Charlaine was skeptical of the vaccines at first. She wondered how they were created so quickly, and she was wary of the long history of medical experimentation and disregard for Black people like her in the United States.
But then Charlaine, a nurse in a neonatal intensive care unit, thought about the disparate health outcomes for people of color in the pandemic – and knew that she might not receive the same level of care as others if she got sick.
She did her research and determined that the mRNA vaccines, which became available to health workers late last year, are safe and effective. Charlaine, who asked to use only her first name to protect her job, got her vaccine in January. “Here we have this virus that is killing, maiming, debilitating people, and I knew that if I was in a position of being sick, I would be treated differently and probably not survive. So that was one layer of protection that I wanted to give myself,” she said.
A year and a half into the pandemic, healthcare workers are exhausted, burned out and worried that the worst is far from over. Amid that stress, much attention has been focused on nurses who haven’t received the vaccine, even though the majority of these essential workers have been inoculated. That has left many nurses feeling betrayed, both by their unvaccinated patients and by public perception.
“It’s a major source of frustration for nurses right now that people aren’t getting vaccinated,” said Anna Maria Valdez, a professor of nursing at Sonoma State University. “It’s like we have a big fire, but we also have big hoses to put it out – but people aren’t using them; they’re standing there, watching the fire burn.”
But Laura Denstman, a nurse in Maryland, also worries that the amplification of fringe views makes it seem like health workers don’t trust the vaccines – which is far from the truth, she said.
“One report of a nurse refusing to be vaccinated and all of a sudden it’s ‘a majority’ of nurses,” she said. “And sure, that scares the public.”
Charlaine wishes more news stories would focus on the millions of health workers who have been vaccinated and have “saved lives by not infecting others,” she said.
It can be startling to read reports of disparate vaccination rates among health workers. In the south or the borough of Staten Island in New York City, for example, there are pockets of health workers who are strongly opposed to vaccination. Vaccine hesitancy tends to be more common among the staff of long-term care facilities, where only 60% of staff is vaccinated. A CDC report in July found the lowest vaccination rate of health workers was among aides, including certified nursing assistants, nurse aides and medication aides and assistants, at 45.6% – but that figure was as of March, and it’s likely that rate has risen since. (Nursing aides or assistants usually undergo a four- to 12-week training course, while registered nurses receive two- or four-year degrees and must pass a licensing test.)
In contrast, 88% of nurses and 96% of physicians in the US have already gotten vaccinated or plan to do so, according to surveys by the American Nurses Association and the American Medical Association.
Those with hesitations often said they were waiting for full approval from the Food and Drug Administration, or they weren’t sure about side-effects during pregnancy and breastfeeding, Valdez said.
Recently, health and regulatory agencies have helped raise public confidence. The FDA granted full approval to the Pfizer/BioNTech vaccine on 23 August, with plans to address the Moderna and Johnson & Johnson applications next. On 11 August, the Centers for Disease Control and Prevention urged pregnant and breastfeeding people to get vaccinated, joining leading health associations like the American College of Obstetricians and Gynecologists, which have long recommended the vaccines.
And more workplaces, particularly health systems, are mandating vaccines. The strictest mandates require vaccinations unless there are documented medical reasons, while others require frequent testing if employees forgo vaccination.
Many hospital systems were waiting for full FDA approval before mandating vaccines, which about 1,500 have now done. In August, the Biden administration announced that care facilities would no longer receive Medicare and Medicaid payments if the staff is unvaccinated.
“I think the numbers will only go up even more, across the whole healthcare spectrum,” Grant said, including nurses, physicians, respiratory therapists, cleaning staff, food service workers, lab workers and others.
The mandates may push those who oppose the vaccines out of the healthcare field entirely, a field where there is already a shortage of qualified, experienced workers. Amanda, a certified medical assistant in Delaware, works in an urgent care facility where she regularly sees Covid-positive patients. A blood test earlier this year revealed she already had antibodies to the virus, but she doesn’t recall having any symptoms.
Now, Amanda is battling a second case of Covid. Although she has heard the vaccines don’t contain the virus itself, she believes her first dose gave her Covid-19, she wrote over Facebook Messenger because she was too sick to talk on the phone. She is not willing to get the second dose, even though her employer has mandated it, and even though she loves the work.
“Most medical facilities will want their employees vaccinated, so [it] looks like I’ll be working at Walmart again,” she said.
Not all health workers are based in a hospital or care for seriously ill Covid patients, which may lead them to believe the pandemic is less serious than it is. “They haven’t really seen first-hand what we’re dealing with,” Denstman said. “The healthcare workers outside the hospital speaking against vaccine mandates are kind of misleading and scaring people.”
Denstman says that getting vaccinated is never a personal choice when it comes to taking care of others’ lives. “I look at it as a moral responsibility,” she said. “Do I care about my neighbors? My family? All the children? The elderly? It’s just the right thing to do.”
“I work with an immunocompromised patient population. I have to protect them,” Charlaine said. “It’s somebody’s baby – come on now.” She also encourages everyone to wear masks and take other critical measures for preventing the spread of Covid-19, rather than relying on a single layer of protection with the vaccines.
As the pandemic continues, these frustrations are taking a toll on US nurses. Beyond the relentless workload, caring for people who are dying takes a huge emotional toll. And “knowing that there are vaccines out there that can help prevent this” can make the work even more difficult, said Ernest Grant, president of the American Nurses Association.
But health workers’ impact extends beyond their direct care – they’re also trusted messengers in their communities when it comes to offering information on how best to combat the pandemic. So for nurses like Denstman and Charlaine, their job doesn’t end in the medical facility.
“If the perception is that nurses don’t trust the vaccine, then the general public is going to be more inclined to not trust the vaccine,” Valdez said. “And that’s really problematic, because that’s not even accurate.”