Can Providers be Blamed for Losing Patience with Vaccine Hesitant?

Comes a point in a health care provider’s work life when she or he might be tempted to throw up their hands. It can happen when they’re dealing with the person with diabetes who won’t stay away from sweets, or the person with a substance abuse problem who refuses to seek counseling, or the person with heart problems who won’t take their medications. Compassion fatigue has been around a long time and providers should always be on guard against it says the Centers for Disease Control and Prevention (CDC). Perhaps especially these days when it comes to infection preventionists and other health care professionals who have to treat people who refuse to get vaccinated for COVID-19. The CDC says that as of yesterday, only 49.1% of Americans have been vaccinated, nowhere near the number needed to fend off variants such as the rapidly spreading Delta variant. The ability of variants to circulate among the unvaccinated increases the possibility that COVID-19 might mutate into a strain that can neutralize the vaccines, a possibility some experts have detected in the lambda variant.

Heather Saunders, MPH, RN, CIC, the director of infection control at the Johns Hopkins Office of Population Health, and a member of Infection Control Today^®’s Editorial Advisory Board (EAB), says that it’s impossible to generalize about compassion fatigue though “I do think that for some individuals, providing care to unvaccinated patients could trigger compassion fatigue. Health care workers are experiencing various degrees of psychological trauma, including [post-traumatic stress disorder], as a result of their experiences during the pandemic. This trauma could lead some individuals to feel a sort of indifference or irritability toward unvaccinated individuals who they believe are perpetuating the pandemic.”

EAB member Linda Spaulding, RN, BC, CIC, says that while she hasn’t seen compassion fatigue affect patient care “it is depressing staff because we know the patients could avoid getting COVID and decided not to get the vaccine. Patients ask for it [pre-admission] but that’s too late and they can’t get vaccinated while sick with COVID. It’s just very sad.”

EAB member Kevin Kavanagh, MD, has written extensively for ICT^® about the dangers posed by COVID-19. Kavanagh points out that compassion fatigue can always pounce because poor decisions made by patients necessitates much of health care treatment.

“Vaccination rates are not only low with the public but also with health care workers,” Kavanagh points out. “All need to realize that the public looks up to health care workers for guidance and many have cited the example of unvaccinated workers as influencing their decision.”

Kavanagh also points out that many health care workers suffer from PTSD, as ICT® reported in its May cover story.

“Ideally, counseling and time off of work is desperately needed,” says Kavanagh. “Unfortunately, this is not possible and we will be soon facing a health care worker shortage. The solution is for everyone who can, to become vaccinated and we all need to adopt strict public health strategies. And for all to support, however possible, our frontline workers.”

Robbie Hilliard, MSN, RN, CIC, the infection control coordinator for Carl Vinson VAMC in Dublin, Georgia, recently wrote an article for ICT^® about how Veterans Affairs nurses tackle infections. Hilliard says that there’s a danger that compassion fatigue could set in when it comes to treating unvaccinated COVID-19 patients, but tries not to simply dismiss the concerns of the unvaccinated.

“As a nurse, I am vaccinated for COVID-19, but I still have co-workers who are not, which just emphasizes the importance of understanding and accepting people’s personal choices,” Hilliard tells ICT^®. “Most of these providers are very educated individuals, who are compassionate, but continue to feel that not enough research on side effects, etc., was done for a vaccine released on an emergency basis.”

Hilliard agrees that compassion fatigue comes with a provider’s job “and I am sure, at times, compassion fatigue creeps in with COVID patients, but most of us understand the fear associated with the unknown/new pharmaceutical treatments that have long-term unknown effects.”

The attitude that both Kavanagh and Hilliard encourage—patience in the face of vaccine hesitancy—might be easier said than done. For instance, CNN interviews a nurse identified as “Sunny,” who works in Western Arkansas. Sunny says that it’s difficult to watch people die and then “so many people on Facebook or in a Walmart tell you you’re a liar…. Nurses have really been the symbol of the pandemic and all of the hate has been centralized around us…. We heard it more than once that we were killing people on purpose to make it look like it [the COVID-19 pandemic] was worse than it was.”

A study published earlier this month in Pediatric Research states that the tools used before COVID-19 to alleviate compassion fatigue among physicians might not suffice now. “The pandemic has only increased the need for physicians to receive social/emotional support from their institution and to feel their workplace contributions are valued,” the study states. “Successful pre-pandemic workplace interventions may not adequately support physicians during the pandemic.”

The study, by investigators with the Icahn School of Medicine at Mount Sinai, states that “the personal and professional aftershocks of the current SARS-CoV-2 pandemic for physicians will likely persist well into the foreseeable future. Our results suggest that institutions may be able to mitigate these effects using targeted interventions aimed at conveying to physicians that they are valued.”