Vaccine Hesitancy and Compassion Fatigue: Infection Preventionists Battle Both at Once

COVID-19 could now be considered a vaccine-preventable disease (VPD), and with that designation comes an issue we have with other VPDs: vaccine hesitancy. The COVID-19 response has been rife with misinformation; what has been coined “the infodemic” has impeded effective and coordinated response efforts since before the virus was identified.

One year ago as of this writing, the idea of a COVID-19 vaccine was a hope on the horizon. When one was finally available, health care workers had a powerful tool that could help bring the pandemic to an end. I recall how I felt after receiving my first dose. Sitting in my car in the vaccine drive-through clinic, waiting for the obligatory 15 minutes after administration, I burst into tears. Months of anxiety, stress, fear, and hopelessness were released in that moment. I know many other health care workers who felt the same.

Now it is almost 9 months since the vaccine became available, and the nation is still struggling to reach high enough levels of vaccine uptake to meet population-level immunity. We are currently experiencing yet another surge, pushed on by the Delta variant, and health care as an industry is strained once again. There are some differences from our prior experiences: Hospitals are struggling with staff shortages, Delta is more contagious than earlier variants, and patients are younger and sicker. But perhaps the most significant difference in this surge is that we have a powerful weapon available at any drug store or provider’s office and many grocery stores: vaccination.

More and more states are making other preventive moves, such as masking, social distancing, and minimizing indoor groupings, obsolete through legislation and lack of enforcement. Vaccination is seen as a silver bullet that will end the pandemic. And yet public mistrust of the vaccine continues to pervade and affect public health care efforts. Individuals in states with lower vaccination rates have 4 times the risk of hospitalization with COVID-19.¹

Health care workers have been pushed to the brink in this marathon of pandemic response. Frontline and behind-the-scenes workers, mentally and physically at their limit, are again being relied on to take care of an influx of patients with COVID-19 as well as ones without the disease. As the Centers for Disease Control and Prevention (CDC) reports, this surge in hospitalizations is being driven by people who are not fully vaccinated. Does this perceived nonadherence affect providers’ ability to be compassionate to patients? If the means to prevent infection is freely available and people voluntarily refuse it, then do not take other measures to protect themselves and prevent infection, how can health care workers maintain professionalism and treat all patients equally?

Not Judges

We are here not to judge but to care for our patients. We often hear this comment now, as the talk at nurses’ stations and in break rooms can move to anger and apathy toward those who did not get vaccinated and are now filling the hallways of the hospital. Compassion fatigue, although not a new concept, may be more of an issue during this pandemic response. It is the emotional, physical, cognitive, and spiritual drain that results in the decreased ability to provide empathetic care to patients.² Compassion fatigue can affect even the most dedicated health care workers and results from continued stress and long-term exposure to another’s suffering. Over time, without ways to cope with the stressors, health care workers can become detached and have trouble experiencing empathy and emotions when caring for patients. Results from prior studies, conducted prepandemic, found that nearly 40% of nurses had symptoms of compassion fatigue.³ One can imagine that percentage has increased dramatically throughout the past 18 months.

Empathy is a key piece in the healing and caring process for patients.⁴ Not only does empathy improve patient outcomes, it can also increase caregiver satisfaction.⁴ Unfortunately, health care workers who are experiencing compassion fatigue report distancing themselves from others, shielding from emotional connections with patients and families, and isolating themselves from others in their lives.⁵ All these symptoms directly affect their ability to have empathetic connections.

As health care professionals, we are taught to treat the disease and the patient and refrain from judging patients for the behaviors that led to their current situation. But over these past 18 months, with the continued bombardment of fear, anxiety of the unknown, and the struggle to regain some sense of pre–COVID-19 habits, health care workers have not been immune to the emotions the public is experiencing. And yet we are held to a higher standard. We have to set personal opinions aside and provide the best care for all patients, as well as, hopefully, some science and research–based education to help prevent future infection.

News articles and interviews are touching on compassion fatigue and some brave providers have spoken openly about these feelings.⁶ It is important to normalize and address the subject and the frustrations that are permeating the entire health care industry, not just the frontline staff. All the ancillary and support staff, including infection preventionists (IPs), have been called upon to support the work of frontline caregivers and are subject to the same stressors and potential for burnout.

Unique Situation

IPs, as the subject matter experts, have similarly been called upon for other major disease outbreaks and pandemics, such as the H1N1 influenza and the Ebola virus. But the sheer duration of the pandemic response and its impact on all aspects of daily life have made this COVID-19 situation unique for many IPs.

Vaccination hesitancy among some health care workers is a topic that is not always addressed. It can feed into workplace stress and the formation of in and out crowds among health care teams. As more health systems mandate COVID-19 vaccination, the protests and complaints grow. Nurses and other staff members are quitting, with some suing, over vaccine mandates. Vaccine uptake among health care workers varies, with one health system reporting that more than 90% of physicians have taken the vaccine but only 50% or fewer nurses and aides have.⁷ What is sometimes forgotten is that health care workers are humans too, and although they have worked through these surges, a significant number do not trust the vaccines or may have concerns about their efficacy and adverse effects. Those who are angry about patients who refuse vaccination may also find it difficult to empathize with colleagues who refuse vaccination. Such divisiveness on hospital units can lead to communication and trust errors, which can directly affect patient care.

IPs have been trying to educate about vaccination as a public health tool for decades and are no strangers to the concerns raised about vaccines and mandates. Again, IPs are needed to help weed through the myths, misinformation, and political slants to make sure they can help patients understand the facts. But it’s not just patients who need the education, it is also staff and providers.

Media reports that sensationalize vaccine breakthrough infections and adverse effects and downplay the long-term effects of COVID-19 may also have an effect on the urgency people feel to get vaccinated. Sanjay Gupta, MD, chief medical correspondent for CNN, recently addressed the concern with the term breakthrough infection, explaining how it has muddied the true purpose of vaccines and how effective the COVID-19 ones really are.⁸ According to Gupta, the term “doesn’t seem nuanced enough to describe what’s going on; it only serves to alarm those of us who are already vaccinated and potentially discourage those who are hesitant.”

The infodemic surrounding COVID-19 remains a challenge for IPs.⁹ Risk communication is a skill that many working in pandemic response have found valuable. One lesson from this deluge of misinformation is the importance of learning how to communicate during emergencies and become a reliable source of information. Risk communication is a skill that should become part of the core competencies of infection prevention programs.

IPs continue to be a source of knowledge about the epidemiology and prevention of COVID-19. They must find ways to share consistent and reliable messaging with staff and patients about how to stop disease transmission, the benefits of vaccination, and other public health efforts to control transmission. As Delta rips through the country and the fear of more mutations and variants of high consequence takes hold, we are working on borrowed time to push back against the virus and regain the public’s trust. The US Food and Drug Administration’s full approval of the Pfizer-BioNTech COVID-19 vaccine (other approvals may have followed after this writing), may help sway some of the public to get vaccinated, although it will not be enough to stop the current surge. IPs can help staff with compassion fatigue by having crucial conversations and speaking about the anger and betrayal they may be experiencing, all while being the calm in the Delta storm.

REBECCA LEACH, MPH, BSN, RN, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a member of Infection Control Today®’s Editorial Advisory Board, works at a health care system in Phoenix, Arizona, that includes 5 hospitals and more than 100 outpatient treatment centers.

References:

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8. Gupta S. What’s in a name? The term ‘breakthrough infection’ raises doubts about vaccines, but it shouldn’t. CNN. August 12, 2021. Accessed August 12, 2021. https://www.cnn.com/2021/08/12/health/breakthrough-infection-covid-vaccine-misleading/index.html
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