When the COVID-19 vaccine first became available in December 2020, hospitals and healthcare workers were on the front lines in their communities administering the vaccine to those who were most vulnerable. Today, hospitals and health care providers continue to lead the way as we learn more about COVID-19 and its communicability among the vulnerable and unvaccinated populations.
Hospitals must remain prepared to respond to the unpredictable patterns of transmission and infection of individuals that may require hospitalization. Therefore, it is critical for hospitals to maintain an adequate and healthy workforce to provide the needed care and treatment within their communities.
This FHA COVID-19 Resource Guide is a compilation of information intended to support member hospitals with guidance, resources, and tools that will assist with efforts in developing supportive policies and best practices that will build confidence and increase uptake for COVID-19 vaccination among the healthcare workforce.
COVID-19 Vaccine Strategies to Increase Vaccine Uptake:
Leadership— Organizational leaders play a critical role in promoting and/or providing the COVID-19 vaccine to their staff and employees. Here are some tips on how to encourage vaccine uptake in the organization.
Leadership should:
Encourage staff to get vaccinated against COVID-19.
Pledge to get vaccinated if they haven’t already.
Send a company-wide email or memo encouraging vaccination.
Consider hosting an educational session or town hall.
Identify vaccine champions who lead by example to share their story and the importance of vaccination.
Lead with empathy, listen openly to concerns, and be respectful and non-judgmental when addressing staff and employees’ questions regarding COVID-19 vaccination.
Communication and Education – Education is an important component for addressing vaccine hesitancy and several factors must be considered in planning an informative approach sensitive to staff understanding and perceptions about the COVID-19 vaccine.
Distribute COVID-19 vaccine resources to your staff and employees and encourage staff to learn more about the vaccine. The CDC and Florida DOH have developed several COVID-19 vaccine resources that can be used to promote vaccines at your facility. These toolkits/resources will help your organization educate employees about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns. These toolkits/resources can be accessed at:
Supportive policies and practices - In health care, many are evaluating strategies to encourage or consider a mandate of vaccination of the workforce. It is important to be thoughtful in designing effective communication, education and policies that will support this objective.
Employers can take several steps to help employees access vaccines and demonstrate support for vaccination:
Providing paid time off and help with transportation to get vaccinated in the community
Offering vaccination at the worksite
Providing flexible, non-punitive sick leave options (e.g., paid sick leave) for employees with signs and symptoms after vaccination
Issues to Consider When Establishing Vaccine Policy:
Occupational Health
Vaccination Status
Hospitals that require COVID-19 vaccination can ask that employees verify they have received the vaccine. If an employee cannot provide verification of vaccine status, they can be subject to the conditions of the hospital’s vaccination policy unless they meet exclusionary criteria. If exclusionary criteria are met, the hospital must evaluate and offer reasonable accommodation unless the employee asks for an accommodation under the ADA or Title VII.
A hospital that does not require employees to be vaccinated may inquire about vaccine status if it has a legitimate business interest in doing so. For example, if the hospital’s policy allows vaccinated staff to congregate unmasked in breakrooms, it may ask employees to log their vaccine status with their supervisor or human resources. When vaccination is voluntary, management should be cautious when asking questions beyond whether the individual has received the vaccine. Because the vaccine is not required, asking an employee why he or she elected not to be vaccinated could elicit information about an employee’s disability, which violates the ADA.
Hospitals are expected to monitor and enforce their adopted vaccination policies and may include a requirement that vaccinated staff can be easily identified (ex. badge sticker). This can help to consistently ensure that staff is adherent to hospital policies related to masking, social distancing, or reasonable accommodations that were put in place for the employee.
Employee Vaccination Records
Best managed through human resources process.
Medical information associated with the screening, verification and administration of the vaccine is confidential.
Human Resources
EEOC – The Equal Employment Opportunity Commission issued guidance to employers considering COVID-19 vaccine requirements. An employer may mandate staff be vaccinated but must comply with the Americans with Disabilities Act and Title VII of the Civil Rights Act.
EEOC guidance confirms that vaccine administration is not considered a medical exam, but screening questions asked prior to vaccine administration may incidentally elicit information about an employee’s disability.
Employers that mandate and administer vaccines must adopt a policy that validates vaccine screening and verification are “job-related and consistent with business necessity.”
The hospital can impose the conditions of its vaccination policy if an employee refuses to answer the screening questions and is determined to pose a direct threat to workplace health and safety if it cannot be determined whether an employee is vaccinated.
When vaccination is voluntary, the employer does not need to justify screening questions. However, if an employee chooses not to participate in voluntary vaccination programs, the hospital must follow their policies as it relates to no retaliation. Individuals who do not get vaccinated because of a disability or sincerely held religious belief may be entitled to reasonable accommodation.
Religious Exemptions - The employer must establish an objective basis for requesting documentation for a religious exemption, for example, it is known that the staff member has accepted other required vaccines such as the flu vaccine.
the EEOC does not require that an employer request or insist upon documentation from the clergy. It is acceptable to have documentation from a third party with knowledge of the individual’s belief.
Diversity, Equity, Inclusion
Americans with Disabilities Act - The ADA restricts an employer’s ability to require medical exams or ask employees about existing disabilities. The workplace policy can require that employed individuals adhere to organizational policies and practices to ensure that staff “shall not pose a direct threat to the health or safety of individuals in the workplace”.
When an individual declines vaccination for disability-related reasons, the employer must evaluate and offer a reasonable accommodation. The request should be consistent with any other accommodation request for information and may include the following:
Documentation from a health care provider describing the nature of the disability
How it affects one or more major life activities and prevents the individual from receiving the vaccine, and
Whether the condition is permanent or if the employee can be vaccinated in the future.
Title VII, Civil Rights Act
Collective Bargaining - Employees who oppose vaccine requirements may be more inclined to seek unionization. Under Section 7 of the National Labor Relations Act, employees have the right to engage with one another to discuss the terms and conditions of employment.
In the context of vaccines, employees have the right to protest an employer’s vaccine requirement (or the lack of one) without fear of reprisal.
If the employer is subject to a collective bargaining agreement, the language of the CBA will dictate whether the employer may unilaterally require vaccination.
Hospitals with a union presence should consult the specific language of their CBA to determine if the right to unilaterally impose workforce safety policies, such as mandatory vaccination, has been conferred to management.
It is likely in many circumstances that not all employees will be unionized in a hospital. The employer may initially be mandating vaccine requirements for nonunion employees only. In that case, the hospital also may impose safety measures in accordance with current infection prevention guidelines for vaccinated and unvaccinated staff. While this may be appropriate as an incentive to improve vaccination uptake of union staff, use caution to minimize the perception of coercion and/or discrimination against those with legitimate reasons to decline the vaccine.
Regulatory
In its Final Rule for Hospital Inpatient, Long-Term Care Hospital, Skilled Nursing Facility, Inpatient Rehabilitation Facility, and Inpatient Psychiatric Facilities for the fiscal year 2022, CMS included a new quality reporting program metric related to COVID-19 vaccination coverage among health care workers. The measure is intended to track and incentivize hospitals to improve vaccine uptake of staff. The COVID-19 Vaccination Coverage Among Health Care Personnel measure will be reported to the CDC’s National Healthcare Safety Network (NHSN) web-based surveillance system. This will begin with a shortened reporting period from October 1, 2021, through December 31, 2021.
CDC - any employee who shows signs of COVID-19 should be subject to the CDC-recommended procedures for quarantine and isolation.
OSHA ETS - OSHA issued an Emergency Temporary Standard to address workplace hazards arising from COVID-19. For hospitals subject to OSHA jurisdiction, it applies to settings where any employee provides health care services or health care support services. The ETS includes numerous requirements, including but not limited to the following.
A workplace-specific COVID-19 plan.
Patient screening and management, to include limited points of entry.
Standard and transmission-based precautions.
Face masks and PPE appropriate to the setting.
Physical distancing of at least six feet between employees.
Physical barriers at fixed workstations when employees cannot be at least six feet apart.
Cleaning and disinfection.
Employee screening, employer-provided testing and paid time off for employees who contract COVID-19.
The ETS is effective until revised or rescinded by OSHA. OSHA provided numerous guidance documents for implementing the ETS.
Antitrust - Hospitals should make decisions about their respective vaccine policies independent from one another and before disclosing them to the employees and the public to avoid any antitrust implications. An agreement by several hospitals in the same geographic market to mandate COVID-19 vaccination as a condition of employment could raise antitrust red flags as it relates to suppressing competition in the marketplace.
