HomeHealth CareVaccine mandates in health care could alter the training of nurses

Vaccine mandates in health care could alter the training of nurses


Kaitlyn Hevner hopes to complete a 15-month accelerated nursing program at the University of North Florida in Jacksonville in December. For his clinical training this fall, he works 12-hour shifts on weekends with medical-surgical patients at a hospital.

But Hevner and nursing students like her who refuse to get vaccinated against COVID-19 find themselves in an increasingly precarious situation. Your posture can put your required clinical training and eventually your nursing careers at risk.

In early September, the Biden administration announced that workers in healthcare facilities, including hospitals and ambulatory surgery centers, should receive COVID vaccinations. Although details of the federal rule won’t be released until October, some experts predict that nursing students who take clinical training at those sites will also need to be vaccinated.

Groups representing the nursing profession say that “students should be vaccinated when required by clinical facilities” to complete their clinical training. In a policy brief released Monday, the National Council of State Boards of Nursing and eight other nurse organizations suggested that students who refuse to get vaccinated and who do not qualify for an exception due to religious beliefs or medical problems may be canceled. of your registration. nursing program or not being able to graduate because they cannot meet clinical requirements.

“We cannot have students in the workplace who can expose patients to serious illness,” said Maryann Alexander, director of nursing regulation at the national council. “Students can decline the vaccine, but those who are not exempt should be told that this is not the time to be in a nursing program.”

“You’re going to go into practice and you’re going to be very limited in your jobs if you’re not going to get that vaccine,” Alexander said.

Hevner, 35, who will complete his clinical training in early October, said he does not believe it is acceptable to benefit from a vaccine that was developed using fetal cells obtained through abortion, which he opposes. (Johnson & Johnson’s COVID vaccine development involved an abortion cell line; the Pfizer-BioNTech and Moderna mRNA vaccines were not developed with fetal cell lines, but some tests of the vaccines allegedly involved fetal cells, say the Researchers. Many religious leaders, however, support vaccination against COVID).

Since nursing student vaccinations remain optional in many healthcare settings, nurse educators strive to place unvaccinated students in healthcare facilities that accept them.

On the Jacksonville shoreline in Fort Pierce, Florida, 329 students are in the two-year associate degree nursing program at Indian River State College, said Roseann Maresca, an assistant professor who teaches third-semester students and coordinates their clinical training. Only 150 of them are vaccinated against COVID, he said.

Not all of the eight medical facilities that contract with the school require nursing students to be vaccinated.

“It has been a nightmare trying to transfer students this semester” to match them with facilities depending on their vaccination status, Maresca said.

Typically, healthcare facilities have long required employees to be vaccinated against various diseases such as influenza and hepatitis B. The pandemic has added a new urgency to these requirements. According to a September count by Fierce Healthcare, more than 170 healthcare systems require COVID vaccines for their workforce.

In May, the Federal Equal Employment Opportunity Commission made clear that under federal law, employers can require COVID vaccines as long as they allow workers to claim religious and medical exemptions.

Under the Biden administration’s COVID plan, roughly 50,000 healthcare facilities that receive Medicare or Medicaid payments must require workers to be vaccinated. Until the administration publishes its draft rule in October, it is unclear how nursing students assigned to health care centers for clinical training will be treated.

But the federal rule published in August establishing regulations for government hospital payments in 2022 offers clues. It defined health care personnel to be vaccinated as employees, licensed independent contractors, and adult students / apprentices and volunteers, said Colin Milligan, director of media relations for the American Hospital Association.

In addition to staff members, Biden’s plan says the mandates will apply to “people who provide services under arrangements” at healthcare sites.

A spokesperson for the Centers for Medicare & Medicaid Services declined to clarify who would be covered by the Biden plan, noting that the agency is still drafting the rules.

However, vaccination mandates threaten to derail the training of a relatively small proportion of nursing students. A recent survey by the National Association of Nursing Students reported that 86% of nursing students and 85% of new nursing graduates who responded to an online survey said they had been or were planning to get vaccinated against COVID.

But the results varied widely by state, from 100% in New Hampshire and Vermont at the high end to 63% in Oklahoma, 74% in Kentucky and 76% in Florida at the low end. The survey had 7,501 respondents.

Students who do not want to be vaccinated are asking schools to offer them alternatives to on-site clinical training. They suggest using life-size computer-controlled mannequins or computer-based simulations using avatars, said Marcia Gardner, dean of the school of nursing at Molloy College in Rockville Center, New York.

Last year, when the pandemic led to hospitals closing their doors to students, many nursing programs increased mock clinical training to provide nursing students with some kind of clinical experience.

But that’s not a substitute for working with real patients in a healthcare setting, educators say. State boards of nursing allow mock clinical study to varying degrees, but none allow such instruction to exceed 50% of clinical training, Alexander said. A multi-site study found that nursing students could complete up to half of their clinical training through simulation without a negative impact on competence.

The State Boards of Nursing Council Policy Summary states that nursing education programs “are not required to provide alternative or surrogate clinical experiences based on a student’s request or vaccine preference.”

As more nursing students are vaccinated, the problem will become less acute. And if Biden’s plan requires nursing students to be vaccinated to work in hospitals, the number of people resisting is likely to drop even further.

Hevner, a student at the University of North Florida, said she is not opposed to vaccines in general and would consider receiving a COVID vaccine in the future if she could be sure it was not created from aborted fetal cells. Submitted documentation to college to obtain religious exemption from vaccine requirements. It turned out that she didn’t need one because Orange Park Medical Center, where she does her clinical training, doesn’t require nursing staff or students to get vaccinated against COVID “at this time,” said Carrie Turansky, director of public relations. and communications for the medical center, in Orange Park, Florida.

Although Hevner opposes receiving the vaccine, “I am very serious about protecting my patients and protecting myself,” she said. He gets tested weekly for COVID and always wears an N95 mask in a clinical setting, among other precautions, he said. “But I would ask: Do we give up our own religious rights and our own self-determination just because we work in a healthcare setting?”

She hopes the profession can adapt to people like her.

“I am concerned because we are in such a divisive place,” she said. But she is eager to find a middle ground because, she said, “I think I would make a great nurse.”



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