HCW staffing crisis

[Corraleno]

1 hour ago, Frances said:

It’s the same feeling I have when I hear about unvaccinated people who aren’t subject to a mandate saying that no one can tell them what to do. Of course that is true, but it sure seems like a pretty immature way to view the overwhelming advice of medical and public health officials to get vaccinated.

The NYT did a short (7-8 minute) video piece called Dying in the Name of Vaccine Freedom. One of the people interviewed was a covid patient in an Arkansas hospital who, when asked why he didn't get the vaccine, literally said "Well I'm more of a libertarian, and I don't like being told what to do." He died a few days later, at the age of 53. Because nothing says "you're not the boss of me" like choosing to die a slow, painful, easily preventable, and totally pointless death. 

[KSera]

6 minutes ago, Corraleno said:

The NYT did a short (7-8 minute) video piece called Dying in the Name of Vaccine Freedom. One of the people interviewed was a covid patient in an Arkansas hospital who, when asked why he didn't get the vaccine, literally said "Well I'm more of a libertarian, and I don't like being told what to do." He died a few days later, at the age of 53. Because nothing says "you're not the boss of me" like choosing to die a slow, painful, easily preventable, and totally pointless death. 

I saw the same piece, and it was so sad. And what you say is what I can't get over. People think they are some how showing they won't be "owned" by holding out and not getting vaccinated, but in the end, it's the ultimate, most tragic owning of them by the politicians and conspiracy theorists who influenced them. They're dying for those people. Just awful 😞.

[Matryoshka]

4 hours ago, Fritz said:

You may be right that it is just the flu vax. I assumed that if you won't take one vax religious or medical reasons you would be exempt from others. I know I have heard some of them saying they won't be required to take the flu vax any more. I don't agree with mandates and would prefer that they, and all HCW, be allowed to make their own decisions regarding these vaccines. I feel like if they had not made the mandates that, in time, they may decide to get the vaccines. Now with exemptions in hand it's not likely. As far as you finding my views as a healthcare worker interesting. I don't think it's really my business whether or not my coworkers take the vaccine. I will be wearing my PPE all day every day anyway. It's worked well for me so far. No covid here.

Hm.  Since health care workers have been mandated to have all the other vaxxes for years, including the yearly flu shot, how can they suddenly claim a religious exemption when they've been fine with all the others.  As you say, if it's a religious thing they should either be all fine, or all not fine. You think they're going to en masse claim a brand-new relgious conversion?  To what religion would that be, anyway?  

They're not going to en masse get medical exemptions.  There just aren't that many people that need them for these vaccines, and you need an actual medical reason.  My kids have actual medical exemptions to some (but far from all!) other vaccines, but happily and without incident got vaccinated for Covid (as well as the other ones that aren't contraindicated for them).  Medical ex. are based on actual health issues and how different vaccines may or may not interact with them.  "I don't wanna" will not get you a medical exemption to a vaccine.

[Fritz]

15 hours ago, KSera said:

Same experience for one of my siblings (though not Stanford). So competitive (and don't get me wrong, it's wonderful to have highly competent nurses, but the pool of such people is higher currently than the number of spots available for them).

Aren't the HCW making that irresponsible decision the ones responsible for that, and not their employers for "making them" not get vaccinated by requiring the covid vaccine? That seems like the kind of response one would expect from a child ("You can't make me").

If someone is afraid of doing something mandating that they do it anyway doesn't seem like a good way to convince them to do so. Yes, I think it made them dig in their heels more. You may choose to judge them for that.

[Fritz]

11 hours ago, SeaConquest said:

The evidence is exactly the opposite. They've had almost a year to do the right thing. 5.2 billion shots have been given worldwide, enough to fully vaccinate 34% of the global population and yet these lunatics continue to prefer cattle dewormers and fringe conspiracy theories on YouTube to practicing evidence-based medicine. There have been tons of incentives to coax people, and it is insanity to keep doing the same thing over and over and expect different results while people are dying everyday and our healthcare system is collapsing. The carrots haven't worked; time for the stick. 

None of the HCW I know "prefer cattle wormers" or any of the other ignorant BS you have ascribed to them. 

[TechWife]

41 minutes ago, Fritz said:

If someone is afraid of doing something mandating that they do it anyway doesn't seem like a good way to convince them to do so. Yes, I think it made them dig in their heels more. You may choose to judge them for that.

If the HCW and support staff at the hospital where I volunteer decide to dig in their heels they will be fired unless they have a legitimate medical or religious objection. There is a review board that reviews all exemption requests and they make the decision as to whether or not the exemption will be granted. That is the same way all vaccines are handled. The deadline for immunization is set several weeks out & during that time occupational health is hosting several talks about the vaccine to educate anyone who wants more information. All hospitals within a one hour drive have adopted the same policy. This means not only will they lose their job, they also will not be able to get a job at another nearby hospital. 

[Fritz]

4 minutes ago, TechWife said:

If the HCW and support staff at the hospital where I volunteer decide to dig in their heels they will be fired unless they have a legitimate medical or religious objection. There is a review board that reviews all exemption requests and they make the decision as to whether or not the exemption will be granted. That is the same way all vaccines are handled. The deadline for immunization is set several weeks out & during that time occupational health is hosting several talks about the vaccine to educate anyone who wants more information. All hospitals within a one hour drive have adopted the same policy. This means not only will they lose their job, they also will not be able to get a job at another nearby hospital. 

I am aware of the protocol. I think you will see many new religious and medical exemptions given. 

[TechWife]

28 minutes ago, Fritz said:

I am aware of the protocol. I think you will see many new religious and medical exemptions given. 

I highly doubt it. There aren’t many medical reasons to decline, nor are there faiths that shun vaccination. The reason the review board is there in my particular instance is to cut through the crap. 
 

 

[SeaConquest]

On 8/30/2021 at 6:55 AM, Fritz said:

None of the HCW I know "prefer cattle wormers" or any of the other ignorant BS you have ascribed to them. 

Well, thank G-d for small favors. Calls to poison control have skyrocketed because of this Ivermectin nonsense. Good to hear your HCW friends aren't among that crowd. I do find it ironic, however, that I'm the ignorant one in this scenario, and the HCW refusing the vaccine are a-ok by your standards. But, whatever.

Edited September 3, 2021 by SeaConquest

[Dmmetler]

On 8/30/2021 at 9:37 AM, TechWife said:

If the HCW and support staff at the hospital where I volunteer decide to dig in their heels they will be fired unless they have a legitimate medical or religious objection. There is a review board that reviews all exemption requests and they make the decision as to whether or not the exemption will be granted. That is the same way all vaccines are handled. The deadline for immunization is set several weeks out & during that time occupational health is hosting several talks about the vaccine to educate anyone who wants more information. All hospitals within a one hour drive have adopted the same policy. This means not only will they lose their job, they also will not be able to get a job at another nearby hospital. 

At my child's college, permanent exemptions are running less than 1% of students and faculty. There are some short term exemptions due to things like recent COVID infection or recent arrival in the USA from a country that is not yet vaccinating young adults or does not have a WHO approved vaccine.  Religious exemptions require a religion that has a stated, practiced doctrine that does not allow vaccination. There aren't many faiths that fit that category. Medical exemptions would require having a reason to be unable to take ALL currently available in the US COVID vaccines, and the formulations are different, so the number of people who qualify for permanent exemptions from the vaccine are few and far between. 

 

 

[KSera]

1 hour ago, Dmmetler said:

Medical exemptions would require having a reason to be unable to take ALL currently available in the US COVID vaccines, and the formulations are different, so the number of people who qualify for permanent exemptions from the vaccine are few and far between. 

I read something from a hospital saying there were only two reasons for people to be medically exempt. I’m trying to find it again to see what the first one was. The second was a known allergy to a specific ingredient in the vaccine. I read another thing that said that other than a known allergy, there were no specific medical contraindications, and in fact most conditions that people might think would make it contraindicated are ones that doctors particularly think important for such people to be vaccinated. Such as People with cancer or who are immunocompromised. 
 

I’ve been looking for the specific thing that I was reading yesterday, but instead found a lot of other similar things but nothing quite as succinct. This one is the most succinct I found: 

https://dailynews.mcmaster.ca/articles/ask-a-mcmaster-expert-medical-conditions-and-covid-19-vaccine-exemptions/

“While there may seem like many vaccine exemptions, in reality there are very few.

Allergy to a component of the vaccine or allergy to the first dose of vaccine, while considered an exemption, can often be mitigated with the help of an allergist or immunologist.

Individuals who develop myocarditis (inflammation of the heart), Guillain-Barre Syndrome or Bell’s Palsy (inflammation of the nerves) after the first dose should not receive a second dose until better data becomes available. These are all incredibly rare side effects and are very unlikely to happen to the average individual.”

 

Apparently, there have been no reported cases of GBS in either of the mRNA clinical trials, and just one in J&J. It’s not considered a contraindication. Bell’s palsy has not been found to occur any more commonly than the rate expected and the general population and it’s also not considered a contraindication.

All that to say, it seems like there will be vanishingly few people who have an actual medical contraindication.

[Frances]

Unfortunately here it appears that the religious exemption is very broad and very general. As someone who is covered under one of the three vaccine mandates in my state, from everything I’ve heard the chances of having a religious exemption turned down are almost zero and basically anything goes. 
 

On the other hand, the medical exemption at least requires specific information about the reason for the exemption and the signature of a medical provider.

Edited September 2, 2021 by Frances

[TechWife]

7 minutes ago, Frances said:

Unfortunately here it appears that the religious exemption is very broad and very general. As someone who is covered under one of the three vaccine mandates in my state, from everything I’ve heard the chances of having a religious exemption turned down are almost zero and basically anything goes. 

Out of curiosity, do you know what body or bodies is/are making the decision on what qualifies as an exemption? Is it at the state, local or employer/school level? I think to get such a uniform response the decision would have to be fairly high level. I am just wondering if I'm going in the right direction with that line of thought.

[Frances]

46 minutes ago, TechWife said:

Out of curiosity, do you know what body or bodies is/are making the decision on what qualifies as an exemption? Is it at the state, local or employer/school level? I think to get such a uniform response the decision would have to be fairly high level. I am just wondering if I'm going in the right direction with that line of thought.

The mandate is from the state and primarily covers state and local government employee (executive branch employees and all k12 staff) plus healthcare workers (some of whom would also be government workers). So state agencies have developed forms and processes.  I’m guessing that a private employer such as a hospital or nursing home who already had a system in place for other vaccines could possibly interpret the religious exemption more narrowly, but I don’t know for sure.

I do know that outside of covid, we have a very broad and general non-medical exemption for other vaccines required for school attendance that covers religious, philosophical, and personal reasons. So again, basically anything goes unfortunately.

Edited September 2, 2021 by Frances

[kbutton]

https://www.kevinmd.com/blog/2021/09/physicians-have-gone-from-being-heroes-to-villains.html?fbclid=IwAR37_7RMcJ8wvrPKJFby9sikDyeqS3OlAzCL5xikUHtPrcfRpYYSEneO94I

Quote

Every day, I gently and patiently try to dispel misinformation one by one in discussions with my patients and their families. I try to share the AAP, CDC, MDH, etc. school recommendations with a school mom’s group in response to another post against safe return to school recommendations (only to be shut down and told it is inappropriate for a physician to share accurate medical data). I tell my patients that my family is vaccinated, including my older son, and as soon as it is available for my younger kids, they will be too. I explain why wearing a mask is a way their child can protect themselves and learn the valuable lesson of caring about and protecting the people around them. I took my son and my goddaughter to volunteer with me at community vaccine clinics, putting love of and service to our community in action. I try to explain complex scientific concepts in simple language to dispel the rampant misinformation circulating and keep people from accepting lifesaving preventative measures. I try to appeal to a sense of community by asking people to protect themselves and those around them.

In the end, though, I feel increasingly demoralized as I am buffeted by the epic storm of the dual pandemic – that of a deadly virus and deadly misinformation. Some days it feels like trying to bail water out of the Titanic with a teaspoon. Every day, it feels like we are losing the battle anew.

I am exhausted and sad and disappointed and discouraged.

I am losing faith in humanity. Where is the “love your neighbor as yourself”? Where is the willingness to help each other? Where is the solidarity of those first days? Physicians have gone from being heroes to being villains. We have dedicated decades of our lives to learning how to care for you, but now our knowledge and expertise are being thrown back in our faces as not good enough and not as believable as your cousin’s friend who saw something on social media.

It is hard to keep going. But we do. We keep going because we have dedicated our lives and careers to our patients. We follow our Hippocratic Oath, and we do the best we can for every patient no matter who they are, what they believe, or what choices they make. But many of us are barely clinging to our passion to serve.

 

[Carrie12345]

I just found out from dd#1 that her ambulance company isn’t mandating vaccines. I found out because she is now in quarantine for contact with a positive coworker. They’ve recently had 3 or 4 employees hospitalized for Covid (only 1 for more than a couple days.)   
Reason given is fear of people quitting.  

I can’t even be bothered to share my feelings about it. 

[Mrs Tiggywinkle]

1 hour ago, Carrie12345 said:

I just found out from dd#1 that her ambulance company isn’t mandating vaccines. I found out because she is now in quarantine for contact with a positive coworker. They’ve recently had 3 or 4 employees hospitalized for Covid (only 1 for more than a couple days.)   
Reason given is fear of people quitting.  

I can’t even be bothered to share my feelings about it. 

We have three current positives for Covid.  All those people are quarantining for ten days.  All 3 though were fully vaccinated and we’ve been told that if we were in contact with them we don’t have to quarantine if we’re vaccinated(we only have 1 employee holdout who isn’t, and she’s also an ER nurse, go figure).   But having 3 people out for ten days at an ambulance company that only has around 60 employees is a big deal, even if(fortunately) none of them are sicker than the common cold.
 
My bosses are finally starting to think what this is going to look like long term.  People get sick every year, of course, but they don’t miss almost two weeks of work usually.  It’s another aspect of Covid we never considered(I honestly think my bosses had put too much hope that fully vaxxed people wouldn’t catch Covid).  now that we know it does happen, they’re trying to figure out how the quarantines affect us long term.  It’s another aspect that a lot of people hadn’t considered.

[Faith-manor]

7 hours ago, Plum said:

I have questions for CA nurses. I’ve read some things and want to get some clarification.  
 

CA has the nations only nurse to patient ratio mandate. They were allowing hospitals to waive the ratios due to the emergency. Are those waivers still in effect? If so what happens when there are too many patients and not enough nurses? Do the nurses take the extra patient or are they left in the ED until a bed/nurse can be assigned? 
 

Also prepandemic were nurses sent home frequently because of low census numbers? Or furloughed? 
 

There was a bill introduced to Congress to mandate nurse to patient ratios except in cases of an emergency. It doesn’t sound like there is a plan to work on increasing capacity in nursing programs at the same time. Hospitals and other facilities would have a few years to comply (assuming covid doesn’t get in the way). But I would think they would already be increasing capacity in these programs. No? 

https://www.healthleadersmedia.com/nursing/congressional-bill-seeks-set-federal-nurse-patient-staffing-requirements

https://www.congress.gov/bill/117th-congress/senate-bill/1567/text#toc-HFCAC2FA1CFED4ED1AC9D3A35AAAD2500

https://calmatters.org/health/coronavirus/2021/08/california-nurses-shortage/

 

failing miserably at my board break…

I am in total agreement with these ratios. It will save lives, and it will also produce better long term outcomes for patients. But, without increased capacity in RN programs and tuition incentives/scholarships in order to fill those slots because it is NOT cheap to get a BSRN, I do not see how on earth it can be achieved in the next 5-10 years. We need to take the AMA and other organizations out of the driver's seat on this. We need docs, nurses, OR techs, respiratory therapists, you name it.  The situation is out of control, and too many qualified students cannot get into these programs. How do we, as everyday citizens, get this point across? I am at a loss.

[SeaConquest]

14 hours ago, Plum said:

I have questions for CA nurses. I’ve read some things and want to get some clarification.  
 

CA has the nations only nurse to patient ratio mandate. They were allowing hospitals to waive the ratios due to the emergency. Are those waivers still in effect? If so what happens when there are too many patients and not enough nurses? Do the nurses take the extra patient or are they left in the ED until a bed/nurse can be assigned? 
 

Also prepandemic were nurses sent home frequently because of low census numbers? Or furloughed? 
 

There was a bill introduced to Congress to mandate nurse to patient ratios except in cases of an emergency. It doesn’t sound like there is a plan to work on increasing capacity in nursing programs at the same time. Hospitals and other facilities would have a few years to comply (assuming covid doesn’t get in the way). But I would think they would already be increasing capacity in these programs. No? 

https://www.healthleadersmedia.com/nursing/congressional-bill-seeks-set-federal-nurse-patient-staffing-requirements

https://www.congress.gov/bill/117th-congress/senate-bill/1567/text#toc-HFCAC2FA1CFED4ED1AC9D3A35AAAD2500

https://calmatters.org/health/coronavirus/2021/08/california-nurses-shortage/

 

failing miserably at my board break…

So, these federal proposed ratios are actually better than what AB 394 requires in California.

This is our requirement:

https://www.nationalnursesunited.org/what-does-california-ratios-law-actually-require

The waiver was in effect earlier in the pandemic, but the Governor received a ton of pushback from the nursing unions for having done so, especially since we did not utilize all the Health Corps resources that were available, so the waiver was rescinded in Feb 2021.

https://www.nationalnursesunited.org/press/california-nurses-declare-victory-safe-staffing-standards

With the Governor facing a recall election, there has been zero discussion about reimposing the waiver. Without the waiver, hospitals bring in travel nurses to make up the difference in staffing. California pays a lot of money to nurses and is generally a nice place to visit, so we get lots of travelers who come for the great pay. I make double what a staff nurse in Florida or Texas makes and travelers can make 4X what a staff nurse makes. Add in our lower patient ratios and mandatory meal and rest breaks and it's not usually a hard sell.

No matter where you go, nurse staffing is always driven by the census. When some units were temporarily shut down, there were some crappy hospitals that furloughed nurses. They later regretted that decision when they opened back up and had a bunch of pissed off nurses. The better ones moved nurses around. 

But, the evidence is clear that better ratios save patient lives and reduce nurse burnout and turnover. California has paved the way with this legislation for years and I am shocked that no other state has followed our lead. Clearly, we need to do more to increase the pipeline of new nurses and there are many ways to do that. Hopefully, once we are out of the fog of war with this virus, we as a nation will take a serious look at the many issues with our healthcare system. We need a comprehensive overhaul. The nursing shortage is just one of so many things that we **must** address. 

 

Edited September 3, 2021 by SeaConquest

[TexasProud]

1. Just saying I feel so badly for all of the HCW...  Not fair. Not fair at all.

[katilac]

 

On 8/30/2021 at 9:37 AM, TechWife said:

  unless they have a legitimate medical or religious objection.  

I don't understand granting religious exemptions for anything related to public health. The chances of getting and/or spreading certain diseases are not changed by someone's personal beliefs. 

[Faith-manor]

1 hour ago, katilac said:

 

I don't understand granting religious exemptions for anything related to public health. The chances of getting and/or spreading certain diseases are not changed by someone's personal beliefs. 

Agreed.