The Nurse’s Role in Immunization Services
To begin our introductions of the Every Child By Two Scientific Advisory Board, I had the pleasure of interviewing one of our distinguished members Mary Beth Koslap-Petraco, DNP, PNP-BC, CPNP.
Dr. Koslap-Petraco is the coordinator for child health at the Suffolk County Department of Health Service in New York, where she is also a primary care provider. She is a clinical assistant professor and preceptor for graduate and undergraduate students at the Stony Brook University School of Nursing, as well as a fellow of the National Association of Pediatric Nurse Practitioners (NAPNAP).
“ Knowledge is not knowledge until it is given away.” Dr. Koslap-Petraco
What first motivated you to begin working in the field of immunizations?
Immunizations became my life’s work almost by accident. I worked in the Emergency Department for years where I gave lots of tetanus shots. Since it has always a passion of mine to keep up with the most current literature, I remember reading a CDC article which supported the use of tetanus-diphtheria (Td) vaccine for wound prophylaxis rather than tetanus toxoid.
When I left the ER, I took a position as a Public Health Nurse for Suffolk County Department of Health Services (SCDHS) in New York, where I was assigned to the Treatment Room to administer vaccines. Since the only vaccine I had ever administered was Td, it was time to hit the books again, and I turned to my trusted resource, the CDC.
Eventually, I went back to school to become a Pediatric Nurse Practitioner. Soon after I graduated, the CDC’s National Immunization Program began to offer Immunization Action Plan (IAP) grants to local health departments to promote immunizations to the underserved, and I was given the opportunity to develop the plan for Suffolk County.
At this time Walter Orenstein, MD, MPH, director of the National Immunization Program, was developing a course in vaccinology and immunology aimed specifically at health care professionals, and most notably nurses. Dr. Orenstein believed that if the nurses were to be giving vaccines, then they should have the education to do so. He also believed, along with William Atkinson, MD, MPH, a medical epidemiologist from the CDC, that immunization programs could not be successful unless the nurses were behind them.
As a result, all of the managers of the IAP grants were asked to take the CDC’s vaccinology-immunology course. To this day, that course is one of the best courses I have ever taken in my life! Dr. Orenstein and Dr. Atkinson both spoke with such passion about this mission that it became my mission too. I was hooked for life!
Can you explain your current job responsibilities?
In short, I am responsible for making sure that every question about immunizations in Suffolk County – whether from lay person, parent, child, or provider – is answered using the most current, scientifically supported information. The goal is to ensure that everyone in Suffolk County receives all of the age appropriate vaccines they need to stop vaccine preventable diseases.
Have you ever had any personal experiences with diseases that are now vaccine preventable?
Dr. Koslap-Petraco with her mother, Mildred Bliss Koslap, on her 90th birthday.
Unfortunately, I have. Both of my sisters and I had measles, rubella, and mumps, and one of my sisters developed measles meningitis and almost died. I can remember my mother rocking my sister in her arms in a darkened room and praying out loud for her survival. Also, my mother developed polio when she was three years old and now suffers from post polio syndrome. I’m so grateful that my career path has brought me in this direction, because I can help prevent other families from experiencing what my family has experienced.
What’s the most rewarding aspect of your job?
I love sharing my knowledge of vaccines with others. Whether it is parents, nurses, or providers, each group gives me a tremendous sense of satisfaction, knowing that I have contributed to their education and ultimately their confidence in immunizations. Parents hear so many things about vaccines and they truly want to do what’s best for their children. By taking a few minutes to anticipate their questions, and then responding in a thoughtful, sensitive manner, I help them resolve their concerns. It’s also an honor to help so many nurses and providers and it’s gratifying to know that I’m able to expedite answers to their questions and clarify immunization information with detailed sources.
What’s the most challenging aspect of your job?
I would have to say that it’s in addressing vaccine refusal. Well meaning parents who have heard so much negative information about vaccines will sometimes refuse one, or all, of the ACIP
recommended vaccines. My job is to address parental apprehensions and explain that there is no scientific basis for their concerns. Most parents ultimately choose to vaccinate their children, but it’s the families – and some nurses too – who are not vaccinated that I worry about the most. I worry about the health of their children, who may end up with first-hand knowledge of vaccine preventable diseases. I worry about my nurse colleagues, who not only put themselves and their colleagues at risk, but our patients as well. Some may say that there is nothing you can say or do to change the mind of a vaccine refuser, but I say we must continue to try.
What is the single most influential thing you have learned over the years?
I have learned a great deal about communication and some of the most useful information I have learned has come from Alison Singer, president of the Autism Science Foundation. Alison taught me to start the conversation by finding common ground with the person with whom you are conversing. Alison has developed a communication paradigm called CASE, which I have been privileged to share with literally thousands of nurses through the internet and through continuing education programs sponsored by the American Nurses Association. It’s rewarding to know that thousands of nurses have now learned and can apply Alison’s CASE method of communication, especially when addressing immunization questions.
What would you consider to be a highlight of your career?
I had once assumed that everyone knew what I knew about immunizations, but Dr. Bill Atkinson once told me to “Assume others know nothing about immunizations and start from there”. I took this advice and found it to be extremely helpful, especially when I was working on a free, web-based, continuing nursing education (CNE) program with ECBT for the ANA. I would have to say that working on this project has been the highlight of my career so far. It was truly a labor of love and a gift to my fellow nurses. I can’t tell you how I nit-picked over everything – and I’m certain that I drove everyone who had to work with me absolutely crazy – but I wanted the nurses to have all of the tools they need to make their jobs rewarding, easy, efficient and fun.
Dr. Mary Hibberd talks about her love for Public Health by explaining that when we care for individual patients we influence individual lives, but when we practice Public Health we care for and influence entire communities. This is what made this CNE so satisfying for me. I was able to influence an entire community of nurses who will now use the knowledge they have gained to influence entire communities of patients.
What drives your passion for immunizations?
My passion is driven by my sincere desire to prevent the ravages of vaccine preventable diseases for all families. For example, I’m honored to work with Lynn Bozof and Frankie Milley, two moms who lost their sons to meningitis. Neither mom knew there was a vaccine available to prevent meningitis before their sons had died. To honor them, I’m determined to vaccinate every child I can to prevent another mom from having to lose a child.
Knowledge is power, and giving moms the knowledge they need to make the decision to vaccinate is very important to me. I went into nursing because I wanted to help others become healthy and stay healthy, and that continues to be my personal and professional goal. I do not just see this work as a job, but as a mission…a mission to arrest vaccine preventable diseases and thereby improve the quality of life for all.
What are your ambitions for the future of immunization practices?
My desire is to continue educating, speaking, and writing about immunizations and the role of the professional nurse in providing immunization services. I have heard others say “Nurses own immunizations”. That’s because nurses are able to take the time to teach our patients and their families about immunizations and vaccine preventable diseases. I believe nurses are the driving force behind immunization programs and I want to share that message with nurses and give them the tools they need to keep promoting and administering vaccines.
Dr. Koslap-Petraco is the recipient of numerous awards and honors for her work. Dr. Koslap-Petraco is widely published, speaks nationally, and has authored chapters on immunizations in two textbooks. She received the Doctor of Nursing Practice at Stony Brook University where she also received an MS in child health and pediatrics. Dr. Koslap-Petraco received a BSN from Excelsior College in Albany, New York and earned a diploma from the Bellevue School of Nursing in New York City. She is the past chair of NAPNAP’s Special Interest Group on Immunizations and a past member of the Advisory Board of the Immunization Action Coalition (IAC). She served on the National Vaccine Advisory Committee (NVAC) of the Centers for Disease Control and Prevention (CDC) and continues to be a consultant for the CDC. Dr. Koslap-Petraco is also a member of the Advisory Board of Parents of Kids with Infectious Diseases (PKIDS) and is the PKIDS on line Advice Nurse. We are thrilled that she is now also a member of the Every Child By Two Scientific Board.
If you have any questions you would like to ask Dr. Koslap-Petraco, feel free to include them in the comments below.