Vaccination rates for COVID-19 for nightshift workers in nursing homes significantly lag their dayshift counterparts, creating a higher-risk environment for residents and other staff, according to new research from Brown University.
The researchers found that clinics and other measures to boost the number of vaccinated workers were often held at inconvenient times for nightshift employees. Testing also was more sporadic for nightshift workers. The study was published Monday on Health Affairs.
“Nursing homes have been disproportionately impacted by COVID19 because they care for a highly vulnerable population in a congregate care environment that requires hours of direct patient-staff contact every day,” said lead researcher Elizabeth White, assistant professor of Health Services, Policy, and Practice at the Brown University School of Public Health, in a statement to McKnights Long Term Care News. “When staff testing and vaccination rates are lower on the evening and night shifts than on the day shift, that’s an important weakness in the line of defense to be aware of and address.”
Brown’s team reviewed data for 294 nursing homes from April 2020 to March 2021, analyzing vaccine and shift records for employees in direct care, as well as maintenance, dietary and housekeeping. The study did not include staffing agency workers due to potentially incomplete testing and vaccine records. An employee was considered vaccinated if he or she had received at least one COVID-19 vaccine dose as of March 31, 2021.
Across the board, there were higher vaccine and testing rates of dayshift workers compared with the nightshift. The research also showed clear demarcations in nursing categories with certified nursing assistants and certified medical assistants testing less frequently than registered nurses. The research also showed that, overall, Black employees had lower testing rates than White employees. However, the study said that its models showed this was due to shifts worked rather than any racial reasons.
“Staff who were younger; were of Black race; worked part time; or were employed as LPNs, CNAs, CMAs, or other direct care aides, on average, had the lowest odds of vaccination among the sample,” the study noted, adding that there tend to be higher concentrations of Black employees on nightshift instead of dayshifts.
White said another important factor that could explain the disparity is that nightshift workers have “much less exposure” to nursing homes senior leaders, particularly nursing and medical directors keep daytime hours.
“We know that those senior leaders in particular have been important for helping to build trust in the vaccines among nursing home staff,” she said.
While nursing home employees remain under a federal vaccine mandate, US Health and Human Services Secretary Xavier Becerra said there are approximately 1,000 facilities in the country with zero people vaccinated.
Gaps despite effort
The study noted that the workarounds to accommodate night- and even evening-shift workers did not address the issue of access.
The federal Pharmacy Partnership for Long-Term Care Program took place during the day and had limited scheduling flexibility or access to vaccines outside of the clinics. Facilities received just three clinics to administer the two-dose mRNA vaccine to all workers. That meant non-dayshift workers had to come in early, stay late, or come in on off-days to receive vaccinations.
“The expectation for staff to stay beyond their paid work hours to receive testing or vaccination presents a significant structural barrier, particularly for those who must report to second or third jobs, attend to family needs, or connect with transportation,” the report noted, adding that this disproportionately affected CNAs, CMAs, and other low-income workers.
White said it is important that vaccine clinics be scheduled at convenient times for all workers and that dedicated personnel are brought in to administer shots so that shift supervisors do not have to manage that on top of their daily workload. Also, senior leaders should interact with nightshift workers and encourage them to be vaccinated. And with nursing homes experiencing significant staffing shortages, federal and state governments should look at how they can support nursing home providers in boosting vaccine rates.
“It is critical that nursing homes receive support from local, state, and federal health authorities when coordinating key public health initiatives,” report authors stated.
