ARN Advocates for COVID-19 Vaccinations of Rehabilitation Nurses and Nursing Staff

Background

With the COVID-19 pandemic ravaging the country’s health and wellness, the Association of Rehabilitation Nurses (ARN) has been on the forefront, along with other nursing organizations, of advocating for the protection and safety of our nursing workforce, patients, caregivers, and communities. ARN has stood side-by-side with the members of the nursing affiliate organizations, rehabilitation organizations, and the Centers for Disease Control & Prevention (CDC) to support mask-wearing, handwashing, and social distancing. The entire world waited in hopes for the development of the COVID-19 vaccine, made possible through fast-tracked scientific discovery, clinical trials, and public-private partnerships.

On December 14, 2020, Sandra Lindsay, RN, became the most famous nurse in this country. Ms. Lindsay was the first nurse and person in the U.S. to receive the COVID-19 vaccine, saying, “I trust the science.” The Director of Critical Care Nursing at Long Island Jewish Medical Center in New York, she wanted to lead by example, especially as a Black woman, knowing how many are skeptical of taking the vaccine. 

The close, direct care relationship nurses have with patients and caregivers puts them at greater risk for contracting COVID-19. According to the CDC, about 6% of adults hospitalized from March through May were health care workers, and more than a third of those were nurses and nursing assistants (Abelson, 2020). In long-term care (LTC) settings, the vulnerable resident population accounted for 27.5% of all confirmed cases documented in a June report from the Centers for Medicare & Medicaid Services (CMS, 2020).  The New York Times completed further analysis and reported that nursing home residents and workers, including registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants,accounted for one-third of COVID-19 deaths in the U.S. (Yourish et al., 2020). LTC facilities’ residents and staff are at even greater risk and incidence because they are asked to accept patients with possible or known COVID-19 infection (D’Adamo, 2020). LTC settings have fewer options for strict isolation, inadequate supplies of personal protective equipment (PPE), and fewer medical and respiratory health specialists to manage these patients.

Additionally, workforce shortages of these professionals are anticipated, and the aging of the nursing workforce is well-documented. “Of approximately 1.2 million registered nurses employed outside of hospital settings, 24% are aged 55 to 64 years and 5% are aged 65 years and older” (Ouslander, 2020, p. 3).  Unknown is the age distribution of rehabilitation nurses in the inpatient rehabilitation facility or rehabilitation hospital setting. Many hospitals and health care systems are developing strategies to modify work assignments for these health professionals in productive ways that may not necessarily involve direct patient contact (Buerhaus et al., 2019).

In our country, COVID-19 is now the leading cause of death, with adult age groups over 55 years of age having the highest death rates (National Center for Healthcare Statistics, 2021).  This statistic is expected to change over time, now that the vaccine is becoming available and people are getting vaccinated. Like all nurses, the rehabilitation nursing workforce is at great risk for COVID-19-related morbidity and mortality.

Rehabilitation Nurses

Rehabilitation Nurses practice in all settings, including freestanding rehabilitation facilities, hospitals, long-term subacute care facilities/skilled nursing facilities (SNFs), long-term acute care (LTAC) facilities, comprehensive outpatient rehabilitation facilities (CORFs), home health agencies (HHAs), and private practices. Rehabilitation nursing is a philosophy of care, not a work setting or a phase of treatment. We base our practice on rehabilitative and restorative principles by: (1) managing complex medical issues; (2) collaborating with other specialists; (3) providing ongoing patient/caregiver education; (4) setting goals for maximum independence; and (5) establishing plans of care to maintain optimal wellness.

Rehabilitation nurses take a holistic approach to meeting patients’ nursing and medical, vocational, educational, environmental, social, spiritual, and safety needs. We lead and coordinate rehabilitation, restorative care, and community reintegration for populations across all age groups and ethnicities across the care continuum, from ambulatory care to hospice.  Rehabilitation nurses begin to provide care to individuals, their families, and caregivers soon after the onset of a disabling injury or chronic illness and continue to provide specialty care, patient and family education, and care transition planning that empowers these individuals to return home, work, and/or school.

Rehabilitation nurses, in collaboration with interdisciplinary teams, provide comprehensive, population-specific care management to access health care services, adaptive technology and equipment, and community resources.

ARN supports efforts to ensure persons with disabilities and chronic illnesses have access to the appropriate level of rehabilitation services to maximize functional outcomes, independence, and quality of life. ARN also supports efforts to decrease these persons’ risks for harm, complications, and disease, which includes COVID-19.

Statement of ARN Position

Rehabilitation nurses are effective and essential members of the rehabilitation team providing services to all individuals with disabilities and chronic diseases, their families, and caregivers. Even prior to the devasting, disabling, and debilitating effects of COVID-19, the World Health Organization found that at least 1 of every 3 persons in the world will need rehabilitation at some point during their illness or injury, according to a study on the global estimate of rehabilitation needs (Cieza et al., 2020).  To protect all rehabilitation nurses’ lives, function, well-being, and contributions to life-saving care and rehabilitation of all persons, effective protection must include proper supplies of PPE and immunization against infectious diseases, in this case, COVID-19. Advocacy for vaccination of the rehabilitation nursing workforce will reduce further disease spread and provide greater protection, consistent with the mission, values, and goals of rehabilitation nursing.

Therefore, ARN:

Strongly recommends that all rehabilitation registered nurses be vaccinated against COVID-19.

Strongly advocates that all rehabilitation nursing staff, including licensed practical nurses and nursing assistants, be vaccinated against COVID-19.

Supports the independent decision of RNs to receive the COVID-19 vaccination, understanding the experimental status of the vaccine, unknown side effects, and impact on future fertility (addressed by the American Nurses Association Position Statement on Immunizations, updated September 11, 2020, located here).

Joins nursing organizational affiliates’ coordinated efforts for the vaccination of nurses, nursing staff, and the public.

Asserts the role of rehabilitation nurses as advocates and role models for educating the public about the importance of vaccination. 

Recommends that all rehabilitation nursing staff in SNFs and LTACs are prioritized for COVID-19 vaccination due to the high morbidity and mortality associated with infection in the resident population.

Supports ongoing research on the efficacy of the COVID-19 vaccine and accessibility of vaccinations for all.

Approved by the ARN Board of Directors January 15, 2021.

References

Abelson, R. (2020, October 26).  Nurses are at high risk for Covid among healthcare workers, CDC Says. The New York Times. https://www.nytimes.com/2020/10/26/health/covid-nurses-.html

Buerhaus, P.J., Auerbach, D.I., & Staiger, D.O. (2020). Older clinicians and the surge in novel coronavirus disease 2019 (COVID-19). JAMA, 323(18), 1777-1778. https://jamanetwork.com/journals/jama/fullarticle/2764073

Cieza, A., Causey, K., Kamenov, K., Hanson, S.W., Chatterji, S., & Vos, T.  (2020). Global estimates of the need for rehabilitation based on the global burden of disease study 2019: A systematic analysis for the global burden of disease study 2019. The Lancet. Advance online publication. https://doi.org/10.1016/S0140-6736(20)32340-0

Ouslander J. G. (2020). Coronavirus disease19 in geriatrics and long-term care: An update. Journal of the American Geriatrics Society, 68(5), 918–921. https://doi.org/10.1111/jgs.16464

National Center for Health Statistics. (2021, January 13). Weekly updates by selected demographic and geographic characteristics. Retrieved January 15, 2021 from https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

Yourish, K.K., Lai, K.R., Ivory, D, & Smith, M. (2020, May 11). One-third of all US coronavirus deaths are nursing home residents or workers. The New York Times.  https://www.nytimes.com/interactive/2020/05/09/us/coronavirus-cases-nursing-homes-us.html