Throughout the COVID-19 pandemic, short-staffed rural hospitals have been stretched to their limits.
Some have cut back, delayed or eliminated services such as elective surgeries, labor and delivery, and other inpatient care. Nurses and other health care employees have worked double shifts, and many rural hospitals have had to create makeshift intensive care units.
In the broadest sense, President Joe Biden's vaccine requirement for the more than 17 million U.S. health care workers will alleviate the strain on all health centers and clinics by boosting the country's overall vaccination rate — and by reducing the number of health care workers who are forced to take sick leave because they contract COVID-19. Big-city hospitals have brushed aside some workers' protests and lawsuits, implementing vaccine mandates without a significant effect on staffing or patient care. About 41% of U.S. hospitals already have a vaccine mandate, according to the American Hospital Association.
But the story may be more complicated in rural America, where resistance to the vaccine remains strongest. Some rural hospital leaders worry the vaccine mandate will exacerbate a labor shortage that was profound even before the pandemic. There are predictions that some hospitals will have to close their doors.
"I've talked with administrators of hospitals that have estimated anywhere from 3% to as much as 20% of their workforce may have to quit their jobs if they're required to have the vaccine as a condition of their employment," said Brock Slabach, chief operations officer for the National Rural Health Association, a nonprofit that represents rural hospitals and clinics as well as doctors, nurses and administrators.
"In a rural hospital, that could be two, maybe three nurses," Slabach said, "which could cripple their ability to meet the demands of patient care."
As of early October, nearly 43% of the rural population was fully vaccinated, compared with 53% of the U.S. population, according to an analysis of federal Centers for Disease Control and Prevention data by the Daily Yonder.
To get more jabs in arms, the Biden administration announced last month that it will require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement, including hospitals, dialysis facilities, ambulatory surgical settings and home health agencies. The federal Centers for Medicare & Medicaid Services hasn't yet announced a deadline for workers to meet the requirement.
Even before the federal requirement, at least 22 states plus the District of Columbia announced that state health care workers — or, in some cases, all health care workers — would need to be vaccinated or regularly tested, according to the nonprofit National Academy for State Health Policy.
But six states — Arkansas, Georgia, Indiana, Montana, Tennessee and Texas — have approved laws or have executive orders from their governors prohibiting vaccine mandates as a condition for employment.