A view of the entrance to Mount Sinai Hospital in New York on May 14, 2020. Employees of New York City hospitals and nursing homes must have at least one dose of a COVID-19 vaccine by Monday , raising concerns about non-compliance and potential staff shortages.

Cindy Ord / Getty Images

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Cindy Ord / Getty Images

A view of the entrance to Mount Sinai Hospital in New York on May 14, 2020. Employees of New York City hospitals and nursing homes must have at least one dose of a COVID-19 vaccine by Monday , raising concerns about non-compliance and potential staff shortages.

Cindy Ord / Getty Images

New York state officials brace for a staffing shortage when the mandate to vaccinate state health workers goes into effect Monday, and could look to the National Guard – as well as medical professionals other states and countries – to help them fix it.

Gov. Kathy Hochul on Saturday released a plan outlining steps she could take to increase staff in the event that large numbers of hospital and nursing home workers miss the state deadline.

“We are still in a battle against COVID to protect our loved ones, and we must fight with all the tools at our disposal,” she said.

That could mean declaring a state of emergency to allow licensed medical professionals outside of New York City, as well as recent graduates and retirees, to practice there. Other options include deploying medically trained National Guard members, partnering with the federal government to send disaster medical assistance teams to local health and medical systems, and “explore ways to accelerate visa applications for health professionals ”.

The state labor department also issued guidelines clarifying that workers made redundant because they refuse to be vaccinated will not be eligible for unemployment insurance, “absent a valid application for medical accommodation approved by a physician “.

All healthcare workers in New York City hospitals and nursing homes must have at least one dose of a COVID-19 vaccine by Monday, according to state regulations and a warrant issued by the former Governor Andrew Cuomo last month. Staff in other facilities, including home care, hospices and adult care facilities, should be vaccinated before October 7.

The most recent figures suggest the state still has some way to go: As of Wednesday, 84% of all hospital workers were fully immunized. And 81% of staff at all adult care facilities and 77% of staff at nursing facilities were fully immunized as of Thursday.

State and nationwide health care systems are already struggling with staff shortages.

Critics of the requirement have challenged it through protests and lawsuits, as reported by North Country Public Radio, opposing mandatory vaccination and challenging the lack of exemptions for religious objections.

At this point, healthcare workers have the option to apply for a religious exemption at least until October 12, when a federal judge will consider a court challenge in favor of such exemptions.

As hospitals prepared their contingency plans – many of which included limiting certain procedures – at the end of last week, Hochul stuck to the deadline. She told reporters on Thursday that there was “no excuse” for workers to refuse to be vaccinated, and called the looming shortages “completely preventable.”

How health systems prepare for the deadline

Hospital systems and nursing homes statewide are encouraging their employees to get vaccinated and prepare for disruptions if they don’t. Some cut back on elective surgeries, limit admissions, and retain volunteers.

Northwell Health, the state’s largest health care provider, has held meetings with staff members in an attempt to persuade “thousands of holdouts,” the Associated Press reports. Some 90% of its 74,000 active staff had been vaccinated as of Thursday, although the hospital said it does not expect full compliance and has more than 3,000 retirees, students and volunteers in waiting.

Erie County Medical Center Corporation in Buffalo predicts that about 10% of its workforce (some 400 workers) may not be vaccinated by Monday, according to AP, and is prepared to potentially suspend elective hospital surgeries, cut back on hours in outpatient clinics and temporarily stop accepting Intensive Care Transfers.

As reported by NPR, the Lewis County General Hospital in Lowville, NY, said it would suspend maternity services starting this weekend because dozens of staff resigned rather than to get vaccinated.

Unvaccinated employees at New York City’s 11 public hospitals (which cites a compliance rate of around 88%) will be put on unpaid leave but could return to work if they get vaccinated soon, CNN reports.

Some hospital systems are seeing increased vaccination rates. New York-Presbyterian, for example, enacted its own mandate with a deadline of midnight Wednesday, and reported that only 250 of its 48,000 employees had not complied.

The University of Rochester Medical Center said in a statement that 99% of professional medical staff and 91% of all employees at its six hospitals were partially or fully vaccinated last week.

Dr Michael Apostolakos, its chief medical officer, said intensive care and many essential services will continue uninterrupted – but staff shortages unrelated to the mandate are causing some wards to hiatus.

Patients will see longer wait times for routine appointments, some employees will be asked to take on additional responsibilities, and beds may be temporarily closed, Apostolakos said in a statement.

A piece of a national conversation

New York isn’t the only place to require vaccination of healthcare workers – California announced a similar policy over the summer, and the US Department of Veterans Affairs is also requiring healthcare workers first. line get vaccinated.

President Biden announced earlier this month that the 17 million healthcare workers in facilities that receive Medicare or Medicaid funding will need to be vaccinated or regularly tested, with details to be finalized in the coming weeks.

While such demands in the workplace have the backing of many public health experts – and more than half of nurses, according to a recent survey – some politicians and hospital officials have expressed concern. And this is especially true in rural areas, where vaccination rates are low and hiring is already difficult.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, told NPR that the Biden administration was pursuing a tenure due to stagnant vaccination rates in hospitals across the country. She noted that while many hospitals are worried about staff shortages, employees missing from work due to illness or quarantine are also a staffing issue – and safety.

“It is very clear from the data that unvaccinated staff affects both patients entering facilities as well as their colleagues,” she said.

It remains to be seen how severe the staff shortages will be, in New York and elsewhere. Although a state has already adopted a mandate to vaccinate healthcare workers and could serve as a data point.

The governor of Maine announced a mandate for the healthcare workers in mid-August, and hospitals are reporting only a handful of resignations so far – although the application does not begin until October 29.