Convincing Nurses to Take the COVID Vaccine

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

The news this week on the vaccine front is very encouraging. The Pfizer vaccine should be available soon, and research so far indicates that the efficacy level is high. Great news for nurses on the frontline right – not so fast. Nurse leaders across the country are beginning to confide in me that the next battleground will be convincing nurses to take the vaccine. Some of these leaders work in communities with deep skepticism about vaccines in general – even the flu vaccine was a workplace battle. Others have nurses that follow and believe in some of the conspiracy theories on social media. Nationally only slightly more than 50% of the public would take a vaccine. Nurse leaders predict that the nursing workforce is probably similar. An October ANA pulse survey of more than 12,000 nurses indicates that there is concern about pushback from nurses. 67% of nurses were either unsure or would not take the vaccine if it was not required. The issue for nurses seems to be a lack of confidence in the safety of the vaccine. There is also skepticism about the speed of development of the vaccine.

Nurse leaders are confronted with the following issues relative to the question of vaccine choice for nurses:

Should nurses in their organizations have the right to decline a vaccine?
Should a vaccine be mandatory based on what type of patient population you are working with?
What if you have COVID-19 antibodies already – should you still be required?

The American Nurses’ Association’s (ANA) stance on nurse immunizations is clear: vaccinate unless there is a medical exception. The organization notes that they do not support vaccine exemptions based on “philosophical or religious exemptions,” and they note that anyone who cannot receive a vaccine due to medical reasons “may be required to adopt measures or practices in the workplace to reduce the chance of disease transmission.”

Mandating it outright might not be the right approach. Many leaders already worry about not having an adequate workforce – what if some nurses elect not to work. Communications experts said it matters greatly who promotes the vaccine. People believe in “trusted messengers.” Many have already observed that the name of the government’s vaccine development effort, Operation Warp Speed, was a mistake. People want a vaccine as soon as possible, but they want to be sure it works, and they want it to be safe. There’s an association between breakneck speed and mistakes that will now have to be addressed.

Using a model like David Rock’s SCARF model built on threats and rewards that drive human behavior is worth studying. The brain, he points out, tries to minimize threats and maximize rewards. Rock points out that every threat and reward is examined through a lens which considers the following:

Status – how do I see myself, and how do others see me? Is my status threatened by this decision or strengthened. Have my rights here been respected and appreciated?

Certainty – how certain am I that this will be of benefit to me, or are there unknown risks that I might not be willing to take.

Autonomy – how much choice do I have here, or are you mandating me to do something that I have no control over.

Relatedness – how connected do I feel to others in this situation or others who have this problem. Are we all in this together?

Fairness – how reasonable is this decision – am I being treated fairly?

A big issue with the COVID vaccine will be creating a psychological safety level for staff to talk about their concerns. These discussions need to begin now on how to best influence nurses to take the vaccine through a campaign or other collective action. Nurse leaders should talk with the social influencers within their own settings and shared governance councils to gain buy-in and help with the effort.

Don’t let nurse leaders in your organization go without development. Virtual programs include Nurse Leader Coaching, Coaching Staff to Promote Resilience and Leading Teams in Turbulent Times, or schedule your customized Nuts and Bolts of Nursing Leadership Virtual Workshop taught by experts for either new or experienced leaders. Nuts and Bolts Flyer

Read Rose Sherman’s book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave