Vaccine Mandate Deadlines Push Healthcare Workers to Get the Shot

a medical worker administers J&J vaccine

Spencer Platt / Getty Images

Key Takeaways

  • In California and New York, deadlines for healthcare workers to be fully vaccinated approached this week. Thousands of employees got the shot before the deadline.
  • A handful of states don’t allow unvaccinated employees to undergo regular COVID-19 testing, meaning they must get the shot or be terminated.
  • Some workers refuse to be vaccinated, causing some health systems to fire employees and contributing to concerns about staff shortages in already strained hospital settings.

The deadline for healthcare workers to be vaccinated or face termination has arrived in two states and quickly approaches in others. The mandate appears to have compelled tens of thousands of workers to get the shot, setting the stage for employer vaccine mandates nationwide.

In New York, the implementation of vaccine mandates has led to a smaller exodus from the workforce than some hospitals expected. According to state data, the number of unvaccinated healthcare workers dropped from 8,000 last week to about 5,000 on September 27—the deadline for workers to be fully inoculated.

Today is California’s deadline for healthcare employees to be vaccinated. Dozens of major hospital systems said they were confident that the mandate would not disrupt daily operations, and the state’s largest systems have achieved a 90% or higher vaccination rate, reported CalMatters.

In at least five states, healthcare workers must be vaccinated to remain employed. Despite positive reports so far, some experts fear that enough workers would quit to avoid vaccinations and exacerbate the current staffing shortage.

“While the importance of having all healthcare workers vaccinated is unquestioned, this is coming at a time when many hospitals are facing serious staffing shortages,” Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, tells Verywell in an email. “It’s hard to predict exactly how the vaccine mandate will play out—every hospital is implementing its own processes and procedures.”

Deadlines Pressure Workers to Get the Shot

When the mandate deadline kicked in on Monday, 92% of New York’s healthcare and nursing home workers had received at least one dose of the vaccine, up from 82% of nursing home staff and 84% of health workers two weeks ago, according to state data.

Despite the last-minute vaccinations, many healthcare workers chose to quit or be fired than get inoculated. New York City Mayor Bill de Blasio said that 5,000 employees of the city’s public hospital system remained unvaccinated after the deadline, and could not come to work or be paid. New York’s largest health system, Northwell Health, says it has already begun firing unvaccinated workers.

Outcomes in New York and California could influence how other states and districts proceed. Healthcare workers in California, New Jersey, Pennsylvania, Maryland, and Illinois must be vaccinated or undergo regular testing. Those in New York, Rhode Island, Maine, Oregon, and Washington, and D.C. won’t have a testing option—they must be vaccinated to remain employed.

In total, 23 states have taken steps to require some or all healthcare workers to be inoculated, according to the National Academy for State Health Policy.

The mandate deadlines come as President Joe Biden makes a national push to get all healthcare workers fully vaccinated. Under his plan to end the pandemic, the roughly 17 million workers at health centers that receive federal funding will need to be vaccinated.

White House press secretary Jen Psaki said that health centers in Houston and Maine lost relatively few employees after implementing vaccine mandates—a signal that a national requirement could be successful at bolstering immunization rates.

“We’re seeing in a lot of places that this is working, it’s effective, it’s creating more certainty and protection in their workforces,” Psaki said at a press briefing on Monday.

Concerns About Short Staffing

In a survey of 50,000 health care workers, 13% of respondents said they have been or will be vaccinated because of their employer required it, according to the HERO Registry.

Meanwhile, in states that have no mandates, some health systems are enforcing their own. A North Carolina hospital system fired about 175 workers in one of the largest-ever mass terminations due to a vaccine mandate. A health system in Delaware said it fired about 150 employees.

Private employers and state governments are legally allowed to require workers to be vaccinated, according to the Equal Employment Opportunity Commission. Still, some states are avoiding firing unvaccinated employees for fear of worker shortages.

Short staffing in hospital settings was an issue well before the vaccine mandates, says Susanna Naggie, MD, associate professor of medicine and vice dean of clinical research at Duke University.

Nurses and others have gone for more lucrative traveling positions or left the workforce due to pandemic burnout. Plus, when healthcare workers get sick with COVID-19—an outcome that's more likely among unvaccinated staffers—they must stay away from the hospital until they’re no longer ill, meaning they can’t care for patients.

“This has been a very grueling 18-plus months for people who work in health care," Naggie tells Verywell. "We've had a lot of loss across the board—people are burned out and looking to do other things. Quite frankly, I think those challenges are less about the vaccine mandates—do they play a role? Sure. But are they major drivers of the current challenges that we're seeing? I personally don't think so."

The effect of the mandates on staffing will likely vary based on the hospital's capacity, existing resources, and geographical location, Naggie says.

Ahead of this week's deadlines, some hospitals put a two-week pause on elective surgeries and told patients to expect longer wait times for care. Health systems in California said they expect state health officials to grant them a 45-day grace period on compliance so they could fill staff shortages caused by the mandate.

New York Governor Kathy Hochul signed an executive order ahead of the state's vaccination deadline, giving her the power to call in the National Guard to fill shortages and to lift licensing requirements to allow out-of-state healthcare workers to assist New York hospitals.

“My desire is to have the people who are out there continue to work in their jobs, work in them safely," Hochul said. "And for all the other healthcare workers who are vaccinated, they also deserve to know that the people they’re working with will not get them sick."

What This Means For You

Some fear that nursing staff shortages and longer wait times for care will come as vaccine mandate deadlines approach for healthcare workers. In some places, that has not proven to be the case so far. If you're planning an elective surgery or other inpatient visit, consult with your doctor ahead of time.

By Claire Bugos
Claire Bugos is a health and science reporter and writer and a 2020 National Association of Science Writers travel fellow.