Findings released in the first-ever Pulse of the Profession report from the National Association of Pediatrics Nurse Practitioners (NAPNAP) show that NPs are optimistic about the future of their profession, they also report that finding suitable work is a major challenge and an urgent need for full practice authority in more states and more training on mental and behavioral health.

The report is based on findings from surveys and interviews of advanced practice registered nurses (APRNs) conducted in the fall of 2021 by NAPNAP to help provide an accurate assessment of the profession and highlight issues that require corrective action, according to Andrea Kline-Tilford, PhD, CPNP-AC/PC, FCCM, immediate past president of NAPNAP.

“The vast majority of respondents feel optimistic about the future of their profession,” said James Wendorf, executive director of NAPNAP. Of the 980 respondents to the survey, which included 795 current members of NAPNAP, 71% were primary care providers. NAPNAP asked practitioners what drew them to the pediatric specialty. “Respondents attributed their career choice to a combined interest in health care and a passion for helping children,” as noted in the report. “They were also attracted to the holistic care approach of NPs, which allows for more quality 1-on-1 time with patients and families across the care continuum.”

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Survey participants also mentioned that their favorite part of the job included building relationships with patients and their families. “That’s made possible by the amount of time they spend together and the holistic philosophy of considering health impacts beyond a diagnosis or health complaint,” said NAPNAP.

In contrast to the rewarding aspects of the job, NAPNAP also asked survey participants about the challenges that they encounter. Respondents indicated that various factors hindered them from finding suitable work such as pandemic-related hiring freezes and state laws preventing NPs from practicing to the full extent of their education and training.

COVID-Related Burnout

Burnout also played a large part in the challenges experienced in the profession. “Without question, the COVID-19 pandemic has exacerbated stressors on all health care practitioners,” noted NAPNAP. Contributors to burnout such as high workloads, staff shortages, and extended shifts, are not unique to COVID-19. Even without a global pandemic, nurses face burnout rates “ranging from 35% to 45%.”

“COVID has had a huge impact on the field. Depending on where you are, the NP role has gotten more stretched and people are re-evaluating what it looks like and what roles they want to play,” wrote one survey respondent.

To help PNPs, NAPNAP will support measures to address the risks and effects of burnout on those working in pediatrics as well as develop additional resources and programs for PNP mental health and well-being. This will include programs on stress reduction, coping mechanisms, and recognizing warning signs. NAPNAP will also advocate for work-based policies to support staff such as early referral programs for crisis management, mentoring and coaching, and voluntary employee assistance support.

Team Setting: Traditional vs Holistic Care

Despite established mandates and legislation to promote interprofessional team-based care, a significant number of PNPs noted that they struggle to strive in a team setting. Barriers include a lack of respect for their contributions and little understanding among colleagues for their role within the team.

“What makes this revelation more unfortunate is the fact that it’s not news,” said Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, a past-president of NAPNAP. “We need to do a better job of ensuring that everyone — from individual clinicians to entire health systems — understands the incredible value and unique skills PNPs bring to a patient, a family, a team.”

To address this issue, NAPNAP plans to collaborate with leaders at the American Academy of Pediatrics and other medical societies to educate physicians about the value of PNPs.

Traditional vs holistic care also appeared to be a challenge faced by survey responders. Many participants mentioned that they find the holistic approach to care rewarding; they are passionate about the relationships fostered with their patients. However, many respondents noted that their work environment today reflects a transactional physician model of care, which prioritizes seeing as many patients as possible.

NAPNAP states that time was a central theme in many responses:

  • “There’s a growing complexity around the care provided in a decreasing amount of time.”
  • “I don’t have enough time to do all the creative things I would like to do as a primary care PNP.”
  • “There’s not enough time for visits to properly cover all the issues. Some offices have the luxury of mental health providers or social workers to help.”

There are real concerns that spending less time with “patients and families could lead PNPs to feel like they are underperforming or even letting down their profession,” NAPNAP noted.

Increase in Mental Health Training

Respondents make a “clarion call” from respondents for specific training involving pediatric and family mental health including “90 mentions of the need for increased mental health education,” according to NAPNAP. Pediatric NPs expressed a need for training in the following mental illnesses affecting pediatric patients:

  • ADHD
  • Anxiety
  • Bullying
  • Depression
  • LGBTQIA+ health challenges
  • Obesity
  • Sleep disruption
  • Substance misuse and abuse

One respondent wrote, “many children are suffering from depression and anxiety and are unable to get the care they need.” According to Dr Kline-Tilford, “the holistic approach to care that PNPs practice is perfectly suited to addressing mental health care needs among children and adolescents….The potential to make a difference is too great to ignore.”

As the next steps, NAPNAP plans to develop CME programs and training programs on this topic for PNPs. The organization is also encouraging members to seek the Pediatric Primary Care Mental Health Specialist certification.

Full Practice Authority

Full practice authority (FPA) expansion was flagged by respondents as an urgent need. “With FPA, PNPs can do more to address America’s growing need for health care access, especially for children and families in traditionally underserved communities,” reported NAPNAP.

Currently, 26 states and the District of Columbia have passed FPA legislation. The remaining states are designated as either reduced or restricted practice, indicating that they limit the ability of PNPs in at least 1 area of practice and require collaboration with or supervision from another health care provider.

NAPNAP noted that they will continue to advocate for national standardization of pediatric-focused APRN practice across states, including providing more training in advocacy work for chapter leaders to “increase their impact on FPA legislation/regulation.”

Public Awareness

Although the public’s knowledge about PNPs and their job description is growing, responses by survey participants indicate that more work remains to be done. Survey respondents report fatigue from constantly explaining to the public what they do and why they are valuable.  One respondent wrote: “Nurses in general are helpers, not self-promoters, but that holds us back because people don’t realize how powerful and useful we are.”

To enhance PNPs’ profile, NAPNAP is implementing multichannel awareness campaigns as well as targeted education/outreach for underserved communities. To enable members to hit the airways, NAPNAP will be providing media training to PNPs.


Assessing the Pediatric Nurse Practitioner profession. National Association of Pediatric Nurse Practitioners. Accessed August 2, 2022.