While COVID-19 rates are continuing as a result of the Delta variant, many people still feel hesitant about taking the COVID-19 vaccines. In July 2021, the CDC reported that a significant number of nurses (56.7%) were not getting vaccinated in a comparison of vaccination rates between physicians, nurses, and other healthcare workers. As of August 18, 2021, the American Nurses Association (ANA) reported new survey results from 4500 nurses nationwide that show 90% of nurses are vaccinated against COVID-19, or plan to get vaccinated, and are comfortable recommending the vaccines to others .
Greater Access to the Vaccine
The CDC noted in July that one of the biggest reasons the vaccination rate among nurses was so low was due to lack of access, especially for nurses in low-income areas and at long-term care facilities. The data that was collected also had some limitations, such as not being able to fully validate the data, not using a reliable sample (a non probability-based convenience sample was used), and not checking for duplication of reports for employees who work at multiple sites. The report also suggested that vaccination rates for nurses and aides were lower in zip codes where there were high social vulnerabilities, and were predominantly made up of female ethnic minorities. This indicates the presence of healthcare inequities among healthcare employees, in addition to their patient population.
Educational Push
In May 2021, the Centers for Medicaid Services (CMS) published an “interim final rule requiring long-term care facilities (LTCFs) to educate healthcare providers (HCPs) on COVID-19 vaccines, offer vaccination, and report vaccination status to CDC’s National Healthcare Safety Network (NHSN)”. This prompted a massive educational outreach campaign that specifically targeted healthcare workers, including aides and nurses. The ANA and 22 other large healthcare organizations launched a COVID Vaccine Facts for Nurses educational campaign “that provided critical, current, and culturally sensitive COVID-19 vaccine information for the nation’s nurses.” Vaccination rates appeared to climb once vaccine access improved in addition to increased availability of high-quality accurate information about the vaccines.
Ethical Considerations
The 2015 Code of Ethics for Nurses lays out nine ethical provisions to consider when nurses make healthcare decisions regarding their patients and their own health. The nine ethical provisions are:
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The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes to every person.
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The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
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The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
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The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.
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The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
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The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
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The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
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The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
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The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
It’s easy to see how it could be ethically challenging to both respect the autonomy of the patient, while also protecting the safety of the community. On the one hand, nurses don’t want to push any type of medication or treatment on a patient without informed consent or disregard their decision-making autonomy. On the other hand, public safety is paramount in providing quality care for all patients一especially since healthcare doesn’t happen in a vacuum. The COVID-19 pandemic has presented nurses with a healthcare crisis that hasn’t happened in 100 years, with the responsibility to find new ways to resolve potentially conflicting ethical standards.
Fortunately, leaders in the nursing community stepped up to help guide us through the ethical considerations regarding the vaccine, such as Dr. Grady, a nurse bioethicist, in an interview with Dr. Liz Bridges, the president of the American Association of Critical Care Nurses. Dr. Grady noted that nurses early on were having some serious questions about the safety of the vaccine, as she outlined here:
Nurses, like everybody else, need information. They need information in order to make an informed decision about whether or not to take a vaccine. And that information should include things about the process by which these vaccines were developed. The research studies that were done. Nurses need information about what those data are, how they were granted an emergency use authorization, what an emergency use authorization means, what the side effects or a lack of serious side effects that the data show, but that both of these vaccines are reactogenic, and what that means. Then in the end, each person, each nurse makes their own choice about whether or not to get vaccinated.
Dr. Grady then went on to emphasize the Code of Ethics for Nurses as a valuable resource to use during a pandemic, especially provisions 4 and 5. Dr. Grady noted that “getting vaccinated (so that you can be safe in your own profession, in your own job, and in your own life) fulfills this [provision 4] commitment that's in the code for nurses”.
Dr. Grady commented in regards to provision 5 that “we have a responsibility to ourselves to protect ourselves from getting sick, from spreading virus, and from being unable to take care of our patients or our families.”
Nurses Support Mandates and Following the Guidance of Health Officials
In addition to getting vaccinated themselves, 58% of nurses also support mandatory COVID-19 vaccinations according to the ANA survey. This number isn’t quite as high as the number of nurses who support getting vaccinated in general, but is still an overall majority.
The ANA survey also showed that 86-87% of nurses surveyed confirmed that they had access to the most current and reliable information on the vaccines, understood the urgent need to stay up-to-date on the research, and were referring their patients to credible resources such as the CDC and NIH. Additionally 86% of nurses reported that they would support booster shots if recommended.
Ultimately, it is clear that nurses had many of the same questions as the general public about the safety of the vaccines. They had to take time to research the validity of the evidence, and weigh the ethical considerations. Currently, it is clear that nurses are supporting the use of the vaccine, but are also staying vigilant and following any new recommendations that come from trusted health sources like the CDC and NIH.
Write in the comment section below what your greatest hesitancy was about getting the vaccine, and what was the thing that tipped the scales for you?
References:
July 2021 CDC Report on Vaccination rates of healthcare providers
https://www.cdc.gov/mmwr/volumes/70/wr/mm7030a2.htm
August 2021 American Nurses Association New Survey Data: Nurses recommend Covid 19 vaccination https://www.nursingworld.org/news/news-releases/2021/ew-survey-data--nurses-recommend-covid-19-vaccines/
ANA Nursing Code of Ethics 2015 https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
Covid Vaccine Facts for Nurses
https://covidvaccinefacts4nurses.org/
American Association of Critical Care Nurses: Covid Vaccine Ethical Considerations
https://www.aacn.org/newsroom/covid-19-vaccination-ethical-considerations
Susannah Marshall, BSN, RN-BC, CCM has been a Registered Nurse for 8 years, and is board certified in both case management and psychiatric nursing. Prior to becoming an RN, she worked for 10 years with children in social service settings, where she became passionate about patient advocacy and de-stigmatizing mental healthcare needs. When she isn’t practicing Argentine tango or west/east coast swing dancing, she loves to play with her baby nephew and write children’s stories.
