Despite the national narrative that children have not been impacted by the pandemic or don’t get sick from COVID-19, “we know very well” that pediatric advanced practice registered nurses (APRNs) and their patients were significantly affected by the pandemic, said Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, during a session at the National Association of Pediatric Nurse Practitioners (NAPNAP) virtual conference held April 26 to 29, 2022. The pandemic has led to high burnout rates and a constrained APRN workforce pipeline, she said.

Dr Sonney and Dr Peck presenting at NAPNAP 2020.

“The COVID-19 pandemic fundamentally altered norms of pediatric care delivery across the care continuum,” said Dr Peck, who is immediate past president of NAPNAP and clinical professor at the Baylor University Louise Herrington School of Nursing in Dallas, Texas. Immediate effects included greater health disparities, mental health crises, economic distress, collective national trauma, misinformation, and a disinfodemic (deciphering COVID-19 disinformation) along with fear. Long-term effects for APRNs include concerns regarding how the pediatric workforce will recover and the personal impact of loss and poor mental health that cross clinical, education, and research domains, Dr Peck said.

In response, Dr Peck and Jennifer T. Sonney, PhD, APRN, surveyed pediatric APRNs (N=886) from February to March 2021 to better understand the holistic effects of the pandemic and to inform a NAPNAP strategic response. Nearly three-fourths of respondents (73%) reported child mental and behavioral concerns.

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Marginalized Children Are Most Affected

“Evidence indicates that marginalized youth are disproportionately affected by the pandemic,” said Dr Sonney, who is president-elect of NAPNAP and the Elizabeth C. Giblin Endowed Professor of Symptom Science at the University of Washington School of Nursing in Seattle, Washington. “We know it is going to take swift, sustained, and multilevel interventions to address these needs and that we, the pediatric APRN workforce, are here and represent the critical access to care.”

High Level of APRN Burnout Found

“Another alarming finding is related to us and our colleagues,” Dr. Sonney said. “We are seeing record-breaking levels of burnout and mental health impacts.”

One-third of APRNs (33%) indicated moderate or extreme concern regarding feeling professionally burned out, 26% for feeling nervous or anxious, and 15% for feeling depressed or hopeless.

The pandemic has also affected nursing students with 70% of ARPN educators reporting moderate or extreme concern regarding clinical training site shortages, Dr Sonney explained. This decreased availability of training sites translates into a constrained workforce pipeline, she said.

“We have a surging need for APRNs, a workforce that is facing burnout, and a constrained pipeline of new graduates,” Dr Sonney said, adding that this is a major threat to the NP profession.

Drs Peck and Sonney are conducting a follow-up survey examining the effects of COVID-19 on the pediatric NP and encouraged attendees to participate.

NAPNAP’s Response

To support pediatric APRNs, NAPNAP has issued 2 position statements. The first is designed to promote resilience in the postpandemic pediatric workforce. In the position statement, the association offers strategies for pediatric-focused APRNs, health care and academic organizations, and professional organizations. The second soon to be published statement is designed to promote the pediatric NP workforce pipeline.

Table. Strategies to Support Resilience Among Clinicians

APRNs• Prioritizing personal well-being
• Seeking mental health support and resources (eg, mindfulness-based stress reduction techniques, CBT, intentional gratitude)
• Committing to healthy lifestyle behaviors (eg, limit alcohol intake, stop smoking, exercise regularly, eat a healthy diet, and prioritize sleep)
• Mindfully limit consumption of and exposure to pandemic-related media and social media discussion forums
• Seek mental health support early when symptoms first appear
Health care and academic organizations• Reinforce the value of and regard for pediatric-focused APRNs
• Ensure occupational safety
• Eliminate stigma for those seeking mental health care and enhance access to those services via telehealth options
• Promote team cohesion, support time for collaboration and social interactions
Professional organizations• Provide opportunities for clinicians to connect and share lived experiences
• Develop programs focused on peer support
• Advocate for policies that enable work-based employee support
APRNs, advanced practice registered nurses; CBT, cognitive-behavioral therapy
Source: NAPNAP; Gigli et al.

NAPNAP also offers a COVID-19 safety resource, child health equity resource page, and TeamPeds Town Halls (member forum), TeamPeds Experts Live (Facebook), and TeamPeds Talks (podcast).


Peck JL, Sonney JT. Update on NAPNAP’s study: exhausted and burned out: COVID-19 emerging impacts threaten the health of the pediatric advanced practice registered nursing workforce. Presented at: National Association of Pediatric Nurse Practitioners (NAPNAP) virtual conference; April 26-19, 2022.