September 28, 2021

Are vaccine mandates actually driving out health care workers? Here's what CEOs say.

Daily Briefing

    Staff shortages are hitting providers across the country, especially in New York, where hospitals and nursing homes fear losing staff to the state's vaccine mandate for health care workers. But many hospital CEOs stand by vaccine mandates, saying it's their ethical duty to protect their patients and workers.

    Biden unveiled a vaccine mandate for nursing homes. What does it mean for the staffing crisis?

    New York prepares for vaccine mandate enforcement

    New York has mandated that all health care workers and support staff, including food service workers and cleaning staff, have until Sept. 27 to get their first shot of a Covid-19 vaccine. Teachers and school staff are also included in the mandate.

    Gov. Kathy Hochul (D) said Thursday there are "no excuses" for refusing to meet the state's mandate. "Every single person who is in your care has the right to know that there is no chance they will be infected by the person in charge of protecting them and their health," she said.

    In anticipation of losing staff due to the mandate, hospitals in the state have started preparing to cut back on non-urgent surgeries, and some nursing homes have started limiting admissions, the Associated Press/NPR reports.

    "We would like to see some more time to be able to comply and implement the vaccine mandate, because at the end of the day it's a situation where we're very concerned about our ability to care for the patients," Tom Quatroche, CEO of the Erie County Medical Center Corporation, said. Erie County Medical anticipates losing about 10% of its workforce.

    And officials at Northwell Health estimate they may have to fire thousands of employees for not getting vaccinated. NewYork-Presbyterian said more than 200 employees face potential termination for the same reason.

    According to state data, about 84% of the 450,000 hospital workers in New York and around 83% of the 145,400 nursing home workers in the state have been vaccinated, meaning tens of thousands of people impacted by the mandate have yet to get vaccinated, the New York Times reports.

    "We give patients a Bill of Rights, and they are able to choose what procedures or tests or medications they want to put in their system," Gregory Serafin, an RN at Erie County Medical and lead plaintiff in a lawsuit aimed at stopping New York's mandate, said. "Health care workers deserve the same medical autonomy to make those decisions."

    New York is also preparing for shortages of teachers and other school workers once the mandate goes into effect. More than 90% of teachers and principals in New York City have received at least one shot of a Covid-19 vaccine, the New York Times reports. But according to Michael Mulgrew, president of New York City's teachers' union, there are still about 6,000 teachers who remain unvaccinated.

    Most CEOs stand by vaccine mandates, refute claims of staff shortages

    Despite staff shortages nationwide, many hospital CEOs and health leaders continue to support vaccine mandates and have pushed back on staffing fears related to the policies.

    Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania and a former White House health policy advisor, pointed to the limited workforce fallout among the providers that have already implemented these mandates. He remarked, "If you look at health care systems that have actually mandated this, they've retained over 99% of their workforce."

    And according to Modern Healthcare, these early numbers suggest the concern of mandates exacerbating staff shortages might be overblown.

    Stephen Jones, president and CEO of Inova Health System, said few employees are leaving due to the mandates. "It'll be disappointing losing a single person," he said. "We'll regret that they're not here. But we have a responsibility to prioritize the safety not only of our patients, but our own team members."

    Inova's vaccine mandate has an Oct. 1 deadline, and according to Jones, only a few dozen employees are expected to leave because of the mandate. "You have to go back to the math," he said. "The clear majority of people in health care had already been vaccinated. They kind of were sending a signal they wanted to work in a place where the people around them were vaccinated."

    Marc Boom, president and CEO of Houston Methodist, said the decision to implement a vaccine mandate was clear. "We have a sacred obligation to care for patients and keep them safe. And frankly, we have an ethical responsibility as an employer to keep our employees safe," he said. "It was absolutely, unequivocally the right thing to do. I'm very proud of our almost 26,000 men and women for everything they've done for this pandemic, for stepping forward and doing the right thing."

    Boom rejected the argument that bodily autonomy was the most important consideration in vaccine mandates. "My autonomy to throw my fist ends when it hits your face," he said. "My autonomy as an individual is essentially overwritten by those other ethical principles if my autonomous decision to not get vaccinated as a health care worker results in the irreversible harm to somebody I'm caring for."

    Houston Methodist ultimately received around 150 resignations because of the mandate, representing 0.06% of its staff, Modern Healthcare reports.

    Patrick Cawley, CEO of the Medical University of South Carolina (MUSC), also said a vaccine mandate was the obvious choice for his health system. "I myself never fully believed [vaccine mandates] would be a problem, for two reasons," Cawley said. The first reason was safety. He said, "I just had a hard time believing that somebody would leave our organization because we were doing something that was more safe." The second reason was that his organization had "pretty good employee engagement scores."

    Ultimately, MUSC lost just four employees—0.0002% of its staff—as a result of the mandate, Cawley said.

    An example worth setting

    In addition, some leaders believe vaccine mandates will provide long-term staffing advantages. According to Jones, Inova's vaccine mandate could help with hiring and recruitment. "We're worried about it being a staffing challenge, maybe, in the short term. I think that it's actually going to be an advantage for us, that people will want to work around others who are vaccinated," he said.

    According to Arthur Caplan, director of New York University's division of medical ethics, health care workers getting vaccinated is an "ethical no-brainer."

    "Patients come first. That's what it says in every code of ethics of administrators, doctors, nurses, pharmacists, occupational therapists," Caplan said. "They don't say doctors' choices come first or nurses' worries come first." (AP/NPR, 9/24; Young, Modern Healthcare, 9/27; Otterman/Goldstein, New York Times, 9/27; Shapiro, New York Times, 9/25; Muoio, Fierce Healthcare, 9/27)

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