Today in the chart

From Paramedic to Pediatric ER RN

“If you can’t figure out your purpose, figure out your passion. For passion will lead you right into your purpose.” -Bishop T.D. Jakes

I started my EMS career in 2007 when I got my EMT basic card from a local vocational school when my wife, Jenni, pushed me to follow my dream of working in an ambulance. We were newly married, living on love, and perpetually broke. She fronted the money to handle the student loans, and I became an “asphalt cowboy.” At the time, I only knew of 911 ambulance services that were usually funded by local municipalities and primarily housed in fire departments, but I submitted applications, got a job working for a private ambulance company, and volunteered at my local EMS department.

I soon discovered what kind of EMS crew would come to your home. In small towns or villages, volunteer departments would run calls with personnel responding from full-time jobs or from home in their community. The private EMS company I worked for was contracted to respond to 911 calls every other week for the city, and handled county 911 calls on the off week. As the NG (new guy), I would was assigned to the “day car.” “Day car” ambulances would transport patients from nursing homes to doctor’s appointments, dialysis, and back home from the hospital or home to hospice.

Transport calls were where, as a new EMT, I honed my craft. I learned how to listen to patients and read between the lines. Understanding transport paperwork with doctor’s notes, MAR, and demographics helped you determine the medical lexicon. I learned pretty quickly how to hear lung sounds and take blood pressure with the low hum of a diesel engine and road noises in the background. Here, I also learned how to lift patients properly so I wouldn't succumb to years of back problems, built a rapport with the “regulars” and started networking with nurses, doctors, and fellow EMTs.

About a year into my career, I knew I wanted more. In some states, EMTs can become EMT- Intermediates (at the time) or Advanced EMTs (the current appropriate name for the level.) The additional training opens your scope of practice to starting IVs and administering some IV medications accompanied by fundamental EKG reading. So, I enrolled at a community college and became an Advanced EMT. I job-hopped with a couple of organizations, working at a full-time rural county 911 station. Here, I interacted with the Mennonite community and discovered the terrors of horse and buggy vs. motor vehicle accidents. I eventually returned to the organization where I started as an EMT, but this time, I got to be a part of the 911 crew.

Every other week, I was assigned to 911 response for a small city of about 40,000. There I learned the latest street drugs, discovered the “shady side of town”, and became proficient in deciphering between if a patient was suffering from an opioid overdose or hypoglycemia. I learned how to start IVs in precarious situations like highway MVCs (motor vehicle crashes) and finding the one “good vein” in a heroin user. The organization had its own paramedic program that was an hour and a half away from where I lived, but I still signed up. I still wanted more out of my career and realized I had to learn more, expand my skills, get different opportunities, but at the same time, keep making a difference.

I enrolled in the paramedic program and a year and a half later, I became a newly minted paramedic, fulfilling my lifelong dream. I finally got to work primarily on a 911 ambulance and also started working in a local hospital as a paramedic tech. Unfortunately, the company I worked for went under, and I had to look for another job. I started working for a county EMS service that provided emergency services for all the towns and highways in the county. The area was unique, having rural emergencies, high-speed highway calls, diving emergencies (from a diving quarry), a bariatric population from a specialized ECF, and the usual run-of-the-mill emergency calls. I also picked up a part-time job working on one of the Lake Erie islands. The island brought a unique twist to pre-hospital care, as it utilized helicopters and boats to transport people off the island. The experience helped hone my skills and learn how to talk with many inebriated patients. During this time, I was partnered with a person who would lead me down the path to nursing.

My EMS partner, Dave, was in nursing school while I worked at my county EMS job. Our schedule was 24/48; we worked 24 hours straight and then were off for 48 hours. It was great, in theory, until you are up most of the night fielding calls and have to spend the next day recovering. I had a crash course in the nursing school experience with Dave; figuring out how to work full time, attend clinicals, and manage to sleep and prepare for tests and skill check-offs. When I became frustrated with being a paramedic, what I thought was my dream career, Dave encouraged me to enroll in nursing school.

I enrolled at a local community college and was accepted into the nursing program. It was interesting to say the least. I was in my mid-30s, married, and had two kids. My classmates were in their 20s and just dipping their toes into life and healthcare. On the first day of nursing school, we ended up having to shelter in the school bathrooms when a tornado warning popped up. Unfortunately, the weather was an omen of things to come. While working full time and attending nursing school, my mother-in-law was diagnosed with colon cancer and succumbed to the vile disease. Then, my wife and I experienced a miscarriage while I was in my OB rotation. We also soldiered through our first stay at Ronald McDonald House for our second oldest child who has cystic fibrosis There, I was able to speak with families going through difficult medical circumstances like us. At the time, I had no desire to work exclusively with the pediatric population; I’d experienced enough heartache and seen too many tears, but that was about to change.

I graduated with honors from my nursing program and was hired as a resident nurse at a community hospital coincidentally where my old EMS partner, Dave, also worked. After that, I became an ER nurse. Our ER was small, with about 20 rooms, and was nestled near the interstate with a plethora of ECFs (extended care facilities) nearby. I quickly learned how to care for patients with chronic conditions, have a patient load of multiple critical patients, navigate multiple IV drips, and experience end of life care. It was a nice change in pace from trauma care and being out in the elements with the EMS.  

Then Covid happened.

The pandemic brought challenges to everyone in healthcare. I did my best with limited PPE and equipment while watching people my age die right before my eyes from the virus. It was a terrifying time, but it was also a time of great community support, love, and compassion. If the pandemic wasn’t stressful enough, at the same time, my hospital was being acquired by another health system with sub-par insurance. I had to look for another nursing job to get the insurance coverage my family needed and make a lateral move to a level-one trauma center in the area.

I applied for a pediatric ER nurse position, but it was filled internally. I ended up being hired as a nurse in the adult ER. The hospital was completely different from the community hospital I had just left. There were neuro, trauma, and orthopedics teams who did things quite differently than I was used to and there were resources aplenty. During my orientation process, new hires had to do a few weeks of training in the pediatric ER. During my rotation, I quickly fell in love with the specialty. The children were honest and genuinely grateful for your help. The smiles and laughter that come when you make a child feel better is a feeling that warmed my heart. I found that I could connect with the parents of these children and calm their fears because of my life experiences. (Being the father of a cystic fibrosis patient has taught me so much from the patient experience that I’ve implemented into my nursing practice.) Shortly after my rotation in the pediatric ER, I was offered a position to work full-time in the pediatric ER. I eagerly accepted the position.

The experience has been humbling and challenging. I’ve learned that children are not little adults; their anatomy constantly changes, and with that, nurses have to remember and be aware of age-appropriate developmental milestones. I’ve also learned that while kids can compensate well, they can also crash terrifyingly fast. One of the worst experiences however, are enduring the heartbreaking moments due to increased mental health problems amongst the pediatric population with a failing mental healthcare system.

Today, I am still working full-time as a pediatric ER nurse; a position that I never thought I would end up working in. It has honestly been the most fulfilling part of my healthcare career. I still keep my paramedic card while enjoying a career in nursing I never once dreamed of. So, for anyone out there contemplating their next move, my advice is simple: follow your passion. You’ll be surprised by who you’ll become and your impact on another person.

You can follow more of Jeremy’s adventures as an RN on his Instagram account here.

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