The Expanding Role of the Nurse Practitioner Shifts to Meet the Needs of the Pandemic

Contemporary Clinic interviewed April Kapu, DNP, a professor at the Vanderbilt School of Nursing, an acute care nurse practitioner based in Nashville, TN, and president of the American Association of Nurse Practitioners, on the future of the nurse practitioner workforce amid health care staffing burnout and the extreme fatigue and stress of the pandemic.

Alana Hippensteele: With current strains on staffing numbers, have you seen more nurse practitioners need to step in and fill the roles of physicians who may be focusing on treating patients with COVID-19?

April Kapu: So, nurse practitioners, like other health care workers, have been under sustained crisis mode for the last 2 years, going into the third year. We're kind of moving past our fifth wave, and it has been sustained adrenaline, sustained taxing on your physical being, your emotional wellbeing, and your mental wellbeing throughout.

I think that's for all health care workers but certainly NPs—they work right alongside physicians, so our NPs are seeing COVID-19 positive patients 24/7 in our ICUs. We opened additional ICUs to specifically treat COVID-19 positive patients, and those NPs are right there taking care of patients.

I think we've spent a lot of time talking about the physical exhaustion because of the staffing shortage because staff are out because of COVID-19 reasons, families with COVID-19, or we've just seen a lot of professionals leave the health care workforce because of burnout. We were in a staffing shortage before we even went into the pandemic because of all those things you're seeing people having to stay 12, 14, 16, 24, or more hours on the job caring for patients, working shift after shift. You may think you're going to take off for the weekend, but you're called in to come back and work, so multiple days in a row—so you see that physical exhaustion.

What we don't talk about as much is the mental and emotional exhaustion because these patients are sick and you're caring for these patients and you get to know the patients and the family, and as they get sicker and sicker, and they pass away, maybe you're coordinating final conversations with the family via Zoom—this is all new territory and it's very emotional. It takes a lot out of you because you're grieving just like the patient and the family and oftentimes you must work with those final conversations and the patient passes away and then you must just immediately move on to the next patient without having time to debrief or grieve.

So, this has been tough on everyone in the health care workforce. I don't know that people outside the hospital doors know that until they're in the hospital with their family and they see what's happening and just the tremendous stress that COVID-19 has brought to the inpatient environment.