Kaitlyn Hevner plans to complete a 15-month accelerated nursing program at the University of North Florida in Jacksonville in December. For her clinical training this fall, she works 12 hour shifts on weekends with medico-surgical patients in a hospital.

But Hevner and nursing students like her who refuse to be vaccinated against COVID-19 are in an increasingly precarious position. Their position can jeopardize their required clinical training and possibly their nursing career.

In early September, the Biden administration announced that workers in healthcare facilities, including hospitals and day surgery centers, would be required to receive COVID-19 vaccines. Although details of the federal rule will not be released until later this month, some experts predict that nursing students who complete clinical training at these sites will also need to be vaccinated.

Groups representing the nursing profession say “students should be vaccinated when clinical facilities require” to complete their clinical training. In a recent guidance note, the National Council of State Boards of Nursing and eight other nursing organizations suggested that students who refuse to be vaccinated and who cannot benefit from an exception because of their religious beliefs or medical problems may be removed from their nursing program. program or be unable to graduate because they cannot meet clinical requirements.

“We can’t have students in the workplace who can put patients at risk for serious illness,” said Maryann Alexander, director of nursing regulation at the national council. “Students can decline the vaccine, but those who are not exempt should perhaps be informed that now is not the time to be in a nursing program.”

“You are going to train and you are going to be very limited in your work if you are not going to get this vaccine,” Alexander said.

Hevner, 35, who is expected to complete her clinical training in early October, said she didn’t think it was acceptable to benefit from a vaccine developed from fetal cells obtained through abortion, which she objected to. . (The development of the Johnson & Johnson COVID-19 vaccine involved a cell line resulting from an abortion; the Pfizer-BioNTech and Moderna mRNA vaccines were not developed with fetal cell lines, but some vaccine tests have reportedly involved fetal cells, researchers say. Many religious leaders, however, support vaccination against COVID-19.)

With vaccines for nursing students still optional in many healthcare settings, nursing educators scramble to place unvaccinated students in healthcare settings that will accept them.

On the Jacksonville coast in Fort Pierce, Florida, 329 students are in a two-year nursing program at Indian River State College, said Roseann Maresca, an assistant professor who teaches third semester students and coordinates their clinical training. . Only 150 of them are vaccinated against COVID-19, she said.

Not all of the eight medical institutions that have contracts with the school require student nurses to be vaccinated.

“It has been a nightmare trying to move students during this semester” to match them with facilities based on their immunization status, Maresca said.

Commonly, healthcare facilities have long demanded that employees be vaccinated against various illnesses such as influenza and hepatitis B. The pandemic has added a new urgency to these requirements. According to a September tally from FierceHealthcare, more than 170 health systems are mandating COVID-19 vaccines for their workforce.

In May, the Federal Equal Employment Opportunity Commission made it clear that under federal law, employers can require COVID-19 vaccination as long as they allow workers to apply for exemptions. religious and medical.

As part of the Biden administration’s COVID-19 plan, about 50,000 healthcare facilities that receive Medicare or Medicaid payments are to demand that workers be vaccinated. Until the administration releases its draft rule in October, it is unclear how nursing students assigned to healthcare sites for clinical training will be treated.

But the federal rule released in August that sets rules for government hospital payments in 2022 offers clues. It defined the healthcare staff who should be vaccinated as employees, licensed independent contractors, and adult student / interns and volunteers, said Colin Milligan, director of media relations at the American Hospital Association.

In addition to staff members, the Biden plan says the mandates will apply to “people providing services under arrangements” at health care sites.

A spokesperson for the Centers for Medicare & Medicaid Services declined to say who would be covered by the Biden plan, noting that the agency is still writing the rules.

Nonetheless, immunization mandates threaten to derail the training of a relatively small proportion of nursing students. A recent National Student Nurses’ Association survey reported that 86% of nursing students and 85% of recent nursing graduates who responded to an online survey said they had been or were planning to get the vaccine. against COVID-19.

But results varied considerably from state to state, from 100% in New Hampshire and Vermont at the high end to 63% in Oklahoma, 74% in Kentucky and 76% in Florida at the low end. . The survey had 7,501 respondents.

Students who do not want to be vaccinated ask schools to offer them alternatives to clinical training on site. They suggest using full-size, computer-controlled mannequins or computer simulations using avatars, said Marcia Gardner, dean of nursing at Molloy College in Rockville Center, New York.

Last year, when the pandemic caused hospitals to close their doors to students, many nursing programs increased simulated clinical training to give nursing students some sort of clinical experience.

But it doesn’t replace working with real patients in a healthcare setting, educators say. State nursing boards allow mock clinical study to varying degrees, but none allow such instruction to exceed 50% of clinical training, Alexander said. A multi-site study found that nursing students could complete up to half of their clinical training using simulation without negatively impacting skills.

The guidance note from the Board of State Nursing Commissions states that nursing education programs “are not obligated to provide substitute or substitute clinical experiences based on a student’s demand or vaccine preference ”.

As more nursing students are vaccinated, the problem will become less acute. And if the Biden plan requires nursing students to be vaccinated to work in hospitals, the number of holdouts is expected to decline further.

Hevner, the University of North Florida student, said she was not opposed to vaccines in general and would consider getting the COVID-19 vaccine in the future if she could be assured that it was not created using aborted fetal cells. She filed documents with the college for religious exemption from the vaccine requirements. It turned out that she didn’t need it because Orange Park Medical Center, where she takes her clinical training, does not require staff members or nursing students to be vaccinated against COVID-19 “for the moment, ”said Carrie Turansky, director of public relations and communications for the medical center in Orange Park, Fla.

Although Hevner opposes getting the vaccine, “I take the protection of my patients and myself very seriously,” she said. She is tested weekly for COVID-19 and always wears an N95 mask in a clinical setting, among other precautions, she said. “But I would ask: are we giving up our own religious rights and our own self-determination just because we work in a health care setting?

She hopes that the profession will be able to welcome people like her.

“I am worried because we are in a place that divides so much,” she said. But she is eager to find common ground because, she said, “I think I would make a really good nurse.”

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(KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is a nonprofit staffed organization providing information on health issues to the nation.)

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