Vaccine mandates kick in as hospitals struggle with staffing 

DOUGLAS BROWN, president of UMass Memorial Community Hospitals, put it bluntly: “We’re going through the worst staffing crisis in our history.” 

Yet, UMass fired more than 200 employees earlier this month, many of them working in clinical care. The reason: those employees did not comply with the health system’s mandate to get vaccinated against COVID-19. 

“The thought of having to terminate anyone or causing anyone to leave at this time was just really hard for us,” Brown said. But, he said, “We knew it was the right decision.” 

“We just felt like we really had a moral responsibility in light of what we knew about the science,” Brown said. “And because we were in health care, our patients would expect it.” 

A nationwide staffing shortage is hitting Massachusetts hospitals hard, at a time when demand for patient care is surging. Gov. Charlie Baker recently began requiring hospitals to cancel non-urgent procedures once they reached a threshold where they were short on hospital capacity. Many hospitals have done so. Hospitals have taken beds out of use due to insufficient staffing. Yet the staffing problems are coming at the same time as hospitals have been letting employees go due to vaccine mandates. 

Although the state does not require it and a federal mandate for health care workers is not yet fully implemented, virtually all Massachusetts hospitals are requiring their workers to be vaccinated against COVID-19. That puts hospitals in a tough spot, having to fire workers at the exact moment they need them most. 

Many hospital officials, however, say the vaccine mandates are not the major driver of staffing shortages. The number of employees fired is generally small, and other issues – burnout, retirements, a lack of traveling nurses, and high patient demand – are larger contributors. Officials say they believe the benefit of a vaccine mandate to patient and worker safety outweighs the cost in lost staff. 

Dani Hackner, chief clinical officer for Southcoast Health, said he has seen hospital systems have large numbers of staff call in sick or become exposed to COVID-19, and a vaccine mandate lowers the risk that the hospital will lose clusters of staff temporarily to illnesses and quarantines. “We could not afford that under these circumstances,” Hackner said, pointing to rising virus rates and low vaccination rates in surrounding Bristol County. 

President Biden instituted a national vaccine mandate for health care workers at facilities that participate in Medicare or Medicaid – essentially all Massachusetts hospitals – requiring workers to be fully vaccinated by January 4. The mandate was temporarily halted in November by a US District Court judge in Louisiana who imposed a nationwide injunction, but that injunction was lifted Wednesday by an Appeals Court for about half the country, including Massachusetts. 

The board of the Massachusetts Health and Hospital Association, a trade association representing the state’s hospitals, recommended as early as July that hospitals adopt a vaccine mandate. Some large health systems in Massachusetts – Baystate, Mass General Brigham, Trinity Health of New England – announced their intention to impose mandates this summer, though most only went into effect in the fall. Others came on board more recently, some after Biden announced the national mandate in early November.  St. Vincent Hospital, for example, which has struggled with staffing due to a lengthy nurses’ strike, began implementing its mandate when the federal rule was issued last month. 

The Massachusetts Health and Hospital Association does not keep track of how many employees were let go due to mandates, but Valerie Fleishman, senior vice president and chief innovation officer at the association, said hospitals have been preparing for the impact to their workforces. “The safety benefits of these protocols far surpass any complexities that they might bring, including the termination of a small percentage of health care professionals,” she said in a statement. 

Joe Markman, a spokesperson for the Massachusetts Nurses Association, said he does not know how many nurses were let go, but he too believes other factors are having a greater impact on staffing. They include pandemic-associated burnout and a staffing model pre-pandemic that did not build in flexibility to account for nurses who were out sick. He said many nurses are leaving the industry entirely or switching from hospital to agency work, where they can get more flexible shifts for higher pay. 

One of the earliest adopters of a vaccine mandate was Mass General Brigham, the largest hospital system in Massachusetts, which told employees in May that a vaccine mandate was coming once the shots were fully FDA-approved. 

Rosemary Sheehan, senior vice president of human resources, said when the Delta variant hit in late August, the hospital set an October 15 deadline for its workforce of 82,000 to become fully vaccinated or seek an exemption. Two weeks before the deadline, 5,000 to 6,000 people remained out of compliance. Sheehan said the hospital system spent a lot of time educating people about the vaccines, and making sure those who were vaccinated submitted information. 

Ultimately, Mass General Brigham delayed its deadline, telling employees that as long as they got their first shot by October 15, for those who got a two-dose regimen, they could continue working, assuming they got their second shot on schedule. Mass General Brigham ultimately fired 430 people across the system, or 0.5 percent of its workforce. Sheehan acknowledged that some additional people may not have interviewed for jobs there due to the mandate.  

Mass General Brigham has had to delay non-urgent procedures under Baker’s order. But Sheehan said the vaccine mandate is not driving the hospital’s staffing problems, which she attributes to a “perfect storm” of factors. She said there is not a robust pipeline of people entering health care, particularly in fields like laboratory science. Workers exhausted by the pandemic are retiring. Some non-clinical staff are opting out of health care for more flexible jobs, like driving for Uber or working for Amazon, and scientists can get paid more at pharmaceutical companies. Meanwhile, the demand for patient care is “sky high,” Sheehan said, primarily due to patients who deferred care earlier in the pandemic and now are sicker.  

While comprehensive data is not available, anecdotally the number of employees losing their jobs in health systems due to a vaccine mandate is significant, but represents a small percentage of total workforce.  

Boston Medical Center fired 104 employees out of 9,500. SouthCoast Health fired 216 employees out of 7,100. The approximately 200 workers who lost jobs at UMass Memorial represent slightly more than 1 percent of its workforce. Wellforce, the parent company of Tufts Medical Center, has said it fired 107 people, fewer than 1 percent of employees. South Shore Health fired nine people. Trinity Health of New England, the parent company of Mercy Medical Center, said only 0.3 percent of its workforce did not comply with its mandate. 

Several hospital officials said the firings tended to be spread across departments, in clinical and non-clinical positions. 

Hackner, of SouthCoast Health, said the health system closely monitored federal guidance, and also saw the impact of a lack of vaccination on staff in terms of illness and quarantines, before it moved forward with its mandate, which led to firings in early December. “We didn’t go ahead with it until we had guidance from the CDC that was strongly supportive of mandatory vaccination, and we were also supported by case law across the country,” he said. 

Hackner said the bigger impact on staff has been from other COVID-related causes. People have missed work because they or a family member were ill or quarantined. Traveling nurses and other temporary sources of labor have been less available. Some professionals who worked through the pandemic are burnt out and cutting back on extra shifts. Areas like food service are affected by a statewide worker shortage, leading the hospital to eliminate cafeteria food service in favor of “grab and go.” 

Brown, at UMass Memorial, said while the vaccine mandate affected the workforce, “it hasn’t been anything near the impact of just the environmental factors that are causing severe staffing shortage issues in our organization.” The organization typically has 400 open positions at any one time; it now has 600 to 700, with high turnover. Brown said the conditions health care workers are operating in are difficult – putting themselves at risk daily to care for patients, including patients who chose not to get vaccinated. Many older workers retired.  

Brown said the organization continually weighed the various factors in deciding whether to move forward with its vaccine mandate. “What we kept coming back to is we need to do everything in our power to protect the patients in our organizations,” he said. “If you’re choosing to work in health care and want to be employed in our organization, you have to have a fundamental belief in science and medicine, and everything we know about this vaccine is it’s safe and effective.”