FROM PREPARING the syringe to persuading hesitant patients, nurses play key roles in vaccinations. They are critical to decreasing patient hesitancy and increasing overall vaccination rates, but vaccine advocacy can often be as stressful as dealing with staffing shortages and safety concerns.

Recent research from the Missouri Department of Health and Senior Services (DHSS) examined perceptions and behaviors related to vaccine acceptance from two perspectives: Missouri residents and healthcare providers (HCPs). This included surveying 950 residents statewide and hosting 11 resident focus groups, including parents, those identifying with various races/ethnicities, and those in rural or high Social Vulnerability Index (SVI) regions.

Missouri HCP research included in-depth interviews and a statewide online survey of 242 HCPs (physicians, physician assistants, nurse practitioners, nurses and pharmacists). Over half of survey respondents were nurses or nurse practitioners. Over thirty percent of nursing professionals were in primary care. More than one in five were in pediatrics, obstetrics/gynecology, or emergency medicine. Over eight out of ten said they see children under 18.

The research revealed many key insights for nurses who talk with patients about vaccines:

Missouri residents trust their healthcare providers.

The research showed Missourians trust their HCPs. Sixty-seven percent of residents surveyed “mostly/highly trust” nurses as vaccine information sources, the second most of any other HCP or information source. Eight of ten Missouri residents said family physicians/HCPs are their most trusted resource for vaccines.

However, rural residents were less likely to trust nurses or family physicians/HCPs than those in more populated areas. Residents identifying as Black/African American, Hispanic/Latinx, and all other ethnicities also reported lower trust than those identifying as white. Parents of minors were twice as likely to have little to no trust than non-parents.

Missourians are concerned about safety, side effects, and efficacy.

Even though patients trust their HCPs, these interactions may still cause tension. While nearly all Missourians who participated in the study vaccinated themselves and their children, at least half surveyed had concerns about vaccine safety or side effects. A third were unsure or disagreed that vaccines are the easiest way to protect themselves and their family.

These concerns were more common for those in rural areas among parents of minor children, and those identifying as Black/African American. High SVI county or Hispanic/Latinx residents were less likely to agree vaccines are safe or a way to protect themselves/family.

HCPs and patients don’t align on how often vaccine conversations occur.

The research showed Missouri HCPs and patients have differing perspectives on how often vaccine conversations occur. Only one in five residents reported talking frequently (at most or all appointments) with their HCPs about vaccines. The majority said they only discussed vaccines when they had questions or concerns, or if the HCP brought up the topic.

In contrast, nearly three out of four HCPs reported discussing vaccines with patients at least once daily, and more than half reported discussing vaccines multiple times a day. However, only one in ten physicians said they bring up vaccines at every appointment.

Nurses were slightly less likely to bring up vaccines compared to physicians, but among those who do, close to a third do so at every appointment. Two out of three nurses or nurse practitioners said they discuss vaccines two or more times a day.

Missourians and HCPs feel vaccine conversations have become more negative.

Both residents and HCPs generally agree vaccine conversations have become more negative over the past two years. Seventy-three percent of registered nurses said patients have become more negative, as did sixty percent of all HCPs. They noted patients are more skeptical and less trusting of HCP expertise and vaccine safety and efficacy.

One bright spot emerged among the nursing professionals surveyed: Nurse practitioners were nearly twice as likely than physicians to say patients had become more positive and much less likely to report increased negativity.

Fifty percent of residents said they believed vaccine conversations, in general, have become more negative. They are more vocal in expressing these views, perhaps more so with nursing professionals, a quarter of whom said patients respond “very openly” when they discuss vaccines – three times more than physicians.

Despite this change in tone, most HCPs said they handle these conversations the same as before the pandemic. Around a fifth have shifted their approach. One in ten nurses said they have changed from requiring and/or recommending vaccines to providing information.

Taken together, the Missouri resident and HCP research offers some suggestions for having more effective discussions with patients:

• Normalize vaccines as standard of care by engaging patients together as a clinical team: Though it competes with many other clinical priorities, discussing vaccines at every appointment can help reinforce their importance.1 One nurse practitioner uses a team-based approach: “The nurse starts the conversation [when rooming the patient] and then I revisit it, make recommendations, and answer questions.”
• Use an empathetic, patient-centered approach that provides recommendations, reeducation, and reassurance. Listen to concerns in an open-minded and non-judgmental way and provide information. Dismissing patient questions and concerns may cause further division. Said one nurse practitioner: “We constantly just reeducate and reassure.”
• Respect personal choice. Personal choice emerged as a consistent theme among Missouri residents. They don’t want to feel pressured or forced, and they fear being judged. They want their HCPs to listen and acknowledge their right to make informed decisions.

This research offers insights nurses can use today to leverage their roles as trusted providers and vaccine advocates. One nurse shared her mindset when entering a patient room: “[I make a] mental note that prior to speaking to a patient, I want to maintain the confidence they’ve put in me.”

Reference:

1. Foster Support for Vaccination in Your Practice. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/conversations/your-practice.html