While the proportion of vaccinated health care workers varies widely from facility to facility, surveys suggest that significant numbers of direct-care workers—including nurses—remain unvaccinated. According to an analysis by WebMD and Medscape Medical News, about 25% of direct-care hospital workers had not received even a single COVID-19 vaccination by June 1. The Centers for Medicare and Medicaid Services reports that 38% of nursing home staff were not fully vaccinated as of July 11. And a survey of over 4,900 nurses conducted by the vaccine education campaign COVID-19 Facts for Nurses found that 11% of nurses were not vaccinated as of early May.
COVID-19 infections in the United States quadrupled in July to more than 54,000 new cases per day as the Delta variant surged through unvaccinated populations. The jump in infections combined with a faltering national vaccination effort led many health care organizations to begin initiating mandatory vaccination policies for their workers.
Houston Methodist health system was ahead of the pack, achieving a 97% compliance rate after rolling out a vaccination requirement for all employees last March. By July, hundreds of other U.S. health care organizations were following suit, including major medical centers such as the Mayo Clinic, University of Chicago Medicine, and St. Jude Children's Research Hospital, as well as large hospital chains such as Trinity Health, Mercy, and, notably, the U.S. Department of Veterans Affairs.
Some of these mandatory policies carve out exemptions for medical or religious reasons, pregnancy, or staff who had already been infected with COVID-19. The Mayo Clinic instituted a formal refusal process that includes mandatory education modules and mandatory mask wearing for staff who decline to be vaccinated.
States and municipalities are also taking action. California now requires that all health care workers either be fully vaccinated or be tested weekly for COVID-19. New York State issued a similar “get vaccinated or get tested” mandate for all frontline health care workers at state-run hospitals as did New York City for its 42,000 workers in city-run hospitals and health clinics.
At least one federal court has upheld mandatory vaccination, after some staff members sued Houston Methodist to overturn its policy. “Employer mandates are being upheld and even recommended by public health experts,” says Edie Brous, a nurse attorney and contributing editor of AJN. “Hospitals must also deal with a growing number of patients who don't want to be cared for by unvaccinated nurses.”
The American Hospital Association put its muscle behind the trend, saying in a July 21 statement that it “supports hospitals and health systems that adopt mandatory COVID-19 vaccination policies for health care personnel,” taking into account “local factors and circumstances” during implementation. Major nursing, medical, public health, and pharmacy organizations agreed. By the end of July, more than 88 had signed a joint statement, published in the Annals of Internal Medicine, supporting mandatory COVID-19 vaccination for “all workers in health and long-term care.” Nursing signatories include the American Nurses Association, the National Council of State Boards of Nursing, the National League for Nursing, the American Academy of Nursing, and several nursing specialty groups.
Labor unions are less united on the issue of mandatory vaccination. The AFL-CIO supports vaccination mandates. National Nurses United has stopped short of endorsing them, instead saying all eligible people should be vaccinated, with medical and religious exemptions respected.
Recent projections have the current surge in COVID-19 infections peaking in mid-October, just as the season for influenza and other respiratory pathogens gets underway. Could mandatory vaccination of nurses and other health care workers flatten that curve?—Betsy Todd, MPH, RN