The National Association of Pediatric Nurse Practitioners (NAPNAP) had the opportunity to respond to the March 7, 2022, U.S. Department of Health and Human Services request for information, “Impact of Health Misinformation in the Digital Information Environment in the United States Throughout the COVID-19 Pandemic Request for Information” (87 Fed. Reg. 44; pp. 12712-12714). The below statement was submitted to Surgeon General Murthy on May 2, 2022.
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The National Association of Pediatric Nurse Practitioners (NAPNAP) is gravely concerned about the impact and prevalence of health misinformation in the digital information environment during the COVID-19 pandemic. As requested in the RFI from the U.S. Department of Health and Human Services, this response will address the following elements:
- How important a role COVID-19 misinformation played in patient decisions not to vaccinate, including the types of misinformation that influenced decisions
- How COVID-19 information has impacted healthcare systems and infrastructure
- How COVID-19 misinformation has impacted healthcare worker morale in the workplace
As you know, PNPs and pediatric-focused APRNs are committed to providing optimal health care to children in primary, specialty and acute care settings. APRNs who concentrate on children’s care have attained enhanced education in pediatric nursing and health care using evidence-based practice guidelines. They have provided quality, accessible, affordable healthcare to children and families for more than 50 years in an extensive range of community practice settings including pediatric offices, hospitals, clinics, and schools. They are acutely aware of the crucial importance of adequate nutrition in the growth and development of healthy, active children. Practicing in primary care, specialty, and acute care in all 50 states and in U.S. territories, they diagnose illnesses, prescribe medications and are fully qualified to provide both primary and acute healthcare services to children, including those with disabilities, in a trauma-informed, culturally responsive, evidence-based manner. Throughout the coronavirus public health emergency, they have confronted and responded to prevalence and harmful impact of misinformation affecting the health of children and adolescents and their families.
By the fall of 2020, a widely adopted public narrative reinforced the notion that children were not impacted by COVID-19. While it is true that children did not seem to face as significant a physical disease burden as adults did in the initial stages of the pandemic, pediatric care delivery was widely and drastically disrupted across the care continuum with significantly destabilized infrastructure. This public narrative also translated to a professional narrative, unintentionally excluding pediatric nursing professionals from research and survey efforts because of the misplaced perception if pediatric patients were unaffected, the nursing care force would be unaffected as well. Early nursing workforce surveys emphasized impacts on emergency room and intensive care nursing professionals working with adult populations and exploring such issues as personal protective equipment and COVID exposure.
NAPNAP quickly recognized the pain points of our organizational members (pediatric-focused advanced practice registered nurses [APRNs]) and the Executive Board commissioned a survey of our membership to objectively begin to collect data to drive policy creation and resource allocation. This study was published in the summer of 2022 and generated media coverage of the underreported impact on the nursing population.,, It also was selected as the article of the year by the Journal of Pediatric Health Care and was entered into the Hall of Fame by the International Academy of Nurse Editors. This recognition demonstrates the resonation of this issue and the crisis facing the pediatric-focused APRN workforce.
The NAPNAP study Exhausted and Burned Out: COVID-19 Emerging Impacts Threaten the Pediatric Advanced Practice Registered Nursing Workforce, engaged 886 respondents and data was collected from February 4, 2021, to March 10, 2021. This study used an investigator-developed survey to analyze both professional and personal impacts on pediatric-focused APRNs across the domains of clinical practice, nursing education, and research.
Of most concern, 79% of respondents reported concern for feeling professionally burned out, with 33% of those reporting moderate or extreme concern. There were alarming reports of feeling anxious, depressed, inability to cope with stress, lack of social support systems, and concern for personal mental health. More than half of respondents reported working in primary care environments, which supports concern for impacts across the care continuum.
These concerns are even more alarming when considering survey results on barriers to clinical practice. By far and away, the number one reported clinical practice concern reported by pediatric-focused APRNs was responding to disinformation with 84% reporting this as a barrier and 55% reporting this as a moderate or extreme barrier. This concern superseded barriers of rapid policy changes, access to personal protective equipment, adopting new technologies, and health inequities and racial discrimination.
Nearly 60% of respondents in the board-commissioned survey reported concern for delayed immunizations. In another survey conducted by NAPNAP members (Exploring the Effects of the COVID-19 Pandemic on the Children and Families Cared for by Pediatric-Focused Advanced Practice Registered Nurses), fewer than 10% (n=109) reported their patients refused all childhood vaccinations, but the majority estimated more than 30% of their patients would refuse vaccination for COVID-19. Misinformation about vaccines was again the primary reported clinical barrier by pediatric-focused APRNS with patient concerns reported from social media (50.5%), fear of side effects (50.5%) mistrust of government (36.7%) and fear of vaccine ingredients (34%). This survey identified lack of necessary resources to address misinformation and social concerns (76.8%) as the primary deficiency.
In March of 2022, a follow-up survey to the Peck and Sonney survey was commissioned by the NAPNAP Executive Board to reissue the original survey for data comparison one year later. This survey is ongoing and is expected for release in summer of 2022 but in a preliminary midstream data collection review, results are extremely concerning. In an item inquiring about the perception of responding to misinformation as a clinical barrier, 88.3% of respondents to date report it as a barrier to clinical practice, with more than a quarter of those rating the barrier as “extreme.” Lack of availability of reliable and credible information to guide practice is also reported by 70.4% of respondents as a primary clinical practice barrier. Most urgent, however, is the fact that nearly 90% of respondents to date report concern for professional burnout, with nearly 20% extremely concerned and more than a quarter moderately concerned.
While there is no statistical correlation yet to make accurate statements about causation, it is sufficient to say NAPNAP has significant concerns regarding the connection between responding to misinformation and provider burnout. Prior to the pandemic, NAPNAP issued its first White Paper warning of the impending critical shortage of pediatric-focused APRNs. Pediatric health care providers play a critical role in the attainment of optimal child health and without proper resource support and investment in both the educational pipeline and professional sustainment, child health is critically at risk when every provider is desperately needed to respond to the rapidly emerging mental health crisis among youth that is growing beside a multitude of other pediatric health threats.
NAPNAP has taken steps to issue policy recommendations to immediately support pediatric-focused APRN workforce and would heartily welcome any inclusion in policy-making forums to urge the prioritization of nursing workforce support.
Nursing is the largest and most trusted profession and serves as the face of healthcare to the American public. Our nursing workforce pipeline is critically endangered by the pandemic and NAPNAP advocates in the strongest possible terms to leverage all resources to immediately support pediatric-focused APRNs to ensure adequate continued provision of a critical source of affordable, equitable, accessible, high-quality healthcare.
We are ready, willing, and available to serve in any possible capacity to advise on these issues of critical importance.
Respectfully Submitted on behalf of NAPNAP,
Jessica L. Peck DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, Immediate-Past President
Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, President-Elect
May 3, 2022