Nurse Practitioners Positioned to Play a Key Role in Defeating the Covid-19 Pandemic
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Americans have rated nurses as the #1 most ethical and honest professional for the past 19 years, placing nurse practitioners and nurses at large in a position of potential influence. We as a profession have earned the trust of not only our patients, but friends, family members, those in the communities in which we live, and elected officials.
Nurse practitioners are well-positioned to provide trusted information and guidance in the fight against the Covid-19 pandemic. This country needs to hear the voices of nurse practitioners who know how to collect and analyze data, work with others, have a deep understanding of the problems faced by their communities, and have spent their careers improving the health of people.
The advice and counsel of experts were not heeded in the national response to the Covid-19 pandemic, leading to tremendous suffering and failure to reduce the spread of a deadly virus.
Dark Days in the Pandemic
As of February 8, 2021, there have been 26,852,809 cases of SARS-CoV-2, hereafter referred to as the Covid-19 virus, and 462,037 deaths across the United States (CDC). Nurse practitioners have witnessed the global response to this novel virus and seen countries that were shining examples of a robust public health effort to contain and defeat the virus; other countries such as the U.S. have not performed well at all.
According to the New England Journal of Medicine, “The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000.” Healthcare workers have been left to address widespread disease and death due to an anemic federal response to guide the state and local public health systems.
There has been tremendous human and economic suffering, which has been compounded by the rampant spread of misinformation and public mistrust in our institutions. Traditionally during times of crisis, our nation has pulled together; however, that did not happen with this crisis. We have all watched as hospitals have filled to maximum capacity and beyond, stressing (and at times overwhelming) our healthcare system.
Healthcare workers are being pushed to do more with fewer resources. Nurses and nurse practitioners do not enter the profession because they will become rich or desire accolades. They do so to provide the best care they can because they care about people. Being stretched thin and unable to provide the level of care needed contributes to burnout and emotional trauma. The Covid-19 pandemic will have profound and long-lasting consequences upon our healthcare delivery system.
Nurse practitioners have an opportunity to work to overcome vaccine hesitancy, influence human behavior, and be community leaders. There is a need for reliable, trusted information as well as advocacy for responsible, evidence-based practice and public health policy.
A Ray of Hope in the Battle Against Covid-19
We are not without weapons to fight this pandemic. We know how to slow the spread by following CDC guidelines and the 3Ws: wearing masks, frequent hand washing, watching your distance.
Having two new vaccines receiving emergency use authorization and more on the horizon is a much-needed ray of hope for nurse practitioners and everyone else working in healthcare. The first round of Covid-19 vaccines was administered to healthcare workers and older folks across the country.
Nurse practitioners can be an integral part of vaccine education, providing expertise on distribution and process improvement. We can advocate for responsible governmental oversight and transparent rollout individually or through our professional organizations, providing needed feedback and expertise.
We are fortunate to be part of a democracy, a government accountable to the people it serves and one that performs better when we are civically engaged. We can make our voices heard as healthcare providers, offering high-quality care and advocating for the health of our patients and our communities.
Overcoming vaccine hesitancy will be a key hurdle to overcome. Nurse practitioners provide holistic, compassionate, and competent care. Utilizing the relationships and trust we have developed within our own communities, we are positioned to speak truth to misinformation, lead by example, and use an evidence-based approach to overcome vaccine hesitancy.
There are evidence-based approaches available to facilitate effective communication. The National Institute of Health has proposed a strategy of vaccine communication to address vaccine hesitancy through the use of behavioral and social science. This strategy was not developed specifically for the Covid-19 vaccine, but the science can be applied to address any vaccine hesitancy.
Overall, nurse practitioners can use their position of trust to encourage people to get immunized. One of the most important places to begin is with our fellow colleagues. The scientific community has been surprised by the lack of vaccine uptake: in some areas, up to 40 percent of hospital staff have passed on receiving the vaccine. This is precisely the group of people who are most at risk of contracting the virus. That number includes all workers in a hospital, from those who keep the building clean to those who transport patients, as well as nurses, doctors, and administrators.
Three categories emerged that illuminated some of the biggest reasons for not taking the vaccine: people taking a wait-and-see approach, those with lower educational attainment, and people of color, who have historically been the subjects of institutionalized medical racism and were subjects of unethical experiments in the U.S. such as the Tuskegee syphilis experiments, which continued until 1972.
How Nurse Practitioners Can Facilitate Covid-19 Vaccinations
Beyond outreach to colleagues, nurse practitioners can work to encourage patients, family members, and friends to get the vaccine by dispelling misinformation. Unfortunately, anti-vaccine groups have downplayed the risks of the diseases vaccines protect against, pushed false narratives questioning the safety and effectiveness of vaccines, spread false claims about adverse outcomes, and leveraged political and social divisions to diminish trust in vaccines.
The consequences of this could be dire. If not enough people are vaccinated, the pandemic will stretch on indefinitely, leading to future surges, more death, excessive strain on the healthcare system, and economic decline.
Explain Who Gets Vaccinated
Nurse practitioners can stay up-to-date on who is to be vaccinated through their employer, professional organizations, and state authorities such as the Health Departments in their home states. Beyond emphasizing the importance of completing the two-dose vaccine series, it will be critical to ensure adherence in order to provide adequate protection from the virus.
Provide Public Assurances
It is imperative that healthcare professionals are able to provide assurance of the safety and efficacy of the vaccine, as well as the limitations of what is known. We know that the two-doses of the Pfizer vaccine conferred 95 percent protection against Covid-19 in persons 16 years of age or older and safety was similar to that of other viral vaccines (NIJM).
We also know that the Moderna vaccine is 94.1 percent efficacious in preventing symptomatic coronavirus disease and demonstrated efficacy in preventing severe Covid-19. Investigators identified no safety concerns (NIH). Additionally, both trials included a diverse population from which to draw conclusions.
Effective communication on the vaccine should also highlight the collective as well as individual benefits of vaccination. Getting the vaccine allows people to protect themselves, their families, and their communities. Getting the vaccine is a step towards a return to “normalcy.”
Messages on the Covid-19 vaccine should establish social norms for vaccination, increasing the perception that members of one’s social group plan to or have already been vaccinated. They should emphasize how herd immunity results from high vaccine uptake and can protect the health and well-being of others.
Nurse practitioners should also be prepared to explain the vaccine development, FDA approval, monitoring, and distribution process. Emergency use authorization allows for an expedited path to approval to address a public health emergency—that does not mean important steps in assessing safety were skipped but rather the timeline was compressed. Both FDA and CDC continue ongoing pharmacovigilance.
Nurse practitioners, being part of the first wave of those vaccinated have an opportunity to participate in this directly through the VSAFE program in which you receive post-immunization health checks via text messages. Nurse practitioners should check with local institutions, professional organizations, and employers. Nurse practitioners also should gain familiarity with the plan in their state to disseminate information on the process and location for people to get the vaccine.
Each conversation or communication to address vaccine hesitancy must respond to concerns without judgment or overly directive language. Vaccine communication must be accurate, transparent, and truthful. Acknowledging that there is much we do not yet know because this is a new virus and a new vaccine is appropriate.
Beyond the Exam Room: What’s Next for Nurse Practitioners Fighting Covid-19?
Our patients are our first priority, but there are other opportunities to shape the narrative within our social circles and communities.
Fifty-five percent of Americans get their news “often” or “sometimes” from social media. Nurses can leverage their position of trust to influence peers, patients, and their community by participating in social media campaigns with their employer, professional organizations, alma maters, or as individuals. Nurse practitioners can be influencers on social media and contribute accurate content about the vaccine and why it is important to them and the general public good.
There are opportunities for NPs to present information on the vaccine and answer questions at community meetings, civic engagement groups, churches, and other organizations. We can write letters to the editors of local newspapers. In short, we as professionals can facilitate a ripple effect of vaccine uptake by providing accurate evidence-based information.
This pandemic has brought to light the deep need to educate our elected officials. The failures of our governmental response are outlined in the New England Journal of Medicine in their article, “Dying in a Leadership Vacuum.” Nurses are at a unique moment in time in which it is imperative to explain to our elected officials the consequences of public policy decisions and provide education and perspective.
Nurse practitioners should join their professional organizations because it is important to have a collective voice that speaks for the best interests of our profession and our patients. In addition to advising our policymakers through email or calling our elected officials, there is also a need for the voices and perspectives of NPs to be heard as we have a skill set that should be used in all levels of government. We have plenty of lawyers and business executives creating policy that will affect our practice—and these policy decisions dictate who can access healthcare and how they will access it.
Now more than ever, we need nurse practitioners who understand public health, know how to collect and analyze data, collaborate, spend their professional lives serving people, and have a deep understanding of the problems faced by the people in their communities.
Celeste Williams, MSN, APRN, FNP-BCWriter & Contributing Expert
Celeste Williams is a family nurse practitioner and alumna of Southern Nazarene University and the University of Arkansas for Medical Sciences. Celeste is passionate about healthcare policy, especially its effects on rural and other underserved communities. She believes more nurses belong in all levels of government and places where decisions are made. She is active in her community through her professional organizations, local political organizations, Rotary, and her church. She lives in NW Arkansas with her husband, four children, two cats, a dog, a rabbit, chickens, ducks, peacocks, and a bearded dragon.