Nurse Practitioners’ Vital Role in COVID-19 Vaccine Education

The first two COVID-19 vaccines issued emergency use authorizations in the United States have started slowly rolling out to communities across the country, offering hope for the end of the COVID-19 pandemic. Nurse practitioners (NPs) have been serving on the front lines, providing vaccine information and administering the vaccines.

“It is important for advanced practice nurses to help lead vaccination efforts in their clinical settings,” said Kristen R. Choi, PhD, MS, RN, assistant professor at the University of California, Los Angeles School of Nursing. “As providers in settings like NP-led practices or midwife-led birth centers, they should take an active role in encouraging staff vaccination and planning for when their patient population will be eligible for vaccination.”

J. Hudson Garrett Jr., PhD, MSN, MPH, MBA, FNP-BC, IP-BC, PLNC, CFER, AS-BC, VA-BC, MSL-BC, CPPS, CPHQ, FACDONA, FAAPM, FNAP, adjunct assistant professor of  Medicine at the University of Louisville School of Medicine in Kentucky, said during an American Association of Nurse Practitioners (AANP) webinar that nurse practitioners’ job is to serve as an ambassador for the vaccines.

“The role of the nurse practitioner and the nurse is vital in stopping this pandemic,” added Ruth Carrico, PhD, DNP, APRN, FNP-C, CIC, FSHA, FNAP, a professor at the University of Louisville School of Medicine, during an AANP webinar. “The public will listen to us. The public hears what we say, but the public also hears our silence.”

Carrico said the goal must be to educate and engage across ages, ethnicity, gender and socioeconomic situations, so the entire community has access to the vaccine and accepts it.

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Available COVID-19 Vaccines

Two vaccines have received emergency use authorization from the U.S. Food and Drug Administration, one from Pfizer-BioNTech and another from Moderna. Both vaccines are messenger ribonucleic acid (mRNA) vaccines, which prompt people’s cells to produce a protein that generates an immune response, so when the immune system sees the SARS-CoV-2 spike protein it will mount a response and protect the person from infection. Both offer similar efficacy.

The Moderna vaccine requires storage in a freezer and can be administered to anyone age 18 or older. The Pfizer one must be stored in an ultra-cold freezer and can be given to people age 16 years or older. The vaccines contain no preservatives. The Pfizer vaccine must be reconstituted with normal saline. Both vaccines must be given into the deltoid muscle. 

Patients should not receive any other vaccines within 14 days of a COVID-19 vaccine. Both vaccines require two doses, with 21 days separating the initial Pfizer vaccine and the booster, and 28 days for Moderna’s product.

Other COVID-19 vaccines remain in development.

Concerns about vaccination 

Most commonly people are expressing concern about the speed of development of the vaccines, but mRNA vaccines have been in development for years.

Adverse reactions and severe allergic reactions have also worried some people.

Moderna’s vaccine labeling mentions “pain at the injection site, fatigue, headache, myalgia, arthralgia, chills, nausea/vomiting, axillary swelling/tenderness, fever, swelling at the injection site and erythema at the injection site.”

In clinical trials, the Pfizer-BioNTech vaccine has led to “injection site pain, fatigue, headache, muscle pain, chills, joint pain, fever, injection site swelling, injection site redness, nausea, malaise and lymphadenopathy.”

The adverse reactions are an indication the vaccines are working and learning to fight the SARS-CoV-2 virus. They will resolve in a few days. Choi considers them a small expense compared to the risk of COVID-19 illness, serious complications and death.

Severe allergic reactions and anaphylaxis remain a risk with any vaccine and the mRNA vaccines are no exception. The Centers for Disease Control and Prevention (CDC) reported in early January 2021 a rate of anaphylaxis after receiving the Pfizer vaccine of 11.1 cases per 1 million doses. That compares to a rate of 1.3 cases per one million doses with the influenza vaccine.

“Anaphylaxis after COVID vaccination remains rare,” said Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases at the CDC.

The COVID-19 vaccines should not be given to anyone with a history of a severe reaction to any of that vaccine’s components. The vaccines should be administered in a location with medical personnel and medications and equipment to deal with anaphylaxis, and patients should wait 15 to 30 minutes before leaving, depending on allergy risk, after receiving a vaccine.

Patients should weigh the benefits and risks with their healthcare professional, Choi said.

However, Messonnier, recommended people with allergies accept the vaccine, because healthcare professionals know how to manage anaphylaxis, while the risk from COVID and poor outcomes from COVID is still more than the risk of a severe outcome from the vaccine.

A team of allergists at Massachusetts General Hospital in Boston examined relevant information and issued reassurance in Journal of Allergy and Clinical Immunology: In Practice that the vaccines can be safely administered to people with food, medication, latex or insect venom allergies.

The CDC considers the vaccines “safe and effective” and the anaphylactic risk rare.

Nurse practitioners “have the power to stop this pandemic, to get a head of the pandemic,” Carrico said. “Our challenge now is whether or not we are going to use this power and how.”

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