Providing consistent, high-quality healthcare is difficult and complex, and because frontline workers who directly interact with patients are critical to achieving that, attracting, retaining and motivating these staff is essential. Conversely, anything that enhances staff turnover can result in compromised care and adverse outcomes.

This issue became crucial during the height of the COVID-19 pandemic when the question arose of healthcare facilities such as acute care hospitals and nursing homes imposing vaccine mandates for staff. Whether or not to require staff to update COVID vaccinations remains a critical question, given that coverage with 2023-2024 COVID-19 vaccination was only 15.3 percent among 4,112 acute care hospital personnel and a dismal 10.5 percent among personnel at more than 14,000 nursing homes, according to a study published in October in the CDC’s Morbidity and Mortality Weekly Report.

The decline to those dangerously inadequate levels followed the expiration in June 2023 of a Biden administration vaccine mandate for health workers and the end of free access to government-funded COVID shots. Mandates imposed on employees by individual facilities could increase vaccination levels. Still, they could also exacerbate turnover if vaccine-hesitant employees choose to quit rather than comply with the mandate.

Thus, healthcare facilities considering mandating staff COVID vaccination face a difficult decision, or at least the perception of one. Despite evidence that vaccine mandates are effective at increasing vaccination coverage and the benefits, facility administrators were reluctant to implement them, fearing that mandates could worsen already high turnover and result in shortages of qualified staff. Although there is evidence that state-level vaccine mandates for healthcare workers are effective and do not cause high turnover, individual facilities deciding on mandates is somewhat different because employees hesitant to take the vaccine could more easily find a job at a nearby nursing home or another facility that did not impose a mandate.

To quantify vaccine mandates’ risk-benefit effects, a group of researchers at prominent U.S. academic institutions analyzed copious administrative data covering virtually all the nation’s nursing homes, including payroll-based records on 500 million daily nurse shifts and weekly data on COVID transmission and mortality at each facility. They reported their findings in a Working Paper published by the National Bureau of Economic Research titled “The Health and Employment Effects of Employer Vaccination Mandates.”

The analysis calculated the effect of employer-imposed vaccine mandates at 581 nursing homes on disease spread, employment outcomes and several patient-care metrics. Although there was a statistically significant increase in turnover and decreased staff time spent on patient care at mandate-issuing facilities, the magnitude of these effects was small. For example, the mandates reduced patient care by only two minutes per patient, just 1.4 percent of the mean.

Also, the attrition was concentrated among part-time staff working less than 20 hours weekly. (Turnover among such staff, which was already notoriously common pre-pandemic, is likely to be less disruptive than separations of full-time staff.)

A critical finding was that there was no evidence that the marginally increased staff turnover at vaccine-mandated facilities compromised patient care, as reflected by parameters such as patient falls, pressure ulcers and urinary tract infections.

On the other hand, the study found significant, positive effects of employer-imposed vaccination mandates. Nursing home residents experienced a significant reduction in both COVID infections and mortality. The investigators estimated that vaccine mandates saved one patient’s life for every two facilities that enacted a mandate.

The essential conclusions of the study were: “The health benefits of (vaccination) mandates far outweigh the costs in terms of reduced patient care from staff turnover” and “mandates by private organizations can and do make a difference.”

Let’s remember that when the next epidemic arrives.

Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger distinguished fellow at the American Council on Science and Health. He wrote this for InsideSources.com.