Sadly, that title is not clickbait! Unfortunately, you read it right! A neonatal nurse in the United Kingdom is indeed currently on trial for allegedly murdering seven babies. She is also accused of trying to do fatal harm to 10 more infants. The nurse, Lucy Letby, denied these allegations.

Maybe like me, you are shaking your head in disbelief. I should know because I felt the same exact things – maybe even more given my Pediatric and Neonatal Nursing backgrounds. Needless to say, this hits close to home as far as I am concerned. However, before we jump to conclusions, let us first know the important details of this issue.

Here is the link to the podcast episode of this blog post: https://open.spotify.com/episode/4jDyIjrz9RHZJEXExoTRAX?si=7xp54Tb6Q4CbSwAd6Ajd7A

The Allegation

Letby was working at Countess of Chester Hospital from 2015-2016 when the alleged incidents occurred. The complaint stated that five boys and two girls who were taken care of by her died within that period of time. Some died due to extremely low blood sugar levels or injuries caused by such conditions. Others died due to the injection of air through their intravenous (IV) lines or through the nasogastric (NG) tube. As a result of this, one particular baby girl developed an infection, and responded to treatment for a while, but eventually succumbed to her progressive deterioration.

At one point, it was stated that a mother of twin boys found one of them bleeding in the mouth. She expressed concern to Letby who replied to trust her because she is the nurse. The mom was instructed to go back to her post-partum room to rest which she hesitatingly followed. Long story short, one of her twin babies died, while the other survived.

http://pexels-jonathan-borba-3279207

Putting this Story into Context

Let me premise this discussion with the fact that I have been working with the littlest of babies for the last 20 years or so. Thankfully, most of my experiences in both the well-baby world and in the Neonatal Intensive Care Unit (NICU) have been triumphs. However, it can never be denied that I have seen babies through the worst of times as well. Who could ever forget the restricted visitation during the peak of Covid 19? And, that is not even the worst part of it.

Being a NICU nurse, one should have the strongest of guts. I could never forget how I froze when a baby as white as paper was handed to me! At that moment in time, all of my Neonatal Resuscitation Program (NRP) skills and knowledge flew out of the window.

After I regained my composure a split second later, I dutifully followed the orders of the neonatologist which included the administration of IV fluids and working with the respiratory therapists in ensuring proper ventilation, among others.

Since the situations stated above-included injection of glucose or air through the IV lines and the NG tube, let us review how that happens in the NICU.

Basic Neonatal Nurse Responsibilities

Nurses ensure that lines, either peripherally or centrally inserted, are patent and fluids are infusing correctly. The ordered fluids should be appropriate to the patients’ diagnosis. Particularly speaking about insulin, it is needed by a diabetic teenager, for example, when the blood sugar level is dangerously high. On the flip side, glucose is necessary when blood sugar is low.

Some babies meet the criteria to have their blood sugar levels checked. This group includes small for gestational age, large for gestational age, and children of mothers who were diagnosed with gestational diabetes. If those blood sugar levels are low, glucose may be given either orally or intravenously.

I could never think of a moment in my nursing career when I gave insulin to a newborn.

So, why was it used in this case, you may ask?

Well, insulin is essential in our physiological functioning, thus it doesn’t raise any red flags when given for nefarious reasons.

And what about the injection of massive amounts of air via the IV route?

http://pexels-rodnae-productions-6129232

Air Embolism Kills

Different researchers have cited air embolism as a cause of death in children and in adults alike. In very simple terms, air embolus is simply the presence of air bubbles in a person’s cardiovascular system. While there is no specific measure of how much air can cause death, even small amounts can cause a decrease in the oxygen level, less perfusion to the heart, constriction of the blood vessels, etc.

Needless to say, small amounts of air can get into a patient’s circulation if the healthcare professionals are not very careful when preparing IV fluids, for example. Remember this whenever you see nurses flicking on the syringe or the IV tubing whenever they start infusions.

Now, if the accidental introduction of air is detrimental to health. How much more if it is intentional and calculated? Carried out by no less than a knowledgeable and skillful neonatal nurse?

How Important is Ethics in Practice?

Nurses, or healthcare professionals for that matter, practice within the prescribed laws and regulations. Aside from these legal prescribes of practice, we are expected to carry out our professional tasks morally and ethically. Ethics, in this context, is defined as a set of moral principles. The nursing code of ethics includes autonomy, beneficence, justice, and non-maleficence.

While babies could not autonomously take care of themselves, their parents are their advocates and alternate decision-makers. In a nutshell, the care provided should be person-centered. It should not be solely based on the baby’s diagnosis alone, like being born prematurely as some of those who died in the above case.

Beneficence, justice, and non-maleficence, to me anyway, go hand in hand. What will benefit the patient the most should be the priority in the provision of care. It has to be fair and should result in no harm.

http://pexels-sora-shimazaki-5669619

Putting Them All Together

Now that you have a good grasp of the multiple factors that come into play, hopefully, you are able to understand why this is another hallmark case! If there are nurses who are victims of the circumstances, sadly, there are also nurses who mean harm. I am in no way stating that the neonatal nurse in question is guilty, but the truth is, not all nurses are cut from the same cloth.

Nursing is already bursting at the seams. We are trying to combat so many challenges on all fronts: patient: nurse ratio, burnout, the mass exodus from the profession… We really don’t need any other dark cloud to dampen our already sagging morale.

I challenge both you and myself, what are we doing about it? How can we uplift each other while being vigilant in weeding out those who may find nursing as not a good professional fit? So many things to reflect on, right?

Let’s start with self-evaluation:

What can I do to keep on raising the nursing banner high in my own little way?