California’s Healthcare Worker Vaccine Mandate Further Impacts Nursing Shortage

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By Hamdy M. Masri

On August 5, 2021, Tomás J. Aragón, the State Public Health Officer & Director of the California Department of Public Health (CDPH), issued an order requiring that all healthcare workers in California be vaccinated against COVID-19. The order followed Governor Newsom’s July 26, 2021 announcement of the requirement. Pursuant to the order, workers in specified healthcare facilities are required to have received their first dose of a one-dose regimen vaccine (Johnson & Johnson), or second dose of a two-dose regimen vaccine (Pfizer-BioNTech or Moderna), and facilities are required to comply with the order, by September 30, 2021. California is the first state to have a vaccine mandate for healthcare workers, including nurses.

This order is in response to increased outbreaks of COVID-19 caused by the highly transmittable Delta variant. According to CDPH’s order, increasing numbers of healthcare workers are among the new positive cases, despite vaccinations being prioritized for this group when vaccines initially became available, and recent outbreaks in healthcare settings have frequently been traced to unvaccinated staff members. The CDPH found that California’s healthcare system is currently able to address the increase in cases and hospitalizations, but that all healthcare workers must be vaccinated to reduce the chance of transmission to vulnerable populations. The mandate applies to workers in 14 enumerated healthcare facilities, including hospitals, skilled nursing facilities, ambulatory surgery centers, clinics and doctor offices.

According to the order, healthcare workers can be exempt from the vaccine requirement only if they provide the operator of their facility with a declination form stating either: (1) the worker is declining the vaccination based on religious beliefs, or (2) the worker is excused from receiving any COVID-19 vaccines due to a qualifying medical reason. To be eligible for a qualified medical reason, a worker must provide a written statement, signed by a licensed medical professional practicing under a physician’s license, stating that the individual qualifies for the exemption and indicates a probable duration of the worker’s inability to receive the vaccine. If a worker is exempt from the vaccine requirement, they must submit to weekly COVID-19 tests. Acute healthcare and long-term care workers must test twice a week, while workers in other healthcare settings must test once a week. Exempt workers must also wear surgical masks or other higher-level respirators (such as KN 95’s) at all times while in the facility.

Hospitals nationwide face a widespread shortage of nurses due to the COVID-19 pandemic. According to media reports, California has the second-highest number of positions posted for nurses, following Texas. Experts say the primary cause of the shortage is emotional and physical exhaustion. Meanwhile, many hospitals have more patients now than in the COVID-19 surge last winter, which caused the emergency suspension of regulatory nurse-to-patient ratios. [26:2 CRLR 76–78]. Although the emergency suspension ended in February 2021, hospitals can apply for program flexibility waivers in response to staffing shortages. These waivers, with CDPH’s approval, allow facilities to be exempt from ratio regulations due to staffing shortages.

Hospital administrators have publicly raised concern that the vaccine mandate will drive workers away. It has been reported that some nurses have joined other healthcare workers in protest of the mandate and that traveling nurses—nurses from across the country who are hired temporarily by hospitals to meet rising demand—who do not wish to get vaccinated have begun turning down California assignments.

At the time of this writing, BRN has yet to address the new healthcare worker vaccine mandate.

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