As we begin 2022, we see some progress in our fight against COVID-19, although there remains uncertainty about a return to anything that resembles a prepandemic "normal." Our national health care resources are being wrung dry through our efforts to stop the spread of this virus. And so, it might seem of less consequence to comment on anything else but this seemingly never-ending battle. And yet, we know that there are many other issues that face nurse practitioners (NPs) and NP educators. One of our most pressing health care issues that requires our attention is the scourge of gun violence across the country. The issue is complicated and polarizing, and a nation-wide solution is not imminent, even as calls for gun violence measures are made public by nationally representative groups in nursing and medicine.

Gun violence has become an insidious chronic disease deeply rooted in our society. Each mass murder shatters communities and hundreds of families for years to come. We learn about them in real time through social media, and the immediate response is outrage, protests, and a call for solutions. But gun violence occurs daily in our neighborhoods all throughout the country. The consequences are felt for years by the survivors and family members who are our patients. Firearm injuries affect people across the lifespan and are considered among the five leading causes of death for people ages 1-64 years. The issue deserves our sustained attention.

Survivors and their families are at high risk to develop mental health sequelae as well as permanent physical disability. Repeat violence and a normalization of gun violence have been documented in communities that are disproportionately affected by an influx of guns. Young adult males account for most of both firearm deaths and nonfatal firearm injuries. Firearm suicide rates are highest among the older person (75 years and older), and the Centers for Disease Control and Prevention (CDC) reported that in 2019, out of the 38,300 deaths from guns, 23,900 were suicides (CDC, nd).

These alarming statistics are beginning to receive important attention. For the first time in more than 20 years, there is congressional support for research and development of evidence-based methods to prevent gun-related injury and crime. The Gun Violence Prevention and Community Safety Act of 2020 provides a new platform on which to expand the pioneering efforts of the small group of researchers and clinicians who have made inroads in gun violence prevention and treatment. The 25 million dollars attached to this initiative is much needed because projects funded by this act will enable the families and survivors of firearm violence to rebuild their lives.

The issue of gun violence is not only of professional concern, for me, it is also a highly personal issue. While in my NP program in 1979, my brother-in-law was murdered with a gun. My sister became a single parent to two young children when she was 30 years old. My family has learned the effects of survivorship, firsthand. The circumstances are unimportant and at this point serve to distract from the discussion. What I can say is that we continue to feel the impact of this violent act all these years later. I am not surprised by research that describes the negative impact that is associated with chronic exposure to gun violence. At the time, we were lucky to have the support we needed. Today, the incidence of gun violence far outweighs our readiness as a nation. There are, however, some sterling resources that have developed in response to this ongoing problem and can be tapped by NPs and NP educators.

The University of California Firearm Violence Research Center opened in 2017 as the first state-funded program of its kind. They assumed a leadership role to develop policy, disseminate findings, and train health care professionals and researchers in the field of firearm violence. A major focus is on the risk factors for recurrent firearm-related injury. As its Director, Dr. Garten Wintermute stated in a recent editorial "Health professionals are not on-the-side lines people." I agree, especially when describing NPs.

NPs assume leadership roles in our profession as well as work directly with patients and families. We have a responsibility to identify and work to heal survivors of gun violence. What do most NPs (outside of the military) know about how to respond to mass murder? What is our responsibility in relation to our patients' safety and their guns? How do we impact the health of people who live in high gun-death communities who have no resources? How many of us know who the Post-traumatic stress disorder clinicians are in our communities? The answers to these questions are evolving and NPs can avail themselves of the emerging literature to design effective gun violence prevention and interruption programs in their own environments.

There are successful models on which to build. One approach is known as Cure Violence. The programs use outreach workers and violence interrupters to break the cycle of community-based gun violence. These people are known and respected in the community and their positive impact on recurring violence has been well documented. They work to prevent retaliation and mediate conflicts to change behaviors and community norms. They collaborate with hospitals and local nonprofit organizations to break the cycle of violence.

The Health Alliance for Violence Interruption works toward the development of hospital-based violence prevention and intervention, with one goal to provide trauma-informed care for survivors of violence. The organization is growing and has both national and international partnerships who recognize the value of hospital-based programs to decrease recidivism, victimization, and violence as a recurrent event. Their Violence Prevention Professional certification training for frontline violence intervention staff invests in the notion of community as the place of healing.

I have witnessed the positive effect that programs like this have on gun ravaged communities such as in the city of Chester, Pennsylvania, where gun violence has been an endemic and growing problem for years. The chance of becoming a victim to violence in Chester is 1 in 72 as compared with 1 in 326 across the state. Reports of shootings occur daily, and most residents know someone who has been murdered or maimed by a gun. Recently, however, the homicide rate was down by 58%, in part due to the sustained efforts of several grassroots organizations. Chester Community Coalition is one of the programs that is making a positive impact using peer and professional counseling aimed at entire families. Both immediate and long-term sequelae are addressed in group therapy, and young children are helped through art therapy. The group partners with the local hospital to identify victims and families in the emergency department after a shooting. In addition, they are aligned with like-minded groups in Chester and beyond. I am encouraged by the positive outcomes reported of late because they represent progress, but we know that much more is needed and more interested people are needed, especially among NPs.

What does a platform for education and practice in the prevention and treatment of gun violence look like? How do we come together as a profession to improve our curricula, update our practices, prepare for the next mass casualty, and address the lifelong consequences of violence? Where do we find space in an already overburdened curriculum to give this issue the voice it requires? Tackling these questions is up to all of us. Stronger linkages between schools of nursing and community violence prevention groups can alter the trajectory of this epidemic. As NPs (and especially as AANP fellows), we are encouraged to use our knowledge and talents as a force for positive change. My experiences in working in this space has fortified my belief that NPs can play a much bigger role to mitigate the devastating and long-lasting effects of gun violence.

Viewpoints shared are those of the writer and not the editorial team, the AANP, or JAANP.

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