In 2020 the world plummeted into COVID-19, one of the deadliest pandemics in U.S. history. Scores of people fell critically ill and died in hospitals, in quarantine and out of reach of their loved ones. Global chaos rolled like a tidal wave over the United States and the world, overwhelming doctors, nurses, and other medical staff. Hospitals overflowed with patients who tested positive for COVID-19. Who would have believed that hospitals in the United States would be forced to ration care?
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) waited until scientists isolated the bug that was causing the illness and named it the Coronavirus. The name comes from the word “crown” (or corona) due to the appearance of spikey proteins sticking out of it. These proteins are what attach to the human cell to infect it. The disease caused by the Coronavirus became known as COVID-19. After studying the virus, the CDC, WHO, and other public health specialists issued recommendations for the world on how to identify and prevent COVID-19 illness. The recommendations, some of which later became mandatory, included wearing a mask when out in public, staying six feet apart, washing hands frequently, and not going out except for essentials like groceries and medical care.
After some months, three major drug companies: Pfizer, Moderna, and Johnson & Johnson announced that they had a Coronavirus vaccine available. The public saw this as a light at the end of the tunnel. It seemed that the world breathed a sigh of relief. However, as with any new medicine or treatment, there have been skeptics, including nurses who were hesitant to receive the vaccine.
COVID vaccine hesitancy among nurses worldwide is still an issue, although it has waned just a little since 2020. The refusal rate among nurses was 23.4 percent in 2020 and 18.3 percent in 2021. Many reviews suggest that nurses could have one of the highest hesitancy rates for the vaccine. The major reasons for refusal are concerns about the vaccine’s safety, effectiveness, and side effects. There is also mistrust in the government and drug companies as well as the belief that COVID-19 is only a mild illness or does not exist at all.
In response to the hesitation of nurses and other healthcare professionals to receive the vaccine, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule in November 2021 requiring vaccines for healthcare workers in facilities funded by CMS. CMS was aware that there would be nurses and other healthcare professionals that would leave their positions rather than be forced to become vaccinated. However, both the Medicare and Medicaid programs are administered by the Secretary of Health and Human Services, who has the authority to declare law “as may be necessary to the efficient administration of the functions with which he is charged.” In other words, CMS has the right to mandate the vaccine in facilities that it funds. Nurses went to the media to let their feelings about the mandate be known. This created public debate.
Shortly after the November 2021 CMS interim final rule, two groups of states (one led by Louisiana and one led by Missouri) filed a suit against the Biden Administration challenging the rule. The United States District Courts for the Western District of Louisiana and the Eastern District of Missouri entered a preliminary injunction against the rule. In each case, the government moved for a stay of the injunction from the relevant Court of Appeals. In both cases, this was denied.
Finally in January 2022, the United States Supreme Court upheld the Biden Administration’s authority to issue a vaccine mandate for all workers in healthcare facilities that are funded by Medicare and Medicaid.
Groups representing nurses were in favor of the vaccine mandate. For example, a spokesperson for National Nurses United (NNU) said in a press release that the NNU was happy with the decision of the United States Supreme Court in January 2022 to uphold the Biden Administration’s authority to issue a vaccine mandate for healthcare workers.
The American Nurses Association (ANA) also supported the vaccine mandate. Its decision to support the vaccine for nurses is due to its position on all immunizations, which is that they provide protection for the nurse and the public. The ANA also supported the vaccine mandate because it wants to be an example of what it is asking its patients to do.
The ANA represents roughly 4.2 million nurses nationally. According to the ANA, most nurses supported receiving the COVID vaccine. However, despite the ANA’s support of the vaccine mandate, some nurses remain hesitant. The ANA took a poll in late 2021 which showed that 88 percent of the nurses surveyed were vaccinated or were going to be, but only 81 percent said they were comfortable getting the vaccine, and only 59 percent said they supported the vaccine mandate. Two-thirds (66 percent) said that Food and Drug Administration (FDA) approval of the vaccines would not change their minds, 58 percent were not clear on the vaccine’s immunity and effectiveness, and 84 percent of those not vaccinated declined because they didn’t have enough information. Some nurses are pursuing religious or medical exemptions to avoid the vaccine mandate.
Amidst the vaccine controversy, most hospitals and nursing homes worried about staff, including nurses, leaving their jobs instead of becoming vaccinated. Most facilities around the country prepared for nurses leaving as a group and overtaxing an already strained system. Some turned to travel nursing, using the provision of federal emergency funding provided to hospitals to help them with staffing during the pandemic.
There has been a nursing shortage globally for a long time. For example, recent data from the Kaiser Family Foundation indicated that among 14,156 nursing home facilities in the United States surveyed, 28 percent reported staffing shortages and 24 percent specifically reported nursing shortages. Therefore, it’s difficult to ascertain exactly how much the vaccine mandate has affected the nursing shortage. At least one hospital had to pause maternity services after dozens of staffers quit rather than get the COVID-19 vaccine. Nurses and other staff are also quitting their jobs due to burnout, COVID-19 safety concerns, and other reasons.
However, according to John Brownstein, an Epidemiologist and Professor at Harvard Medical School, “while overall the number of health care workers being terminated or suspended [for refusing to get vaccinated] is not huge, at the same time we cannot afford to lose anybody at this point.”
Vaccine mandates have proven over time that they work, as evidenced by requirements that school-aged children be vaccinated for certain diseases prior to enrolling in school. Many nurses stepped up and received the COVID vaccine, but there are still many who did not get the vaccine for reasons that only they know. There is really no specific way to determine the exact number of nurses who left the profession due to the COVID-19 vaccine mandate. Ultimately medical facilities will need to determine the reasons for this staff refusal and offer evidence-based strategies, truthful information, and incentives to get nurses vaccinated. For the most part, the COVID vaccine mandate is working as time goes on. The longer the vaccine is out and is gaining a track record, the more people will get vaccinated.
