Eduardo Munoz / AP
Hospitals and nursing homes in the United States prepare for worsening staff shortages as state deadlines for health workers to be vaccinated against COVID-19 hit.
With ultimatums going into effect this week in states like New York, California, Rhode Island, and Connecticut, fears exist that some employees may quit or be fired or suspended instead of receiving the vaccine.
“We don’t know how this will play out. We are concerned about how it will exacerbate an already fairly serious staffing problem,” said Jan Emerson-Shea, spokesman for the California Hospital Association, adding that the organization is “absolutely” required to be vaccinated of the country.
New York health care workers had until the end of the day on Monday to receive at least one dose, but some hospitals had already begun to suspend or otherwise take action against them.
Erie County Medical Center Corp. in Buffalo said about 5% of the hospital workforce was given unpaid leave for not being vaccinated, along with 20% of the staff in his nursing home. And the state’s largest health care provider, Northwell Health, said it had started removing unvaccinated workers from its system despite its workforce being nearly 100% vaccinated.
“To those who have not yet made this decision, please do the right thing,” said New York Governor Kathy Hochul.
Some New York hospitals put in place contingency plans that included cutting down non-critical services and limiting nursing home admissions. The governor also made plans to call for help from members of the National Guard with medical training, retirees, or vaccinated workers from outside the state.
About a dozen states have vaccination assignments for health workers in hospitals, long-term care facilities, or both. Some allow exceptions for medical or religious reasons, but these employees often need to undergo regular COVID-19 tests.
Countries that have set such requirements usually already have high vaccination rates. The highest rates are concentrated in the northeast, the lowest in the south and the Midwest.
The Biden government will also require that the roughly 17 million health care workers who receive Medicare or Federal Medicaid be fully vaccinated, under a rule that is still under development.
This has worried some hospital officials, especially in rural communities where vaccination rates tend to be lower.
“We are considering the need to reallocate staff, in some cases just to maintain essential services, and there will be some delays in care,” said Troy Bruntz, president and CEO of Community Hospital in McCook, Nebraska.
He said 25 of the hospital’s 330 employees would definitely quit if they needed to be vaccinated. The rest of the roughly 100 unvaccinated employees – a group that includes nurses and cleaning and maintenance staff – have not yet made up their minds.
He also fears that it will be difficult to recruit new workers when the hospital is already in short supply.
“We’re not overly confident that this won’t be a nightmare for American healthcare,” he said.
Many hospitals and nursing homes are already suffering from a staff shortage because many nurses and others have quit because of a pandemic burnout or have traveled from state to state for lucrative jobs.
White House press secretary Jen Psaki noted that Houston and Maine hospitals recently lost relatively small numbers of staff after requiring staff to be vaccinated.
“We see in many places that this works, it is effective. It creates more security and protection in your employees,” said Psaki.
In California, where health care workers have until Thursday to fully vaccinate, some hospitals are awaiting layoffs, suspensions or relocations, Emerson-Shea said. She said many traveling nurses have turned down assignments in California because of the state’s vaccine requirement.
But with a statewide mandate, health workers can’t just quit their jobs and go to other hospitals, said Dr. Jeff Smith, CEO and Executive Vice President of Hospital Operations at Cedars-Sinai Medical Center in Los Angeles.
He assumes that around 97 percent of the nearly 17,000 Cedars-Sinai employees affected by the vaccination order will meet the deadline. Another percent applied for medical or religious exemptions. Those who fail to comply by Friday will be suspended for a week and released on October 8 if they fail to comply or there are no extenuating circumstances, he said.
The hospital has also hired over 100 nurses last month and has some travel nurses on duty.
“We’re in a good place, but we don’t want to minimize the challenges other hospitals are likely to face,” said Smith.
In Rhode Island, where the vaccination mandate goes into effect Friday, hospitals can allow unvaccinated employees to work 30 days past the deadline if their discharge would jeopardize patient safety. The mandate is being challenged in court because it does not allow any religious exceptions.
In states that do not have mandates, some hospitals impose their own.
Ginger Robertson, a registered nurse who works in a psychiatric clinic at a hospital in Bismarck, North Dakota, has applied for a religious immunization waiver at her hospital. She said she would find other work if she didn’t get it.
“Honestly, I really love my job. I’m good at it. I enjoy my patients. I enjoy being where I am,” she said. “So this is a really difficult place to choose between two things that I don’t want to do. I don’t want to go and I don’t want to get a vaccine.”
She said other nurses are also considering giving up what she called the “offensive” mandate.
“We feel demoralized, as if we aren’t intelligent enough to make these decisions ourselves,” said Robertson.
A North Carolina-based hospital system announced Monday that more than 175 of its 35,000+ employees have been laid off for non-compliance with the COVID-19 vaccination requirement.
Last week, Novant Health announced that 375 employees had been suspended and given five days to do so. Nearly 200 of them – including those who filed approved exemptions – did so before the Friday deadline, spokeswoman Megan Rivers said.
The Massachusetts mandate given by Republican Governor Charlie Baker applies only to nursing homes, assisted living facilities, hospice programs, and home care programs. It allows medical and religious exemptions, but does not require regular testing. The deadline for entries is October 31.
In Connecticut, a vaccination mandate for government hospitals went into effect on Monday. It does not apply to privately run hospitals, some of which have their own requirements. Medical and religious exceptions are possible, but anyone else who does not get vaccinated will be banned from work.
About 84% of New York’s 450,000+ hospital workers were fully vaccinated on Wednesday, according to state data. Data from nursing homes through Sunday showed that about 89% of nursing home workers were fully vaccinated.
The New York City hospital system reported a 95% vaccination rate for nurses and a higher rate for doctors.
In Missouri, which became a serious COVID-19 hotspot this summer, the Mercy Hospital System is demanding vaccinations from staff at its hundreds of medical centers and clinics in Missouri and neighboring states by Thursday.
Anyone who does not comply by then will be placed on a 30-day unpaid ban, Mercy spokeswoman Bethany Pope said.