https://www.bloomberg.com/news/articles/...-hospitals
Nurses Who Won’t Vax Threaten Staffing Shortages
Front-line workers were already in tight supply. With
almost 1 in 8 nursing professionals not planning to get a shot, the problem’s going to get worse.
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A person holds a sign in front of Houston Methodist in Baytown, Texas, to
protest a policy that says hospital employees must get the Covid vaccine or lose their jobs. PHOTOGRAPHER: YI-CHIN LEE/HOUSTON CHRONICLE/AP
Mandate the vaccine, and some of your nurses will quit. Don’t mandate the vaccine, and some of your nurses will get Covid—rendering them unable to work, or even landing them in the very intensive care unit where they normally work. For a hospital administrator who’s been dealing with nursing shortages escalating throughout the pandemic, this is the dilemma.
“It’s a cynical question, but what gets us to losing the higher amount of staff?” says Alan Levine, chief executive officer of Ballad Health, which has 21 hospitals and other centers serving patients in Kentucky, North Carolina, Tennessee, and Virginia.
He decided not to require vaccinations for his health-care workers after modeling suggested he could see 15% of nurses, or as many as 900, leave if he did. That’s more than he anticipates losing to Covid-19 quarantines and illness, even with the most recent surge filling up the network’s ICUs and 130 staffers quarantining on a single mid-August day. At Ballad, 97% of doctors are vaccinated. Among front-line nurses, he estimates vaccination rates hover around 50%.
It’s hard to comprehend how nurses, who see firsthand evidence of how Covid can kill people, could oppose getting a vaccine that’s been shown in numerous studies to provide extraordinary protection against severe illness and death. But it’s a problem hospital administrators all over the country find themselves facing. In the most recent survey by the American Nurses Association (ANA), fielded as part of a broader coalition of nursing groups intended to combat vaccine hesitancy in its ranks, almost 1 in 8 hadn’t gotten the vaccine or didn’t plan to, despite having had access to the shots for almost nine months.
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Demonstrators protest against Houston Methodist’s employee vaccine rule, including Jennifer Bridges (second from right), a nurse who hasn’t been inoculated against Covid.
PHOTOGRAPHER: YI-CHIN LEE/HOUSTON CHRONICLE/AP
“The overwhelming number of our nurses are female and young and in childbearing years,” Levine says. Rumors on social media caused some young women to fear that the mRNA vaccines such as those made by Pfizer Inc. and Moderna Inc. could affect their fertility. That’s not true. But it’s a worry that’s taken firm hold in some circles, even after the American College of Obstetricians and Gynecologists said publicly that there is no evidence the vaccine harms fertility.
In April the government temporarily paused the rollout of Johnson & Johnson’s vaccine because of rare cases of blood clots in women. Federal agencies investigated the issue, ruled it a remote risk, and resumed the shots. But the pause left a lasting impression. “What we’ve decided to do, besides jumping right into a mandate, is try to educate staff who are women,” Levine says. “I can’t say that’s generated a whole lot of results yet.”
Vaccine hesitancy has many faces. There are the entrenched beliefs of the vaccine-skeptic campaigners who stoke fears on social media with false health claims. There are those with concerns that the vaccine has been around only a short time. And there are the merely ambivalent, people who aren’t ardently opposed to getting the vaccine but might still need an extra push.
(đọc tới đây thấy hơi hề , vì những người chống vaccine , đâu phải chỉ ở trong tuổi còn đẽ ...
những người không còn ờ trong tuổi này , cũng chống , không lẻ nào vì họ còn muốn đẻ)
“There are not enough nurses to go around. That is clear”
Nationally, only 35% of hospitals have mandated that staffers get vaccinated against Covid as of Aug. 19, according to the American Hospital Association. With the U.S. Food and Drug Administration fully approving the Pfizer vaccine on Aug. 23, that percentage could rise over the next few months. About 22 states now require Covid vaccinations for at least some health-care workers, according to data from the National Academy for State Health Policy. Not all states are moving in that direction. Four so far—Arkansas, Georgia, Montana, and Tennessee—established bans before the FDA’s Pfizer vaccine approval that could prevent mandates being imposed on some workers. A number of others have yet to weigh in, leaving hospital administrators balancing their staffing concerns with their desire to protect workers and patients.
Houston Methodist, a health system in Texas with eight hospitals and 26,000 employees, says it was the first large hospital system in the nation to mandate Covid vaccinations for its staff. “It was never really a question of if we would mandate,” says CEO Marc Boom, but rather “when would we mandate.” Boom’s team started educating staffers on the importance of the vaccine as early as last fall, before the shots had even gotten the regulatory green light. Then, at the end of last year, Houston Methodist started offering what Boom called a $500 “hope bonus” to employees, knowing the winter months were going to be trying for staff with Covid surging again after the holidays. Employees could qualify for the bonus by late February, but there was a catch: They had to have their first shot by then. When Boom announced a vaccine mandate at the end of March, about 85% of Houston Methodist’s staff were already vaccinated. He estimates Houston Methodist spent $13 million incentivizing its staff to get shots.
Then Boom got word the hospital was being sued. A nurse, Jennifer Bridges, led a group of employees in a lawsuit to overturn the mandate, arguing it would be unlawful for the hospital to force vaccination and that the shots were experimental and dangerous. “When you’re dealing in Covid units, it’s very exhausting. All the PPE you have to put on, you can’t breathe. You’re sweating all day,” Bridges says. “I did it for over a year, and I would do it again if they’d let me.”
That said, she wasn’t willing to take the vaccine because she doesn’t believe it’s safe, despite the evidence that regulators and companies have put out showing that it is. A federal judge dismissed the suit, and Houston Methodist lost 153 employees who either resigned or were terminated. “I’m really, really glad we did it,” Boom says of the mandate, particularly now that the hospital is facing another surge. About 838 Covid patients were in his hospital system as of Aug. 24, a number that’s on the rise, breaking records set in previous surges.
Other hospitals have looked at Houston Methodist’s mandate and decided to follow suit even when they’ve had a bigger vaccination gap to overcome. In June, Sanford Health executives were concerned to see that immunization rates among its almost 48,000 employees had stalled at around 50%. So in late July, Sanford announced a vaccine mandate for its 46 medical centers and other facilities across the Upper Midwest. Vaccination levels have since risen to about 70%, which CEO Bill Gassen attributes to the mandate, educational initiatives, and the rapid spread of the delta variant. By Gassen’s estimate, another factor working in Sanford’s favor is that its facilities are located in rural areas, where there aren’t many other employment opportunities. He foresees no more than 1% of his employees leaving over a vaccine mandate.
Many nurses do have opportunities—lucrative ones—if they want to change jobs. Contract and traveling nurses have helped fill gaps and are often well paid for doing so. At Aya Healthcare Inc., a nurse staffing agency, April Hansen, the group president of workforce solutions, has an ICU position advertising pay of about $5,000 for three shifts a week. Other positions are offering more than $10,000 in pay for 60 hours of work a week. The company has more than 43,000 listings for nurses right now, up from almost 13,000 a year ago and 7,300 in August 2019. “There are not enough nurses to go around. That is clear,” Hansen says. “Even with replacements and backfills and travels, there are still not enough.”
Shortages lower morale in nursing units. Some nurses end up leaving hospital jobs for travel nursing gigs, and the ones left behind know that the travel ones filling in can be making as much as four times what they’re getting. “There could be a little animosity there,” ANA President Ernest Grant says. After a year and a half of treating Covid patients, burnout is high. Almost 30% of front-line health-care workers have considered leaving their profession as a result of the pandemic, according to a survey conducted before the most recent Covid surge.
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