Six months after the COVID-19 vaccines first became available, just 55% of the CNAs, nurses and therapists who work at our 50-bed skilled nursing facility have chosen to get vaccinated.
It’s a challenge, as I’m sure many other nursing facility administrators agree. We know how important it is for our staff members, especially direct care workers, to get vaccinated. At the same time, we recognize that this is a decision they have to make themselves. The best we can do is support them in their decision-making by providing them with credible information, encouraging them to get vaccinated and reducing barriers to their getting vaccinated.
But we need help getting the message across effectively. I want to bring attention to an excellent new resource, Invest in Trust: A Guide for Building COVID-19 Vaccine Trust and Increasing Vaccination Rates Among CNAs, designed to assist nursing home leaders in doing just that. Produced by the federal Agency for Healthcare Quality and Research ECHO National Nursing Home COVID-19 Action Network, Invest in Trust is a comprehensive, evidence-based guide informed in part by the voices of CNAs who either chose to get vaccinated or hadn’t made up their minds yet.
The observations and findings in this guide reflect what I’m hearing from my staff. It also offers practical ways to address workers’ concerns, including a conversation guide that walks you through how to talk about COVID-19 vaccination with CNAs.
Several nuggets that stuck with me:
Some workers worry about getting the vaccine because they can’t afford to take unpaid time off from work to get vaccinated or if they have side effects. We’re exploring our options for how to address this problem, and this finding from the guide confirms our urgency. We’re continuing to offer in-house vaccination clinics to at least reduce the burden of staff going offsite on their own time. We’re also experimenting with offering them on Fridays to make it a little easier for those who don’t work weekends to have time to recover. But that’s only a start—we need to do more.
Many staff of childbearing age continue to fear possible impacts on their pregnancies or their ability to become pregnant. Invest in Trust offers direct advice and resources for addressing those worries, as well as links to relevant research.
When talking with staff about their concerns, don’t nag and don’t lecture—listen and respond to their fears. It’s hard not to get frustrated sometimes, and I fell into the lecture trap one time when an employee told me she didn’t want to put something in her body when she didn’t know the ingredients—yet she smokes and drinks soda pop. I’m pretty sure my words had little impact on her. The guide advises probing beneath the surface to understand what workers are worried about and supporting their decision-making, either by offering credible information or telling them where they can find it.
Don’t broadcast hesitancy. That’s something else I could have done better at the beginning when people were so afraid and there were still so many questions about the vaccines. If I were to do it again, I would start by telling staff that we are all in this together and we’ll get through it together.
There are some things I feel we’ve been doing right. I was the first person at our facility to get vaccinated because I felt that, as the director, I needed to set an example, which I shared with staff. We’ve been doing in-house vaccination clinics for residents and staff once a month so that workers who are undecided have multiple opportunities to change their minds. Instead of strong-arming workers to get vaccinated, I try to appeal to their concern for the safety of our residents. And I always encourage them to seek out people they trust—especially their own health care providers—for guidance on the vaccines.
One of the points Invest in Trust makes is that workers who are most vaccine-hesitant are also least likely to trust their employers. Obviously, this puts us in a quandary. Invest in Trust offers useful strategies for earning workers’ trust around COVID-19 vaccination while making good use of other, more highly trusted messengers, like local medical experts.
It’s not a magic wand, but it is a powerful tool for helping nursing home leaders address this challenge. I, for one, plan on putting it to good use!
Rachel Shearer is executive director of Ignite Medical Resorts-Adam PARC, a 50-bed skilled nursing facility in Bartlesville, OK.
