Addressing Vaccine Hesitancy Among Staff and Patients
Healthcare workers were hailed as heroes in 2020 during the early months of the pandemic. They were shown in memes in superhero costumes. People delivered pizzas to hospitals. Strangers praised healthcare workers and thanked them for their service — much as they would a person in military uniform.
That changed in 2021 after the COVID-19 vaccines became widely available. Unvaccinated COVID-19 patients continued to flood emergency departments and fill hospital beds, and people objecting to vaccine and mask mandates held protests, sometimes even in front of hospital doors.
“Now, it seems people have forgotten that [healthcare workers] are still putting their lives on the line every single day,” says Kathleen Moreo, RN-BC, BSN, BHSA, CCM, CDMS, founder of PRIME Education, LLC, in Fort Lauderdale, FL. “Now, you have polarization of what this disease has done to us as a society. Regardless of where your thought process is or whether you believe in vaccines, look at the folks coming into the hospital, and realize that every day they come into work they are facing an ethical dilemma. Every single day.”
This is a new phenomenon and extremely challenging for case managers and other healthcare professionals.
In other national crises when lives were at stake, including the 9/11 terrorist attacks and World War II, the nation pulled together and largely embraced restrictions and calls to action. In the case of the COVID-19 pandemic, with the death toll heading toward 1 million Americans, many are placing their individual beliefs or desires ahead of public health and the national welfare. Healthcare professionals are caught in the middle of the fight over vaccines and masking mandates.
“You have people who are sophisticated individuals who still will not get vaccinated,” Moreo laments.
At the same time, health system leaders have to navigate between confusing federal and state instructions. Some states prohibit them from mandating vaccination, while the federal government requires it for all organizations that receive federal funding, such as Medicare and Medicaid. This leaves case management directors and other health system leaders with too little direction and help in preventing the spread of the highly contagious COVID-19 omicron variant.
“If everyone were vaccinated, health systems would be in a way better place right now,” says Stephen Colodny, MD, FIDSA, FACP, chief of infection control and prevention at St. Clair Hospital in Pittsburgh. “The incidence of hospitalization after vaccination is much lower than incidence of hospitalization among unvaccinated patients.”
Vaccines prevent serious infection, but masking and social distancing prevent people from coming into contact with the virus, Colodny says.
Staff members who have not been vaccinated complicate work schedules and infection prevention for leaders. For example, if a case management leader’s employee has not taken the vaccine, this employee could be out of work for days or weeks if he or she is exposed to the virus.
“If we lived in an ideal world where everyone listened to infectious disease physicians, then every employee would be vaccinated and get their booster,” Colodny says. “Incidences of exposures and infections among staff would be much less and put much less pressure on staffing levels.”
Because of misinformation about the COVID-19 vaccines and the cultural and political fight over vaccine mandates, incentives and educational sessions are not as effective at convincing vaccine-hesitant people to take the shot.
“The only things that have been successful are mandates,” Colodny says. “I’m interested to see if omicron has a different effect because fear seems to be a better motivator than information.”
When hospital healthcare workers deal with patients and co-workers who refuse vaccination, they have a moral and ethical responsibility to provide safe care to patients. But when they are at the bedside, how do they feel about it?
“There’s a dichotomy of thought process that hangs over our heads every day we go into work,” Moreo says. “We’re a mess right now, and it’s not anything we could have anticipated.” Case managers and healthcare leaders should suspend their judgment when dealing with unvaccinated patients and staff, she adds.
Be careful to not present vaccination as a right and wrong belief because many people who are vaccine hesitant have received inaccurate information from their leaders, politicians, and the media, as it often misinterprets research. This makes people very skeptical.1
“Everyone is quoting the science, and it’s appalling to me that you have media interpreting science,” Moreo says.
From a case management perspective, all they can do is educate patients and families. “We’re at a crossroads where we have a greater responsibility than ever before to educate patients appropriately, and it’s inevitable that we’ll hit ethical dilemmas in doing this,” Moreo says.
Case management leaders should look to their own biases about vaccination. It is natural to feel resentful toward patients who are in the hospital with an illness that vaccination could have prevented. This influx of patients is exhausting hospital staff and has resulted in some case managers having to work in COVID-19 units.
“It’s a tough time, and many case managers are being pulled from their jobs and being put on the floor, so you can imagine the resentment they’re experiencing,” Moreo says.
The entire situation is unfair to staff and managers. They have little control over decisions about mandates and workflow changes. Manage resentment and biases and treat co-workers and patients with patience and empathy — even when people have made poor decisions that helped contribute to the crisis hitting hospitals.
“It’s a really unfair situation. I feel so sorry for our middle management people because they really don’t have the support they need,” Moreo says. “They’re on an island, making decisions on their own.”
Managers can provide unvaccinated staff with information, but it is likely persuasion will not work because vaccine hesitancy has become a cultural issue. There is considerable mistrust among those who refuse vaccination for COVID-19.
“Anytime you have a negotiation, the best place to start is from a position of neutrality,” Moreo says. “Say, ‘Help me understand where you are in your thought process. What are the top three things that concern you about vaccination?’”
Another tactic is to hold a staff meeting or a lunch-and-learn where people can discuss their reasons for taking the vaccine or their reasons for not doing so.
“It’s important to verbalize what your thoughts are and encourage the team to do the same,” Moreo says. “This is way beyond understanding this is a disease, or pandemic, or public health; people’s biases are very intertwined in this process.”
As omicron spreads and scientists learn more about its effect on both vaccinated and unvaccinated people, public health officials will offer more suggestions on how to prevent infection and reduce risk of serious illness.
“We’ll know more in six months than we know now,” Moreo says. “Even if you can’t offer solutions, you can offer a sounding board to your staff because it’s important for them to know that other people are struggling with this.”
REFERENCE
- Moreo K. Addressing vaccine hesitancy with an open mind and ethical approach. Prof Case Manag 2022;27:33-35.
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