As a nurse in the NICU, Becky is well-respected by RNs, RTs, Neonatologists, and all team members in the NICU. She consistently provides leadership as well as care for NICU infants by leading through example. Her compassionate and caring attitude is a model for new and experienced nurses. Covid-19 has posed many challenges this past year. This nurse researched NICU care and visitation in the NICU, then provided guidance regarding any person entering the NICU, with the ultimate goal to keep infants and staff safe. An updated binder is kept at the Team Leader desk to keep staff informed of current guidelines and the many changes we have experienced throughout this pandemic. Her thoroughness in obtaining evidence-based practice has had the outcome of keeping infants and staff protected in these precarious times.

Families infected with the Covid-19 virus are not allowed to visit the NICU in order to keep this susceptible population free from getting sick with this devastating virus. We know babies need their parents and need to be held. The NICU team, with this team member's guidance and assistance, have been able to hold these babies, provide excellent care, and allow parents to "see" their baby through the use of Angel Eye cameras. These cameras allow parents to visualize their infant at any time during the infant's hospitalization. Nurses leave notes for parents to view on camera and make sure they communicate through phone calls, so the separation is less distressing.

This nurse is always available to those that need her -in staffing during times of need, in projects when research or data is required, and in any other process that is required in the NICU. She is trusted with extremely sensitive information and will go out of her way to provide care and assistance as needed. Her consistent and positive behaviors are a model for others. This nurse is passionate about communication and what is best for the NICU. She worked thoroughly on starting nurse-led rounds with the NICU multi-disciplinary team. Evidence-based articles were found and brought to the leadership team to evaluate. She brought in another nurse that started nurse-led rounds in another unit of the hospital to discuss rounding with the team so that we had a clearer idea of expectations. She requested and helped develop a nurse report sheet be built to assist our team with what to discuss during rounds. This report sheet showed a comprehensible picture of what was currently happening with the infant but also had room for nurse and parent questions about care. This project resulted in outcomes of nurses becoming better at finding information in electronic documentation, being acutely aware of the history of an infant (especially of infants born extremely early), and nursing staff becoming comfortable speaking with providers about issues infants are having and finding answers with the provider. It has empowered nurses to be better prepared when caring for any infant and has brought our team together in ways that improve outcomes for infants and their families.

This nurse is an unwavering advocate for infection prevention in the NICU. She is a project leader in decreasing central-line associated bloodstream infections (CLABSls) in the NICU and continues to monitor, research, and report any NICU CLABSI. When discussing a CLABSI with staff, she educates on preventing infections and discusses ways to remain diligent in handwashing and line care. This vulnerable population can potentially die from preventable infections, making this a priority for this nurse. The outcomes of this project showed an increase in diligent line care, a significant decrease in NICU CLABSI rates, an awareness of infection prevention at all times, and an understanding of the importance of handwashing. This project is ongoing and even more important during the covid pandemic and flu season.

This past year has also proven to be a challenge for the unique products needed in the NICU. Many of the items we use can't be or aren't used in adult populations. This nurse meticulously searches for any products available as replacements for items on "back order". Many items are back orders for back orders, making finding similar products even more difficult. To keep staff from doing without, she consistently researches for needed products and makes sure staff are aware of the updated products. She even finds exceptional solutions for the staff to use for items that are currently on low inventory or back-ordered.

Many staff don't know the lengths she goes to to make sure the NICU runs smoothly with as little interruption to patient care as possible. One of her obligations as part of the leadership team in the NICU includes quality improvement. The NICU consistently participates in the Tennessee Initiative for Perinatal Quality Care (TIPQC) projects, which this nurse is a vigilant contributor. These projects bring together partners across the state of TN, as well as those in our region to improve care for infants and mothers. Some of the most recent projects that have improved the outcomes of infants include Safe to Sleep, Opioid Exposed Newborns, Antibiotic Stewardship, and Improving Nutrition and Growth in Very Low Birth Weight Infants. All of these projects she has contributed to, making this NICU a safe environment for infants and their families. Education to families for Safe to Sleep is imperative. In TN, from the years 2014-2018, sudden infant death syndrome was the 4th leading cause of infant death. Through this initiative, safe sleep family education and modeling increased from 70% to 100% in the NICU. For opioid exposed newborns, developing strategies for monitoring infants exposed to illicit substances in utero has been essential to decreasing the length of stay and increasing the ability of these moms to care for their infant at discharge. Antibiotic stewardship has led to the outcomes of infants not receiving antibiotics when not needed and improving nutrition allowed our data to show how we could safely increase intralipids and amino acids to infants, helping their growth curves and brain growth, which leads to improved developmental progress. Working with teams across TN helps us all to improve outcomes for all infants.

Small changes make a big difference in the NICU and this nurse is constantly looking for how best to improve practices the NICU. Becky more than exemplifies all qualities as an extraordinary NICU nurse.