Burnout, not vaccine mandates, remains the driving force behind labor shortages

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As vaccine mandates become more common in hospitals, and as President Biden's national vaccine mandate looms, there have been fears about how these requirements will affect the healthcare sector's already precarious labor situation.

Passed earlier this month, Biden's mandate requires that all healthcare workers at Medicare and Medicaid participating hospitals or who work in other settings get vaccinated against COVID-19. The mandate applies to over 17 million healthcare workers, according to the White House.

The rule will be enforced by the Centers for Medicare and Medicaid Services, which is developing an interim final rule with a comment period that will be issued in October.

The mandate has been generally well received, however, some, including the American Hospital Association, have raised concerns that it could exacerbate "the severe workforce shortage problems that currently exist."

But these worries that vaccine mandates will have widespread implications on the healthcare staffing shortage is perhaps misguided, according to Alexa Hanlon, an associate at Fisher Phillips who focuses on healthcare labor and employment law.

"I think [saying] a causal factor [of the labor shortage] is the vaccine mandate is certainly an overexaggeration," Hanlon said.

Instead, she says, the mandate's effects will likely be felt differently, depending on how the location is already managing the pandemic. Rural areas with low vaccine rates will be hit the hardest, Hanlon predicts.

"When you look at a map in terms of where we're seeing the highest and lowest vaccination rates, I think that essentially with regards to healthcare workers that pattern follows," she told Healthcare Finance News. "I think among the nurses from these rural areas, there's less education, there's stronger religious convictions and there's a multitude of factors of why people are saying no or refusing to be vaccinated. And yeah, I think it's a very regional issue."

WHY THIS MATTERS

Fears over vaccine mandates exacerbating worker shortages in healthcare miss the bigger picture, which is burnout, according to Hanlon.

"We are seeing shortages because of nurse burnout, healthcare worker burnout," she said. "At first [they were] inundated with cases and struggling to understand the virus also from a scientific standpoint. And then I think that's only compounded and exacerbated now by many abuses and mistreatment of healthcare workers by patients. And so… as a whole, nurse burnout and the nursing shortage is because they are facing mistreatment and abuse by their patients."

Reports of burnout in the clinical setting are not new to the COVID-19 pandemic. For instance, almost a third of nurses who left their jobs in 2018 did so because of burnout, according to a JAMA Network Open study. Even among those that didn't leave their job, 43.4% identified burnout as a reason that would contribute to their decision to quit.

Working in a hospital setting was associated with 80% higher odds of burnout as the reason for quitting than for nurses working in a clinic setting, according to the study.

The added layer of the pandemic – and with it, higher levels of staffing shortages and fears of exposure – has only made matters worse for healthcare workers. In fact, during the spring and summer of last year, 49% of healthcare workers reported feelings of burnout, while 38% reported having anxiety or depression, and 43% suffered work overload, according to an EClinicalMedicine study.

Hanlon isn't alone in saying other factors in healthcare are to blame for the lack of workers. Nurse.org, an online community of nurses, launched the #TheREALNursingShortage campaign earlier this month to bring awareness to the systemic issues causing nurses to leave the profession, such as burnout, understaffing, concerns over COVID-19 and lack of support.

"Yes, nurses are leaving the profession, but the so-called 'nursing shortage' should not be blamed on nurses alone. There have been whispers for years. Now we are screaming for change. We are overworked, underpaid and are collectively feeling the effects of burnout, compassion fatigue and moral injury," Alice Benjamin, APRN, MSN, ACNS-BC, FNP-B, CCRN, CEN, CV-BC, chief nursing officer and correspondent for Nurse.org, said in a statement.

"The problem is not with nurses or nursing. The problem is that nurses have been so busy taking care of others that no one has taken care of them. And we're here to change that."

THE LARGER TREND

Regardless of what will happen to the healthcare worker shortage nationally, individual hospitals and health systems must prepare themselves for the impending vaccine mandate.

New York's statewide vaccine mandate took effect this week, regardless of reports of staffing shortages. The state's governor did however step in and sign an executive order to alleviate potential staffing shortages in hospitals. It expands the healthcare workforce by allowing for out-of-state workers to practice in New York in addition to other flexibilities.

Some have faced legal opposition from their employees. For example, as one of the nation's first hospitals to implement a vaccine mandate, Houston Methodist was hit with a lawsuit from more than 100 of its employees claiming they were being used as human guinea pigs.

Days after the case was filed, a federal judge dismissed it saying if the employees don't want a vaccine, they can work elsewhere, likening it to refusing an assignment or other work requirement.

Hanlon anticipates the Houston Methodist case will be a landmark decision for other lawsuits challenging the vaccine mandate, because of the threat that being an unvaccinated healthcare worker poses to patients.

"It is so in opposition to what a nurse is. To provide sufficient healthcare services, you need to be safe. And that includes the vaccine," Hanlon said. "And that's why most hospital systems mandate flu shots every season. And it's the same type of underlying principles of patient care."

Other hospitals might even have to adjust their service offerings, as was the case at Lewis County General Hospital in New York when it closed its maternity ward after six of its staff members resigned instead of getting vaccinated.

For hospitals that are looking to avoid potential disruptions caused by the mandate, Hanlon says educating employees on the science of vaccines is the best route.

"I think a huge thing is education and educational campaigns, and I have been kind of advising that since the advent of the vaccine, and before any type of mandates," she said.

When developing these informational sessions, it's important to include all employees, regardless of vaccination status, to avoid alienating people and to be respectful of employees' reasons for being hesitant, according to Hanlon.

"But other than that, I don't know how much more you can force someone. And at the end, it is a choice," she said. "For example, if you don't wear your safety goggles on a construction site, that's your choice, but you can get fired for that because of the direct threat of injury, of course, or of harm to a safe environment and making it unsafe there. And I think we can liken it to another condition of employment that certainly people can object to, but then they won't have their jobs."

Twitter: @HackettMallory
Email the writer: mhackett@himss.org