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For nurses who work with pediatric heart patients, the blend of challenging medicine with the warmth of children is what makes the work so rewarding and professionally satisfying.

Many of Judy Ashford’s patients arrive in the operating room clutching a special blanket or stuffed animal. She rubs her patients’ backs and cuddles them, sometimes talking about their toys and interests. These nurturing moments are a contrast to the fast-paced, often cutting-edge surgery about to take place.

Ashford, RN, works in pediatric cardiac care at Lucile Packard Children’s Hospital at Stanford University Medical Center, where she assists in transplants and other complicated heart surgeries. For Ashford and other nurses who work in this field, the blend of challenging medicine with the warmth of children is what makes the work so rewarding and professionally satisfying.

Children, from newborns to 17-year-olds, account for about 7% of the people waiting for heart transplants in the United States this year, according to the Organ Procurement and Transplantation Network. The most common conditions that cause children to need transplants are congenital heart defects and cardiomyopathy, a disease that prevents the heart from pumping blood efficiently.

The wait for a new, healthy heart — often the most agonizing part of the procedure for families — can take a few days or a few months. The United Network for Organ Sharing coordinates organ transplants throughout the United States and places potential recipients on a list. Those with the most urgent needs are given priority. For children, an appropriate size must be found, because the tiny chest of an infant cannot hold an adult-sized heart.

As of Oct. 1, 243 children were waiting for a new heart, according to the United Network for Organ Sharing. Twenty-eight of those waiting were younger than 1. Another 26 children were awaiting heart and lung transplants.

“It’s very exhilarating and it’s very emotional,” says Ashford, describing the moment when a family learns a new heart is available for a dying child. “Everyone feels happy that a child is given life, but everyone feels sad that a life had to be given up. It’s a mixed blessing in a way.”

After 22 years as a nurse in cardiac care, Ashford still loves her job, and hopes new nurses will look at this demanding field as a desirable career opportunity.

“I don’t see myself retiring for another 10 years,” she says. “I love what I do. Hands down, this is part of my life. I feel like I’ve found my niche.”

Hard to handle

That niche isn’t for everyone. The emotional intensity can be draining and at times, heartbreaking.

Linda Merritt, BSN, another Packard OR nurse, has worked with adult cardiac patients in addition to pediatric patients.

“I think it’s more intense,” she says of working in pediatrics. “You have such a small little being there, and things happen so quickly with children so you have to really be on alert.”

To do this kind of work, Merritt says, you need to be somewhat compulsive about details during long hours of surgery. A typical heart transplant on a child takes four to five hours, but other cardiac surgeries can take longer. Surgical nurses who assist on heart transplant teams are also involved with a wide range of corrective heart surgeries that don’t involve transplants but many times are more scientifically challenging, Merritt says.