Vaccine mandates have hospitals concerned about staffing

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Amid President Joe Biden's plan to vaccinate healthcare workers against COVID-19, hospitals are expressing concerns about potential unintended consequences of the mandates, such as exacerbating workforce shortages.

President Biden revealed Sept. 9 his administration's six-pronged approach to curb the pandemic, including requiring all employers with 100 or more employees to ensure their staff are fully vaccinated or undergo weekly COVID-19 testing. Federal officials said the Department of Labor's Occupational Safety and Health Administration will issue an emergency temporary standard to implement the requirement, affecting more than 80 million workers in private sector businesses. 

President Biden's plan also requires that federal executive branch workers, as well as employees of contractors that do business with the federal government, be vaccinated, with limited medical and religious exemptions. 

Additionally, CMS will require COVID-19 vaccinations for more than 17 million healthcare workers at Medicare- and Medicaid-participating hospitals and other healthcare settings. The requirement applies to hospitals, dialysis facilities, ambulatory surgical settings and home health agencies, the White House said. It expands on the CMS announcement Aug. 18 that nursing homes must have staff vaccinated against COVID-19 as a condition for receiving federal funds.

After President Biden revealed his pandemic plan, American Hospital Association President and CEO Rick Pollack issued a statement, reiterating support of hospitals implementing vaccine mandates but expressing concerns about what the federal approach could mean for facilities already grappling with staffing strain.

"As a practical matter, this policy may result in exacerbating the severe workforce shortage problems that currently exist," said Mr. Pollack. "Consequently, given the critical challenges that we are facing in maintaining the resiliency of our workforce, and dealing with severe shortages, which the American Nurses Association has called a national crisis, we call on the administration to work with us as partners in developing aggressive and creative strategies to address this matter to ensure that hospitals and health systems on the front lines of fighting the battle against COVID-19 have the necessary human resources to both win this battle and maintain essential health services for the patients and communities we serve."

John Henderson, executive director of the Texas Organization for Rural and Community Hospitals, told the Texas Tribune Sept. 10 that some hospital administrators in Texas, where public hospitals have been banned from enacting mandates under Gov. Greg Abbott's executive order, were concerned the federal mandates would cause more staff to retire if they didn't want to get inoculated and were already considering a departure, while others were happy about the move.

"I won't say it's been universally applauded or condemned [among the rural hospitals]. Initially it was, 'We're conservative, independent rural Texans that generally don't like to be told what to do,'" Mr. Henderson told the publication. "This morning I started getting more positive reaction. … Most private hospitals in Texas were already requiring it of their staff. You don't want a different standard of public vs. private, and when everybody is in it together and has to jump together, it helps with the nurse staffing musical chairs that we were in some ways expecting."

Some healthcare organizations have already seen staff resign because of vaccine mandates, including Lowville, N.Y.-based Lewis County Health System, which announced in September that it will temporarily close its maternity unit after 30 people resigned because of New York's vaccine mandate. The state's mandate requires healthcare workers at hospitals and nursing homes to receive their first vaccine dose by Sept. 27.

In Texas, at Houston Methodist, 153 employees either resigned during a two-week suspension period or were terminated June 22 for noncompliance with the system's mandate.

While some larger systems may be able to handle a loss of employees, rural hospitals can be substantially affected by such an exodus, Alan Morgan, CEO of the National Rural Health Association, told USA Today.

He told the newspaper: "Right off the back, vaccines are safe and effective and it's imperative that all rural health care workforce providers and staff need to be vaccinated. But we also know that there are higher rates of hospital workers that are unvaccinated and have no intention of getting vaccinated in the rural context. … This is a significant concern."

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