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COVID-19 Vaccines: Healthcare Workers and Nursing Home Residents Were First, but It’s Complicated

Vaccine or no vaccine. Covid-19 vaccination concept.. 3D render, illustration

by Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA

When the COVID-19 vaccines were first rolled out earlier this year, it was a joyful surprise that healthcare workers, SNF staff, and nursing home residents were put first on the list. For many, it was exciting to hear, “YOU are first!” This was the day we had all been waiting for—the day we could finally be set free of COVID-19 and could resume our normal lives. But not everyone in the nursing profession felt that way. To some, being first felt experimental. And what did it change? We still need to wear masks, remain socially distanced, and be diligent about hand washing. Yes, even if we’ve received the vaccine!

It can be hard for the director of nursing services and other nurse leaders to convince staff that they need the vaccine when it appears nothing about daily life changes after vaccination. Additionally, the vaccines come with many unknowns; but one thing is clear, COVID-19 has the potential to be severe and cause death and the vaccine has the potential to save people from that severe illness and death. Nursing professionals risked their lives during the pandemic and now, they can protect themselves and others by accepting the vaccine. Below are some concerns nursing staff are expressing most frequently, and some talking points to help address these concerns.

mRNA is new.”

Staff often mention concerns about messenger RNA vaccines being new. However, while mRNA technology is new in vaccine production, it is already being used in cancer treatment. It has been studied for more than ten years. Both Moderna and Pfizer vaccines underwent extensive trials prior to being given emergency use authorization (EUA). In fact, Pfizer had over 40,000 people enrolled in their trial, which included 30% racially diverse individuals. Moderna had over 30,000 people enrolled in their trial with 37% racially diverse individuals. The side effects of these trials were minimal. The most common side effects included site pain, swelling, and redness. Other common side effects included chills, fatigue, and headache. These occur within a day or two of getting the vaccines and are normal reactions to the vaccine.

It will give me COVID-19.”

Staff also express concerns that the vaccine will give them COVID-19, which is not true. COVID-19 mRNA vaccines give instructions for our cells to make a harmless piece that looks like the “spike protein.” The spike protein is found on the surface of the COVID-19 virus. Our bodies recognize that this protein should not be there, so they build antibodies that will remember how to fight the virus that causes COVID-19 if we are infected in the future. This is how the vaccine works, it doesn’t change our DNA or give us COVID-19.

I want to wait to see how the vaccine affects others.”

Forty-six percent of adults between the ages of 50-80 haven’t expressed a willingness to accept the vaccine (Malani, Singer, Solway, Kirch, & Kuullgren, 2020); instead, they want to wait to see “how it goes” with other people first. That was before the introduction of a third vaccine, which is a viral vector vaccine, not an mRNA vaccine. This new vaccine could lengthen the time staff want to wait and see, and it could also change the minds of some who were waiting, because it is a single vaccine with quicker protection. This change might encourage some staff to finally get it, while others will hold onto the fear of the safety of this vaccine.

On Feb. 27, 2021, Johnson & Johnson received an EUA for their Janssen COVID-19 vaccine. It works in a similar manner to Pfizer and Moderna, by providing genetic instructions. For many wanting to “wait and see,” they are worried about the safety and long-term effects of the vaccine and they don’t know anyone who received one. If your staff are feeling this way, it’s important to check back with them and provide education on the safety of the vaccines. This group isn’t saying “no way,” they are saying “not now,” so keep that in mind.  

The Janssen vaccine isn’t as good.”

Although it doesn’t have the same efficacy that Pfizer and Moderna have, the Janssen still prevents severe illness, hospitalizations, and death with a single dose. There are some great advantages with the Janssen vaccine:

  • There’s no need for the ultracold storage so the vaccine can more easily be used in rural areas.
  • There is no need to be concerned about the availability of a second dose.
  • Protection against severe illness starts within two weeks of the Janssen vaccine, rather than two weeks after receiving the second Pfizer or Moderna vaccine dose (for a total of five-six weeks for full protection).

AAPACN offers additional education on vaccines and vaccine hesitancy, along with a host of resources to help you understand regulations regarding COVID-19. Click here for more COVID-19 resources and tools.


Malani P, Singer D, Solway E, Kirch M, Kullgren J. Older Adults’ Perspectives on a COVID-19 Vaccine. University of Michigan National Poll on Healthy Aging. November 2020. Available at: http://hdl.handle.net/2027.42/163523

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