I am a pediatric pulmonary nurse coordinator and remain per diem as a bedside NICU nurse. I made the decision to get vaccinated a couple of months after it became available at my hospital. As the vaccine was brand new, I put a lot of thought and research into it before making my decision. Ultimately, based on the facts I found and the science, I decided the benefits outweighed the risks. While I felt I would be okay if I were to get COVID, as I am relatively young and very healthy, we have all seen exceptions to this. However, I moreso felt a responsibility to those at higher risk in my personal life and my professional life—Most of all my vulnerable patients.
I believe this reasoning was the driving force for a lot of healthcare workers to get vaccinated—more than just any fear of contracting COVID themselves. I think this is why we all get so emotional when it comes to still discussing the vaccine and the pandemic. In fact, just about a month ago after a particularly hard week, I could not wait to get home. It had been a week filled with parents arguing against the vaccine for their children. A week filled with ordering COVID tests for children who might end up hospitalized if they were to turn out positive. A week of writing school letters for patients to ensure accommodations that would keep them safe. A week of parents demanding letters from our section stating their child should be exempt from wearing a mask to school. A week of explaining to parents why we could not write that letter because their child would be safest with a mask.
Not Making A Difference
Due to these taxing conversations, it was no surprise how upset I became when I was driving home on my hour-long commute behind a bumper sticker that read, “Unmask our kids.” I tried to ignore it but it kept catching my eye until it eventually overwhelmed me and brought me to tears. Tears we have all cried during this pandemic, even if in different roles and different levels of care for our communities. Tears from being burnt out and unheard. Tears from being unappreciated. Tears from feeling like we are trying so hard, but not making enough of a difference.
So where do we go from here, over a year and a half into this new way of life? When our co-workers and friends are refusing vaccinations, what can we do? They are people with the same basic training as us, but somehow do not view the science and statistics the same way. I have spent a lot of time contemplating this. In my opinion, it comes down to Roger’s diffusion of innovation theory.
It Takes Time For Ideas To Gain A Following
If you are not familiar, Roger’s diffusion of innovation theory essentially explains how it takes time for ideas or products to gain a following. The adoption of this idea or product happens throughout five stages or groups. First, we have the innovators, who make up just 2.5% of the population and seek out new ideas such as this vaccine. Next, we have the early adopters, 13.5%, who embrace change. After that, the early majority, 34%, who usually need to see some evidence of this idea or product and its success, but still adopt it before others. Then we have the late majority, 34%, who are skeptical, but once tried by the majority they will adopt the change. Finally, we have the laggards, the last 16%, who are very conservative to change, but may eventually give in to the majority because of things like pressure or fear.
In terms of nursing, I usually consider myself the early adopter. I love to keep up on the latest research and changes. I get excited when I see a new study and think, “I want to implement that in my practice or on my unit!” However, when it came to the vaccine, I was more of the early majority. Since statistically, my personal risk was low, I thought it might be better for me to wait for more people to get vaccinated and see if any side effects appeared. However, as my coworkers began to get vaccinated and the momentum grew, I decided not to wait any longer. As stated before, I weighed my risk and benefits and from the statistics I had seen initially, I decided it was better to go for it.
However, I think what makes me an excellent confidante for talking to coworkers as well as patients and their families about the COVID vaccine is that initial hesitancy I felt. We as healthcare workers know to assess risks versus benefits of everything. We also know that so many medications or products can come with side effects, however minimal. We have often seen first hand these very things, even after much research and FDA approval, get pulled off the market due to side effects that are not seen until much later. This is why we have a duty to do our due diligence, as I believe I did mine prior to deciding the vaccine was the best choice for me. This is also why I see the importance of discussing such controversial matters.
Thus that is how I start these hard conversations. I do not dwell on politics. I do not attack people’s opinions. I do not insult people. I keep my emotions in check. I try to meet people where they are and understand what they are seeing. Now, albeit some people cannot be reasoned with, but in my opinion, those people only make up a fraction of the “laggard group.” So to have these conversations, I revert back to the basic building blocks of our careers—including therapeutic communication and being non-judgmental. This approach can give us the added bonus of not being as emotionally invested and thus help prevent additional burnout by these conversations.
Use Psychology and Research
In combination with these techniques, I try to use psychology and research to help make my case successful. For instance, when you listen and agree with the other person, you make them feel understood. This is as easy as, “If I were you, I would feel the same way if that was the information I had.” Not immediately disagreeing with people opens up a better line of communication and makes them more likely to also listen to your point of view. Personally, I actually do feel many who are hesitant do have valid concerns based on the knowledge they have. Additionally, we do not have to get defensive off the bat and we can ask to share our point of view as well. We can admit to certain shortcomings of the vaccine, such as how those who get vaccinated can still get COVID. We can then use this as an opportunity to explain why the vaccine is still beneficial, such as lessening symptoms. Trying to have an honest conversation where both parties are heard can truly have a profound impact in my experiences.
Beyond that, a study looking at the adoption of evidence-based practice (EBP) using Roger’s diffusion of innovation theory found that adoption is influenced by individual motivation, attitude, knowledge, work experience, and the perception of EBP attributes. Interestingly, attitude was found to have the greatest effect on adoption of a change. The article suggests that changes should thus be promoted through, “use of cognitive principles that can change people’s attitudes in positive ways”1. I like to think this is similar to the approach I use based on therapeutic communication and psychology as described above.
Take A Step Back
Sometimes the best thing we can do whether we are at the bedside with one patient, speaking with a coworker, or trying to sway a group opinion, is just take a step back. Take a step back to breathe and listen. Give people space to express themselves and establish rapport. Remember that decisions take time and people all reach decisions differently, as we often see day to day in our field. While we feel the urge to get as many people vaccinated as quickly as possible in hopes that it will help rid our communities of COVID, we need to remember that we cannot simply force things onto people and expect them to happen. In a world where the past year and a half has been so complicated, we may need to simplify our approach to get the best results. We also may need to understand that while doing this work, based on the theory of diffusion, it may still take time. However, we need to keep having the difficult conversations until we begin to reach of late majority and laggards. There really is a light at the end of the tunnel, but unfortunately, adoption of change takes time and the COVID vaccine is no exception to this theory. However, by focusing on how we approach implementation, we can perhaps shorten this timeline.
1Evaluating the adoption of evidence-based practice using Rogers’s diffusion of innovation theory: a model testing study