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Profiles & Personalities

Working as a Pediatric ER Nurse

Nov 14, 2019
Casey Smith, RN

It’s funny where nursing will take you (if you let it). When I think back to nursing school, I vividly remember sitting in my “Nursing in Pediatrics” course with a pit in my stomach, terrified at the thought of screaming babies and overbearing parents. I didn’t have much experience caring for children and imagined babies to be tiny, little, fragile aliens. I recall dramatically whispering to my classmate, “I will NEVER be a pediatric nurse.”

I was certain, with every fiber of my naive nursing-student body, that I, Casey Smith, was going to be an adult Cardiac ICU nurse. Fast forward a year later, I was wearing a SpongeBob scrub top and walking into my first-ever job on a brightly-colored unit, a pediatric ER in a level 1 teaching hospital. 

I truly didn’t plan on becoming a pediatric ER nurse or specializing in pediatrics. While everyone is talking about the “nursing shortage” and how nurses are needed everywhere, no one ever mentions how hard it is to get your first nursing job. After applying to a plethora of adult critical care nurse residencies across the country with no luck, I began to frantically apply to every new grad nurse position I could find.

A spot in a pediatric ER was my first and only job offer, and the absolute best gift that life has handed me. 


Oh baby, it was tough at first. It wasn’t that I didn’t like children; I found out I LOVED children. I just hated the thought of hurting them. Unfortunately, a lot that we have to do to help our pediatric patients involve testing or procedures that are painful, uncomfortable, or just plain scary. My first few IV attempts were terrible (I think I closed my eyes on the first one), and it took me the better part of a year to figure out how to get an accurate blood pressure on a toddler.
 

ambulance toy car on table pediatric er nurse


I quickly learned that:

  1. Distraction and bubbles are your best friends
  2. Child Life Specialists have superpowers
  3. There is a small portion of the population that actually enjoys my singing (as long as it was a Disney song and they were drooling)

Once I was able to catch my breath, I realized that I really liked working in the pediatric ER. I loved the fast-paced environment, constant need for critical thinking, and incredible level of teamwork. I often describe that working in a pediatric ER is like organized chaos: you never know what is going to come through the front door (or the ambulance bay); however, there are systems and protocols in place that ensure safety and good patient care. Teamwork is essential to the success of your unit.

You (must) come to trust and rely on your teammates to help you through your shift. 


I truly fell in love with my job when I realized the impact I could make on other people’s lives. It’s not always the grand moments that you see romanticized on shows like Grey’s Anatomy that patients and their families appreciated.

It’s the small gestures that made all the difference to them. A hug, a 3am cup of coffee, or helping a new dad take off his baby’s onesie. Even holding a crying baby so that a hungry and sleep-deprived mother could go grab food from the cafeteria to eat for the first time that day; or, sitting and talking with a teenager who feels lonely, scared, or misunderstood.

It was incredibly humbling to see their eyes shine bright with appreciation for doing what felt like the smallest of gestures. If people are coming to the pediatric ER, it’s typically one of the worst days of their lives. While it does not always end up being an emergency, these families perceived it to be and trusted that I would help them through it. 

casey smith pediatric er nurse

My job broke me at times. I started as a young, inexperienced 22-year-old who had been fortunate enough to never experience trauma or true sorrow in my lifetime. I don’t think there’s a way to prepare yourself for the hard parts of this job, but I also don’t think I ever took the time to really consider how it would affect me. I will never forget the first time I was in the room when a parent realized that there was nothing else we could do for their child. Or seeing a young boy’s face crumple in despair when he realizes the cancer has spread to his spine and he might never walk again.

It was heart-wrenching, but it was also an honor that I was allowed to experience these life-changing moments with these families. The most beautiful thing I have ever witnessed in my life was watching a mother and father tell their son goodbye for the last time. It was love in its purest form, and I will never forget it. 

Almost six years later, I still love everything about being a pediatric ER nurse. I have completed seven different travel contracts in various pediatric ERs across the country as a travel nurse and learned so much along the way. I can now quote every line of “Frozen” and have a vast collection of animal pen lights. It’s still disorienting to walk out of a critical patient’s room, directly into another room with a patient with a common cold, but it has gotten easier with time.

I still cherish those meaningful human connections and am humbled by my job every day. While it may have not been where I wanted to be in nursing school, I am so thankful it’s where I ended up.

If you're looking for the most challenging but rewarding career out there and are thinking of pursuing a degree in nursing and becoming a registered nurse, go for it! There's so much to learn and so much that can been done in this high-demand field. Or, perhaps you're already an adult ICU RN and are considering diving into the world of pediatrics; in this case, I say do it!