In the rural northeastern corner of Missouri, Scotland County Hospital has been so low on staff that it sometimes had to turn away patients amid a surge in COVID-19 cases.
The national COVID staffing crunch means CEO Dr. Randy Tobler has hired more travel nurses to fill the gaps. And the 鈥� what he called 鈥渃razy鈥� rates of $200 an hour or more, which Tobler said his small rural hospital cannot afford.
A little over 60% of his staff is fully vaccinated. Even as COVID cases rise, though, a vaccine mandate is out of the question.
鈥淚f that becomes our differential advantage, we probably won鈥檛 have one until we鈥檙e forced to have one,鈥� Tobler said. 鈥淢aybe that鈥檚 the thing that will keep nurses here.鈥�
As of Thursday, about 39% of U.S. hospitals had announced vaccine mandates, said Colin Milligan, a spokesperson for the . Across Missouri and the nation, hospitals are weighing more than patient and caregiver health in deciding whether to mandate COVID vaccines for staffers.
The market for health care labor, strained by more than a year and a half of coping with the pandemic, continues to be pinched. While urban hospitals with deeper pockets for shoring up staff have implemented vaccine mandates, and may even use them as a selling point to recruit staffers and patients, their rural and regional counterparts are left with hard choices as cases surge again.
鈥淥bviously, it鈥檚 going to be a real challenge for these small, rural hospitals to mandate a vaccine when they鈥檙e already facing such significant workforce shortages,鈥� said Alan Morgan, head of the National Rural Health Association.
Without vaccine mandates, this could lead to a desperate cycle: Areas with fewer vaccinated residents likely have fewer vaccinated hospital workers, too, making them more likely to be hard hit by the delta variant sweeping America. In the short term, mandates might drive away some workers. But the surge could also squeeze the hospital workforce further as patients flood in and staffers take sick days.
Rural COVID mortality rates were on average than urban ones for the week ending Aug. 15, according to the Rural Policy Research Institute.
Despite the scientific knowledge that COVID vaccinations sharply lower the risk of infection, hospitalization and death, the lack of a vaccine mandate can serve as a hospital recruiting tool. In Nebraska, the state veterans affairs鈥� agency prominently displays the lack of a vaccine requirement for nurses on its job site, The .
It all comes back to workforce shortages, especially in more vaccine-hesitant communities, said Jacy Warrell, executive director of the . She pointed out that some regional health care systems don鈥檛 qualify for staffing assistance from the National Guard as they have fewer than 200 beds. A potential vaccine mandate further endangers their staffing numbers, she said.
鈥淭hey鈥檙e going to have to think twice about it,鈥� Warrell said. 鈥淭hey鈥檙e going to have to weigh the risk and benefit there.鈥�
The mandates are having ripple effects throughout the health care industry. The federal government has or risk losing Medicare and Medicaid reimbursements, and industry groups have warned that workers may jump to other health care settings. Meanwhile, Montana has , and the Montana Hospital Association has gotten one call from a health care worker interested in working in the state because of it, said spokesperson Katy Peterson.
It鈥檚 not just nurses at stake with vaccine mandates. Respiratory techs, nursing assistants, food service employees, billing staff and other health care workers are already in short supply. According to the latest KFF/The Washington Post Frontline Health Care Workers Survey, released in April, at least who assist with patient care and administrative tasks have considered leaving the workforce.
The combination of burnout and added stress of people leaving their jobs has worn down the health care workers the public often forgets about, said interventional radiology tech Joseph Brown, who works at outside Sacramento, California.
This has a domino effect, Brown said: More of his co-workers are going on stress and medical leave as their numbers dwindle and while hospitals run out of beds. He said nurses鈥� aides already doing backbreaking work are suddenly forced to care for more patients.
鈥淓xplain to me how you get 15 people up to a toilet, do the vitals, change the beds, provide the care you鈥檙e supposed to provide for 15 people in an eight-hour shift and not injure yourself,鈥� he said.
In Missouri, Tobler said his wife, Heliene, is training to be a volunteer certified medical assistant to help fill the gap in the hospital鈥檚 rural health clinic.
Tobler is waiting to see if the larger St. Louis hospitals lose staff in the coming weeks as their vaccine mandates go into effect, and what impact that could have throughout the state.
In the hard-hit southwestern corner of Missouri, CoxHealth president and CEO Steve Edwards said his health system headquartered in Springfield is upping its minimum wage to to compete for workers.
While the estimated $25 million price tag of such a salary boost will take away about half the hospital system鈥檚 bottom line, Edwards said, the investment is necessary to keep up with the competitive labor market and cushion the blow of the potential loss of staffers to the hospital鈥檚 upcoming Oct. 15 vaccine mandate.
鈥淲e鈥檙e asking people to take bedpans and work all night and do really difficult work and maybe put themselves in harm鈥檚 way,鈥� he said. 鈥淚t seems like a much harder job than some of these 9-to-5 jobs in an Amazon distribution center.鈥�
Two of his employees died from COVID. In July alone, Edwards said 500 staffers were out, predominantly due to the virus. The vaccine mandate could keep that from happening, Edwards said.
鈥淵ou may have the finest neurosurgeon, but if you don鈥檛 have a registration person everything stops,鈥� he said. 鈥淲e鈥檙e all interdependent on each other.鈥�
But California鈥檚 Brown, who is vaccinated, said he worries about his colleagues who may lose their jobs because they are unwilling to comply with vaccine mandates.
that health care workers complete their COVID vaccination shots by the end of September. The state is already seeing traveling nurses turn down assignments there because they do not want to be vaccinated, .
Since the mandate applies statewide, workers cannot go work at another hospital without vaccine requirements nearby. Brown is frustrated that hospital administrators and lawmakers, who have 鈥渮ero COVID exposure,鈥� are the ones making those decisions.
鈥淗ospitals across the country posted signs that said 鈥楬ealth care heroes work here.鈥� Where is the reward for our heroes?鈥� he asked. 鈥淩ight now, the hospitals are telling us the reward for the heroes: 鈥業f you don鈥檛 get the vaccine, you鈥檙e fired.鈥欌��
