Nursing Certifications: Which Ones are Right for You?

Nursing Certifications: Which Ones are Right for You?

Professional certification in a specialty indicates that a nurse demonstrates high competencies in their field, according to research in the Journal of Trauma Nursing.

“Certified nurses have reported feeling more empowered, with better collaborative relationships, as well as believing that they provide better care,” the article abstract says. “Nurses also have perceived intrinsic value to obtaining certification in a specialty practice area.”

Nursing certifications can help nurses grow personally and professionally, improve patient outcomes and advance their careers. While some basic nursing certifications are universally required, nurses can pursue additional specialty board certification to further their professional opportunities and gain advanced practice expertise.

Read on to learn more about some of the different types of nursing certifications. 


After graduating, a Family Nurse Practitioner (FNP) must obtain certification before they can practice. There are two certifications FNPs can obtain — FNP-BC and FNP-C — which are provided by two different certification boards.  

Types of Nursing Certifications 

There are a number of nursing certifications nurses can obtain based on their specialty. Some specialties require board certification for nurses to practice. Before obtaining certification, candidates must confirm their eligibility and pass a certification exam. Here are some of the certifications offered within different specialties, as well as their requirements:

Specialization Area: Family Nurse Practitioner (FNP)

After completing a family nurse practitioner program, aspiring FNPs can receive certification from one of two bodies.


Certifying organization: American Nurses Credentialing Center 

Eligibility requirements:

  • Current active RN license.
  • Master’s, post-graduate or doctoral degree from an accredited FNP program.
  • Three graduate-level courses in advanced physiology/pathophysiology, advanced health assessment and advanced pharmacology.
  • Content in health promotion/maintenance, differential diagnosis and disease management.

Applicants for the FNP-BC certificationExternal link:open_in_new must pass an initial certification exam of 175 questions. Offered year-round, the 3.5-hour test is a competency-based examination that assesses entry-level knowledge and skills of FNPs. The ANCC provides free study aids to assist examinees. Initial certification costs $290–$395.

After receiving their initial certification, FNP-BCs must maintain the credential through professional development and renew the certification every five years. Renewal fees run between $275 and $375.


Certifying organization: American Academy of Nurse Practitioners

Eligibility requirements:

  • Current active nursing license.
  • Master’s, post-graduate or doctoral degree from accredited FNP program, including supervised clinical hours.
  • Academic transcript. 

The initial certification exam for the FNP-C certificationExternal link:open_in_new consists of 150 questions that assess an FNP’s entry-level knowledge of clinical care for families and individuals across their lifespan. The cost for the initial application is $240 for AANP members or $315 for nonmembers.

Similar to the FNP-BC, the FNP-C must also be renewed every five years after completing at least 1,000 hours of clinical practice hours and 100 hours of advanced continuing education, or recertifying by examination. It costs $120 for members to renew or $195 for nonmembers through clinical hours and education. Recertification by examination costs $240 for AANP members or $315 for nonmembers.

In 2019, the average school certification rate was 100% for Georgetown University FNP program graduates who took either the American Nurses Credentialing Center exam or the American Academy of Nurse Practitioners Certification Board exam. 

Specialization Area: Adult Gerontology-Acute Care Nurse Practitioner                                                             

Georgetown University’s School of Nursing & Health Studies offers an online adult gerontology acute care nurse practitioner (AG-ACNP) program that prepares students to provide evidence-based care in acute and complex care settings. Once complete, aspiring acute care nurses can begin to explore certification options. Certifying bodies retired general certification for Acute Care Nurse Practitioners (ACNPs) to opt for certifications that focus on specific patient populations. However, nurse practitioners (NPs) can still get certified in acute care for adult gerontology and pediatrics.

Here are some of the certifications available:

Acute Care Nurse Practitioner Certified in Adult-Gerontology (ACNPC-AG)

Certifying organization: American Association of Critical Care Nurses

Eligibility requirements:

  • Current unencumbered registered nurse (RN) or advanced practice registered nurse (APRN) license.
  • Graduation from a graduate-level education program focused in advanced care adult-gerontology as an ACNP at an accredited nursing school.  

Adult-Gerontology Acute Care Nurse Practitioner – Board Certified (AGACNP-BC)

Certifying organization: American Nurses Credentialing Center 

Eligibility requirements:

  • Current active RN license.
  • Master’s, post-graduate or doctoral degree from an accredited adult-gerontology ACNP program, including 500 clinical hours.
  • Three graduate-level courses in advanced physiology/pathophysiology, advanced health assessment and advanced pharmacology.
  • Course content in health promotion/maintenance, differential diagnosis and disease management.

Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC)

Certifying organization: Pediatric Nursing Certification Board

Eligibility requirements:

  • Current unencumbered RN license.
  • Official transcripts after graduating from an accredited college/university with an ACEN- or CCNE-accredited nursing master’s or doctoral program, with a concentration in pediatric acute care.
  • At least 500 hours of supervised direct patient care hours. 

In 2019, 100% of Georgetown University’s Adult Gerontology Acute Care Nurse Practitioner program graduates passed the American Association of Critical Care Nurses’ exam, and 100% passed the American Nurses Credentialing Center’s exam. 

Specialization Area: Nurse Anesthetist

The American Board of Perianesthesia Nursing Certification, Inc. offers two anesthesia-related certifications for nursesExternal link:open_in_new, and the National Board of Certification and Recertification for Nurse Anesthetists offers one, too.

Certified Post Anesthesia Nurse (CPAN)

Certifying organization: American Board of Perianesthesia Nursing Certification, Inc.

Eligibility requirements:

  • Current unrestricted RN license.
  • At least 1,200 hours of direct clinical experience within two years of applying for certification.
  • For dual certification as a CPAN and CAPA, nurses must have at least 1,200 hours of clinical experience caring for patients in postanesthesia phase I, as well as at least 1,200 hours of direct experience caring for patients in the preanesthesia phase, day of surgery, postanesthesia phase II and/or extended care.

Certified Ambulatory Perianesthesia Nurse (CAPA)

Certifying organization: American Board of Perianesthesia Nursing Certification

Eligibility requirements:

  • Current unrestricted RN license.
  • At least 1,200 hours of direct clinical experience within two years of applying for certification.
  • For dual certification as a CPAN and CAPA, nurses must have at least 1,200 hours of clinical experience caring for patients in postanesthesia phase I, as well as at least 1,200 hours of direct experience caring for patients in the preanesthesia phase, day of surgery, postanesthesia phase II and/or extended care.

Certified Registered Nurse Anesthetist (CRNA)

Certifying organization: National Board of Certification and Recertification for Nurse Anesthetists

Eligibility requirements:

  • Master’s, post-graduate or doctoral degree in nursing (by 2025, all candidates must have a doctorate). 

Specialization Area: Nurse-Midwifery

Individuals interested in providing physical care to women and their newborns can complete a dual nurse-midwifery/women’s health nurse practitioner program. Nurse-midwives who complete such a program can become nurse-midwife/women’s health nurse practitioners (NM/WHNPs). See below for more on WHNPs.

Certified Nurse-Midwife (CNM)

Certifying organization: American Midwifery Certification Board

Eligibility requirements:

  • Active RN license.
  • Master’s, post-graduate or doctoral degree from an accredited nurse-midwifery education program. 
  • From 2017-2019, an average of 86.15% of Georgetown University nurse midwifery/women’s health nurse practitioner program graduates were certified annually through the American Midwifery Certification Board. 

Specialization Area: Pediatric Nurse

There are a number of pediatric nursing certifications in different specialties. Here are some of them:

Certified Pediatric Nurse (CPN)

Certifying organization: Pediatric Nursing Certification Board 

Eligibility requirements:

  • Current unrestricted RN license.
  • At least 1,800 hours of pediatric clinical experience within the previous two years; or at least five years as an RN in pediatric nursing and 3,000 hours in pediatric nursing during the previous five years, including at least 1,000 hours during the most recent two years.

Pediatric Nursing Certification (PED-BC)

Certifying organization: American Nurses Credentialing Center

Eligibility requirements:

  • Current active RN license.
  • Two years of practice as an RN.
  • At least 2,000 hours of pediatric nursing clinical practice within the previous three years.
  • 30 hours of continuing education in pediatric nursing within the previous three years.

Certified Pediatric Emergency Nurse (CPEN)

Certifying organization: Board of Certification for Emergency Nursing

Eligibility requirements:

  • Current unrestricted RN license.
  • Two years of clinical experience in an emergency specialty are recommended, but not required.

Critical Care Registered Nurse (CCRN) – Pediatric

Certifying organization: American Association of Critical-Care Nurses 

Eligibility requirements:

  • Current unencumbered RN or APRN license.
  • 1,750 practice hours as an RN/APRN in direct care of acutely/critically ill children during the previous two years, with at least 875 hours during the year before applying for the CCRN; or 2,000 practice hours as an RN/APRN in direct care of acutely/critically ill children during the previous five years, with at least 144 hours during the year before applying for the CCRN.

CCRN-K (Pediatric)

Certifying organization: American Association of Critical-Care Nurses

Eligibility requirements:

  • Current unencumbered RN or APRN license.
  • At least 1,040 practice hours within the previous two years, with at least 260 hours in the most recent year.

ACCNS-P (Pediatric)

Certifying organization: American Association of Critical-Care Nurses 

Eligibility requirements:

  • Current unencumbered RN or APRN license.
  • Completion of an accredited, graduate-level advanced practice education program as a pediatric CNS. 

Specialization Area: Trauma Nurse or Emergency Nurse

Both RNs and NPs are able to obtain certification in trauma and emergency specialties.

Certified Emergency Nurse (CEN)

Certifying organization: Board of Certification for Emergency Nursing

Eligibility requirements:

  • Current unrestricted RN license
  • Two years of practice in emergency nursing are recommended, but not required.

Trauma Certified Registered Nurse

Certifying organization: Board of Certification for Emergency Nursing

Eligibility requirements:

  • Current unrestricted RN license
  • Two years of practice in trauma nursing are recommended, but not required.

Emergency Nurse Practitioner (ENP)

Certifying organization: American Academy of Nurse Practitioners

Eligibility requirements:

Three eligibility tracks:

  • At least 2,000 direct emergency care clinical hours as an FNP in the previous five years, 100 hours of continuing education in emergency care and at least 30 continuing education hours in emergency care procedural skills during the previous five years; or
  • Graduation from an accredited emergency care graduate or post-graduate NP program, or completion of a dual FNP/ENP graduate or post-graduate certificate program from an accredited program; or
  • Completing an approved emergency fellowship program.

Specialization Area: Women’s Health Nurse Practitioner

Before pursuing certification, those interested in this specialty usually earn an advanced degree from a women’s health nurse practitioner program. [email protected] offers an online MS in Nursing degree with a focus on women’s health. Students develop the skills and knowledge to provide primary, prenatal and postpartum care to women.    

In addition to nurse midwife/women’s health nurse practitioner certifications, there are others related to women’s health. They include: 

Women’s Health Care Nurse Practitioner (WHNP-BC)

Certifying organization: National Certification Corporation 

Eligibility requirements:

  • Current unencumbered RN of APRN license.
  • Graduation from an accredited master’s, post-graduate or doctoral WHNP program.
  • Diploma, transcript and certification of completion from educational program.

Maternal Newborn Nursing (RNC-MNN)

Certifying organization: National Certification Corporation

Eligibility requirements:

  • Current unencumbered RN license.
  • Two years and at least 2,000 hours of specialty experience.
  • Employment in maternal newborn nursing sometime during the previous two years.

Inpatient Obstetrics Nursing (RNC-OB)

Certifying organization: National Certification Corporation

Eligibility requirements:

  • Current unencumbered RN license.
  • Two years and at least 2,000 hours of specialty experience.
  • Employment in obstetrics nursing sometime during the previous two years.

Required Certifications 

Some basic certifications are required for RNs,External link:open_in_new such as Basic Life Support (BLS) certification, but specialty nursing certification is not always required to practice in the field.

As indicated in the section above, a number of certifying bodies require nurses to first have an active license and accrue a certain number of clinical hours in the field before pursuing nursing certification in a specialty. Understanding nursing certification requirements — including licensure, clinical hours and continuing education — can help nurses work toward achieving a certification in their desired specialty.

As a nurse focuses on a specialty, receiving a nursing certification indicates that a nurse exceeds the minimum skill and education requirements for that particular specialty, and obtaining and maintaining certifications may help nurses advance in their careers. Typically, more advanced or specialized practice areas require more nursing certifications and additional education. 

Living Organ Donation: A Guide for Nurses and Patients

Living Organ Donation: A Guide for Nurses and Patients

Living organ donors are a valuable and essential resource for patients in need of kidneys, livers, and other lifesaving organs and tissues.

Medstar Georgetown University Hospital transplant nurse Allie Hayes has seen the benefits of living donation firsthand: The organs start functioning quickly, patients’ life expectancies increase, and a donor does not have to be deceased in order to save a life.

“Now you have two people with working kidneys and great urine output and no dialysis, and no one had to die in order for that to happen,” Hayes, a Family Nurse Practitioner and Georgetown University alumna, said. “It really is the best of both worlds.”

Although organ donation does not significantly affect most donors’ lifestyles in the long term, prospective donors should still consider how donating will affect them physically, psychologically, spiritually, and financially.

Living Organ Transplants: Needs, Benefits, and Risks

In June 2020, the U.S. Department of Health and Human Services released new guidelines for organ transplants aimed at improving access to organs and reducing the waitlist for organ transplant candidates.

Glossary of Living Organ Transplant terms

There are several types of living donation.

Blood type incompatible donation: A transplant in which the recipient receives specialized treatment to reduce the risk of organ rejection from a donor whose blood type is not compatible.

Directed donation: Organ donation in which the donor chooses the recipient.

Non-directed donation: Organ donation in which a donor gives an organ to an individual they do not know.

Related donation: Organ donation between parents, children, siblings, or other blood relatives.

Non-related donation: Organ donation between individuals who are not blood relatives, such as spouses or friends.

Kidney paired donation (KPD): Two or more kidney donor/recipient pairs who are willing to participate in a transplant, but whose blood types are incompatible. Recipients are able to swap donors for kidneys that are compatible with their blood types.

Positive crossmatch: Typically a last resort, this type of donation occurs between a donor and a recipient whose antibodies will cause rejection of the organ. Specialized treatment is required to prevent rejection.

Which Living Organs and Tissues Can Be Donated?


  • Kidney (most common)
  • Lobe of liver
  • Part of intestines
  • Part of pancreas
  • Partial lung
  • Uterus


  • Amnion
  • Blood (including from umbilical cord)
  • Bone
  • Bone marrow
  • Skin

Who Can Become a Living Organ Donor?

In order to become a living donor, candidates should:

  • Be at least 18 years old
  • Be in good physical and mental health
  • Have normal organ function for the organ they wish to donate
  • Be willing to donate
  • Be well informed
  • Have a strong support system

Conditions that prevent people from donating include:

  • Acute infections
  • Cancer
  • Diabetes
  • High blood pressure
  • HIV
  • Hepatitis
  • Serious mental health conditions

What Are the Benefits of Living Donation?

There is a greater chance that an organ from a living donor will begin working more quickly than one from a deceased donor, and there is also a greater likelihood that the organ will work to its full capacity, Hayes said.

Living donation can also increase life span and quality of life for transplant recipients before going on dialysis.

“Many are not aware of the immense benefits of living donation prior to dialysis,” Hayes said. Dialysis puts patients at greater risk for cardiovascular events, blood infections and other long-term complications that can be mitigated with a transplant.

“We, as a team, are actively engaging in outreach and education to increase knowledge about living donation prior to dialysis so that donors and recipients can make informed decisions regarding an option likely to result in the best possible outcomes for both individuals.”

Although undergoing transplant surgery carries risk, living organ donors typically see few changes after the procedures, Hayes said.

What Are the Risks of Donating an Organ?

As with any major surgery, donating an organ carries some short- and long-term risks.

Short-term risks  may include:

  • Allergic reaction to anesthesia
  • Blood clots
  • Blood loss
  • Collapsed lung
  • Death (in major surgery)
  • Hernia
  • Infection, including urinary tract infections
  • Pain
  • Pneumonia
  • Psychological complications
  • Side effects of medication

Long-term risks may include:

  • Difficulty getting or keeping disability/life insurance
  • High blood pressure
  • Intestinal obstruction
  • Nerve damage
  • Pain
  • Pregnancy complications
  • Proteinuria (increased protein levels in urine)
  • Reduced kidney function or kidney failure

Considerations for Living Donors

Donors should ensure they have a strong support system in place prior to donating an organ, and making the decision to donate should include conversations with their friends and family, as well as the surgical team and social workers at a transplant center. A donor can opt out of completing a transplant at any point before the procedure.

Once a donor is approved for a transplant, the surgery will be scheduled in advance. Helpful preparations for donors can include compiling a contacts list for communication after the procedure, writing down questions for the transplant team, and having a caregiver or loved one attend pre-op appointments. Donors should make arrangements to take time off work, find childcare if needed, and organize post-operative care and assistance at home. Depending on the recipient and transplant center’s location, donors may have to travel for the surgery, so they should make travel arrangements ahead of time.

Prospective donors should also weigh:

Physical Considerations

Before surgery, potential donors must undergo a series of tests and appointments to reveal whether they are a good match for their transplant candidate. In addition to physical examinations and testing, evaluations for kidney donation include financial consultations and psychological evaluations.

“To make sure that organ donation will not negatively affect the life of the donor is super important,” Hayes said. “So, they go through a pretty rigorous process just to make sure that it is a safe and desirable outcome for everybody involved.”

Donors typically spend several days recovering in the hospital after surgery while the surgical team monitors them for any unexplained pain, infection around the incision, and other complications.

“They go through a pretty rigorous process
just to make sure that it is a safe and desirable outcome for everybody involved.”

—Allie Hayes, Family Nurse Practitioner

“Some patients experience more pain than others, but that really varies patient to patient,” Hayes said. “We are pretty good at managing that right from the start.”

Hayes encourages donors to move as soon as possible after surgery.

“We want people getting up and out of bed either the day of surgery or the following day,” she said. “Early ambulation is one of the biggest measures that people can do to both start regaining their strength and preventing complications, like blood clots. It helps people start gaining their stamina back again. It helps regain muscle. It helps the lungs inflate more to prevent pneumonia.”

Donors can consult with their surgical team to discuss appropriate exercises for regaining mobility and strength following surgery. They will have to return for follow-up appointments shortly after being discharged, as well as annual tests, blood pressure checks, and blood tests.

Beyond the weeks or months it takes to recover from surgery, most donors do not have to make significant lifestyle changes after donating an organ.

Psychological Considerations

Most donors experience some degree of uncertainty during the evaluation process, according to Hayes.

“Oftentimes, this is because donors worry about what will happen if their only remaining organ fails, putting them in the position of the recipient, waiting for someone to come to their rescue,” she said. “This is why the donor evaluation is so thorough.”

It is also normal for donors to experience mixed emotions after donating an organ. The psychological side effects of organ donation can include anxiety and depression. Family conflict and concerns about finances and health can also create tension that is sometimes overlooked, Hayes said.

“You consider it more of a physical procedure and less of a psychological procedure, but there is always going to be that psychological aspect to it,” Hayes said. “Some patients then get a little bit nervous.”

In the early days of recovery, it can also be difficult for young and healthy donors to adjust to the vulnerability required to depend on a caregiver.

“These are people who are not used to being incapacitated in any way,” Hayes said. “They are the healthy one. So going from being that healthy person, helping someone else, to being the one who needs a little bit of help, even that can take a toll psychologically.”

After the procedure, donors and recipients have phone access to a transplant team member.

“We are always available to answer questions and address concerns, even after the surgery is complete,” Hayes said.

Tips for Addressing the Psychological Effects of Organ Donation

Establish a strong support system.

Having family and friends who can drive donors to follow-up appointments, help with tasks such as cooking and cleaning, and provide encouragement will be helpful as donors are recovering.

Have confidence in the decision to donate.

Donors can build confidence ahead of the procedure by talking to their surgical team, who will not try to pressure them into undergoing surgery.

Write down thoughts about the motivation to donate before surgery.

Having this reference in writing can help remind patients why they chose to donate if they are questioning their decision after the procedure.

Consider the relationship with the recipient.

For non-directed donations, both the donor and recipient must want to contact each other for transplant coordinators to connect them. Donors should consider expressing their desires to contact their recipient if they think it would help in their recovery.

Join a support group for organ donors.

A transplant center may be able to provide referrals to other living donors who have undergone similar experiences.

Tips for Caregivers

In the days and weeks following transplant surgery, an organ donor’s designated caregiver can aid in the donor’s recovery. Caregivers can help support a donor in a variety of ways:

  • Gather instructions from the surgical team.
  • Keep visitors to a minimum after surgery.
  • Make sure the donor is eating and drinking regularly.
  • Help with tasks like driving, cooking, and cleaning.
  • Remind the donor that recovery takes time.

Other Considerations

Spiritual considerations

Religion and culture can influence attitudes toward organ transplants But many major religious groups support organ donation as a charitable act or see it as a personal choice. Talking to faith leaders can help individuals process whether organ donation is the best decision for them.

Financial considerations

Donors should anticipate how a transplant will affect time they need to take off work and how they will pay for the costs associated with transplants, such as:

Financial Assistance/Guidance for Living Organ Donors:

Additional Resources

These links offer additional information about the living transplant process.

How Is the Pandemic Changing Perinatal Health Care?

How Is the Pandemic Changing Perinatal Health Care?

Nearly overnight, the coronavirus pandemic transformed health care, including perinatal care. Anticipating more and more COVID-19 patients, hospitals needed to create space quickly, both to manage the influx of patients with the disease and to protect non-infected patients from exposure to SARS-CoV-2. 

Elective surgeries were postponed, telehealth was utilized when possible, and some care shifted to outpatient with remote monitoring. One procedure that cannot easily be postponed or managed remotely, though, is childbirth. And, even as the pandemic dramatically reshapes parents’ expectations of labor and delivery, the coronavirus is colliding with crises already affecting pregnant people and new mothers and parents — namely, the struggles to reach families in rural or remote areas and to prevent the unnecessary perinatal deaths of Black people. 

Melicia Escobar, BSN, MSN, CNM, WHNP-BC, believes this complex moment in perinatal health is one that nurse-midwives, trained to move through a crisis without forgetting the client at the heart of it, are more than prepared to meet.

“This is why I think midwife leaders are really shining in this time, across academic settings, medical centers, and home birth, because that’s what we’re trained to do,” said Escobar, a certified nurse-midwife (CNM) and Women’s Health Nurse Practitioner (WHNP) and Clinical Faculty Director of Georgetown University’s Nurse-Midwifery/Women’s Health Nurse Practitioner (WHNP) and WHNP programs.

Intentional support provided by antenatal and birthcare providers is essential in helping families navigate this crisis safely — as well as mitigating the potential negative effects that the pandemic’s social and economic consequences could have on perinatal health in the future. Escobar considers these and offers action steps for supporting people in pregnancy, birth, and the postpartum period below.

Parents Have Fewer Choices About the Birth Experience

Parents tend to have better outcomes when they are empowered to make choices about their birth experiences.

“Having options, offering unbiased guidance around those options, and listening to clients is so important. When people have options for where to birth, for example, and have information to weigh pros and cons, then they know where they should be,” said Escobar. “They know what’s best for them. We just need to listen.”

Consider one key decision parents have to make: Where should I have my baby? In many rural areas, birthplace options can be extremely limited. Options for out-of-hospital care may be rare, and even when parents choose an in-hospital birth, they may only have one hospital accessible to them. Some community hospitals have discontinued childbirth services completely, forcing families who want a hospital birth to travel elsewhere for care.

A CNM in Philadelphia, Escobar set the scene of the pandemic’s early days: “People were afraid of being in a hospital and exposing themselves or their babies to COVID-19. They were also afraid of being subject to hospital policies around COVID-19.”

At some hospitals, one such regulation was limiting the number of support people allowed at the birth to reduce providers’ exposure. But there was an unintended — and unjust — effect, as detailed in the article Reflecting on Equity in Perinatal Care During a Pandemic” in Health Equity: “A policy of no support persons unduly impacts marginalized communities and implicitly reinforces the ‘sacrificial’ or expendable status of Black and Indigenous parents, who have long borne the consequences of mistreatment and abandonment in their health care experiences.”

Protecting parents’ options and respecting their choices surrounding the birth experience is especially important in a crisis. Options should be safe, affordable, and respectful — in other words, a real choice among viable options.

Whether because of the coronavirus or biased, inequitable treatment, “it’s not really a choice when going into the hospital can mean real and present danger,” said Escobar. 

Existing Risk Factors May be Compounded, Especially for Women of Color

Prior to the pandemic, pregnant and birthing people in marginalized groups were already at higher risk of complications and death, as explored in [email protected]’s “How Does Race Impact Childbirth Outcomes?” Perinatal mortality rates are highest among Black women in the United States, as are rates of severe maternal morbidity (SMM), an unexpected labor and delivery outcome that may create significant short- or long-term consequences for a person’s health.

~42 non-Hispanic Black women die for every 100,000 live births, compared to 13 deaths for non-Hispanic white women.

Source: CDC, “Pregnancy Mortality Surveillance System.” 

70 cases of severe maternal morbidity events, or “near misses,” occur for each maternal death of a non-Hispanic Black woman.

Source: The American Journal of Managed Care, “Racial Disparities Persist in Maternal Morbidity, Mortality and Infant Health.” 

~4.2% of non-Hispanic Black women experience a severe complication compared to 1.5% of white women.

Source: American Journal of Obstetrics and Gynecology, “Site of Delivery Contribution to Black–White Severe Maternal Morbidity Disparity.

Some methods of adapting perinatal care during the pandemic could ultimately prove harmful to women, especially women of color, according to the aforementioned Health Equity article. For example, some providers have encouraged early inductions and elective cesarean births (C-sections) to help manage “hospital census and staffing.”

However, these procedures often require increased close contact between patients and providers, increasing the risk of COVID-19 exposure. They can also lead to longer inpatient stays, creating a higher risk for both the parent and newborn.

“Given that women of color already experience higher rates of inductions and cesareans, these policies are likely to further exacerbate the disparities in outcomes,” wrote the article’s authors.

Traumatic Experiences Could be Worsened

Most people bring trauma into the childbirth experience to begin with, said Escobar. COVID-19 adds another layer of stress and fear that may be especially difficult for expectant parents.

~14% of women are affected by perinatal depression.

Source: National Institute of Mental Health, “Perinatal Depression.”

~9% of women experience post-traumatic stress disorder (PTSD) after childbirth caused by real or perceived trauma during delivery or postpartum.

Source: Postpartum Support International, “Postpartum, Post-Traumatic Stress Disorder.”

“Then there’s a second-layer trend where Black, Indigenous, and people of color (BIPOC), who already enter our health system at a disadvantage and carrying trauma, are forced to choose between COVID risk and a system in which they perceive they are unsafe due to racism and bias,” said Escobar. 

“The baseline level of trauma that Black birthing people in particular experience is already so high,” said Escobar. “For folks opting to stay out of care or seeking out-of-hospital birth, it is very easy to understand the logic: Why compound things by introducing either of those two factors, COVID risk and racism?”

Action Steps for Supporting Maternity Care in a Crisis

Giving birth during a pandemic can be traumatic, especially for those who have already experienced trauma in the health care system. With trauma comes fear. When people — both patients and providers — start making fear-based decisions, “that’s when you start getting bad outcomes,” Escobar said.

Still, a negative outcome does not have to be traumatizing. Listening to and empowering the person giving birth can transform the experience.

“There have been clients I’ve been caring for in labor who have had obstetric emergencies, like postpartum hemorrhages or uterine abruptions, where my perception was that the experience was probably traumatic for them,” said Escobar. 

However, the patient tells a different story. “Afterwards when we were debriefing, one of those clients said to me, ‘Thank you so much. That was the most empowering experience in my life,’” she said.

Escobar believes the difference between a traumatic childbirth and a difficult but empowering birth is in listening, sharing information, and partnering together even in the midst of a crisis. When people start from a place of listening to expectant parents, they can understand and mitigate their fears. They can work through or around the trauma to comfort the client and overall have better outcomes — even if the childbirth has scary elements.  

Below, find suggestions for providers, loved ones, and communities to better listen to and support women in pregnancy and the postpartum period during the coronavirus pandemic and beyond.

  • Adopt a midwifery-model mindset: Nurse-midwives are trained to stay calm in difficult births, create an action plan, and move through it with the person “always centered,” said Escobar.
  • Treat listening and clear communication as vital clinical skills, as essential as doing an abdominal exam or listening to heart sounds.
  • Listen to the client, especially when discussing sexual health history and gender-based violence.
  • Find ways to communicate empathy and understanding, even through layers of personal protective equipment.
  • Share information and partner with the patient throughout their care, especially in potentially traumatic childbirths.

How Can Family and Friends Offer Support When You’re Expecting During a Pandemic?

Reserve judgement and honor the choices being made around childbirth and coronavirus precautions.

  • Before visiting, ask about the family’s comfort level with in-person interactions, and again, avoid adding to guilt or shame about those precautions.
  • Identify alternative ways to be helpful, such as sending takeout meals or taking care of yard work. 
  • Consider offering financial support if needed and requested. 
  • Check in if you have not heard from a new parent and ask if they need any support or reassurance.
  • Extend compassion to new parents in the postpartum period. “We’re going through a collective grieving process in this pandemic,” said Escobar. “That loss and fear juxtaposed with the excitement, joy, and hardship of transition is a really intense nexus.” 

How Can Communities Better Preserve Perinatal Health in a Crisis?

Develop a trauma-informed approach to every level of health administration and public service, from intake to birth to discharge. 

  • Consider how to address the external factors that affect pregnant and birthing people and their families. “Pregnant people don’t exist in isolation,” said Escobar. “They have housing needs, they have food needs.”
  • Have a nurse-midwife on maternal health leadership teams. “It improves outcomes, culture, and patient satisfaction everywhere,” said Escobar.
  • Create policies that make perinatal care more holistically accessible. For Escobar, accessibility includes having a hospital to go to that offers safe, effective, unbiased, and respectful care.

Citation for this content: [email protected], the online Women’s Health Nurse Practitioner program from the Georgetown University School of Nursing & Health Studies

Share This: 7 Ways to Support Nurses in 2021

Share This: 7 Ways to Support Nurses in 2021

During the initial US COVID-19 outbreak last March, Americans were quick to express their gratitude to nurses and other healthcare workers. Entire cities boosted the spirits of HCWs with nightly cheers, and individuals as well as businesses sent meals to hospitals, offered nurses personal assistance, and performed other acts of kindness. Now, with the massive fall/winter surge courses around the nation, people are searching for new ways to support nurses’ efforts in fighting the pandemic. If anyone asks you what they can do to support nurses, here are some suggestions from our friends at the Georgetown University School of Nursing and Health Studies (see the full story here):

1. Follow the Recommended Safety Protocols

Help slow the spread of the virus by taking the recommended precautions, such as staying home, wearing masks in public, and following social distancing guidelines. And make time to get a Covid-19 shot ASAP when the vaccines become available to the general public later this year!

2. Donate Blood

In times of crisis, there is often a shortage of blood donations, which can be critical for patient care. Organizations like the Red Cross offer information on how to find local blood drives. 

3. Contact Community Leaders

Find out if groups in your area are making efforts to help. For example, local churches have done cloth mask drives to help minimize the use of personal protective equipment (PPE) outside of health care settings, Arceneaux said.

4. Be an Advocate

Supporting policies and legislation that benefit public health and health care professionals can help make a lasting change. The American Nurses Association provides a regularly updated list of COVID-19 issues and information on how to help.

5. Get a Flu Shot

As we enter flu season, health care experts are worried about managing influenza outbreaks while also continuing to treat COVID-19 patients, Arceneaux said. Taking this precaution can help slow the spread of the influenza virus.

6. Ask a Nurse

If you know a nurse or health care worker, consider asking them if they need assistance with running errands, child care, or other tasks.

7. Give to Charities that Support Covid Frontliners

Several nonprofit organizations are currently raising money for COVID-19 initiatives. To make sure your money will be put to good use, look up the groups you are considering on Charity Navigator or Charity Watch to verify their trustworthiness.

Organizations That Aid Healthcare Workers

CDC Foundation Coronavirus Emergency Fund 

This crowdfunding effort by the CDC Foundation was established to direct funds toward purchasing medical supplies, increasing lab capacity, deploying emergency staffing, providing support to vulnerable communities, and other health care efforts related to COVID-19.

Center for Disaster Philanthropy (CDP) COVID-19 Response Fund 

This fund aims to “support containment, response, and recovery activities.” In addition to providing services for vulnerable populations and small businesses, the fund also supports frontline health care workers by providing PPE and deploying emergency medical teams.

COVID-19 Frontline Health Worker Fund 

Intrahealth International is behind this initiative, which directly supports health care professionals. Services provided through donations vary, as they strive to address the current and ever-changing needs of medical teams.

COVID-19 Solidarity Response Fund for WHO 

The World Health Organization is raising money to address the pandemic in many ways through their partnerships. In addition to accelerating COVID-19 research, WHO also offers PPE and other supplies to health care workers.

GlobalGiving Coronavirus Relief Fund 

Organized by GlobalGiving, this fund supports health care workers by sending medical teams to communities in need of additional help, as well as providing supplies such as masks and ventilators to hospitals. The fund additionally serves vulnerable community members affected by the pandemic.

Project HOPE 

Project HOPE focuses primarily on providing PPE to health care workers, delivering training on how to care for COVID-19 patients, and deploying health care workers to medical facilities in need of additional staffing.

Citation for this content: [email protected], the online MSN program from the School of Nursing & Health Studies

Vaccinating a Nation: a Guide to Achieving Herd Immunity

Vaccinating a Nation: a Guide to Achieving Herd Immunity

Flu season is here, and the media is filled with news about the new Covid vaccines, so this is a good time to have a sort of primer explaining the profound importance of vaccination for communities as well as individuals. [email protected], the online MSN program from the School of Nursing and Health Studies at Georgetown University, has kindly allowed DailyNurse to share their guide to the essentials of herd immunity and tips for addressing vaccine-hesitant patients and loved ones.

What is Herd Immunity?

Also referred to as “community immunity,” herd immunity is a public health term used to describe a case in which the potential for person-to-person spread is significantly reduced due to the broader community’s resistance against a particular pathogen.

A Glossary of Important Vaccination-Related Terms

  • Active immunity: Immunity as a result of the body’s antibody creation after exposure to disease-causing pathogens, either through natural infection or vaccination.
  • Herd immunity threshold: Also called the “critical vaccination level,” this is the approximate percentage of a population that needs to be vaccinated in order to reach herd immunity status.
  • Immunity: Resistance to a particular pathogen, or disease-causing bacteria, through antibodies.
  • Inactivated vaccine: A vaccine using a killed form of the disease-causing germ. This vaccine usually requires multiple doses over time to form immunity. Examples include the DPT and Hepatitis A vaccines and the flu shot.
  • Live attenuated vaccine: A vaccine using a weakened form of a germ to produce an asymptomatic infection and generate an immune response similar to a natural infection, without sickness. Examples include the MMR and chickenpox vaccines.
  • Natural infection: Contraction of a disease through person-to-person transmission or interaction with disease-causing bacteria.
  • Passive immunity: Immunity after receiving disease-fighting antibodies from an external source.
  • R0 (Pronounced “r-naught” or “r-zero”): The reproductive number of a disease that describes the average number of additional cases a single infected person creates.
  • Subunit vaccine: A vaccine using a component of the germ (such as a specific protein) to produce an immune response. This vaccine does not contain a live germ. Examples include the shingles and HPV vaccines.
  • Vaccine: A controlled simulation of natural infection meant to trigger antibody creation that helps fight against the disease later, without sickness.

Why is Herd Immunity So Important?

When enough community members are immune to a virus so that it inhibits spread, even those who are not vaccinated will be protected. The “herd” collectively provides insulated safety to all members, which is important for those who are too high-risk for certain vaccinations.

For example, the yellow fever vaccine should not be administered to individuals who are pregnant, have a weakened immune system, or have specific allergies, according to the CDC guidelines on who should not be vaccinated.

For these individuals, it is important that their community has built an immune response to the yellow fever so they are not at risk of infection and transmission. Individuals who are too high-risk to get a vaccination are often more likely to contract the illness and experience serious symptoms.

Some other reasons why people cannot get certain vaccinations include:

  • Age
  • Allergies
  • Pregnancy
  • Recent blood transfusion
  • Underlying medical conditions like lung or heart disease
  • Weakened immune system

Elke Jones Zschaebitz, DNP, ARPN, FNP-BC, and faculty member at Georgetown University School of Nursing & Health Studies, likens herd immunity to a perimeter fence that ensures the safety of the broader community.

“It’s like a little nuclear circle,” she said. “So that our babies that can’t get vaccinated yet, or our pregnant mothers, or our elderly with immune systems [that] are not as robust, or people who have certain kinds of conditions that they don’t have the correct immunity, will have protection from the active pathogen that could possibly harm or kill them.”

HITs and R0s: the Science Behind Herd Immunity

Herd Immunity: Few vaccinated
Herd Immunity: all vaccinated

In a community where no one is immune to a virus, a disease can spread rapidly and lead to an outbreak. As individuals acquire immunity, either through infection or a vaccine, the disease spreads more slowly because fewer people can pass it on.

In a community where enough members are vaccinated, the disease will stop spreading because the virus will not be able to find susceptible hosts.

The herd immunity threshold (HIT) varies depending on a variety of epidemiological factors. The primary consideration is the infectiousness of a disease. Infectiousness is measured by the Basic Reproduction Number or reproductive ratio—often referred to as R0 (“r-zero”). R0 refers to the number of cases expected to occur on average in a susceptible population as a result of infection by a single individual at the start of an epidemic before widespread immunity starts to develop. So if one person develops the infection and passes it on to two others, the R0 is 2. Herd immunity helps R0 drop below 1.

Here are some examples of R0s for a few well-known infectious diseases:

  • Measles R0: 12-18
  • Polio R0: 5-7
  • Ebola R0: ~2

Numbers for COVID-19’s R0 vary —The Atlantic reported a range of about 1.5 to 5.5 in February, while more recent estimates from WHO place COVID-19’s R0somewhere between 2 and 4 (PDF, 2 MB). The herd immunity threshold (HIT) varies depending on a variety of epidemiological factors. The primary consideration is the infectiousness of a disease, often referred to as R0; herd immunity helps R0 drop below 1.

“The higher R0 is, you’ll have to have really, really high [levels of active immunity], or it’s still transmissible and the vulnerable population will still get it,” Thompson-Brazill said.

A September 2020 report in Nature Reviews Immunology expects COVID-19’s herd immunity threshold to equal 67%, if R0 is 3. However, the Government Accountability Office cautioned researchers against reaching any conclusions regarding herd immunity for COVID-19 (PDF, 276 KB), as much is still unknown about the contagiousness of the disease.

The Role Clinicians Play in Herd Immunity and Vaccination

Zschaebitz and Thompson-Brazill have years of experience in various health care settings— from travel clinics and trauma units to international research. Some of the ways that clinicians increase herd immunity and vaccination include:

  • participating in global research to genotype communities and help produce viable vaccines.
  • administering vaccines so patients can stay up-to-date on immunization schedules and travel requirements.
  • educating patients on the importance of vaccination and specific information related to different vaccines.

How to Talk to Patients, Family, and Friends About Vaccination

Thompson-Brazill shared her experience speaking with patients who are vaccine-hesitant and said she has learned that one of the roles clinicians play in herd immunity is educating patients about why vaccines are safe and normative for society.

Zschaebitz also shares the importance of herd immunity with patients — often through the retelling of her own experiences genotyping Maasai tribal women for an HPV vaccine.

“We were interested in preventing deaths of cervical cancer because in certain countries women just die,” she said. “Declining a vaccination is sort of a first-world problem because people in other nations would walk for miles to get what we have and what we take advantage of.”

Thompson-Brazill and Zschaebitz’s tips for speaking to vaccine-hesitant friends and family:

Tip #1: Avoid pointed questions that could make someone defensive.

Instead of: “Why wouldn’t you get the shot?” Try: “What about the shot worries you?”

Tip #2: Use storytelling as a way to share your experience.

Instead of: “I can’t believe you are not going to vaccinate your children” Try: “I chose to vaccinate my kids because…”

Tip #3: Refer people to credible, reliable sources.

Instead of: “Why would you believe that? That’s just a hoax!” Try: “The CDC has a lot of useful information about vaccines and potential risks. Have you read what they have to say?”

Tip #4: If you do not know how to respond, recommend an expert who does.

Instead of: “I can’t talk to you about this; we will never agree.” Try: “Have you shared your concerns with your clinician? They will be able to answer your questions.”

A Herd Immunity FAQ

Is it possible to achieve herd immunity without a vaccine?

Because the herd immunity threshold is so high, achieving herd immunity without a vaccine is unlikely, according to the American Lung Association. The likelihood depends on the disease’s R0, because a lower threshold would be easier to reach naturally. However, the severity of a disease could also mean that many individuals in a community would succumb to a disease before broader immunity is obtained.

Is herd immunity effective against all diseases?

No, not all diseases can be overcome with herd immunity. For example, herd immunity cannot be achieved for Clostridium tetani, the bacteria that causes tetanus. Although infection is avoidable via individual vaccination, the “herd” cannot provide protection. For example, the immunity of others will not prevent an individual from contracting tetanus after stepping on a rusty nail.

Can you still get the flu after a flu shot?

It is possible to become sick with a strain of influenza that the vaccine was not developed to protect against. However, the CDC says that the flu vaccine will minimize the severity of symptoms among those who do get sick. Other reasons someone could experience flu-like symptoms after getting a flu shot include contracting a different respiratory illness and exposure to the flu virus shortly before vaccination.

Why do I need to get vaccinated for diseases we already have herd immunity for?

Some immune responses weaken over time, which is why booster shots are so important. Additionally, vaccine refusal can lead to waning community immunity. For example, in 2019, measles outbreaks in New York and Oregon threatened the United States’ 20-year measles elimination status, according to a press release from HHS on measles outbreaks in 2019.

Is immunity from a natural infection stronger than immunity from a vaccination?

Yes. Natural immunity, the result of antibody production after natural infection, is often more effective and longer-lasting than acquired immunity via a vaccine. However, acquired immunity is safer. Some cases of natural infection can be accompanied by symptomatic illness and severe outcomes like pneumonia, liver cancer, and even death, according to an article on vaccine safety from the Children’s Hospital of Philadelphia.

Reliable Information Sources on Vaccines and Vaccination

Both Zschaebitz and Thompson-Brazill recommend using nationally recognized, expert-led sources to learn more about vaccines, like the CDC, FDA, and NIH. Some of the additional resources available include:

  • CDC Immunization Schedules External link : The CDC-recommended vaccination series and timing schedule for children, adolescents, and adults.
  • The CDC Yellow Book External link : A set of travel health guidelines, including country-specific vaccine recommendations and requirements.
  • Questions About Vaccines, FDA External link : The FDA’s collection of information regarding specific vaccines and approvals.
  • The Power of Herd Immunity, TED Talk by Romina Libster External link : Health researcher Romina Libster tells the story of an H1N1 outbreak in her town and the role of herd immunity.
  • Vaccines by Disease, HHS External link : Vaccine-specific answers to questions such as: “Why is this vaccine important?” and “What are the side effects of this vaccine?”

DailyNurse would like to thank the Georgetown School of Nursing and Health Studies and the [email protected] site for allowing us to share this guide.

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