After she graduated from Pacific Lutheran University in May 2009, Natasha Wills, age 27, joined the Neonatal Intensive Care Unit at Madigan.

Although she had visited several units, her heart was in the NICU, she said.

"Working in the neonatal unit has all the aspects of nursing that I enjoy - teaching, technology, intensity and caring - all wrapped up in one package," she said.

Wills is one of 56 full-and part-time civilian nurses who comprise the NICU team at Madigan Army Medical Center.  On a recent morning Wills and a couple of her fellow nurses shared their experiences as NICU nurses.

Susan Hicks, who started her career 40 years ago as a pediatric nurse, arrived at Madigan in 1987, to find there were no pediatric positions available.  She accepted a position in the NICU, and liked it so much that when a pediatric position did come available, she wanted to stay where she was, she said.

Today Hicks oversees the Madigan NICU, in which 191 neonatal (babies 24 weeks to term) babies, and about a third of the 401 babies admitted to the ICN (Intermittent Care Nursery) were cared for last year.

To fill her staff, Hicks looks for a specific kind of nurse, she said.  It must be someone who is enthusiastic, compassionate, has the best integrity, wants to ask questions, and is not afraid to say "I don't know," she said.

"What scares most nurses about working in the NICU is that the babies are so small, and there is no room for error," she said. "On the other hand, our nurses are scared of pediatrics, because everything is so big."

Started in the late 1960s, Neonatal nursing is unique in several ways.

First, the NICU nurses deal more with the parents than the babies, Hicks said.

"The parents can't hold the babies, until they are stable," she said. "And the babies aren't stable for a long time."

Secondly, things can change almost instantly with babies who are so small, she said.

"At 24 weeks, a baby has an infinite number of things that can happen to it," she said.

Thirdly, NICU nursing is very exact, which scares some nurses off, she said.

"On the whole, the student nurses run from the NICU," she said. "They come in and see IVs everywhere, and five drips, and it's very intimidating."

When a new nurse decides to work in the NICU, they undergo a comprehensive training program that spans two years.  To start, they work with a preceptor for 12 weeks during which time they learn how to handle the baby, and perform everyday tasks such as diaper changing.

When Wills started in the NICU, she was astonished at how small the babies were, she said.  The first baby she cared for was 24 weeks old, weighed less than a kilogram, and had respiratory problems.

"It is so nice to see how big they become when they reach term," she said. "Being involved in this type of high-intensity nursing is wonderful, and seeing her stable was just incredible."

Kimberly Ledesma, 28, began working for the NICU about three years ago.  After she graduated from Loma Linda University, in Loma Linda, Calif., she worked as a pediatric nurse.  Then she married a state trooper and moved to Washington where she took her job at Madigan.

"I was intrigued with the neonatal unit," she said. "I came and fell in love with what's going on here.  To see actual soldiers in uniform and be working where they serve was just wonderful to me. "

However, at first, the NICU terrified her, she said.

"When I first looked at a one pound baby, I thought, "oh my gosh" this baby is so small," she said. "I was surprised at how within a span of a few weeks the babies grow so much."

She learned quickly, she said.

"Everything is done is such small quantities here," she said speaking of the NICU.  "If you give a child in pediatrics 2 milliliters of something it's a normal dose.  If you give a baby in the NICU 2 milliliters, it could be like a bullet for them."

When the day is done, she feels she made a difference, she said.

"It's super rewarding," she said. "We have lost a few the last couple of months, but we get to bond with the family, and we see what they are going through with them."

She recalled some twins who recently were discharged from the unit.

When the babies were first admitted, one twin was more critical than the other, and one of the babies took a turn for the worse, she said.

"The mother came in and she grabbed me," she said. "She allowed me to embrace her.  Both of the babies are thriving today, so it had a good ending.  NICU nurses see things that most of the population never sees.  You are always dealing with people in their most desperate times."