How CEOs are balancing staffing shortages and vaccination mandates

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As many hospitals in the U.S. grapple with staffing shortages exacerbated by the COVID-19 pandemic, they are also preparing for potentially losing employees over vaccination mandates.

Many organizations and states have mandated vaccines for healthcare workers. The federal government is also requiring mandates at more than 17 million healthcare workers at Medicare- and Medicaid-participating hospitals and other healthcare settings. CMS said it is developing a mandate-related interim final rule with a comment period that will be issued in October.

Meanwhile, unvaccinated workers have been fired for noncompliance, while others have quit. Hospitals, particularly those in rural areas, have expressed concerns that mandates could worsen workforce shortages as employees refuse to get vaccinated. Some hospitals have held off on requiring vaccines because they were concerned they wouldn't have enough staff to care for patients.

This all comes as healthcare staff shortages are projected to reach 3.2 million by 2026.

CEOs told Becker's how they are preparing for the potential loss of workers at a time when a robust workforce is more crucial than ever.  

Protecting employees, recruiting new ones

UCHealth, an Aurora, Colo.-based system with more than 26,000 employees in Colorado, Wyoming and western Nebraska, announced July 28 its requirement that employees be vaccinated by Oct. 1. UCHealth's employees may receive the vaccine of their choice or obtain an exemption for medical or religious reasons. Those who obtain an exemption must be tested weekly. 

Elizabeth Concordia, the system's president and CEO, said her system has focused on creating the safest possible environment for patients and employees, while providing enough time to avoid detrimental staffing shortages.  

UCHealth's strategy was to let employees know as soon as possible about the mandate, effective Oct. 1, giving them time to learn about the vaccine and affect the workforce as minimally as possible, Ms. Concordia told Becker's.

"We need to protect the already strained workforce we have, and we can't afford to have any more folks out because they're not vaccinated. We really spent a lot of time trying to educate, meeting individuals in their specific departments, addressing any specific issue, language barriers, to make sure we would have minimal impact on our workforce," she said.

As of Sept. 20, about 95 percent of system employees had been vaccinated, and since UCHealth allows medical or religious exemptions, the total vaccination policy compliance rate was above 95 percent, she said. Still, Ms. Concordia estimated a couple hundred employees will leave the system because of the mandate. She said UCHealth has prepared for this by examining specific departments where people have not been vaccinated and making contingency plans.

Ms. Concordia said it's tough to hire, so UCHealth has been teaching staff news skills.

"We have a large cohort of new grads that come, so we increased the number of new grads we hired, and we've been training them over the last couple months in preparation for various vacancies we will have," Ms. Concordia said.

UCHealth has about 2,000 open positions and a vacancy rate of about 10 percent or 11 percent, compared to a rate that is normally closer to 6 percent, she said. The open positions include nurses, medical assistants and environmental services workers, among others.

UCHealth has hired more than 4,400 employees, including more than 1,100 nurses in the first half of this year, and has about 7 percent more employees than at this time last year, she said. 

Retaining and recruiting employees are both top priorities, said system spokesperson Dan Weaver.

Workforce shortages preceded pandemic

Although health systems across the country are facing staff shortages, they are nothing new.

A 2017 infographic created by Georgetown University School of Nursing & Health Studies, used data from "The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025," to project the supply of nurses in each state. Arizona was projected to have the largest nurse shortage by 2025, with 28,100 fewer registered nurses than necessary. It was estimated that North Carolina and Colorado would need 12,900 nurses each by 2025.

Flo Spyrow, MSN, RN, president and CEO of Flagstaff-based Northern Arizona Healthcare, said recruiting staff while enforcing vaccination mandates at a rural health system like her own has been a challenge. She told Becker's that is one of the reasons her system took a little longer than some other organizations to mandate vaccinations.

"Being a rural healthcare system, fairly isolated in Northern Arizona, the recruitment of our staff — and quite frankly retention of some of our younger staff— has always been a challenge for us, so we were very thoughtful in regard to making this decision to require vaccinations," she said.

Northern Arizona staff have until Dec. 31 to be fully vaccinated. As of Sept. 27, about 20 percent of its 3,500-member workforce was not.

Ms. Spyrow said the system has strategies to help unvaccinated workers feel comfortable complying. They include a $10,000 lottery for vaccinated workers, staff meetings related to vaccination and a video to educate staff.

She said while some health systems "lose 1 to 2 percent of staff. We hope to lose less than 1 percent."

"From a numbers perspective, you might say that's not very many, but it's still that 1 to 2 percent, and those critical workers are not easily lost or easily replaced for us because they're part of our NAH family and we want to keep every one of them," said Ms. Spyrow. 

But the system is preparing for the possibility of losing workers by trying to recruit to open positions and making a bigger push for traveling workers.

"Arizona is providing some surge nurses, and we're expecting to get 80 of those in the next 30 days," Ms. Spyrow said. "They will stay for eight weeks, but we'll be trying to recruit some of them to stay longer. And we're looking at how we might rearrange patient care areas."

Even with the possibility of losing workers, Ms. Spyrow said she believes requiring COVID-19 vaccinations is the right decision given recent COVID-19 surges and the number of employees catching the virus in the community. That's because when employees are infected, it means workers having to take off weeks at a time, leaving staffing gaps to fill.

"This is really a difficult decision, and we received negative comments from community members and staff and saw some withdrawing their support from NAH in public," said Ms. Spyrow. "But it is the right decision to make. I would support any other CEO who was making this decision or thinking about making this decision because we are all about caring for patients and improving health. … This is the best way for us to be able to combat [the virus] within our communities and within our healthcare system."

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