The COVID-19 pandemic spanned a three-year time period and dramatically affected nurses on the frontline, both professionally and personally (Copel et al., 2022; Phillips et al., 2023; Shaw et al., 2021). Nurses caring for adult patients shared their fears of contracting the virus or infecting others, while struggling with a lack of knowledge about COVID-19 and limited supplies of personal protective equipment (PPE) (Grailey et al., 2021; Joo & Liu, 2021; Ness et al., 2021; Schroeder et al., 2020; Stimpfel et al., 2022). As patients with COVID-19 experienced increased morbidity and mortality, adult nursing workloads became exhausting, resulting in symptoms of physical and psychological stress for nurses (Alameddine et al., 2021; Harris et al., 2023; Heydarikhayat et al., 2022; Kissel et al., 2023; Nelson et al., 2021; Phillips et al., 2023; Schroeder et al., 2020).

Nurses caring for pediatric patients and families experienced many of the same challenges as nurses caring for adults, but working with children also presented some unique situations. Unlike the inpatient census for adult hospitals, pediatric hospitals were not initially overwhelmed with an influx of critically ill patients. During the first year of the pandemic, there was a significant decrease in pediatric census, partially due to the ‘lockdowns,’ and the implementation of online distance–learning required by schools (77 % public schools and 73 % private schools) across the nation (Berger et al., 2022). With this decreased exposure, children experienced less frequent episodes of illness compared to pre-pandemic years, and when they did become ill, experienced less severe outcomes.

Despite the limited census, children's healthcare systems were still faced with numerous challenges related to the pandemic. Pediatric nurses, like adult nurses, experienced physical discomfort and exhaustion with continuous donning and doffing of isolation gear, as well as the challenges with communication when using masks and controlled air purifying respirators (CAPRs) (Aldiss et al., 2023; MacKay et al., 2023; Simşek et al., 2022; Wang et al., 2022). The PPE also limited the nurse's ability to comfort children and decrease their fear (O’Neill et al., 2023). Furthermore, to ensure everyone's safety and address the fear of transmitting COVID-19, pediatric organizations responded to the lockdowns by limiting the amount of people who could accompany a child during outpatient visits and hospital stays. Parents/caregivers overwhelmingly reported that these limitations were stressful and disruptive (Aldiss et al., 2023; Iobst et al., 2023; MacKay et al., 2023; Richter et al., 2023; Vance et al., 2021; Yance et al., 2023). Notably, the distress experienced by parents, who were separated from their newborns in the neonatal intensive care unit (NICU), was also difficult for nurses. The delivery of family-centered care was compromised by the absence of parents and other family members, affecting both quality of care and communication (Conlon et al., 2021; Meesters et al., 2022; O’Neill et al., 2023; Shaw et al., 2021; Simşek et al., 2022; Yance et al., 2023). NICU nurses had never before in their careers experienced this separation of the family unit. Bainter et al. (2020) described it as the most unanticipated culture change in the NICU during the pandemic.

Globally, pediatric nurses reported feelings of fear and vulnerability due to the uncertainty surrounding COVID-19 and the new demands on their workload to keep patients, families and themselves safe (Buccione et al., 2022; Gibbons et al., 2022; Iobst et al., 2023; MacKay et al., 2023; Shaw et al., 2021; Wang et al., 2022). In particular, pediatric nurses who were assigned to care for adult COVID-19 patients in the pediatric intensive care unit felt unprepared to practice and were concerned for their own safety (Buccione et al., 2022; Gandora et al., 2023; Lulgjuraj et al., 2021; Penwell et al., 2021).

The accumulation of changes in clinical practices and workload affected quality of care and communication with families. This development added to the feelings of uncertainty and fear surrounding COVID-19, resulting in an overwhelming sense of distress. Authors conducting a study examining the moral distress of pediatric critical care professionals during the pandemic reported higher levels of moral distress for nurses (Thomas et al., 2021). In the pediatric literature, nurses clearly described stressful experiences related to changes in PPE, visitor restrictions and family responses, staffing shortages, and concerns for safety with the delivery of nursing care. Many also reported personal stress at home and concerns for infecting family members, which contributed to their physical and emotional exhaustion (Iobst et al., 2023; Lulgjuraj et al., 2021; MacKay et al., 2023; O’Neill et al., 2023).

In the summer of 2021, as the Delta variant became predominant, there was a surge in pediatric emergency department (ED) and urgent care patients with an associated increase in pediatric hospital census, suggesting continual impact of the pandemic beyond the first year (Aldiss et al., 2023; Siegel et al., 2021). Published research on the pediatric nurses' experiences has been primarily limited to the first year of the pandemic and does not explore nurse's experiences, reflections and insight over time. The purpose of this study was to describe the experiences of pediatric nurses providing direct care in a variety of settings during the first two years of the COVID-19 pandemic.