Tackling Vaccine Hesitancy: A Nursing Approach
Lori Campbell, NNPBC Board Vice-Chair, RN Council Vice-President
Sherri Kensall, NNPBC Board Chair, RN Council President
Sally Thorne, RN Councilor at Large
Angela Wignall, RN Island Councilor
January 2021
Many will have seen the case of an Ontario nurse who was fired for speaking at a rally just prior to the insurrection at the US Capitol on January 6, 2021. This nurse was fired for expressing views that were not in alignment with her employer. While some defended her, pointing to the right of any individual to their own opinions as long as they do not impede the provision of her work as a Registered Nurse (and have started an online petition on the matter), others applauded this decision, recognizing that the opinions expressed in the public domain by someone claiming professional status hold much greater sway in terms of potential untoward influence to the detriment of the health of others. Our colleagues at the Canadian Nurses Association posted a news release on January 18, 2021 underscoring the need for nurses to be “arbiters of truth” and pointing to professional standards and the nursing Code of Ethics as a basis for ensuring nurses understand their professional obligation to the public including grounding our practice in science and evidence.
Those of us in BC have seen and heard discussion around the COVID-19 vaccine. Questions about when the vaccine will be available to each of us, how effective it will be, if there will be delays between doses and other concerns are part of our conversations around this important tool for fighting COVID-19. In addition, the online discussion reveals considerable controversy and criticism about who receives it first, and who will be lower priority in the sequence. Some nurses will be frantically eager to get the vaccine as soon as possible, while others say they have no intention of taking the COVID-19 vaccine . Reasons for not getting the vaccine are generally focused around a fear of side-effects and a concern over its ‘newness’, and while the science has been clear about both the safety and efficacy of the COVID-19 vaccines approved for use in Canada, there are myths and unsubstantiated evidence that masquerade as fact that make the rounds online as well. Added to this is the reality that BC is a vast and multicultural province and it can be difficult to disseminate factual, scientific evidence about the COVID-19 vaccine to every person in a manner that they can easily understand.
Nurses and nursing practice are guided by nursing science and scientific evidence. All nurses have a professional obligation to be part of health promotion and disease prevention public health strategy that will undoubtedly save future lives. Through decades of scientific research and evidence, we know that vaccines are an effective, safe, and transformative life-saving intervention. Quite simply, vaccines work. Thus, nurses have a professional responsibility to uphold their practice standards by speaking from the science supporting vaccines and not speaking from a place of personal opinion.
So, what can we do as a profession to make the strongest possible contribution to the behavioral responses that will ultimately save the most lives during this pandemic? And how do we as individual nurses and nurse practitioners help members of the public (and in some cases our colleagues) understand that the COVID-19 vaccine is both safe and effective?
What nurses can do to support evidence-based conversations on vaccines and immunization:
- Understand your audience: Talking to another health care provider may not be the same as talking to an elderly client for example. Tailor your conversation to meet the needs of the person to whom you're speaking.
- Use multi-modal forms of communication: Some people like words and like to read long articles, others like visual representation and others still are auditory learners. Again, know your audience and adjust accordingly.
- Understand the trusted role nurses play in the system: Nurses consistently rank as one of the most trusted professions, why? It is because nurses understand how to take complex information and distill it into what makes sense to people. Nursing is based on evidence and science and when combined with a patient and family centred care approach, there is a huge opportunity to inform and provide clarity. When clarity and facts on immunization are presented by those in trusted positions, uptake increases.
- Don’t focus on absolutes: There is no need to have an either/or conversation. Instead, use the opportunity to continue ongoing discussions and don’t dismiss anyone because they have expressed that they are not planning on getting a vaccine. Ensure that there is nothing in your approach that pushes the other person into an entrenched defensiveness that creates an added barrier to constructive action.
- Create a dialogue: Each discussion is an ongoing opportunity to create a dialogue and potentially plant the seeds that may facilitate future decision making. Immunization is always a personal health decision and nurses can provide clear, evidence based and factual information about the vaccine to support evidence-informed decisions making in a therapeutic and supportive conversation. And remember how many opinions about how many aspects of the challenge have evolved over the course of this pandemic – perhaps yours included.
We recognize that this pandemic brings to fore our fears and uncertainties. Many nurses are operating under conditions of exhaustion, grief for losses in their personal life as well as their professional life, and in many instances moral distress due to knowing what excellent care would look like and feeling unable to deliver it due to the overload. While the nursing role is emotionally and intellectually complex, our public duty and professional responsibility remains, calling on us to stay the course and ground our practice in the strong nursing science knowledge that makes nurses the country's most trusted health profession.
Thank you to authors for writing this powerful blog, Tackling Vaccine Hesitancy: A Nursing Approach. It is the perfect message for this critical time as we move into the mass immunization program in British Columbia the coming months. You raise the important point about the public’s trust in nurses, a duty we have to uphold and continue to earn through our interactions. We are viewed as a valued resource for current information in our workplaces and communities as well as with our friends and relatives.
In this second year of COVID-19, I see new opportunities for nurses in all settings and in all roles to come to the forefront as role models for public health action and messages based on strong evidence. As you note, we have a professional responsibility to uphold our standards and our code of ethics as we ground our practice in the science and evidence. The practical tips and links offered will support our communication in the coming months.
My hope for this year is that the collective voice of the profession will be even more visible in the media as we share our comprehensive expertise and feature stories to highlight nursing’s role in all aspects of the COVID-19 Immunization Program from planning to delivery. We can all do our part to overcome vaccine hesitancy and this is truly our time to make a difference throughout the province.
To the four authors, I commend you for your voluntary service on the RN Council and Board of Directors and for taking time to write this blog on behalf of our professional nursing association.