equipped to care for patients from infancy to adulthood — which, for the NICU transport nurses, includes the tiniest of preemies.

Since their patients are so fragile, "we do a lot of intervening at the referral facility before we transport the baby back," says Lori Brookman, who has worked as a NICU transport nurse for 12 years.

During premature deliveries, they often stand by, ready to provide whatever stabilizing care the baby needs. Community hospitals might also summon them when unexpected issues arise during deliveries or when NICU patients need to move to Mayo for a complicated procedure.

To enable this level of on-the-go care, the team travels with an isolette (a clear, heated crib) equipped with two types of ventilators, medications, nitric oxide to help babies breathe, an array of monitors and an infant cooling system. Altogether, it weighs more than 600 pounds.

"We bring the ICU to the patient," says Tracy Halleck, a nurse who has worked on the transport team for 19 years, accompanying patients to Mayo Clinic by ambulance, helicopter and fixed-wing aircraft.

In addition to the isolette, Halleck also travels with a respiratory therapist and a large dose of compassion.

A few years ago, she received a page about a newborn in respiratory distress at a community hospital. Since the baby was struggling to breathe, the care team had provided ventilation through a mask, unaware of an underlying diaphragmatic hernia.

With this condition, the intestines form in the chest, impairing lung development. Typically, this type of hernia is caught in utero, but in this case, it had gone undetected. Although the baby did need supplemental oxygen, "the mask ventilation was pushing air into the bowel and blowing it up in the baby's chest, making it harder to breathe," says Halleck.

It was at this point that Halleck and the respiratory therapist arrived. "This patient required full everything —  an emergent, complete stabilization," recalls Halleck.

Knowing we have each other's backs creates a sense of belonging. These shared experiences really do bring you closer. It's nice to be able to lean on these people.Julie Mai

Julie Mai

After immediately intubating the baby, she ordered an X-ray, which confirmed her suspicion that the patient had a diaphragmatic hernia.

While the two-person team placed central lines, started a drip to help with blood pressure, inserted a tube to remove air from the infant's stomach, administered antibiotics and drew blood for labs — all within about an hour — they had an important audience of one: the baby's father.   

"The dad was in the room, which is not uncommon," says Halleck. "Fortunately, I'm able to work and talk at the same time. So I was delegating and explaining to the dad what we were doing."

As the father later shared, he was amazed watching Halleck and the team stabilize his son.

"If our anxiety level is high, it's going to rub off on the parents," says Brookman. "It's our job to keep them well-informed but also to remain calm, so they can trust us and see our level of expertise."

Delivering unmatched expertise

The nine NICU transport nurses in Rochester share a certain natural grit. But they've also developed an incredible amount of skill through their experience and training.

Each nurse has a minimum of three years of NICU experience, and all have worked as charge nurses. Since they travel out of state, they maintain two nursing licenses, in addition to their two certifications — one in neonatal intensive care nursing, the other in neonatal pediatric transport.

This equips them to care for babies facing a range of medical challenges.

Though they can call a neonatologist for guidance, "they don't have a physician with them," says Omdahl. "The nurse and respiratory therapist might have a baby that goes into cardiac arrest, and they're the two sole people who are going to manage that patient."

Since a newborn's condition can change quickly, the transport team often needs to perform procedures en route. This requires on-the-spot decision-making — and, occasionally, roadside stops.

"If you need to do a precise procedure, you might have the driver pull over," Brookman says, since the bouncing of the ambulance can interfere. "You're literally sitting on the side of I-90," working to stabilize a patient that may weigh only a pound or two.

Building belonging through mutual support

Not every shift includes a patient pickup like this, so the NICU transport team is purposefully small, ensuring all the nurses can regularly exercise their skills.

As a result, they're a tight-knit group. 

"Knowing we have each other's backs creates a sense of belonging," says Mai. "These shared experiences really do bring you closer. It's nice to be able to lean on these people."

Lori Brookman.

While adrenaline usually keeps emotion at bay during challenging transports, it sometimes hits at the end of a shift, as the outgoing transport nurse briefs the next one.

"Not everybody gets it," says Brookman, "so you have your teary moment with your colleague," relaying the shift's toughest moments.

This forges a strong commitment to each other and the work they do each day. 

"I would trust these women with my children any day," says Brookman. "We're very dedicated to the role. This isn't just a job for us — it's a lifestyle. We will do whatever we can to get to the baby. The needs of the patient come first, so if it's safe to travel, we always show up."