Nursing students and faculty grapple with ongoing struggles regarding vaccines, exemptions and getting back into hospital settings.

By Sarah Bakeman

As the Bethel University Nursing Department prepared for the 2021-22 academic year, faculty sent emails to nursing students seeking exemptions from the COVID-19 vaccine. The email told students that if they could not receive exemptions from clinical hospitals, they had three options: take a year-long break from the nursing program to allow for further research, change majors or get the vaccine.

A senior nursing student who has asked to remain anonymous for fear of backlash from faculty remembers the moment she received that email. She sat on a yoga mat, cell phone in hand and tears streaming down her face. As the gym-goers around her continued their workouts, her mother’s comforting voice rang through her headphones.

Which vaccine do I get? When should I come home to get it? Are there really no other options?

As she finished setting up a September vaccine appointment, another notification came in. This time, it was from GroupMe. A new chat had been made by another senior nursing student, who wishes to remain anonymous for the same reason. Scrolling through the chat, she forgot about her workout. She realized she was one of 10 known seniors who had yet to be vaccinated, and they were going to stick together. Anxious tears turned into tears of relief, and she cancelled the appointment.

“I felt like I was the only one left in the whole program who hadn’t [been vaccinated],” she said. “There’s a lot of power in having more people to back you up and knowing you’re not crazy.”

With COVID-19 hitting in the spring of her sophomore year, the anonymous source has learned to be a nurse in the midst of a pandemic. 

When students were sent home in March 2020, the nursing program and its faculty had to adapt. Clinicals, which provide hands-on experience in hospitals, start during junior year of the nursing program and are required for graduation. Online simulations temporarily filled the role of clinical experiences, and students were occasionally asked to test aspects of family members’ health, such as deep tendon reflexes. 

“I think our major was the most impacted because you can’t … get hands on nursing over the computer,” the anonymous source said.

Getting students back into clinical settings for the 2020-21 academic year meant following the guidelines the hospitals and Bethel had set in place. Masks. Getting tested. No contact with COVID-19 patients.

Then vaccines were developed, and things got a little easier for vaccinated students and more complicated for those opposed to vaccinations.

Nursing Department Chair Diane Dahl spent her summer awaiting a consistent vaccine policy throughout various clinical agencies. Mayo Clinic released its own policy in August. Then, one after another, agencies began releasing individual policies, often inconsistent with the hospitals before them. 

“It wasn’t what they said they were going to do,” Dahl said. “I thought that it would be great if we could have one way… but they really need to care about their own healthcare workers, and they have to make sure the policy fits them first.”

The inconsistent policies were met with even more inconsistent responses. Professor of Nursing Dave Muhovich has observed two sides of an emerging debate at Bethel.

“I know that there are people who don’t believe in the immunization of COVID among both students and faculty,” Muhovich said.

As Bethel Student Nursing Association Student Leader Luke Haider attended meetings and events for nursing students, the division did not present itself in verbal arguments. Instead, students carefully decided who they would associate themselves with.

“You have one side that chose not to get vaccinated, and they don’t want to be vocal about that, because that’s part of their physical health choices,” Haider said. “The other side doesn’t want to cause more controversy and are in support of the mandate. That has been the set standard, so I guess they don’t need to be as vocal.”

The 10 united seniors have a variety of reasons for not getting vaccinated. They share concerns about fertility and the extent of research on the vaccine. They see this decision as a private, personal health choice. Although approved for emergency usage in December 2020, the Pfizer-BioNTech COVID-19 vaccine was officially approved by the U.S. Food and Drug Administration Aug. 23.

“In class, we learn so much about why, as a nurse, you need to respect your patients’ medical autonomy,” the anonymous source said. “Where did our medical autonomy go?”

Muhovich understands the want for medical autonomy, as he has taught it and lived it in his nursing experience.

“Yes, this vaccine was developed more quickly than most … that doesn’t mean there’s no risk. That doesn’t mean there aren’t some side effects,” Muhovich said. “But the scientific evidence that the vaccine is much less risky than giving COVID to all populations is unequivocal. Individuals are still allowed to object to that, to not believe the science.”

Although neither Bethel University nor its nursing program has required the COVID-19 vaccine for students, many of the agencies that Bethel uses for clinicals have taken that step. These hospital mandates don’t necessarily mean unvaccinated nursing students need to switch their majors. All of the agencies are allowing medical exemptions, with the exception of Children’s Minnesota Hospital. In order to obtain exemption, students require a history of not receiving other vaccinations. In other words, they must prove they’ve always been opposed to vaccines, long before COVID-19.

“The students cannot be a nursing student if they aren’t current in all of their other immunizations,” Muhovich said. “So any resistance is just to this COVID [immunization].”

Unvaccinated students are left with one option: a personal, or “religious,” exemption. Some agencies review these exemptions themselves. Others leave Bethel to make the decision. Either way, students are left waiting for a verdict on their academic future.

“We were pleased that they would consider student exemptions,” Dahl said. “We had no idea how they would view them … We have a few that are outstanding, but most of our students that have requested religious exemptions have received them.”

For the time being, clinical agencies and Bethel faculty are doing what they can to get students into hospital settings. However, Dahl cannot guarantee this will always be the case.

“We don’t know about next semester, and we don’t know about tomorrow,” she said. “It depends on what happens with COVID, and the agencies dictate what we have to do. When they say jump, we jump.”

As an uncertain senior year approached, the anonymous student considered transferring to local schools, such as Northwestern University, where the policy is similar to Bethel, or across the country to Florida, where restrictions are looser. If she stayed at Bethel, she knew she had two options: either get vaccinated or hold off and hope she could finish the year and graduate.

Despite considering other schools, the nursing student decided to complete her senior year at Bethel.

“I’ve worked too hard for the grades that I’ve gotten, for the involvement I’ve had at Bethel, for the friends that I have here to switch schools,” she said. “[Transferring] wasn’t the right decision for me, but I still encourage the rest of the [nursing students] to pursue it if they want.”

Because online clinical simulations are no longer an option for Bethel students, agencies barring exemptions entirely would force unvaccinated students to make a difficult choice: either get vaccinated or start fresh with a new major. 

The creator of the unvaccinated seniors’ group chat has submitted two exemptions to two separate agencies. After struggling to find an exemption form for the second agency, she continues to wait for a response. Students were informed via email that they must be vaccinated or have their exemptions approved by Oct. 1. 

“I was supposed to get vaccinated … so they technically can kick me out of nursing right now,” she said. “They could call me and say ‘You’re done’ because I haven’t heard back.”

Mandating vaccines and barring exemptions is not a simple choice for hospitals. Haider spent his summer at a Veterans Affairs hospital, where shifts were often short two nurses with assistant nurses being called to multiple floors simultaneously. Bonuses were handed out frequently to incentivize working long hours while understaffed. 

Junior nursing student Joy Olson spent her summer working at a nursing home and shared a similar experience to Haider. Nursing homes have a reputation for being understaffed, even before the pandemic. As Olson starts clinicals this year, she has seen the nurse shortage first hand in a hospital setting.

“I’m pro-vaccine because the statistics right now are saying most people who are being treated in the ICU for COVID are unvaccinated,” she said. “I see a lot of nurses right now who are still so burnt out and are struggling so heavily with this because of people’s decisions to not get vaccinated.”

Dahl believes this necessity for workers plays a role in the hospital’s flexibility for exemptions.

“I do think that that does drive some decisions,” Dahl said. “I think that’s why they’re taking student exemptions. They want these students to graduate and be nurses.”

For the time being, unvaccinated students can follow their calling to be a nurse at Bethel.  Despite the exemptions that have been allowed and the relief she felt as cried on the yoga mat, the anonymous student decided to get vaccinated a month ago. She continues to support her unvaccinated friends, but she felt the obstacles for unvaccinated nursing students were too much.

“I was done dealing with it,” the anonymous student said. “I was either ready to be done with nursing or to just get it and be done with it and pray that nothing bad happened to me.”