Lack of a Vaccine Mandate Becomes Competitive Advantage in Hospital Staffing Wars

Yves here. We had warned that efforts to impose Covid vaccine mandates, as the Biden Administration has announced for nursing homes receiving Medicare and Medicaid funds, was certain to exacerbate existing staffing shortages. Hospitals have already suffered resignations of nurses and doctors due to burnout and their own fears of contracting Covid. One of our aides quit her job in a local hospital last month. Her floor supposedly had a specialized role, but she said the facility was fabulously disorganized so they got all kinds of patients.

Her floor was converted to a Covid floor: “Two cases the first day. Four the second, Eight the next. I could see where this was going. I resigned.”

This article is frustratingly misleading by omission on several issues. First it does not acknowledge weak efficacy of the existing vaccines against Delta infections, particularly after a few months (the vaccines do still appear to offer solid protection against hospitalizations until they start to wane, which again appears to be much sooner against Delta than the officialdom wants to admit). Second is that the CDC has stated that vaccinated Covid positive cases carry similar amounts of virus in their nasal passages. Viral loads for Delta are so high that later papers trying to argue the the virus in vaccinated patients is somehow less potent did not impress our GM: “Yeah, it got 2x more contagious, the vaccinated are only 1.8x more contagious, we are winning…”

That is a long-winded way of saying that having hospital staff vaccinated is a good idea…for them! Adequate staffing, high grade PPE, and negative pressure rooms are oddly being downplayed as important patient protections in these discussions. And hazard pay. Many hospitals are paying huge amounts for traveling nurses, when bonuses for working a certain number of days a month would keep at least some staffers from leaving.

And why is this article silent on why nurses, who by virtue of seeing how devastating Covid can be, should be in the front of the line to volunteer for getting vaccinated yet many still haven’t? This is a huge CDC failure and the article going soft by being complicit isn’t helping.

We reviewed in our post on the Biden Administration nursing home mandate why some staffers still have not gotten vaccinated. Recall that nurses and other support staff, like cooks and cleaners, are the backbone of hospitals, and they skew female and young. As we wrote:

Let’s look at a few of the cohorts that are on the vaccine hesitant to anti-vax spectrum that have good odds of quitting:

Reproductive age women who’ve heard of cases menstrual period disruption post vaccination. The CDC has simply ignored this issue, which doesn’t engender confidence in women who’ve heard about these problems. The lack of interest reeks of gender and class bias. Well off women could store their eggs before getting a shot and then get IVF later. Or they could afford a fertility doctor if they had issues, whether or not due to the vaccination. Lower income women don’t have these fallbacks.

And these changes are frequent enough to not be “rare” (like the roughly one in a million J&J blood clots) even if not common. And they are in many case alarming. From WBRC last month:

Katharine Lee noticed changes in her menstrual cycle not long after getting her COVID-19 vaccine….

“When we were going through ethics approval, Katie and I had a discussion about how many people we anticipated would participate and the number we put in was 500 and that was being optimistic,” said Kate Clancy, PhD, Director of Graduate Studies, Associate Professor of Anthropology, University of Illinois. “We hit 500 I think in the first couple of hours and in fact, were in the thousands within 24 hours.”

Their research survey launched a few weeks ago and has nearly 130,000 replies from women sharing their menstrual experiences after vaccination…

Among those people, just broadly what we can say, is for the most part their experience is that their period is heavier, but we do also see some people with lighter periods, and really the most important finding for us, is not just looking at the experiences of people who are currently menstruating, but looking at people who are not currently menstruating.”

Clancy said women who are on-long active contraceptives or women who are postmenopausal are reporting breakthrough bleeding.

Some experts (of course men!) have tried to depict these results as stress-driven, but stress if anything leads to late and/or light periods, not early and heavy ones. And since when do post menopausal women have heavy breakthrough periods?

Even some of our male readers have heard about this syndrome. From Isotope_C14:

With the quality of data being collected by CDC and VAERS I don’t know how any person could hang a flag to either side…

Anecdotally, all the girls that run the bar that I shouldn’t go to have incredibly whacked long-term symptoms. All of them are under 30. Most of them are having bizzare menstrual problems. One, who is utterly adorable and reminds me of a young Terry Farrell hasn’t had her time of the month in 55 days.

He also mentioned how odd it was to have women who were just a bit over half his age tell him about their periods, which he took as an indicator of how much it was on their minds.

Back to the current post. We’ve since heard of two cases who haven’t menstruated in months post vaccination. Their specialists don’t know what to do since their hormones look fine. Anecdata like that gets around.

The CDC should have gotten on top of this issue immediately and gathered data on prevalence, in particular how often this was happening and how quickly the irregular periods resolved, and how many had continuing issues. The CDC then could easily have put up comparative data on the odds of this result versus the odds of bad outcomes from getting Covid, not just death but all of the other types of damage, starting with long Covid, which appears to hit women more often then men.

Pretending that this isn’t happening only feeds distrust. As one hospital worker put it: “Most people who want to have kids will gladly tell the boss to take the job and shove it – and they are.”

By Lauren Weber, correspondent for Kaiser Health News, a former health policy reporter for HuffPost, and a 2017 USC Annenberg Health Journalism National Fellow. Originally published at Kaiser Health News

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 prices are steep — what he called “crazy” 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.

“If that becomes our differential advantage, we probably won’t have one until we’re forced to have one,” Tobler said. “Maybe that’s the thing that will keep nurses here.”

As of Thursday, about 39% of U.S. hospitals had announced vaccine mandates, said Colin Milligan, a spokesperson for the American Hospital Association. 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.

“Obviously, it’s going to be a real challenge for these small, rural hospitals to mandate a vaccine when they’re already facing such significant workforce shortages,” 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 almost 70% higher 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’ agency prominently displays the lack of a vaccine requirement for nurses on its job site, The Associated Press reported.

It all comes back to workforce shortages, especially in more vaccine-hesitant communities, said Jacy Warrell, executive director of the Rural Health Association of Tennessee. She pointed out that some regional health care systems don’t 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.

“They’re going to have to think twice about it,” Warrell said. “They’re going to have to weigh the risk and benefit there.”

The mandates are having ripple effects throughout the health care industry. The federal government has mandated that all nursing homes require covid vaccinations or risk losing Medicare and Medicaid reimbursements, and industry groups have warned that workers may jump to other health care settings. Meanwhile, Montana has banned vaccine mandates altogether, 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’s 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 one-third of health care workerswho 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 Sutter Roseville Medical Center 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’ aides already doing backbreaking work are suddenly forced to care for more patients.

“Explain to me how you get 15 people up to a toilet, do the vitals, change the beds, provide the care you’re supposed to provide for 15 people in an eight-hour shift and not injure yourself,” 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’s 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 $15.25 an hour to compete for workers.

While the estimated $25 million price tag of such a salary boost will take away about half the hospital system’s 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’s upcoming Oct. 15 vaccine mandate.

“We’re asking people to take bedpans and work all night and do really difficult work and maybe put themselves in harm’s way,” he said. “It seems like a much harder job than some of these 9-to-5 jobs in an Amazon distribution center.”

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.

“You may have the finest neurosurgeon, but if you don’t have a registration person everything stops,” he said. “We’re all interdependent on each other.”

But California’s Brown, who is vaccinated, said he worries about his colleagues who may lose their jobs because they are unwilling to comply with vaccine mandates.

California has mandated 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, CalMatters reported.

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 “zero covid exposure,” are the ones making those decisions.

“Hospitals across the country posted signs that said ‘Health care heroes work here.’ Where is the reward for our heroes?” he asked. “Right now, the hospitals are telling us the reward for the heroes: ‘If you don’t get the vaccine, you’re fired.’”

Print Friendly, PDF & Email


  1. The Rev Kev

    Those wealthier urban hospitals may be able to pay for new staff thus enabling them to implemented vaccine mandates at the moment but it would depend on a supply of medical staff who are either not worried about getting vaccinated, need the money too badly to resist or may be people who are not worried about having children. But if it comes out in general understanding that these vaccines have an effect on women’s reproductive systems, this situation could change rapidly.

    Another change that may appear may be more men working in this sector as reproductive worries may not phase them as they figure it does not effect them. But also they have the body mass to be able to cope with jobs like moving patients to toilets, moving them around without injuring themselves like could happen with their female counterparts.

    As the article says, adequate staffing, high grade PPE, and negative pressure rooms would go a long way in helping alleviate the worse problems but this is not being done. It would require structural changes to the system so what is happening is that this gap is being filled up with disposable people instead. Seen stuff like this before where instead of hiring a piece of gear to do a job they just use cheap workers to do the work because, well, they are cheap. Doesn’t even matter if the job is not done so well. Same thing here.

    1. d w

      i suspect it will be hard to determine the impact, since its likely that there is no data prior 2020 (we are still having trouble even getting all the data, since states collect it from counties, and they are required to always have a health department, nor are cities, and lots of them dont, so they dont supply data to the CDC, and that doesnt include some …states that actually sabotage the data to begin with) at least in the US. its really hard to tell if we have a problem if we dont have numbers that show how many problems were the ‘norm’

      and men may not care, even if it shown that the vaccines cause problems, because of the must do all my self of many (even its not true).

      course there are reports that many medical professionals are leaving because of covid (burn out, fear of the virus, etc), how many is any ones guess since we dont have pre 2020 numbers for that. and i would guess that the majority of US hospitals today are private, so adding staffing isnt what they want to do, and infrastructure changes (negative pressure rooms,etc) isnt the top of their goals, and high grade PPE, isnt either, and additional expense is how they would view it. so cheap labor (or free say when the states pay the employee aka national guard or military) will certainly be their first choice (since they will think this is a short term issue…..maybe…maybe not…viruses tend to last a long time). now almost all of these are US problems *though some are show u else where)

  2. m

    I was thinking about going to Montana for this very reason.
    As far as the vaccines go, many vaccinated covid + people are very angry and feel lied to. There are so many covid patients, but it is not like before when people died right away. The trouble now is weaning people off high oxygen-takes time and discharging people with a covid diagnosis is tricky.
    On a good note people that come to the ED positive are getting that antibody infusion, a few have returned for other reasons, no covid symptoms. I have seen quite a few that had Ivermectin scripts and when I asked if they tried it, many didn’t-negative stuff they heard on the news.
    With adequate staffing covid floors are the best to work on. Lost one of my jobs due to vacciine mandate, time to hit the road.

      1. m

        Got to watch out for these nursing agencies & the hospitals, these travel jobs like buying a used car. They pull all kinds of scams.
        Montana it is the law, for now, I am sure big pharm will spread money to get it overturned.
        No mRNA or spike type vaccine for me. Many of these vaccine side effects happen in the covid patients as well. Makes me wonder about that study out of CA on the spike protein. Clots and myocarditis.
        Last time I was in Montana, I think it was there, stayed in hotel that had tee pee tent like cabins.

  3. Skunk

    The gig economy is a big factor in this situation. Many workers in nursing homes are forced to hold multiple jobs and to move from one facility to another, transferring infection in the process. Of course, the nursing facilities would probably argue that they can’t afford to pay their workers higher wages or to offer more secure positions with sick pay, etc., but this is typically just a gig economy mantra. Does anyone know the profit margins for nursing homes? I don’t, but suspect that they could easily afford to offer their workers better pay and security. Just preventing the multiple-jobs scenario would go a long way toward reducing infections. If offered better jobs in exchange for vaccination, vaccination rates among staff would likely be higher. I think I’ve seen articles posted in NC that indicate many workers can’t afford to risk becoming sick for a few days after receiving the shots. Remedying these problems would help. Nursing home staff might be delighted to get vaccinated in exchange for decent jobs.

    1. d w

      i would think that nursing homes would be providing the vaccine (its free anyway) or actually offering a bonus to get it…which does seem to work fairly well. and they are subject to being sued if a resident dies, from covid, and they dont know if some one at their site had it.

      nursing facilities arent known for good pay, or environment. some of the assisted living facilities do. just not many

  4. Bob

    “That is a long-winded way of saying that having hospital staff vaccinated is a good idea…for them! Adequate staffing, high grade PPE, and negative pressure rooms are oddly being downplayed as important patient protections in these discussions. ”

    Not to disregard the importance of a vaccine, adequate staffing, high grade PPE (and plenty of it) nor to disregard questions of the nasty side effects of the vaccine however the question of building ventilation as a method of controlling the transmission of Covid really should be addressed.

    An item of interest is that the design of building HVAC systems is governed by building codes and these codes often follow ASHRAE guidelines which recommend that the outside air (fresh air) be limited to a set amount per occupant or about 15%. This means that except for special 100% outside air applications e.g hospital isolation rooms, special manufacturing processes, special storage areas and so forth HVAC systems are designed and sized for a limited amount of outside air. This means that it maybe difficult to introduce more fresh air since the systems as designed may not be physically capable of flowing more outside air..

    No doubt that better ventilation would be helpful but this is not be as simple as it seems.

    1. Yves Smith Post author

      We’ve already posted multiple times, and I am not tracking it down due to the hour, that you can create very high level filtration cheaply (under $30) using simple box fans and a high grade filter. In schools, counting the cost of replacing filters over the year, it’s been estimated at $7 a student. So you don’t have to go the high road to make a big difference.

      And more specifically, there are plenty of articles on how to create negative pressure rooms affordably, in older structures, even homes, without a major HVAC redo. Here is one example from a hospital:

      Agnotology, aka Making Shit Up, is a violation of our written site Policies. Please refrain from misinforming readers if you want to maintain your comment privileges.

        1. Societal Illusions

          and we are “in a pandemic” and liabilities haven’t been waived already for certain solutions deemed beneficial?

          1. d w

            i actually think the lack of liability waivers are the best for all, employers (who wants to work for one that doesnt care to at least have some sense of caring for their workers, and who want to go to a retail establishment that didnt at least seem to want a safe environment. and employers are already having troubles hiring staff today, with at least some sign of care for them.

        2. Yves Smith Post author

          Patients signs massive liability waivers when they walk in the door. If anyone is really worried about staff, tell them they’d need to sign a narrow one to get negative pressure rooms. I’m sure they’d agree.

  5. Henni

    All of our local staff (doctors, nurses, support staff) are on iMask+ protocol (see and none have gotten sick from covid-19. About 40% are vaccinated but remain on the therapeutic dosages of iMask+

  6. Rhondda

    This seems relevant, from MedPage Today, Aug 25.

    U.S. Healthcare Groups Urge Approval of International Nurse Immigration

    “As the nation’s nursing shortage balloons, the American Hospital Association (AHA) has teamed up with other organizations in campaigning for the State Department to expedite immigration approval for international nurses.

    At least 5,000 nurses from other countries have been approved to work in the U.S. and are awaiting immigration, according to campaign leaders, but their paperwork has been held up since they were designated a lower priority for visas in late April.

    After thus far failing to lobby the State Department to re-prioritize these visas, the AHA, the American Association of International Healthcare Recruitment (AAIHR), and staffing firm Avant Healthcare Professionals launched a campaign to apply pressure…”

    1. d w

      some how i dont think this work, since its not unusual for governments to not recognize its other licensing requirements.

    2. Phil in KC

      Sounds good for us in the the states. What about the rest of the world? Ghana, Peru, Belarus, Kazakhstan, and Indonesia will all need nurses too. Ultimately this is a global problem and nurses will be needed there. The virus is not aware of a nation’s GDP.

  7. Skip Intro

    I would find a better appearance of balance if the author had listed the CEO compensation of the interviewees as they talk about the ‘insane’ pay levels for nurses.

    And of course this little ‘big lie’ nugget had to be inserted:
    “Despite the scientific knowledge that covid vaccinations sharply lower the risk of infection”

    1. Samuel Conner

      > “Despite the scientific knowledge that covid vaccinations sharply lower the risk of infection”

      There are two possible interpretations of the semantics of “lower the risk of infection”

      * lower the likelihood that one becomes infected

      * reduce the likelihood of severe consequences of infection if one does become infected

      The vaccines do the second well; the first not so much. The wording is IMO ambiguous and I wonder whether that’s intentional.

  8. Cynndara

    Between the Israeli study showing that natural immunity from Covid-19 infection is 13-27X as powerful as that from the best vaccinations, and the acknowledgement that the vaccinated can not merely become infected, but may transmit that infection as easily as anyone else, it seems absurd to be mandating that healthcare workers — most of whom have already been thoroughly exposed to Covid-19 for the last year and a half — be vaccinated. They are merely adding to the labor shortage by doing this without any real addition to anyone’s safety, whether worker or patient.

Comments are closed.