Exhaustion, irritability, anger, dreading work, somatization, and moral distress are just a few of the many symptoms reported by pediatric advanced practice registered nurses (APRNs) as we enter year 4 of the COVID-19 pandemic. Nearly 90% of pediatric APRNs reported professional burnout and rates are on the rise, according to survey findings reported at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Orlando, Florida.
“My clinical assessment is that as a profession we have suffered from severe complex post-traumatic stress disorder,” said Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, past president of NAPNAP. “And that is where we are as a profession and this is a clarion call for nursing. This should be heeded urgently and immediately at the highest levels of governmental and systems-based organizational power.”
About the Survey
To better understand how to help pediatric APRNs cope during the pandemic and its aftermath, NAPNAP President Jennifer T. Sonney, PhD, APRN, and Dr Peck surveyed pediatric-focused APRNs or APRN students between February and March 2021 (N=886) with a follow-up survey conducted between March and September 2022 (N=1087).
Respondents to the 2022 survey primarily identified as female (95%) and White (89%), 82% were primary care certified and 16% were acute care certified. Approximately 50% worked in a community-based practice or office, 20% in inpatient care, and 7% in critical or intensive care. High vaccination rates for COVID-19 (97%) and influenza (95%) were found.
Rising Rates of Burnout and Mental Health Concerns Found Among APRNs
In the initial survey in 2021, the majority of APRNs reported concern about professional burnout (79%) with one-third (33%) indicating moderate or extreme concern regarding feeling professionally burned out. One-quarter (26%) reported moderate or extreme concern for feeling nervous or anxious and 15% for feeling depressed or hopeless by 15%.
A year later, significantly higher rates of concern regarding feeling professionally burned out and overall mental health were found compared with rates in the initial survey (P <.001; Figure). An excerpt of mental health concerns reported by respondents is shown in the Table.
Table. Mental Health Concerns Reported by Pediatric APRNs in 2022
|“I have never felt so burnt out in my life. I have had periods of grief and depressed mood before in my life but have never felt so anxious and depressed and afraid I won’t recover.”|
|“I feel like I’m on edge at all times. Always waiting for the next shoe to drop. Sometimes it is just hard to breathe. My self-care is not existent. I have no work-life balance. I’m very stressed, burned out, and exhausted and no end in sight.”|
|“I have given all I have to give.”|
“These are our colleagues. This is us,” said Dr Sonney. The burnout and mental health implications of the COVID-19 pandemic are “real, widespread, and devastating,” she said.
Youth Mental Health Crisis
Youth mental and behavioral health was also a key concern identified by 94% of respondents in 2022, up from 73% in 2021.
Responding to the high rate (94%) of concern over pediatric patients’ mental and behavioral health, Dr Sonney said, “The data were alarming in our last study and even more so now. This is a priority; we must respond.”
One respondent said: “In 45 years as a PNP, I have never seen this much emotional turmoil and need for behavioral health assistance” among pediatric patients.
Concerns over delayed routine immunizations among their patient population were reported by 92% of respondents and 83% reported delayed or deferred well-child care visits. High rates of concern about parental anxiety and stress (88%) as well as financial stress and limited access to specialty services were also reported. Many respondents (43%) reported concerns about an increased incidence of child maltreatment and abuse seen among their patients.
Responding to Misinformation Impedes Clinical Practice
Nearly 90% reported responding to misinformation about COVID-19 as a leading barrier to clinical practice. Other key barriers reported were health inequities, racial discrimination, communicating and implementing rapid policy changes, and availability of reliable and credible information to guide practice
Telehealth: a Glimmer of Hope
Widespread adoption of telehealth was the one consistent positive outcome in the survey data. While pivoting to telehealth rapidly was a major challenge, 92% of respondents commented on the benefits of telehealth including increasing access to care.
“We offer our most sincere gratitude to our colleagues who participated in this study,” Drs Peck and Sonney concluded. “We read every comment and want you to know that we see you, we hear you, and you are not alone.”
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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.