Population Health

Understanding vaccine hesitancy of nurses

Image of a nurse in protective gearThe University of Washington Population Health Initiative led an interdisciplinary research team that completed a mixed methods study to understand changes in immunization rates and key drivers of vaccine hesitancy among nursing staff in the United States.

This study helped the team to produce observations about key drivers of vaccine hesitancy among long-term care (LTC) healthcare workers (HCW), and recommendations as to the type and format of interventions (e.g., educational training, public health mandates, workplace incentives, and so forth) that could most effectively combat vaccine hesitancy and build confidence for nursing staff and, in turn, their patients. For this study, HCWs in LTC include those currently working as Advanced Practice Registered Nurses (APRNs), Nurse Practitioners (NPs), Registered Nurses (RNs), Licensed Practical Nurses (LPN), or Certified Nursing Assistants (CNA) within the participating facilities. LTC facilities included skilled nursing facilities and nursing homes without skilled nursing.

This project had three focus areas:

  1. Identify nine representative counties from three states that have had the most significant achievement, least significant achievement and median achievement in COVID-19 vaccination rates and flu vaccination rates in the general populace over the past five years (2016 – 2021).
  2. Compare vaccination rates for nursing staff working at hospitals, clinics and nursing homes (skilled nursing facilities and residential facilities, including assisted living) with that of the local populace.
  3. Identify key drivers of vaccine hesitancy and what programs, policies, or practices have impacted vaccine confidence through a broad survey and focus groups.

Major findings from the study included:

  • Vaccine hesitancy among HCWs in LTCs is a complex issue influenced by several factors, specifically concern about side effects, vaccine safety, negative media/misinformation or not thinking the vaccine was needed (i.e., for influenza).
  • Qualitative focus groups revealed a spectrum of vaccine hesitancy among LTC HCWs, ranging from acceptance (i.e., willingness to take the vaccine and confidence in it) to outright refusal.
  • Effective interventions to reduce HCW vaccine hesitancy included educational campaigns, onsite vaccination and receipt of vaccine recommendations from trusted nursing staff.
  • The study highlights the moral and ethical responsibility of LTC HCWs for protecting residents. Vaccine hesitant HCWs should consider their legal, moral, and ethical responsibilities and reevaluate their reasons for vaccine hesitancy.
  • Future vaccination efforts should include more resources and cross-sector partnerships for LTC facilities to implement multifaceted interventions while reducing the additional burden on already-taxed LTC facilities.
  • The need to understand and address vaccine hesitancy among LTC facilities is crucial to protect residents. LTC facilities should implement strategies such as vaccine education, onsite vaccinations and involving trusted healthcare professionals to address vaccine hesitancy and ambivalence. Collaborating with community partners for interventions can also help improve vaccine uptake.

We believe the findings of this project will support LTC, policy makers and other key partners in understanding key drivers of vaccine hesitancy among nursing staff in hospitals, clinics and nursing homes; which types of interventions most effectively combat hesitancy and build confidence in vaccinations; and, identify if any of those interventions could provide transferrable benefits for general community vaccine confidence.

The UW project team includes faculty, students and staff from the Center for Health Workforce Studies, School of Medicine, School of Public Health and Population Health Initiative.

Read the Final Report

Funding Acknowledgement

This study was funded by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MISP Reference Number 100809).