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Will Vaccine Mandates Affect the Existing Nursing Shortage?

Diane M. Goodman, BSN, MSN-C, APRN

Disclosures

October 07, 2021

Since the onset of the SARS-CoV-2 pandemic, a shortage of skilled nursing staff has spiraled out of control. To understand how substantially the shortage has affected geographic areas of the United States, maps of both urban and rural areas are required. The shortage is now so severe, it is expected to continue into 2030 as the ability to mentor and educate nurses required for future generations has been diminished.

"Nurses need to be taught by other nurses," as cited by the same source, leading to what has been called an "educator exodus." No other modality is as effective, be it a simulation lab, textbook, or e-learning source. Experience counts at the bedside.

But when COVID hit, elective surgeries and outpatient procedures were canceled or postponed at multiple institutions. To maintain solvency, nurses close to retirement age were called off duty or encouraged to leave their posts if they were not needed for acute care areas, particularly pre-vaccines. Nurses close to retirement age also decided to leave the bedside when the stress of COVID proved overwhelming, forcing non-nursing staff to quickly learn bedside tasks such as turning and proning.

In addition, frontline nurses became exhausted and burned out, unable to work additional hours. A "full 66%" began to reach the breaking point, which caused them to consider leaving the profession altogether.

Add these factors, and now place a vaccine mandate into the mix. Will the vaccine mandate be a tipping point? Could vaccine mandates, meant to assure safety for American citizens across the board, worsen the existing staffing crisis?

Dr Randy Tobler, CEO of Scotland County Hospital in Memphis, Missouri, believes a vaccine mandate might deter his staff. Tobler is concerned about losing more nurses, particularly since he has already lost five nurses to facilities that were prepared to offer large sign-on bonuses that his hospital was not able to match. In the geographic area where Tobler's hospital provides care, the community vaccination rate is ~ 35%, lower than many parts of the country. He believes forcing staff through mandates might cause nurses to leave when the rural area is already stressed.

Dr Tobler may not be the only professional who feels this way. Nearly 1 in 8 nurses has stated that they may choose not to receive a vaccine if one were mandated where they work, according to a recent survey by the American Nurses Association (ANA).

Alan Levine, CEO of Ballad Health, which owns 22 facilities serving patients in Kentucky, North Carolina, Tennessee, and Virginia, decided against a vaccination mandate. An internal audit revealed that Ballad Health could potentially lose many skilled nurses if such a mandate were to be enacted. The cost would simply be too high for their facilities, as approximately 38% of Ballad Health's employees remain unvaccinated.

While it is hard to comprehend why nurses might refuse a vaccine that prevents contagious disease, hospital administrators believe that conspiracy theories might have taken their toll, particularly those related to childbearing females (eg, rumors related to reproductivity).

Nationally, nearly 30% of hospitals have mandated vaccines for reasons similar to those mentioned by Levine and Tobler.

The ANA has determined via survey that generally, nurses do support vaccine mandates. In addition, of the nurses surveyed, 88% were vaccinated. These findings are based on a survey completed July 6-30, 2021, which involved 4912 US nurses. Surprisingly, the nurses who were polled said that FDA approval of vaccines had no bearing on how they viewed vaccination. These findings may also suggest that nurses are less likely to walk away than believed. They may indeed roll up their sleeves if asked to do so by employers.

In New York, time has run out for healthcare workers. Hospitals have the National Guard on standby to fill in for recalcitrant workers who could leave positions or fail to show up rather than be vaccinated. As of this writing, New York Mayor Bill de Blasio told a city news conference that he has not yet seen a major impact from the deadline for New York hospital employees to comply with vaccine mandates.

So, we have to wonder: Will vaccine mandates become as dissimilar as vaccination rates and nursing shortages across the country? Will we need a map with geographic data to determine the impact of vaccine mandates on where we might find "nurses who can teach nurses" for the future?

While it may seem we already know the answer, the whole story has not been determined. Vaccine mandates are still being enacted. The Biden/Harris administration has plans to widen mandates to include facilities that receive Medicare or Medicaid funding, which will begin this month. Additional facilities are in abeyance, waiting to see how the industry responds, or they may be trying to appeal.

But you tell me. What would you do in this circumstance? Would you feel strongly enough to terminate employment?

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About Diane M. Goodman
Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who works from home contributing to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Diane worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!

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