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Vaccine Mandates Drive Staffing Shortages for Hospitals, Medical Facilities

'We have fewer personnel than at the beginning of the pandemic and more patients...'

(Bethany Blankley, The Center Square) Federal and state COVID-19 vaccine mandates are exacerbating a nursing shortage in California.

The recent federal mandate requires health care workers at Medicare- and Medicaid-funded hospitals to take the COVID-19 vaccines or the facilities where they work would lose federal funding. The order has resulted in nurses and medical staff nationwide saying they would instead retire or sue. Major health care unions have also said they will sue, arguing the order violates the very federal law used to issue the vaccines to begin with.

Moderna and Johnson & Johnson COVID-19 vaccines are currently only available through Emergency Use Authorization, which federal law requires only be administered on a voluntary basis with informed consent.

But the federal mandate hasn’t yet been implemented and will likely be held up in courts, whereas California issued its own state mandate with a Sept. 30 deadline, posing an immediate concern. California was the first state to mandate that health care workers receive the shots as a condition of employment, with limited exemptions.

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The California Department of Public Health (CDPH) issued an order Aug. 5 requiring health care workers in hospitals, skilled nursing facilities, intermediate care facilities, ambulatory surgery centers and most health care settings to receive both COVID-19 doses by Sept. 30. Workers could apply for limited exemptions but would also be subject to a range of testing and other requirements as a condition of employment.

Years before COVID-19, nursing shortages were already a problem statewide, the Office of Statewide Health Planning and Development reports. Based on 2018 data, it designated 58 out of 72 geographic areas in the state as Registered Nurse Shortage Areas. Among them, 17 had high shortages, 21 had medium shortages.

Now the state is facing an even greater nursing shortage, professionals throughout the state note, resulting in Gov. Gavin Newsom signing an executive order to allow out-of-state healthcare workers to work in California. The order reinstated emergency provisions allowing the CDPH to waive certain staffing licensing requirements through Dec. 31 for applicable hospitals and health facilities per California code.

But even this has hit a roadblock because of traveling nurses, who are in high demand, who won’t comply with the federal or state mandates, turning down California assignments. The traveling nurse shortage is also problematic because the state last year contracted with one of the nation’s largest traveling nurse providers to help already understaffed medical facilities.

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In March 2020, the CDPH contracted with Aya Health, committing to pay up to $1 billion over six months to help hospitals meet nursing and other clinical staff shortages.

“All of our hospitals are saying staffing is a big problem,” Lois Richardson, attorney for the California Hospital Association, told Cal Matters. “We have fewer personnel than at the beginning of the pandemic and more patients.”

But with traveling nurses choosing not to work in California, association spokesperson Jan Emerson-Shea told The Associated Press, “How this is going to play out, we don’t know. We are concerned about how it will exacerbate an already quite serious staffing problem.”

While she says the association “absolutely” supports the state’s mandate, she acknowledges that some hospitals are anticipating having to fire or suspend employees, move some to other positions, and that many traveling nurses won’t take assignments in California because of the state’s mandate.

Advocates for Faith and Freedom says it’s received more inquiries for help to file exemptions than its staff can respond to, and posted an exemption template and guidance on its website. It also provides guidance for Californians to consider when applying for a medical exemption, stating the resources are free and not intended to be an offer to provide legal services.

“Be assured that we are litigating on multiple fronts in an attempt to establish legal precedent that religious exemptions must be granted,” the nonprofit adds. The group is currently litigating “a significant case against a university to try to establish precedent that prevents discriminatory treatment of persons who choose to reject the Covid-19 shots.”

More Texas hospitals, medical facilities, facing staffing shortages over vaccine mandate

Some West Texas rural hospitals are concerns about staffing shortages as a result of President Joe Biden’s COVID-19 vaccine mandate, including one fearing it may have to close its doors. Another rural hospital now says it may not be able to deliver babies, and a children’s facility worries about how it would provide adequate care if it were forced to fire 20% of its employees in order to not lose federal funding.

The recent federal mandate requires health care workers at Medicare- and Medicaid-funded hospitals to take the COVID-19 vaccines or the facilities where they work would lose the federal dollars. The order has resulted in many nurses and other staff nationwide saying they would instead retire or sue. Major health care unions have also said they will sue, arguing the order violates the very federal law used to issue the vaccine to begin with.

In Clifton, Texas, just west of Waco, Goodall-Witcher Hospital expressed concerns over how the mandate will affect its ability to provide services. Its chief executive, Adam Willmann, told NPR it may no longer be able to deliver babies because many nurses in the maternity ward aren’t going to take the COVID-19 vaccines. Likewise, Ability HomeCare, a pediatric home health care agency in San Antonio, anticipates it may have to let go of 20% of its staff who won’t get the shots. Keeping on employees who don’t get the vaccines would cost the facilities federal funds, which they say they can’t afford to lose.

At Goodall-Witcher, some experienced nurses who work in the maternity ward haven’t gotten the shots and don’t plan on getting them, Willmann said. Instead of being fired or the hospital losing money, they’ve said they’ll retire instead.

“They are also near retirement age and a few of them have already voiced that ‘I will just retire,’” Willmann told NPR. “And then a couple of other nurses said, ‘Well, I’ll just go work for my husband’s construction company.’”

Of the hospital’s 250 employees, roughly 70 percent have received the vaccines, he said.

Ability HomeCare could also face a staffing shortage, its CEO Pam Goble told NPR. The company would have to let roughly 21% of its employees go if the mandate were to be enforced. With fewer staff, she says, “I worry if our patients, who are medically fragile children, are going to get the care they need.”

Ability HomeCare can take care of up to 900 children. Of the company’s 261 nurses and therapists, 56 have said they won’t get the shots, Goble said.

Nationwide, a health care worker crisis is growing with nurses and staff quitting or retiring at a higher rate, The Associated Press reports.

The first hospital in the nation to require a COVID-19 vaccine was Houston Methodist. Roughly 200 employees who were fired for refusing to get the vaccine sued, arguing the hospitals’ requirement violates federal law and the U.S. Constitution. The Moderna and Johnson & Johnson vaccines are only approved through Emergency Use Authorization and under federal law cannot be mandatory as a condition of employment, the plaintiffs argue.

The hospital argues the mandate is a standard practice for its employees and the lawsuit is baseless.

Their attorney, Jared Woodfill, points out what attorneys representing nurses are arguing nationwide: frontline workers who worked through state shutdowns during what a pandemic were considered heroes. A year later, they either lost their jobs or face losing their jobs, even though many built natural immunity from contracting COVID performing their jobs.

“Many of my clients actually contracted COVID as a result of treating COVID-positive patients, and the thank you that Methodist Hospital gives them now is a pink slip,” he said.

Texas Children’s Hospital employees also filed a complaint against the hospital after its leadership refused to accept their exemption requests. Their attorneys warned that if the hospital’s exemption policy didn’t comply with federal law, they would also sue.

Both Texas Gov. Greg Abbott and Attorney General Ken Paxton have vowed to fight the federal vaccine mandate.

Paxton is among 24 Republican attorneys general who recently joined a coalition opposing an executive order requiring private employees to get the shots, or undergo weekly testing, or the employers will be fined. The move prompted many employers to issue mandates requiring the shots as a condition of employment. It also resulted in AGs saying they would fight the mandate in court to protect businesses in their states.

The AGs argue the mandate is “disastrous and counterproductive,” warning it “represents not only a threat to individual liberty, but a public health disaster that will displace vulnerable workers and exacerbate a nationwide hospital staffing crisis, with severe consequences for all Americans.”

Biden’s mandate doesn’t include exemptions for those who work remotely, have religious objections or health concerns, or have already obtained natural immunity following recovery from the virus, they add.

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