Milestone: First Day in Pediatrics

I had my first day in my pediatric clinical rotation this week and was in tears by the end of the day. I saw sick babies, preschoolers, and teens during my morning in the emergency department (ED). I wasn’t allowed to pass medications, but I felt useful taking vitals or assisting with assessments. I was honestly enjoying learning about the ED and the quick pace of the unit. I felt like working in the department would be something I’d be able to handle. I was fine until I encountered a patient that cried and wailed continuously when we’d see her. Due to her size and coloring, the patient reminded me of my daughter.

Photo by Lucas Pezeta on Pexels.com

I felt awful at the end my interaction with the patient because I was asked to hold her down to keep her still for a procedure that needed to be performed. The patient was unable to follow directions and kept struggling and fighting against the procedure. The non-verbal patient was terrified and screamed and cried non-stop. I wanted to explain that we weren’t trying to hurt her, that we were trying to help her, but I knew this would be something she’d be unable to understand, let alone be able to hear through her cries. This little girl endured two unsuccessful attempts at this procedure by two different nurses, with me assisting each time.

I started to cry when I looked at the patient’s mom and saw that she was tearing up during our second attempt; I could see mom struggling to hold back tears, continualy wiping her face. Ugh. I imagined what it must be like for her…to feel helpless at seeing your daughter struggle, to be upset with what was happening, but to know it needed to be done. We had explained the importance of the procedure to the mother and why it was necessary so she knew why we needed to keep trying. I wish the patient could have understood this, too. It was hard for me to see this little girl so terrified and be part of what was causing her terror.

After our second attempt, we gave this girl a break and called in a specialty team to perform the procedure. My rotation ended before I could witness this third attempt, but I was relieved to see the patient had calmed down and was in her mother’s arms quietly resting by the time I left the unit. I wanted to be able to comfort this little girl, but I recognized just showing up in her room made her upset. I got the sense she’s interacted with medical professionals before; just the sight of us with our scrubs, masks, and gloves seemed to terrify her. I question how I could have served this little girl better. Was there anything else I could have done to make it easier for this little girl? She was crying before we even touched her. What could I have said or done differently? And what about mom? Was there something I could have said or done to comfort mom? Was there something we could have encouraged mom to do to bring more assurance to her little girl?

Since becoming a mom, I’ve become a lot more sensitive regarding children’s issues. Before I became a mom, I didn’t used to cry everytime I’d hear news stories about children getting abused or killed or injured in a terrible accident. I’d think it was awful, but I wouldn’t necessarily cry over it. Now, it’s not unusual for me to be sobbing after I see or read awful stories about children dying in accidents or getting abused. This was why I was hesitant to be in an ED. The pediatric ED is likely where one would see abuse cases or trauma, and I didn’t want to get emotional about seeing kids this way. I didn’t want that experience on my first day in my Pediatric rotation, yet the ED was where I was randomly assigned. I didn’t object to the assignment, because I felt it was the universe’s way to have me face my fears. No trauma brought me to tears that day; instead, a seemingly simple procedure and interaction caused me to cry.

A nurse on the unit saw me tearing up in the hallway and asked if I was okay. I was in denial and said I was, but started to cry. I then explained how I felt awful, like I was assaulting this little girl, when I know logically, I wasn’t and her nurses and I were doing the best we could for her. This nurse pointed out that at least I cared. What if I were a nurse that didn’t care if I had to perform an invasive procedure on a patient multiple times? In retrospect, I also realize that caring about the wellbeing of this little girl is what had us push through, despite the patient’s tears and cries.

I’m passionate about children and have considered Pediatrics as a possible specialty when I graduate. However, I recognize my sensitivity and don’t want to have to emotionally regulate myself every day I work. I care about people, but never want my emotions getting in the way of what must be done. I don’t believe my emotions stopped me from providing the best nursing care I could have provided that day. When the nurse found me crying, I had already left the patient room and completed my rotation for the morning; I was waiting in a hallway for my instructor to meet me and mulling over my experience. Because I care, I want to know and understand what I could have done better. If I encounter something like that again, I want to know how I could influence things to go more smoothly and have a better outcome.

I spoke with a doctor friend of mine who explained she was starting to feel burnt out: She does what she can for a patient to prevent something from happening, but it happens anyway. It’s frustrating, but that’s medicine/healthcare/nursing – that’s life. We can do our best, and sometimes, that still won’t result in the outcome we wanted. I know I did my best, but it didn’t result in the outcome I wanted on my first day of my Pediatrics rotation. I’m still new and my “best” can only improve with more knowledge and experience. I may be afraid of my emotions being a weakness, but I recognize it’s also a strength that drives me to want to do better for my patients. I’m still not sure if the Pediatric specialty is for me, but I know I’m committed to doing better.

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