With burnout reported by 87% of pediatric advanced practice nurses (APRNs), Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, is making a clarion call to leaders for nursing to be represented at the highest levels of governmental and systems-based organizational power. Policy changes are needed to protect nurses and nurse practitioners from the ever-rising rates of burnout, vicarious trauma, compassion fatigue, and moral distress experienced over the past 3 years, she said.  

The most immediate actionable directive is for “every health care related government and health systems entity to intentionally assess their governance and leadership structures for the presence of nursing voice at decision-making tables,” Dr Peck said at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Orlando, Florida. She called it “unconscionable” to have little to no nursing representation across the care continuum where decisions are being made that dictate and direct nursing practice.

Examples of nurses not being given a seat at the table include during the Trump administration when a dentist was appointed as the head of the National Institute for Nursing Research. When President Biden appointed his first COVID-19 task force team, “there was not a single nursing voice at that table until there was a public outcry and they added 1 public health nurse,” explained Dr Peck who is past president of NAPNAP and clinical professor at the Baylor University Louise Herrington School of Nursing.

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“Health systems blatantly exploit us and they exploit our deep innate and deeply cherished sense of duty with little regard for the heavy cost incurred through mental health crises, caring for patients at the expense of our own families, and desperation to the point of mental health crisis or suicide,” Dr Peck said.

Prioritize Yourself

In addition to changing the system, Dr Peck said APRNs and nurses need to change their professions’ status quo regarding self-care during work and at home.

Jessica Peck

“As nurses, often we treat ourselves as our own worst patient and that is unacceptable,” Dr Peck said. “We cannot run around dehydrated, not eating, and not having gone to the bathroom while we’re checking our patients’ hydration status, nutrition status, and sleep status.”

She encouraged NAPNAP attendees to give themselves a professional consult and determine what areas they need to prioritize.  “Do you need to prioritize nutrition and exercise, vacation time, or to step away from work? We know that if we don’t, then that’s when we are feeling numb, jaded, and dread going to work. This is the most important thing that we can do right here, right now.”

In response to an audience question on how to advocate for basic employee rights such as taking a vacation when it is owed but feeling unable to do so because of lack of coverage in their absence, Dr Peck said to put the burden back on employers’ leadership and administration.

“Why are we taking on the burden of administrative choices?” Dr Peck asked attendees. “Why do they get to choose not to have coverage and then we accept the fallout? They know that nurses will be there every time. That is codependent [behavior]. We have got to say no, and take a proactive preventive approach rather than a reactive approach,” she said.

“The public consistently identifies nursing as the most trusted profession, and they honor us with sidewalk chalk and cheers and free coffee amid adulation and affirmation as health care heroes,” Dr Peck said. “But the truth is, we are not heroes. We are humans with real needs and these public tributes clash with the servant posture of our profession.”

Read more NAPNAP survey results here.

Nursing Is Underrepresented as Media Sources

In addition to being underrepresented at decision-making tables, in leadership positions, and in government-appointed task forces, nurses are “rendered invisible” by the media, Dr Peck said. Nurses are used as sources in only 2% of quotes in health news articles and are never sourced in articles on health policy, according to 2017 data from the Woodhull Study.

“If we are the most trusted voice in health care, then where is our voice in representation?,” Dr Peck said.

NAPNAP Initiatives for Nurse Practitioners

NAPNAP has responded with official position and policy statements, including Promoting the Pediatric Nurse Practitioner Pipeline, that direct policy and affect daily practice. One article by Drs Sonney and Peck titled Exhausted and Burned Out: COVID-19 Emerging Impacts Threaten the Health of the Pediatric Advanced Practice Registered Nursing Workforce, made it to the desk of United States Secretary of Health and Human Services Xavier Becerra and was used to directly inform federal policy efforts.

“We are a small but mighty and very influential group,” Dr Peck said. “What we say matters.”

NAPNAP also launched resource pages on COVID-19 and child health equity as well as TeamPeds town hall, which are forums in which members can discuss emerging issues. The organization also initiated TeamPeds Talks, a podcast with more than 50,000 listeners that Dr Peck started in her home during the height of the pandemic. 

NAPNAP leaders will continue to advocate for system-level change for nursing professionals, Dr Peck said. “We see you, we hear you, we feel your pain,” Dr Peck concluded.

Visit Clinical Advisor’s meetings section for more coverage of NAPNAP 2023.


Sonney J, Peck J. We are not okay: the crisis of confidence facing the pediatric nurse practitioner profession. Presented at: NAPNAP National Conference; March 15-18, 2023; Orlando, FL.