COVID-19 Vaccine Uptake and Factors Affecting Hesitancy Among US Nurses, March–June 2021

Janet W. Rich-Edwards, ScD, MPH; Carissa M. Rocheleau, PhD; Ming Ding, DSc, MSc; Jennifer A. Hankins, MS; Laura M. Katuska, MPH; Xenia Kumph, Andrea L. Steege, PhD, MPH; James M. Boiano, MS, CIH; Christina C. Lawson, PhD


Am J Public Health. 2022;112(11):1620-1629. 

In This Article

Abstract and Introduction


Objectives: To characterize COVID-19 vaccine uptake and hesitancy among US nurses.

Methods: We surveyed nurses in 3 national cohorts during spring 2021. Participants who indicated that they did not plan to receive or were unsure whether they planned to receive the vaccine were considered vaccine hesitant.

Results: Among 32 426 female current and former nurses, 93% had been or planned to be vaccinated. After adjustment for age, race/ethnicity, and occupational variables, vaccine hesitancy was associated with lower education, living in the South, and working in a group care or home health setting. Those who experienced COVID-19 deaths and those reporting personal or household vulnerability to COVID-19 were less likely to be hesitant. Having contracted COVID-19 doubled the risk of vaccine hesitancy (95% confidence interval [CI] = 1.85, 2.53). Reasons for hesitancy that were common among nurses who did not plan to receive the vaccine were religion/ethics, belief that the vaccine was ineffective, and lack of concern about COVID-19; those who were unsure often cited concerns regarding side effects or medical reasons or reported that they had had COVID-19.

Conclusions: Vaccine hesitancy was unusual and stemmed from specific concerns.

Public Health Implications: Targeted messaging and outreach might reduce vaccine hesitancy.


In December 2020, the Advisory Committee on Immunization Practices prioritized health care personnel (HCP) to begin receiving 2 COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) authorized under emergency use authorizations;[1,2] a third vaccine (Janssen) was authorized in a February 2021 emergency use authorization. There have been substantial challenges in gathering information on the uptake of vaccinations by HCP. The National Healthcare Safety Network, a Centers for Disease Control and Prevention surveillance system,[3] rapidly deployed modules for reporting HCP vaccinations but faced substantial challenges in data collection.[4] The US Department of Health and Human Services launched the Unified Hospital Data Surveillance System in January 2021 for hospitals to report staff vaccinations; reporting is voluntary, however, and less than half of eligible facilities had reported data by September 2021.[5]

Without comprehensive, accurate data to estimate vaccinations among HCP, media coverage of vaccine controversies might contribute to public perceptions that many HCP are skeptical about the safety and effectiveness of COVID-19 vaccines. Because nursing is consistently ranked among the most trusted professions,[6] this might influence public vaccine hesitancy. Several small surveys of HCP conducted before the emergency use authorizations indicated varying levels of vaccine hesitancy, with studies in the United States reporting percentages ranging from 8% to 18% among HCP surveyed between October 2020 and January 2021.[7] These studies indicated that female HCP were more likely to be vaccine hesitant than male HCP, and nurses were more likely to be hesitant than physicians.[7] However, after the December 2020 emergency use authorization, opinions could have changed as a result of public health messaging, targeted communications to HCP, and HCP observing their colleagues' experiences receiving the vaccine.

We conducted an evaluation of 32 426 female nurses recruited from 3 large national cohort studies to assess vaccination rates, reasons for vaccine hesitancy, and personal and workplace variables associated with receiving a vaccine by spring 2021. This was a period when most HCP had been offered vaccinations but before vaccinations were widely available to the general population.