The American Association of Colleges of Nursing (AACN) has been awarded $1 million in funding from the Centers for Disease Control and Prevention (CDC) to launch a new initiative titled Building COVID-19 Vaccine Confidence Among Nurses and in Communities. Although COVID-19 vaccines have been widely available for more than a year, only 64% of the US population is fully vaccinated. As part of this project, AACN will award funding to 10 schools of nursing nationwide to launch targeted campaigns to build confidence in the COVID-19 vaccines and dispel health misinformation.
AACN President Deborah Trautman, PhD, RN, FAAN.
Throughout the pandemic, nurses have played a leading role in confronting this public health crisis and keeping communities safe,” said AACN President and Chief Executive Officer Deborah Trautman, PhD, RN, FAAN. “Through our new cooperative agreement with the CDC, AACN will provide guidance and support to amplify the efforts underway at nursing schools to overcome vaccine hesitancy, strengthen community partnerships, and share the latest evidence to help individuals make the smart choice when it comes to protecting their health.”
This initiative was developed to help nursing school faculty and students have effective conversations about COVID-19 vaccinations to boost consumer confidence. Participating schools of nursing will undertake a variety of education and outreach activities to reach individuals and populations at risk. These activities include engaging with faculty and staff on how best to share credible COVID-19 vaccine information and respond to misinformation (including on social media); developing learning resources and nursing curricula to improve vaccine confidence; and connecting with health departments and community organizations to reach target populations.
Following a call for letters of intent issued last fall, AACN has identified 10 schools to participate in this important work:
Emory University Nell Hodgson Woodruff School of Nursing (GA)
Fayetteville State University School of Nursing (NC)
Tennessee Tech University Whitson-Hester School of Nursing (TN)
The University of Alabama Capstone College of Nursing (AL)
University of Houston College of Nursing (TX)
University of Missouri Sinclair School of Nursing (MO)
University of Pennsylvania School of Nursing (PA)
To support the work underway at the local level, AACN will provide technical assistance, including strategic guidance and communication support in the form of training, message development, social media outreach, and video production in collaboration with our partners at AACN-TV. This work includes gathering vaccine confidence “success stories” and disseminating these broadly to all nursing schools and healthcare institutions. AACN will create a central online clearinghouse to highlight the work of participating schools, post videos from the funded sites, and share learnings and best practices with the higher education and healthcare communities.
For more information on this project, please contact AACN’s Chief Academic Officer, Dr. Joan Stanley at [email protected].
The American Association of Critical-Care Nurses (AACN) has created a guide to help those who have been vaccinated to engage in constructive conversations with family members and friends who are hesitant about the vaccine. The toolkit is part of AACN’s Hear Us Out campaign to report nurses’ reality from the front lines of the COVID-19 pandemic and urge those who are unvaccinated to reconsider.
“COVID-19 is still here. The majority of patients with COVID we’re seeing in ICUs haven’t been vaccinated, and their journey often ends with a nurse holding their hand as they die,” said Beth Wathen, AACN president and a clinical practice specialist in Denver. “Nurses need allies to end this pandemic, and productive conversations about the vaccine among family, friends and those who trust each other can open minds.”
The toolkit includes tips to help individuals prepare for potentially challenging conversations and talk with those who hesitate to get vaccinated. It provides resources to continue the conversation, including tip sheets, links to trusted information sources, short videos of nurses sharing profound experiences of taking care of unvaccinated patients with COVID-19 and more to help keep talking with people about the importance of getting vaccinated.
“This toolkit offers straightforward tips to keep sensitive conversations from becoming confrontational,” said Stephanie Burdick, a community health strategist in Salt Lake City. “It fills a critical gap in community health education as the public prepares to celebrate the upcoming holidays with friends and loved ones.”
A recent AACN survey of more than 6,500 acute and critical care nurses found that 76% of respondents say that people who have yet to be vaccinated threaten nurses’ physical and mental well-being. It also found that 92% of nurses surveyed said they believe the pandemic has depleted nurses at their hospitals and, as a result, their careers will be shorter than they intended.
“We know that people in communities with low vaccination rates are at greater risk for becoming seriously ill with COVID-19 and dying from what is now largely a preventable disease,” said Amanda Bettencourt, AACN president-elect and an assistant professor in Philadelphia. “The pandemic has brought the nursing profession into crisis, and the public is a critical part of the solution. The fastest way out of this is by more people getting vaccinated.”
To learn more about how AACN is helping Americans have informed and constructive conversations about the decision to be vaccinated, visit hearusout.com.
New data from the Texas health department released on November 7 proves what health officials have been trying to tell vaccine-hesitant Texans for months: The COVID-19 vaccine dramatically prevents death and is the best tool to prevent transmission of the deadly virus.
“We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
—Dr. Jennifer A. Shuford, state epidemiologist
Out of nearly 29,000 Texans who have died from COVID-related illnesses since mid-January, only 8% of them were fully vaccinated against the virus, according to a report detailing the Texas Department of State Health Services’ findings.
And more than half of those deaths among vaccinated people were among Texans older than 75, the age group that is most vulnerable to the virus, the study shows.
“We’ve known for a while that vaccines were going to have a protective effect on a large segment of our population,” said Dr. Jennifer A. Shuford, state epidemiologist. “By looking at our own population and seeing what the impact of the vaccines have been on that population, we’re hoping just to be able to reach people here in Texas and show them the difference that being fully vaccinated can make in their lives and for their communities.”
The state health department study covers most of the positive cases and COVID-19 deaths reported in Texas among residents from Jan. 15 to Oct. 1. It’s the first time state officials have been able to statistically measure the true impact of the vaccine on the pandemic in Texas — which has one of the highest death tolls in the nation. The majority of Texans ages 16 and up didn’t become eligible for the vaccine until late March.
State health officials also found the vaccine greatly reduced the risk of virus transmission, including the highly contagious delta variant that ravaged the state over the summer.
Only 3% of 1.5 million positive COVID-19 tests examined since mid-January occurred in people who were already vaccinated.
State researchers matched electronic lab reports and death certificates with state immunization records and measured cases and deaths since mid-January, a month after the first shots were administered in Texas.
The study was done using data similar to those used by other states that conducted similar studies and methods recommended by the U.S. Centers for Disease Control and Prevention, Shuford said.
And while the outcome was not particularly surprising, Shuford said, officials hope that the new data will increase trust in the benefits of the shot.
“Texas is a unique place; it’s got a lot of diversity, geographic and population-wise,” Shuford said. “We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
In Texas, it literally requires a disaster — like a pandemic — before the state records precise information about vaccinations. As a result, there is a record for every single COVID-19 vaccine dose of the name and age of the person who received it plus the date it was administered. Normally, vaccination records are shown to schools by parents, but details of all vaccinations are not regularly kept by a state registry in Texas, unlike nearly every other state, because it’s a voluntary system.
However, state officials still don’t have official numbers on how many vaccinated people were hospitalized with COVID-19 because hospitals are not required to report that level of data under state law.
But the state’s largest hospital districts and counties have reported that at least 90% of the hospitalized Texans with the virus were unvaccinated.
The state’s new health data comes as Republican state leaders grapple with local cities and school districts about masking, which has been proven to reduce transmission of the virus, and with federal officials over vaccine mandates.
About 53% of the Texas population is fully vaccinated. More than 70,000 Texans have died from COVID-19 since the pandemic began.
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Mandi Cai contributed to this report.
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With the FDA approval of the Pfizer-BioNTech vaccine and the continued surge of the delta variant, governments across the world have renewed their push to increase the number of vaccinated individuals by persuading the holdouts. On Sept. 9, 2021, President Joe Biden announced sweeping vaccine mandates, expressing frustration at the vaccine holdouts: “We’ve been patient, but our patience is wearing thin. And your refusal has cost all of us.”
As a communication scientist who has studied the effects of media and health campaigns for the past 30 years, I worry that a fevered pitch in vaccine messaging may make the holdouts even more resistant. The direct, blunt messages to go get vaccinated that worked on three-quarters of Americans may not work for the remaining one-quarter. If anything, they might backfire.
Research has shown that some health communication techniques work more effectively than others depending on the audience. It’s a lesson that not only policymakers can apply but also members of the media, industry and even parents and relatives.
When it comes to embracing new ideas and practices, research has identified five categories of people: innovators, early adopters, early majority, late majority and laggards. With COVID-19 vaccination, it’s come down to the last two, and they are the most resistant to change.
Do experts have something to add to public debate?
We think so
This group of unvaccinated people is substantial in number – there are nearly 80 million people in the U.S. who are vaccine eligible yet remain unvaccinated – and they are the ones who could help the U.S. achieve herd immunity. But, research suggests that they are also the ones who will take offense at forceful exhortations to go get vaccinated.
Strong messaging can backfire
Public health messaging can and does often influence people – but not always in the intended direction. Back in 1999, I testified in the U.S. Congress about how powerful anti-drug messages may be turning adolescents on to drugs rather than off of them. Likewise, the strong language of current vaccine messaging may be evoking resistance rather than compliance.
Consider this headline from a recent New York Times editorial: “Get Masked. Get Vaccinated. It’s the Only Way Out of This.” This follows 18 months of public-health messaging urging people to stay home, wash hands and maintain social distancing.
They may be well intentioned, but research in health communication shows that such directive messages can be perceived as “high threat,” meaning they threaten the free will of the message receiver by dictating what they should do. They are likely to trigger what psychologists call “reactance”. In other words, when individuals sense a threat to their freedom of action, they become motivated to restore that freedom, often by attempting to do the very thing that is prohibited or by refusing to adhere to the recommended behavior.
Recent research by my communications colleagues at Penn State shows that even advertisements that include directive slogans such as “No Mask, No Ride” – from Uber – and “Socialize Responsibly to Keep Bars Open” – a Heineken message – can irritate consumers and make them less likely to engage in responsible behaviors.
Reactance to COVID-19 messaging is evident in the form of widespread protests around the world. Many have gone to the streets and social media, with slogans such as “my body, my choice,” “let me call my own shots” and “coercion is not consent.”
These responses demonstrate not simply hesitation to get vaccinated, but rather active resistance to vaccine messaging, reflecting an effort to protect personal agency by asserting one’s freedom of action.
Flipping the script
Freedom is a critical concept in the anti-vaccination rhetoric. “Freedom, not force” is the battle cry of the protesters. “If we lose medical freedom, we lose all freedom,” reads a poster. “Choose freedom,” urged Sen. Rand Paul in a recent op-ed expressing his resistance to mask mandates and lockdowns. “We will make our own health choices. We will not show you a passport, we will not wear a mask, we will not be forced into random screening and testing.”
One way to counter such reactance is by changing the communication strategy. Health communication researchers have found that simple changes to message wording can make a big difference. In one study by my Penn State colleagues who study health persuasion, the researchers tested participants’ responses to sensible health behaviors such as flossing: “If you floss already, don’t stop even for a day. And, if you haven’t been flossing, right now is the time to start. … Flossing: It’s easy. Do it because you have to!” Study participants reacted to such messages by expressing their disagreement through anger and by defying the advocated behavior.
But then the researchers reworded the same advocacy to be less threatening, such as: “If you floss already, keep up the good work. And if you haven’t been flossing, now might be a good time to start.” And “Flossing: It’s easy. Why not give it a try?” They found that the participants’ reactance was significantly lower and their message acceptance higher.
In the same way, softening the message and using less dogmatic language could be the key to persuading some of the unvaccinated. This is because suggestive, rather than directive, messages allow room for people to exercise their own free will. Studies in health communication also suggest several other strategies for reducing reactance, ranging from providing choices to evoking empathy.
Bandwagon effects
Perhaps more important – given people’s reliance on smartphones and social networking – is to make better use of the technological features of interactive media, which includes websites, social media, mobile apps and games. Clever use of digital media can help convey strong health messages without triggering reactance.
Research in our lab shows that people’s responses to media messages can be influenced by the approval of anonymous others on the internet, in the same way that consumers rely on other people’s opinions and star ratings for making purchasing decisions online. In a recent study, we discovered that freedom-threatening health messages can be made more palatable if they are accompanied by a large number of likes on social media from other people. When a lot of others were seen as supporting the advocacy message, the forceful language did not seem any more threatening to their freedom than the gentler version.
In other words, we found that the number of likes has a strong “bandwagon effect” in reducing reactance. We also discovered that providing an option to comment on the health message imbues a higher sense of personal agency and greater acceptance of the message.
In another recent experiment, we found that customization, or the ability to tailor one’s phone or online site to one’s liking, can also aid health communication. Whether it is a phone app, dating site or social media feed, customizing a digital space allows people to reflect their personality. Seeing a health advocacy message in such a personalized space does not pose as much of a threat in such venues because people feel secure in their identity. We found that customization helps reduce negative reactions to health messages by increasing one’s sense of identity.
A communication strategy that is sensitive to psychological reactance could empower the holdouts to willingly get vaccinated instead of grudgingly comply with a mandate.
About 40% of Texas nursing home workers are unvaccinated and could face dismissal or quit their jobs under a federal vaccination requirement for the industry..
Texas nursing homes, crippled by a pandemic that ravaged their residents and decimated their workforce, are asking the state for $400 million in federal coronavirus relief to address a staffing crisis in the system that cares for the state’s oldest and most fragile residents.
Industry advocates fear the federal vaccination mandate could mean the potential exodus of tens of thousands of workers from facilities across the state before Halloween.
“We know we are going to lose additional staff when that vaccine mandate comes out,” said Becky Anderson, head of clinical operations for Focused Post Acute Care Partners, which runs 31 nursing homes and employs about 2,500 workers in Texas. “We just have some staff that are very adamant that they will not get the vaccine.’”
The federal rule comes at a time when the industry is already struggling with a shrinking workforce due to burnout, low pay, increased expenses related to the pandemic, and competition from other health care providers, administrators say.
Gov. Greg Abbott has vowed to fight any vaccine mandates in Texas.
According to recent surveys by the Texas Health Care Association and LeadingAge Texas, two nursing home industry groups in Texas, facilities across the state have seen a 12% decrease in their workforce in the last year. At least one-third of survey respondents are turning away new admissions due to staffing shortages, the survey says.
For the facilities, staffing shortages mean higher costs for overtime and an inability to grow or maintain patient population levels. Facility operators are also facing a pressing need for higher salaries and more money for recruiting tools, industry advocates said.
“The environment providers are operating in today isn’t sustainable,” said George Linial, president and CEO of LeadingAge Texas. “Texas cannot continue to kick this can down the road. A strong commitment and investment by lawmakers will pay huge dividends for the people we serve.”
However, it does not appear that help from Texas officials, either with emergency funding or staff, is imminent.
There is no bill filed in the current special session of the Legislature, which ends in just over two weeks, that would funnel any relief funds to nursing homes.
Texas has about $16.7 billion in American Rescue Plan Act money, and about $7.2 billion is marked in legislation to shore up the state’s unemployment fund, which was overloaded last year by record claims.
The funding request by the nursing homes includes $400 million to help recruit and retain workers, and an additional $350 million to pay for new infection-control measures and maintain them permanently for future crises.
For the remaining $8.5 billion available, requests from everyone else outside the nursing home industry amount to nearly eight times that much, budget officials say.
The nursing homes’ effort to get that funding has not gotten very far, sparking industry concerns that nursing homes will start shutting down.
Already, the nursing home workforce crunch is forcing admission caps, which is having a ripple effect on hospitals that are already at capacity with COVID-19 patients. With nowhere to transport patients well enough to leave a hospital but still too ill to go home, hospitals are now often required to house patients longer than they would have if they’d had a nursing home spot available, said Kevin Warren, president and CEO of the Texas Health Care Association.
It has also placed more burdens on families that may not be equipped to care for an aging relative much longer or older Texans whose medical needs are best met in a skilled nursing facility rather than through costly home care, he said.
“I am concerned that without additional funding necessary to recruit and retain current staff and develop opportunities to bring new employees into the profession, we will see continuously increasing access-to-care issues with expanding admission restrictions, closures, small independent owners being forced to sell, and bankruptcies,” Warren said.
Meanwhile, New York state lawmakers are considering sending medically trained National Guard members to fill vacancies in struggling nursing homes. So far, there are no similar plans underway in Texas to use the military branch to supplement staffing in any of the state’s 1,200 nursing homes.
A spokesperson for the Texas Division of Emergency Management, which oversees the state guard, referred questions about potential help for nursing homes to the Texas Department of State Health Services.
A DSHS spokesperson said that nursing homes with staff who are out sick with COVID-19 or that are overwhelmed with COVID patients can ask the state for help, but the facilities aren’t reporting high numbers of active cases.
While Texas has paid for thousands of relief workers this summer to send to hospitals that are struggling with a similar staffing crisis, Abbott has not announced a similar program for nursing homes.
In an effort to reduce the deadly impact of the virus, both state and federal governments imposed stringent safety mandates on nursing homes that changed daily, sometimes hourly, at the height of the pandemic last year.
The homes struggled to supply tests and personal protective equipment to staffers at their own expense, and some made extensive modifications to their air filtration systems, their building layouts and their staffing plans to respond to the health crisis.
Meanwhile, the cost to run a Texas nursing home has risen dramatically during the pandemic. Safety protocols and the ongoing staffing problems have meant budgets for Texas nursing homes have risen by 25% in the past 18 months, according to the survey released on Tuesday.
And even more trouble lies ahead. About 75% of Texas nursing homes are operating at a loss, the THCA/LeadingAge survey said.
Staffing challenges
These staffing challenges at nursing homes are not limited to lower-paying or entry level positions. Every one of the 31 facilities run by Focused Care in Texas has openings, and the vacancies go all the way to the top, Anderson said. Three facilities have no administrator, and another handful are without a director of nursing, she said.
Bonuses for referring new employees and extra shifts can help attract and retain staff, but about 90% of nursing home residents use Medicaid or Medicare, which keeps budgets limited and pay for most entry-level positions between $10 and $15 an hour.
There is also a shortage of applicants for work that was already difficult and now that work comes with the extra safety requirements and gear needed to treat a COVID-19-susceptible population. Any new worker finds themself working longer overtime hours because of the hiring shortfalls and all of that contributes to employees quitting within a month or two of being hired, she said. The problem has gotten so bad that the company is updating its orientation program to find a way to better prepare new hires for the difficult environment, Anderson said.
The high turnover, especially among new hires, “is quite alarming,” she said. “It’s always been hard work, but it’s even harder now with everything going on, and just the exhaustion.”
Vaccine woes
According to the U.S. Centers for Medicare and Medicaid Services, about 65% of nursing home staff are currently vaccinatednationally. A recent rise in cases among nursing home residents, both in Texas and across the country, driven by the highly contagious delta variant, prompted the federal agency to announce in August that all nursing home employees be vaccinated in order for their facilities to continue participating in the Medicare and Medicaid program.
Those rules are expected to come out later this month.
Anderson is casting an anxious eye on that moment, when potentially 40% of her workforce could become ineligible for employment.
About 62% of the staff and 81% of the residents in Focused Care facilities across Texas are vaccinated, Anderson said.
But while the rates of resident vaccinations are fairly high across the system, they range widely among the staff depending on the facility, state numbers show.
Statewide, the vast majority of nursing homes that have fewer than 40% of their staff fully vaccinated are located in rural areas — mainly east Texas, where counties have some of the lowest vaccination rates in the state.
By contrast, most of the nursing homes with more than 90% of staff vaccinated are in the Rio Grande Valley and in El Paso, which have some of the highest vaccination rates in the state.
Warren, the head of the nursing home advocacy group THCA, said that while administrators work every day to convince their staff to get vaccinated, it is a near-impossible task to move them off the belief system that causes them to reject or fear the vaccine even though it’s free and widely available.
Much of it, he said, has to do with where they live.
“There is that relationship between the vaccine rates within the community and within the facility,” Warren said. “When folks in these facilities are working 8, 10, 12 hours a day, on their days off, they’re spending time with their families and friends in the community. So if that same prevalence of concern and distrust of the vaccine is present in that community, it’s only furthering their own hesitation.”
