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No Vaccine Mandate May Help Some Facilities Recruit Staff, But at What Cost?


It’s no secret that many nurses and healthcare providers are weary of taking the COVID-19 vaccine for a variety of reasons. For better or worse, some people just aren’t willing to get their shots.

Now that the FDA has fully approved the Pfizer vaccine, many hospitals and companies are moving towards mandating the shot for all employees. To avoid getting vaccinated, nurses are now gravitating towards positions at understaffed hospitals where the shots remain optional.

The Staffing Wars Heat Up

The delta variant is pushing many hospitals and health networks to the breaking point. Recent data from the U.S. Department of Health and Human Services show that at least a few hospitals in almost every state are dealing with critical staffing shortages, particularly those in the west and south. To compete for staff in crucial hotspots, some hospitals say they are benefiting from their decision not to mandate the shot.

Scotland County Hospital, in hard-hit rural Missouri, says it has been so low on staff it had to turn away patients during the most recent surge of COVID-19.

CEO Dr. Randy Tobler says they’ve had to turn to travel nurses to fill in the gaps, which can cost as much as $200 an hour, a price his facility can no longer afford.

Even as the number of cases in the community continues to rise, Tobler says a vaccine mandate is out of the question – although just over 60% of his staff has been vaccinated.

“If that becomes our differential advantage, we probably won’t have one until we’re forced to have one,” Tobler said. “Maybe that’s the thing that will keep nurses here.”

Other hospitals are doing the same. A recent job posting in Nebraska for the state’s veteran affairs center prominently displays the fact that being vaccinated is not a requirement.

The Decision to Mandate

Colin Milligan, a spokesman for the American Hospital Association, says so far, 39% of U.S. hospitals have announced plans to mandate the shot. However, facilities are thinking about more than just staff and patient safety when weighing the decision to issue a mandate. Urban hospitals usually have the budgets to enforce a mandate. It may even be used as a selling point to attract fully vaccinated staff.

However, rural hospitals face a different dilemma.  

Alan Morgan, head of the National Rural Health Association, says, “Obviously, it’s going to be a real challenge for these small, rural hospitals to mandate a vaccine when they’re already facing such significant workforce shortages.”

Experts say this could lead to a perfect storm: Areas with the highest number of COVID-19 cases may also have the highest concentrations of unvaccinated healthcare workers. This could leave facilities especially vulnerable to future waves of the virus.

Issuing a mandate may drive away healthcare workers in rural areas in the short-term, but it could also help them prepare for surges in the future.

Jacy Warrell, executive director of the Rural Health Association of Tennessee, says the decision often comes down to the issue of labor in vaccine-hesitant communities.

“They’re going to have to think twice about it,” Warrell said. “They’re going to have to weigh the risk and benefit there.”

The debate is playing out differently across the country.

The federal government says all nursing homes must mandate the shot or risk losing Medicaid and Medicare funding. Experts worry this may drive vaccine-hesitant workers away from the elderly long-term care industries.

Meanwhile, the state of Montana has banned all vaccine mandates. Katy Peterson, a spokesperson for the Montana Hospital Association, says at least one facility has received calls from interested workers because of the ban on mandates.

California recently mandated that all healthcare workers get their shots by the end of September. But, as CalMatters reports, travel nurses are already starting to decline assignments to avoid getting vaccinated.

Tobler of Scotland County Hospital says his wife is currently training to become a volunteer medical assistant to help fill in the gaps until they can find more staff. He’s waiting to see if some of the state’s larger facilities, such as those in St. Louis, will lose staff when their vaccine mandates go into effect later this year.

Steve Edwards, CEO of CoxHealth headquartered in Springfield, MO, says his company recently upped its minimum wage to $15.25 an hour for support staff, including cafeteria workers, janitors, assistants, and nursing aids. It’s an incentive to retain existing workers before the vaccine mandate goes into effect on Oct. 15th. Edwards says the pay increase will cost $25 million a year, but it’s worth it if it prevents essential staff from calling out sick.

Two of his employees have already died from COVID-19. In July, Edwards says around 500 staff members were out sick primarily due to the virus.

“You may have the finest neurosurgeon, but if you don’t have a registration person, everything stops,” he said. “We’re all interdependent on each other.”

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