Blog Viewer

https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/08/31/mise-en-oeuvre-de-la-vaccination

Reasons and implications for non-compliance, and solutions to consider

By Kristi McManus
August 31, 2026

As vaccine-preventable illnesses re-emerge in communities, the risk of exposure for patients and staff is increasing (Alberta Health Services, 2025). Nursing leaders are in a unique position to address this challenge through effective partnerships with staff, organizations and others. This analysis strives to highlight the importance of vaccination, identify causes of vaccine non-compliance, and provide strategies for nursing leaders to mitigate the impacts of non-compliance within health-care settings in order to safeguard patients, staff and organizations.

Vaccination within health care

Due to the nature of health-care environments, health-care workers have increased potential for exposure to vaccine-preventable illnesses when compared to the general public (Maltezou et al., 2022). For example, health-care workers are at a 13–19% increased risk of acquiring measles than the public (Haviari et al., 2015). Health-care workers have also been identified as sources of exposure and communicable illness outbreaks, including 219 staff who were identified as index cases in 1,193 cases of pertussis through a 2014 study (Haviari et al., 2015). Outbreaks of communicable illnesses increase the risk of patient morbidity and mortality, leading to poor patient outcomes and negatively impacting patient safety (Government of Canada, 2015).

The government of Canada highly recommends all individuals working in health-care settings demonstrate proof of immunity to measles, mumps, rubella, varicella, and pertussis, either through blood titers or proof of adequate immunization (Government of Canada, 2026). This recommendation is often emphasized during the hiring process within health-care organizations, requiring staff to provide proof of immunization to meet routine vaccination schedules. Lack of immunization, or incomplete records, leave staff immunity against these illnesses in question.

Causes of non-compliance

Despite public health recommendations and organizational mandates during the hiring process, some institutions struggle to enforce vaccination policies. These struggles include initial enforcement challenges such as the push for staff to begin prior to submitting documentation, tracking and follow-up of vaccination status, and instances of non-compliance due to, for example, lack of knowledge and aspects of organizational culture. These difficulties impact organizational operations through balancing staffing needs with safety and staff sustainability.

Lack of knowledge and vaccine hesitancy

For many, fear of side effects, misinformation over efficacy, and safety concerns have been shown to negatively affect vaccination rates, even among health-care workers (de Araújo et al., 2022). While not a new phenomenon, misinformation and fears include the belief that vaccines are “unnatural,” ineffective, or contain harmful ingredients, and that disease exposure is better than vaccination (Healy, 2014). Other causes include skepticism regarding vaccine benefits, and experiences of vaccine fatigue in a post-COVID-19 system. Such encounters require knowledge transmission and clarification on vaccination efficacy to ensure informed consent. These fears can result in vaccine hesitancy, as well as total non-compliance and should be addressed by nursing leaders to impact both personal decision making and organizational safety. The World Health Organization has identified vaccine hesitancy as a major threat to maintaining vaccination compliance (Fan et al., 2025).

Organizational culture

Organizational culture can affect vaccination compliance and record completion in several ways, including delayed enforcement due to staffing needs, the recent COVID-19 pandemic, and a “why now?” stance among staff. Organizations that are historically lax on enforcement will face an uphill battle in meeting public health and institutional policy requirements (Mounier-Jack et al., 2020). It is vital that organizations understand the implications of vaccine non-compliance, and work collaboratively with occupational health, infection control, and other interested partners to address counterproductive organizational cultures and their root causes through the cultivation of trust, support and leadership to improve compliance (Mounier-Jack et al., 2020).

Implications of non-compliance

Work exclusion

Each communicable illness has its own exclusion period for high-risk exposures, which may prevent staff from working if they do not have proof of immunity (Government of Canada, 2015).

Table 1 outlines the high-risk exclusion criteria, as well as recommended exclusion periods.

Table 1. Exclusion implications by communicable illness

Source: Centers for Disease Control and Prevention [CDC] (2025)

Financial

Organizations face financial implications if a staff member experiences a high-risk exposure. Nursing leaders would then need to consider these factors in the operations of units and provision of care. If one were to consider a full-time registered nurse at top tier wage as per the Ontario Nurses’ Association of $58.98 per hour, for each 12-hour shift, the base cost for a high-risk exposure resulting in workplace exclusion would result in $707.76 for the lost nurse, plus additional expense for a replacement (ONA, 2025). For staff who contract a communicable illness through a work-related exposure, Ontario’s Workplace Safety Insurance Board (WSIB) must be notified, and additional financial implications will be applied to the organization (WSIB, 2023). This results in an eight-fold financial penalty to the organization, equalling $5,044.48 per 12-hour shift lost for that individual, as well as the administrative labour associated with such occurrances (WSIB, 2023).

Patient safety

Without a complete vaccination series, health-care workers increase the risk of nosocomial exposures to vaccine-preventable illnesses to patients (Haviari et al., 2015). This can result in staff-to-patient, and staff-to-staff exposures. Many patients are immunocompromised, or in a weakened state due to illness, making them more susceptible to such exposures which can further compromise their wellness and recovery (Haviari et al., 2015). Nursing leaders have an expectation to not only reduce risk to patients through appropriate infection control and safety practices, but by adhering to upstream prevention strategies that reduce overall risk, such as vaccination.

Personal and public health

Beyond the health-care system, individual safety and the safety of the community are impacted by non-compliance of vaccination. This was noted with the resurgence of measles and other vaccine-preventable illnesses returning worldwide. Within Canada, Alberta experienced a substantial measles outbreak beginning in March 2025, with cumulative case counts exceeding 2,000 later that year, highlighting the resurgence of measles following its elimination in Canada (Government of Alberta, 2026). Inadequate vaccination for measles, for example, can cause fever and cough that can progress to pneumonia and encephalitis, complications in pregnancy, and even death (CDC, n.d.).

Related article

RN prescribing: leveraging Choosing Wisely Canada for evidenced-based practice

Strategies for implementation and compliance

Enforcing employer vaccine policies can be a challenge, and strategies that have shown the greatest impact directly involve nursing leaders. Nurses, both in formal and informal leadership roles, can champion vaccination compliance with positive effect (Mounier-Jack et al., 2020). Visible and engaged leadership that focuses on the needs of staff through teaching, support, and the cultivation of positive organizational cultures results in increased engagement of departments and improved compliance rates of health-care workers (Mounier-Jack et al., 2020).

Vaccine campaigns and alternative measures

Vaccination campaigns that focus on accurate knowledge transmission through non-coercive methods, and foster continuous compliance have been shown to yield greater results than consequence-based strategies (Mounier-Jack et al., 2020). Increased access to vaccination has been noted as a key strategy to effective vaccination campaigns, allowing nursing leaders to reach more staff and improve efficiency of such strategies (Goad et al., 2013). It is important to note, however, that individual autonomy and right of choice may conflict with organizational policy. In such cases, some organizations have implemented alternative measures such as declination forms, mandatory masking, unpaid leave during unit outbreaks, and redeployment to other units as needed (Pless et al., 2017).

Knowledge transmission

Nursing leaders can become information champions, particularly for new graduate nurses or peers new to the organization, ensuring colleagues are making well-informed health decisions (Mounier-Jack et al., 2020). This education should include the wide-reaching benefits of vaccination, such as a decrease in infectious disease mortality and morbidity, the preservation of well-being and independence in older adulthood, decreased absenteeism across the age spectrum, fostering greater health equity, easing strain on the health-care system, mitigating the spread of illness, strengthening health care and social services infrastructure, a decreased incidence of some chronic illnesses, contributing to economic productivity, and reducing health-care system costs (Government of Canada, 2024).

Organizational culture change

To address existing organizational cultures that work against vaccination compliance, nursing leaders can employ transformational leadership practices through the development of positive relationships and collective commitment to outcomes (Diaz-Saenz, 2011). It is typically a slow process, one that requires direct involvement of staff in change initiatives. This requires not only clear communication, employee motivation and positive adaptation toward change, but also collaboration, such as shared governance, which encourages voluntary compliance over compliance based on reward or discipline (Diaz-Saenz, 2011). Employing shared governance practices — in which staff take part in and provide input on initiatives that impact their work environment and practice autonomy — has been shown to increase buy-in and positive strategy outcomes (Murphy et al., 2025).

Conclusion

Ensuring health-care workers meet vaccination requirements in line with public health recommendations and organizational policies is vital for creating and maintaining a healthy environment for patients and staff. Whether through formal or informal leadership positions, nurses can change the landscape of vaccine-preventable diseases within institutions. Nursing leaders have a unique opportunity to positively impact communities through reducing noted barriers such as misinformation, hesitance, and negative organizational cultures, in turn ensuring patient well-being, and safeguarding the health-care workforce.

References

Alberta Health Services. (2025, April 9). Measles update for all healthcare providers and staff. https://albertaopticians.ca/measles-update-for-all-healthcare-providers-and-staff/

Centers for Disease Control and Prevention. (2025). Epidemiology and control of selected infections: Summary of recommendations. https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/summary-recommendations.html

de Araújo, T. M., Souza, F. D. O., Pinho, P. D. S., & Werneck, G. L. (2022). Beliefs and sociodemographic and occupational factors associated with vaccine hesitancy among health workers. Vaccines, 10(12), 2013. https://doi.org/10.3390/vaccines10122013

Fan, X., Zhao, Y., Zhang, X., Li, S., Wu, F., Cui, M., Ye, Y, Duoji, W., Jiang, S., Yuan, J., & Sun, C. (2025). Vaccination burnout impedes the compliance with multiple-dose administration of vaccines. Scientific Reports, 15(1), 13269. https://www.nature.com/articles/s41598-025-97959-4

Goad, J. A., Taitel, M. S., Fensterheim, L. E., & Cannon, A. E. (2013). Vaccinations administered during off-clinic hours at a national community pharmacy: implications for increasing patient access and convenience. The Annals of Family Medicine, 11(5), 429–436. https://doi.org/10.1370/afm.1542

Government of Alberta. (2026). Measles-data and statistics. https://www.alberta.ca/measles-data-and-statistics

Government of Canada. (2026). Immunization of workers: Canadian immunization guide. https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-11-immunization-workers.html#p3c10t1

Government of Canada. (2024). Realizing the future of vaccination for public health. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2024/report.html

Government of Canada. (2015). Canada communicable disease report. https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2015-41.html

Haviari, S., Bénet, T., Saadatian-Elahi, M., André, P., Loulergue, P., & Vanhems, P. (2015). Vaccination of healthcare workers: A review. Human Vaccines & Immunotherapeutics, 11(11), 2522–2537. https://doi.org/10.1080/21645515.2015.1082014

Healy, C. M. (2014). Commentary on “Parental vaccine-hesitancy: Understanding the problem and search for a resolution”. Human Vaccines & Immunotherapeutics, 10(9), 2597–2599. https://doi.org/10.4161/21645515.2014.970074

Maltezou, H. C., Dounias, G., Rapisarda, V., & Ledda, C. (2022). Vaccination policies for healthcare personnel: Current challenges and future perspectives. Vaccine: X, 11, 100172. https://doi.org/10.1016/j.jvacx.2022.100172

Mounier-Jack, S., Bell, S., Chantler, T., Edwards, A., Yarwood, J., Gilbert, D., & Paterson, P. (2020). Organisational factors affecting performance in delivering influenza vaccination to staff in NHS Acute Hospital Trusts in England: A qualitative study. Vaccine, 38(15), 3079–3085. https://pmc.ncbi.nlm.nih.gov/articles/PMC7090903/

Murphy, L. M., Ford, L., & Lamoreux, M. (2025.) Robust shared governance for clinical nurses. American Nurse Journal. https://www.myamericannurse.com/robust-shared-governance-for-clinical-nurses/

Ontario Nurses’ Association. (2025). Highlights of collective agreement changes as a result of the price decision and items in agreement between ONA and participating hospitals. https://ona.org/wp-content/uploads/2024/09/2023-hospital-central-contract-highlights.pdf

Pless, A., Shaw, D., McLennan, S., & Elger, B. S. (2017). Nurses’ attitudes towards enforced measures to increase influenza vaccination: a qualitative study. Influenza and Other Respiratory Viruses, 11(3), 247–253. https://pmc.ncbi.nlm.nih.gov/articles/PMC5410727/

Workplace Safety Insurance Board. (2023). Communicable illnesses. [Web page]. https://www.wsib.ca/en/operational-policy-manual/communicable-illnesses

Kristi McManus, RN, MN, BScN, OHN, is an occupational health nurse with Air Canada.

#analysis
#communicable-disease
#health-policy
#health-care-associated-infections
#infection-prevention-and-control
#leadership
#nursing-practice
#nursing-regulation