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Building a herd: Nurses’ role in championing COVID-19 vaccination

By: By Rachel B. Baker, PhD, RN, CPN; Sharon Brehm, PhD, MSN, RN, ACNS-BC; Kim K. Carter BSN, MSN-INF; and Michele Huff, MSN, RN, CPHQ, BC, CMSRN

A video series dispels misinformation and increases vaccine confidence.

Editor’s note: This is an early release of a web exclusive article for the July 2021 issue of American Nurse Journal

COVID-19 vaccines can help end the pandemic, but only if sufficient numbers of people are vaccinated to achieve herd immunity. Some people, including nurses, have expressed hesitancy about getting vaccinated. Here we describe a project that helped provide nurses with the information they needed to make an informed decision.

TriHealth, an Ohio-based healthcare system, consists of five hospitals, multiple freestanding emergency departments and surgery centers, and more than 120 ambulatory care settings employing over 3,000 nurses. As part of the TriHealth nursing leadership team, we sought to understand whether COVID-19 vaccine hesitancy found in a national survey also existed among the nurses in our system. In early December 2020, before emergency use authorization (EUA) had been granted for COVID-19 vaccines in the United States, we conducted an anonymous survey that included three questions about demographics and 16 questions about COVID-19 and vaccines. (See Initial survey.)

Initial survey

A survey conducted in December 2020 revealed vaccine hesitancy among nurses at TriHealth in Ohio. Consider adapting this survey for your organization.

Demographic Questions
What is your age?

      18-24 years

      25-34 years

      35-44 years

      45-54 years

      55-64 years

      65 years or older

      Prefer not to answer

What is your race/ethnicity?

      African-American/Black

      Asian

      Hispanic/Latinx

      Native American, Alaskan Native

      Native Hawaiian or Other Pacific Islander

      White

      Multiracial

      Not Listed: ________

      Prefer not to answer

What is your gender?

      Male

      Female

      Transgender

      Gender variant/non-conforming

      Not Listed: ________

      Prefer not to answer

Questions on COVID-19 and Vaccines
Have you ever tested positive for COVID-19?


Do you know anyone personally (friend, family member, coworker, acquaintance, etc.) who has tested positive for COVID-19?


Do you know anyone personally (friend, family member, co-worker, acquaintance, etc.) who has died from COVID-19 complications?


Have you provided care at work for a patient who tested positive for COVID-19?


Have you provided care at work for a patient who died from COVID-19 complications?


What is your opinion about how the general public is reacting to COVID-19?

      The general public is overreacting to it.

      The general public is having an appropriate response.

      The general public is not taking it seriously enough.


Outside of work, how much have you personally been adhering to the recommendations around masking, social distancing, and limiting gatherings?

0 = Never    10=All the time


Have you received a Covid-19 vaccine (or placebo) as a participant in a COVID-19 vaccine trial?


Will you voluntarily get a COVID-19 vaccine when one is available?

Definitely will get it

Probably will get it

Probably won’t get it

Definitely won’t get it

I don’t know


If you selected anything except “definitely will get it,” what are your hesitations about getting the vaccine?


How comfortable are you discussing COVID-19 vaccines with your patients?

      Very comfortable

      Moderately comfortable

      Slightly comfortable

      Slightly uncomfortable

      Moderately uncomfortable

      Very uncomfortable

      I do not have conversations with patients.


How comfortable are you discussing COVID-19 vaccines with your friends and family members?

      Very comfortable

      Moderately comfortable

      Slightly comfortable

      Slightly uncomfortable

      Moderately uncomfortable

      Very uncomfortable


How confident are you in the safety of the COVID-19 vaccine?

      Very confident

      Somewhat confident

      Somewhat unconfident

      Very unconfident


How confident are you in the effectiveness of the COVID-19 vaccine?

      Very confident

      Somewhat confident

      Somewhat unconfident

      Very unconfident


What has been the primary source where you have you obtained information about the COVID-19 vaccine?


How likely are you to get other (not COVID-19) vaccines when suggested by your primary care provider?

      Very likely

      Somewhat likely

      Somewhat unlikely

      Very unlikely

      I don’t know.

Within a week, 1,620 nurses had completed the survey. This overwhelming response signaled an interest in learning about the vaccines.

Survey respondents reported obtaining information about COVID-19 vaccines from unreliable sources, such as social media. Many nurses also stated that they didn’t have time to determine whether information about the vaccines was based on science. Accessing unreliable sources led to misinformation, resulting in nurse vaccine hesitancy. Similar to responses on the national survey, only 38% (N=615) of TriHealth nurses stated that they would “definitely” get a COVID-19 vaccine when one was available. Over 26% (N=418) said they wouldn’t get the vaccine and the remaining nurses (N=587) were undecided.

These data highlighted the need to provide COVID-19 vaccine education to TriHealth nurses. In 2021, Press Ganey found that people most likely to obtain the COVID-19 vaccine are those who believe the benefits outweigh the risks, have increased trust in vaccine safety, and have increased trust in vaccine effectiveness. If we could provide information for nurses to objectively weigh benefits and risks as well as data on the safety and efficacy of the vaccines, nurses could make informed evidence-based decisions about whether to obtain the vaccine.

In addition, vaccinated nurses providing care at the bedside would help protect patients. We knew that patients and the community would begin asking nurses questions about the COVID-19 vaccine, and we wanted them armed with evidence-based information.

What we did

Our team developed an educational program called COVID-19 Vaccine: Have You Heard? The title of the series emphasized that education could combat the misinformation nurses had already “heard.” We hoped they would gain confidence in the vaccines and become part of the “herd” of vaccinated people. We sought to disseminate information that was reliable and easy to understand and would reach nurses where they sought information—on social media. We used PowToon, a cloud-based software, to create short, colorful, and engaging animated videos. (See Have you heard?)

Have you heard?

Engaging animated videos educated nurses about some of their top COVID-19 vaccine concerns.

Using the responses from the internal survey, we selected video topics that addressed the top concerns among nurses.

  • Efficacy Part 1: What does 94% to 95% efficacy really mean?
  • Safety: Immediate, local, and systemic reactions and adverse events
  • Long-term effects: Are there long-term side effects associated with COVID-19 vaccines?
  • Reproductive health: Pregnancy, fertility, and breastfeeding
  • Efficacy Part 2: Severe and asymptomatic COVID-19 cases and COVID-19 infection caused by variants
  • What is messenger RNA: How does it work compared to other vaccines?
  • Previous infection: Why should I still get the vaccine if I already had COVID-19?
  • Herd immunity: What is it and how can we achieve it?
  • Racial disparities: Were the vaccines studied in racially diverse populations?
  • Development of the vaccine: An expedited process thanks to funding, global interest, and coordination
  • Post-vaccination questions: Side effects, second-dose timing, mask-wearing, and gatherings
  • Johnson & Johnson Janssen Vaccine: Efficacy, clinical data, and type of vaccine technology

From December 22, 2020, to January 20, 2021, the videos were shared with nurses on a private Facebook page and the healthcare system’s internal nursing website. Initially, the videos were developed specifically for nurses, but they were so well received that our marketing team posted them on the intranet to educate all team members. Marketing also posted the videos on the healthcare system’s external website to allow access by community members.

What we accomplished

On January 26, 2021, an evaluation survey was sent to all nurses. It included the same questions as the initial survey with the addition of questions requesting feedback on the video education series.

Nurses who replied “yes” when asked if they had seen the educational program were asked to rate how useful they found it (0=Not useful at all, 10=Extremely useful). They also were asked what they found most and least useful and to provide general feedback.

A total of 567 nurses responded to the evaluation survey. The nurses reported that the video topics addressed common rumors, were evidence-based, and were short and concise. Nurses also stated that the videos were useful, and many shared them with friends and family.

After viewing the videos, nurses reported higher confidence (“Very confident” or “Moderately confident”) in vaccine safety (89% vs 65% before viewing), higher confidence (“Very confident” or “Moderately confident”) in vaccine efficacy (89% vs 65%), and increased comfort (“Very comfortable” or “Moderately comfortable”) in talking with patients about the vaccines (74% vs 45%) (See Positive results.)

Positive results

Before and after viewing the video series, nurses rated their level of confidence about COVID-19 vaccine safety and efficacy as well as their comfort talking with patients about the vaccines.

Confidence in vaccine safety

Confidence in vaccine efficacy

Comfort talking with patients about vaccines

We were encouraged by these improvements, but we wondered whether they would result in more nurses choosing to get vaccinated.

Before the video series, only 38% (N=615) of the nurses surveyed stated they would definitely get the vaccine when it was available. After the series was released, the first COVID-19 vaccine received EUA and was available to nurses in our system. In the evaluation survey, 87% (N=490) of nurses stated they had received the vaccine. This was a significant increase from their intention just 1 month earlier.

The qualitative feedback received in the evaluation survey reinforced the numeric data when nurses stated that the videos were helpful in dispelling myths and making informed decisions. One nurse stated, “I am glad [the videos] were offered, glad they were done by nurses, very helpful in me deciding to get the vaccine because at first I didn’t want the vaccine at all.”  Another nurse said, “If it had not been for the vaccine video series, I do not know that I would have received the vaccine. They were very informative and very well done! They answered all of the questions that I had and encouraged me and educated me on receiving the vaccination without the feeling of being pressured to do so.”

Larger Impact

The COVID-19 pandemic brought nursing into the spotlight and demonstrated nurses’ powerful voice in addressing current issues. What started as a project to address a local problem became more impactful as it highlighted the strength of nurses on the frontlines of education. We added science to the discussion about vaccines and dispelled misinformation with data. This approach allowed nurses to make educated decisions about personal vaccination and to provide evidence-based information to their patients and the larger community. Building the HERD was the goal, being HEARD was an added bonus.

The authors work in nursing administration at TriHealth in Cincinnati, Ohio. Rachel B. Baker is a nurse researcher, Sharon Brehm is senior director, Kim K. Carter is program administrator for nursing quality, and Michele Huff is manager of nursing quality.


American Nurses Foundation. New survey of 13K U.S. nurses: Findings indicate urgent need to educate nurses about COVID-19 vaccines. October 29, 2020.

Press Ganey. Vaccine hesitancy and acceptance. Data segmentation helps address barriers. February 4, 2021.

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