Are you as puzzled as I am with the “mixed messaging” as COVID-19 outbreaks surge in several states in the U.S.? Just what do we tell our adult patients and parents who entrust us with the care of their babies, children and adolescents to guide them in decision-making for the health and well-being of themselves and their children? We, as nurse practitioners (NPs), advanced practice nurses (APRNs), nurse anesthetists and midwives uphold the highest ethical principles in our practices, our recommendations for care management, and in our everyday lives. For 18 consecutive years, nursing has been rated the #1 most ethical and honest profession.1 Maintaining the highest ethical standards coupled with efforts to continuously build trust is a valued principle embodied by advanced practice nursing professionals. In the midst of a pandemic, in which we must be unified in our approach to providing the highest quality of care and recommending measures that represent the best available evidence, how can we explain the mixed messages that we hear and read every day?

COVID-19 is presenting parents with difficult decisions. They are asking each other and their providers some of the following questions: 1.) Can my children safely play with friends? 2.) Can my children attend camp? 3.) Can our adolescents attend social gatherings and participate in sports? 4.) Can our children and adolescents safely return to school? These questions are not easy to answer, especially in a pandemic compounded with mixed messaging. Before we begin to help parents answer their questions, we need to ask what activities they allowed or are willing to allow their children and adolescents to do.

So how can we answer any of the above questions? As healthcare professionals, we need to frequently review the Center for Disease Control and Prevention (CDC) guidelines. We also need to regularly review local and regional data on the status of COVID-19. Show parents the websites for reliable data. This information should be reviewed with the parents to determine their understanding of the data. The CDC has information specifically written for parents and adults to better understand COVID-19 risks and guidelines. We need to be truthful with parents. We need to explain that what is considered best practice today may change tomorrow as the virus continues to surge in many states. We need to explain that mixed messages are problematic. An example of mixed messages is simply wearing a mask. Best practice is for children (over the age of 2 years), adolescents and all adults to wear masks. It is simple, straight forward, and shown to be effective. We can explain this to parents, children and adolescents. The mixed messaging concerning masks can best be handled in a brief discussion with them. Adolescents may not want to wear masks but parents need to remain firm on this topic and role model this behavior. Controlled outside “play activities” for children and adolescents need to be evaluated by the parent to assure that safe and recommended guidelines are maintained. We want children and adolescent to safely socialize. We can help both parents and adolescents understand the benefits and the potential risks for failing to follow the science regarding safe outdoor activities.

On the topic of return to school, there are a significant number of mixed messages from both the national and state levels. Safety guidelines are in the early phases of development. Encourage parents to advocate for consistent policies that apply to everyone based on local and state data. Masks, testing, social distancing, eye protection, and hand hygiene are essential to the safety of children and adolescents whether at camp or school. Based on the current surges it may not be feasible for children and adolescents to attend camp in these summer months or school in the fall in many states. We want the public to trust that all decisions made by health care professionals have the best interest of the children, teachers, and all school personnel as their guiding principles. We trust that teachers will provide the best possible education for all students whether the educational format is online or in-person. In conclusion, mixed messaging is harmful. Local and state healthcare and educational policies based on the highest ethical standards and trust must prevail throughout this pandemic.


  1. Brusie, C. Nurses ranked the most honest profession 18-years in a row. 2020. Accessed 7-17-2020. Retrieved from

Donna Hallas PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN is a certified as a pediatric nurse practitioner and pediatric primary care mental health specialist. She is a Clinical Professor and Director of the PNP program at New York University Rory Meyers College of Nursing. She has presented nationally and internationally on numerous research and clinical topics with the overall goal of improving health care outcomes for infants, children, adolescents and young adults. 

Her first book, Behavioral pediatric healthcare: A growth and developmental approach to intercepting abnormal behaviors, earned the prestigious American Journal of Nursing 2018 Book of the Year Award earning first place for Psychiatric and Mental Health Nursing and third place for Child Health.

Dr. Hallas is a digital editor for Contemporary Pediatrics and writes a monthly commentary which focuses on applying information in one or more journal articles to pediatric clinical practice. Here is a link to the PNP corner

Dr. Hallas’ most recent research focuses on vaccine hesitancy. She and colleagues designed a web-based intervention study using the concepts of informed decision making and the influence of social media. The study was conducted using two populations: pregnant women  and mothers of newborns and young infants to determine the effectiveness of population-specific web-based interventions to reduce the incidence of vaccine hesitancy (Hallas, Altman, & Fletcher, 2018). The study was statistically significant for prenatal women and approached statistical significance for mothers of newborns and young infants. 

Please click on this link for a brief discussion by Dr. Hallas on vaccine hesitancy and the most recent measles outbreak:–why-do-some-parents-hesitate-to-vaccinate-their-ch.html.

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