Vaccine Mandates Cause for Concern

Staffing Infection Prevention COVID-19

By: Adam Taylor | Senior Editor

Published: 11/4/2021

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Frontline workers face uncertainty as healthcare facilities brace for the impact looming immunization deadlines will have on patient care.


Katie Yarber, RN, BSN, says delivering babies at Houston Methodist Hospital during the height of last year’s COVID-19 restrictions has been the highlight of her career. “It was incredibly rewarding,” recalls Ms. Yarber. “The moms couldn’t have visitors, so I acted as their partners and family members, as well as their nurse.”

Fast forward to June 2021, when Houston Methodist became the first large health system in the country to mandate COVID-19 vaccines. Ms. Yarber was told in an email that failing to get vaccinated would run afoul of the system’s mission of prioritizing patient safety and would be grounds for dismissal. She would not comply, saying she was uncomfortable with the vaccine’s emergency-use status and objected on religious grounds, and was fired. “I went from frontline hero to frontline zero,” she says.

RIGHT TO WORK The vast majority of healthcare workers at major hospital systems with vaccine mandates have agreed to get the injections.  |  Rush Medicine

Jennifer Bridges, RN, a former medical-surgical nurse at Houston Methodist, was let go last June after refusing to get vaccinated. “I was told I didn’t care about my patients because of that decision — but I worked with so many COVID patients last year and loved helping them,” says Ms. Bridges.

Vaccine mandates have created a national divide. About 57% of Americans have been fully vaccinated, according to the most recent CDC data. While a recent study from Northeastern University says only 27% of healthcare workers remain unvaccinated, it shows 15% of the group is firmly opposed to doing so. The sagas of Ms. Yarber and Ms. Bridges are harbingers of what could play out across the country as health systems await clarity on the details of federal vaccine mandates. Healthcare workers who don’t want to get the shots might have to decide between getting vaccinated and remaining employed. 

In September, CMS proposed a rule that would require the vaccination of all staff within Medicare- and Medicaid-certified hospitals and ASCs. At the time of press, CMS had yet to issue its final rule and questions remained about what it would entail. Will it include a twice-weekly COVID-19 testing alternative for healthcare professionals who refuse to get vaccinated? Will it mirror requirements for healthcare workers who don’t get annual influenza shots and must wear masks during flu season?

Cherokee Gonzalez, director of three Florida Medical Clinic ASCs in the greater Tampa area, says waiting for the specific requirements is difficult. “The truth is no one knows how facilities will respond,” says Ms. Gonzalez. “There’s no doubt pushback will occur if vaccines are mandated. There will be workers who will refuse to get their shots, so that’s something we’ll be forced to manage.”

Healthcare systems across the country are preparing to operate with a federal vaccine mandate in place, and facility leaders say clinical operations will be impacted when deadlines to get vaccinated are established. Employees who don’t want to get the shots might leave their jobs or get fired, and terminations could make existing personnel shortages even worse.

Some scenes are already playing out. Houston Methodist terminated about 150 of its 25,000 employees. Kaiser-Permanente suspended 2,200 of its employees across the country, about 2% of the workforce, on Oct. 1 and the workers have until Dec. 1 to get vaccinated or stand to lose their jobs. Northwell Health, New York State’s largest healthcare provider and private employer, terminated 1,400 employees, less than 2% of its total workforce, in October.

While Northwell said the terminations were regrettable, the health system also said it is proud that the moves kept its staff 100% vaccinated. The “rapid and aggressive” strategy was necessary to maintain patient safety, the health system said in a statement.

“Northwell believes that having a fully vaccinated workforce is an important measure in our duty to protect the health and safety of our staff, our patients and the communities we serve,” says the statement. “Northwell regrets losing any employee under such circumstances, but… we understand our unique responsibility to protect the health of our patients and each other. We owe it to our staff, our patients and the communities we serve to be 100% vaccinated against COVID-19.”

The Danger of Dismissing Natural Immunity
MEASURED APPROACH
STOP SHOUTING Dr. Makary believes civil discussions of COVID-19 vaccines would result in more reasonable protection requirements for patients and healthcare workers.  |  Johns Hopkins Medicine

In recent Wall Street Journal op-eds and in his keynote address last month at Outpatient Surgery Magazine’s Virtual OR Excellence conference, Marty Makary, MD, MPH, delivered messages that advocated widespread mask usage, vaccines for healthcare workers who have never had COVID-19 and relaxing the vaccine requirement for those who have contracted the disease.

Studies by The Cleveland Clinic and the University of Washington clearly show that a previous case of COVID-19 is better protection than a vaccine, says Dr. Makary, a professor at the Johns Hopkins School of Medicine and Bloomberg School of Public Health. He believes groupthink by an elite medical establishment has ignored the clinical wisdom of frontline workers across the country who have reported that almost zero patients with COVID-19 for the second time get cases serious enough to warrant intubation or result in death.

“Natural immunity has been dismissed or downplayed for far too long,” says Dr. Makary.

He thinks it’s reasonable for there to be an immunity requirement for healthcare workers who provide direct patient care, because they could be asymptomatic and transmit COVID-19 to high-risk patients. That requirement, however, should include recognizing workers who have had COVID-19 proved by antibody testing.

“This is where it becomes really emotional,” says Dr. Makary. “To see nurses on the front lines of the pandemic jump on the grenade when the virus hit our country, risk their lives, get COVID-19, develop antibodies, have circulated antibodies confirmed by testing and are now told they need to get fired because that immunity is not the immunity that’s been sanctioned. This is a failure of government.”

Many COVID-19 safeguards are rigid overreaches and should now be relaxed, argues Dr. Makary. “The goal should have been to downgrade the public health threat of COVID-19 to defang it. Instead, we put the medical community on a mission to block all virus transmission,” says Dr. Makary. “The problem is we’re not at a point where we’re ready to accept the endemic phase of this virus. The worst thing you can do in public health is have guidance that no one is going to follow. You lose credibility, and we may need it in the future.” 

— Adam Taylor

Florida Medical Clinic would almost certainly have to abide by the CMS rule because they can’t afford to stop performing Medicare cases, according to Ms. Gonzalez. She says smaller surgery centers would be impacted the most because a few terminated employees would make up a larger total percentage of staff than at a larger facility.

Ms. Gonzalez estimates 20 of her 150 employees at the three ASCs she oversees will refuse to get vaccinated. Some think the vaccines are unsafe; some object on religious grounds; and some have already gotten COVID-19 and are confident they’ve been naturally immunized. “Many ASCs already have personnel shortages,” says Ms. Gonzalez. “If we’ll be forced to terminate employees, it’s going to cause a problem for us and will directly impact operations.”

About 80% of the staff at Eye 35 ASC in Schertz, Texas, is vaccinated, but the 20% who aren’t are strongly against getting the jab, according to Carson McCafferty, MSN, RN, CNOR, CSSM, CSRN, the facility’s clinical director. “The problem for them is that they’re not going to be able to get a job anywhere else,” she says. “Hospitals are Medicare-certified, as are most ASCs and medical clinics.”

There's no doubt pushback will occur if vaccines are mandated.
— Cherokee Gonzalez

At least 11 states have issued COVID-19 vaccine mandates of varying degrees for healthcare workers, with some states allowing unvaccinated workers to remain on the job if they get tested for COVID-19. Details in the pending federal mandates from CMS will supersede any state requirements. “If the federal mandates allow for testing, that would be a game-changer for healthcare facilities in states like California that don’t offer that option,” says Casey Duhart, BS, M.Ed., JD, a healthcare attorney based in Nashville.

She says at least 24 lawsuits across the country filed against healthcare companies by employees have been dismissed. Ms. Bridges was the lead plaintiff in a federal wrongful termination lawsuit filed by former Houston Methodist employees in May and dismissed by a judge in June. A similar legal action filed in Texas state court in August is pending. Hospital officials have called both lawsuits “frivolous.”

ADVOCATE NURSE Jennifer Bridges, RN, started working at a private facility the same day she was fired from Houston Methodist Hospital for refusing the COVID-19 vaccine.  |  Jennifer Bridges

Ms. Yarber exhausted some of her savings while out of work for two months after leaving Houston Methodist. She got a job at another hospital, which instituted a vaccine mandate of its own shortly after she was hired, so she worked there for only two weeks. Since August, Ms. Yarber has worked as a telehealth nurse for an insurance company. She says getting fired from Houston Methodist was stressful and costly, but she’s at peace with her decision to remain unvaccinated.

“I wasn’t going straight to another job, so my future was up in the air,” says Ms. Yarber. “It was clear to me that the development of the vaccine was rushed and with no long-term studies to support it, there’s no science to trust that tells me the benefits outweigh the risks.”

She’s also genuinely confused about people’s stance on the issue, saying, “When the pandemic hit, you needed us to take care of you and your family members, and you didn’t question our ability to do so. However, now that there’s a vaccine in place, you question whether we’re safe enough to take care of you. We were safe enough last year. What’s changed?”

Ms. Bridges, meanwhile, was contacted by a private nursing company that is supportive of her position on vaccines and offered her a job. Her first day there was the day she was officially terminated from Houston Methodist. She travels across Texas to oppose vaccine mandates, has been interviewed by media outlets worldwide about her firing and hopes her activism is an extension of her nursing. “I love helping patients, and I know hundreds of healthcare workers got vaccinated against their wishes in order to keep their jobs,” says Ms. Bridges. “I don’t want anyone else to be terrified and full of anxiety about taking a shot they don’t want because they can’t afford to be fired.”

Ms. Gonzalez understands if her employees who have preexisting medical conditions or who’ve had COVID-19 and are naturally immunized don’t want to get vaccinated. She feels everyone else should get the shots. “It’s not just about protecting patients,” she says. “Most surgery centers are small. We share close spaces, from break rooms to the ORs. To me, it’s about protecting each other.” OSM

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