Vaccine Confidence: Nurses Turn Skepticism Into Action

At the Core of Care

Published: March 22, 2021


SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families, and communities. I'm Sarah Hexem, Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium.

As part of our special COVID-19 vaccine confidence efforts, we're creating a series of podcast episodes that can be helpful to nurses at this time, and to the communities they serve. On this episode, we're going to talk about the steps nurses can take to become a vaccine ambassador.  

And joining us for this conversation are Monica Harmon and Maria Mazzocchi, two nurses from Philadelphia where we are based. During these episodes, we'll be hearing from nurses across the country. We know that depending where you are, your experiences with vaccines, vaccine deployment, even with COVID-19 is going to vary. And that's to say nothing of the personal social and cultural histories that we all bring to this facet of public health. So we're starting here in our home and we're looking forward to hearing and sharing with nurses across the country.  

Monica is a public health nurse in many arenas, including working as a school nurse working as adjunct faculty at Thomas Jefferson University and Lincoln University, and currently our nurse Diversity Council co-chair at the Pennsylvania Action Coalition. And Maria is a public health nurse supervisor here at the National Nurse-Led Care Consortium supporting our public health nurse home visiting programs that serve families with children under the age of five. And she's one of our Philadelphia Nurse-Family Partnership supervisors.  

So glad that both of you could join us. Thank you so much for making the time. 

MARIA: Thank you for having us. 

MONICA: Thank You. 

SARAH: So here we are in the heart of vaccination rollout. You both have since gotten vaccinated. So as part of the work that we're doing to boost vaccine confidence, we have been hearing from nurses and other health professionals who have themselves experienced hesitancy you know, wondering whether or when to get inoculated. So can you walk us through your own decision-making process? Monica, maybe we could start with your story. 

MONICA: Sure, I think I was vaccine-hesitant. Because this vaccine was new, I didn't know a lot of information about it. You know, one of the things that family members and friends and community members would ask is, are you getting the vaccine? And you know, why and why not? And why is this seem like it's something that came out of the blue. So I had to do a lot of research on my own for myself to be confident to get the vaccine, which I did wind up getting both immunizations. And now I tell people, look, I got it, nothing's wrong with me.  

SARAH: What were some of the reasons why you started to change your position? Because you had to share that you were feeling sort of vaccine-hesitant. You did your own research. What was the research that spoke to you? Or what were the conversations that you had that started to move you? 

MONICA: Well, I started to look at who were in the clinical trials themselves. What I started to see is that if you look at the backgrounds of those that were in the trials, that they were actually more diverse than any vaccine trials had ever been before. And particularly that they were people that looked like me in those trials. Also, when you looked at the team that developed the trials, they also were diverse. So I knew that again, there was someone on the team that looked like me, and that probably would ask the questions that I would ask, but also look at the data through a lens that I may have, as well. The other piece for me is that as a health care worker, my feeling is that eventually getting the vaccine would be tied to my livelihood. So I wanted to be empowered from the beginning that I was making a decision that was best for me. 

SARAH: Thank you so much for sharing that and I'll move to Maria, so would love to hear a little bit about your vaccine story. 

MARIA: I shared some of Monica’s feelings about that. I was a little hesitant at the beginning also because of being so new, and a different type of vaccine. That, you know, was a new thing for me too. So I did the same. I did a lot of research and specifically with data to see how, you know, people were doing so far. And the same as she said, I think for the Moderna, it was like 20% of Hispanics in the trial group and 10% black. So I was actually surprised by that number. You know, Hispanic population is very hesitant to get the vaccine, but having 20% of people, you know, actually being volunteered for the trials, that was amazing. And I said, you know, I'm a public health nurse, I should be doing role modeling for the other nurses, for clients, for my family, friends. And if these Hispanic and black communities are going there to do these trials, then I should be stepping up and do my own, you know, my job and be that role model. And also just, you know, looking at the data and how devastating COVID-19 has been for the United States. So it is a good way to put it that balance that, you know, having some side effects, and probably, and if there's serious side effects, that definitely was going to be there with the COVID infection. So just putting that in the balance helped me decide to do it. 

SARAH: It reminds me of a conversation, I think, Monica you had raised about, you know, just in nursing in general, having that, that cost-benefit analysis that's always going on. And when you're talking about something like COVID-19, that cost-benefit analysis goes through a pretty rigorous weighing. So, um, so that that was great. And you’re public health nurses, you are, and often I am saying this, you're the experts in my mind when it comes to supporting the community and supporting public health. And you were both hesitant. You both described that that was where you started in this process. So that I think is important for listeners to hear and know that, that if they're feeling hesitant, that they're probably not alone in that. But I would love to hear what you're thinking for nurses who are listening or others, what is it that you would want to make sure that they know? 

MONICA: Can I say too, I think the more that I had to explain to lay-people about how vaccines work, and just using the knowledge that I've already had, and just researching, and, you know, what was the difference between the different types of vaccines? Being able to explain that we've had Coronaviruses with us for years since the 1970s, actually. So this isn't new technology. And I think the more that I dove into the research and into the literature that was current and also explaining it, and my message began to formulate to change. And I think that also fortified my decision to have the vaccine. The other piece is just educating people about what's normal for vaccines, right. So you have this soreness at the injection site, you may have some fatigue, those are normal, right, side effects from getting vaccines. 

SARAH: How about you, Maria? What do you want our listeners to know? 

MARIA: That's important, the side effects, because many people, you know, they take the first one, and then they have that soreness, and they're like, "Oh, I'm getting sick, I better not get the second one." Because of that. Or they listen, you know, stories from other people. And they think that they're going to get sick. So just the right information, that there's no way you can get sick from the vaccine. Maybe you can get sick before taking the vaccine. And that's what caused, you know, people to think that they have COVID because of the vaccine. So just explaining it very well that and also just knowing where they’re at that moment. What their concerns are? Listening to those concerns and making sure that you're not just lecturing them, but rather having a conversation with those people, know your audience. So if there's somebody that really liked the data, just throw that data at them. But if somebody that’s going to be more hesitant, listen to that, then just have a conversation and listen to the history of that, why they are hesitant. And they may have very good reasons because of the history to be hesitant to take that vaccine. So just acknowledging that, and making sure that they don't feel pushed to do something that they're not ready. Because one of the things that I feel is that hesitation is good because it means that at some point they may change is when they're actually saying, No, I want get the vaccine. But when they're like, maybe, I don't know, later, that's good. It means that you can still work on that and get them to choose that to do it. So just yeah, I think that listening and, you know, not trying to give them reasons to do it. But rather, one thing that I feel like it's important is to ask them, what are you looking for once you get vaccinated? What is something that you want to do once you get that vaccine? Do you want to visit your grandparents? You want to kiss your grandchildren or anything that they can just look forward to.  

SARAH: Speaking of knowing your audience, I think we have talked about this, as well as, you know, nurses as providers of healthcare and consumers of health care, and, it’s the largest segment of the healthcare workforce. I'm wondering, what have those conversations looked like among your colleagues, whether that's people you're working directly with right now? Or, you know, through your other professional networks? How have those conversations gone? 

MONICA: I think some of my colleagues are kind of at the same place I was, and just, you know, just wanting to be sure and making an informed decision about getting the vaccine, I will tell you that some that I work within healthcare, say, Yes, I saw all the studies, I watched every video that the job has sent my way. I'm not getting the vaccine. And they've been very clear about that. And so I'm actually okay with people making an informed decision, as opposed to saying I'm not getting it, and not having all of the facts before they get the immunizations, but you know, it has opened up some interesting conversations.  I also was tired of getting tested for COVID. It is a violation, I feel like, and it was probably one of the worst feelings I've ever had in my whole entire life. So if I could stop getting those nasal swabs, I'm all for it.  

The other piece, knowing how vaccines work. So yes, you still could get COVID if you have the vaccination, but it's less effects. And I also don't want to be on a ventilator, as well. You know, knowing what physiologically what that sensation is and what it does to the body. I want no parts of that. So if the vaccine will help me to not have any parts of that, I'm all for it. 

MARIA: Yeah, I think that that's similar to what I've been, experiencing with the co-workers is just that, they want to have that information. They want to make sure that they're making the right decision to vaccinate. And so yeah, and I think that most of the decision comes from that information, but also of wanting to go back to something similar to our normal, you know, before, and just knowing that they're going to be part of that group of people getting others that cannot get the vaccine to be safer. So I think that that's one of the things that I hear from co-workers is that, yeah, they have the information, and they want to make sure that they're not contributing to those people that cannot get the vaccine for any reason to get sick. And I agree with Monica, if they make the decision not to do it, and it's an informed decision, that's fine. It's their decision. And I'm pretty sure that they're taking a lot of other precautions because of just, getting the information. It's important to make sure that they are not putting others at risk. 

SARAH: Thanks, Maria. And obviously, you supervise a team of home visiting nurses with Nurse-Family Partnership. And a huge part of that role is educating clients. And so, could you talk a little bit about the role your team and the other nurses have played in terms of education around vaccines with their clients? 

MARIA: Yeah, that was a tough one. Because we didn't have enough information at the beginning with the vaccine, so now, it's much better with the CDC and all the information that we can have accessible and in a way that it's easy for the nurses to get to clients and not those, you know, studies that it's really hard to understand sometimes when you read scholarly studies. So it's really just that to what I said at the beginning to listen to the clients, their concerns, what is that they're hesitant to, is it, they're afraid of the side effects, are they afraid of, you know, not being able to have babies. And that's understandable, because of like I said, the history of that, but for the nurses to be there, and listen and be the role model. You know, saying I got the vaccine, and I have to be honest, you know, I have these side effects, but being honest with the client, and explaining as much as the client wants to take and not trying to push that information, because then it's a waste of time for the client, because that client is not getting anything. So I think that that's important, just to make sure that we are listening, and opening the door for questions, instead of trying to close them with saying you need to get vaccinated. So leaving that door open. 

SARAH: And so when, when you do have those conversations about some of those topics that we don't know about, you know, things like fertility, or even breastfeeding, and I think that you know, and every day, we're learning more. But how do you navigate those conversations with clients or support nurses?  

MARIA: I don't have the perfect answer for that. But I think that Yeah, just I was talking to one of the other supervisors and I said, you know, it's great when that white nurse goes to the client and say I got vaccinated. Because Yeah, as a black and brown community, we should be role modeling. You know, I'm Hispanic. So I may just say, I got vaccinated, but my clients would say, yeah, you are old, you're not having any babies anymore. So that's fine. But if I’m a white, young, nurse, do that, then they may think that, okay, if they're vaccinating white people, then that may be, you know, something that I can do. And I know that a lot of nurses are saying, Yeah, I got vaccinated, I got vaccinated in this place, so they can know where to go. Because there's also hesitation about, well, maybe I'm not getting the same vaccine that you are getting. There's a lot of questions there and a lot of concerns. So I think that the nurses know their clients best. They're the experts on their clients, and they know how to have the conversation that doesn't feel traumatic for the client. And at the same time, is not pushing something that the client doesn't want to do, but also being an advocate for a healthy United States at the same time.  

SARAH: And it's all about trust. We always come back to when we talk about nurses. And when we come to clients, we talk about public health, it all comes back to trust. 

So Monica, you're a public health nurse educator, you also work with the school district? Can you tell us a little bit about the conversation you've been having with your colleagues, either, you know, on the academic side of things or the school district? And also, how students are reacting. So Monica wears a lot of hats. So really, you can feel free to speak from whichever perspective, where you want to share. 

MONICA: Well, I think I'll start with the academic side. And, you know, this is definitely an unfolding case study. And I probably couldn't ask for a better teaching tool for new healthcare professionals, to understand public health, understand how public health works, I always say that if public health is working, you don't know it. And I think this is a time when public health and nursing, in particular, is highlighted. Because of the work and the knowledge that we have, and, you know, that interfaces, Maria was saying, you know, with our client populations, you know, as well, you know, typically nurses are the ones that are closest to clients to patients, knowing some of those details that clients may not share with other members of the healthcare team, you know, as well.  

The other piece, when you talk about working, you know, as a school nurse, and you have that school community, and so while, in Philadelphia, our nurses, for the most part, are still working remotely with a few of our nurses actually going back into the buildings. We're also thinking about how to safely go back to school.  

The other piece is that, while all of our nurses were vaccinated, there's also the vaccine safe website through the CDC. So the CDC actually does check-ins on those of us who've registered. So you check-in, how you feeling today? What were your symptoms, you know, did you have pain?  

And so that's another opportunity for I think, for all of us to see kind of real-time how people and bodies are reacting to the different vaccination. So the idea about should we vaccinate children? Because that's the next thing on the horizon. When you think about our young people, I work in a high school so those, of course, are people of childbearing age, you know, so what are the long term effects? You know, those are just questions, we don't have the answers to as well and that’s for males and females, too. And I think sometimes we only think about females for childbearing, but we don't consider the male implications, you know, as well.  

So it's just those conversations, getting the messaging across. So thinking about how do you use some of the social media. So my school has an Instagram account, we have a Facebook account. You know, we also have the school's website, so being able to put helpful information out that way, as well as our kind of old school way of getting information out through robocalls. So thinking about how do I script information that my secretary at my school can read, and actually record and send out a few times a week. 

SARAH: Wow, so really, a vaccine ambassador, and good health Ambassador across so many platforms, and definitely a topic for many other podcasts and podcasts I'm sure being recorded as we speak about how nursing care looks so different across all these modalities and how it's continuing to change. 

Have either of you been involved with any vaccine administration, or messaging involving community leaders or organizations outside of clinical health care settings? And I know, obviously, you're both public health nurses. So your clinical healthcare settings are largely in the community. But anything or that you've directly been involved with, or know of, in terms of, you know, libraries, churches, other settings. 

MONICA: Because people in the communities know that I'm a nurse, they certainly ask the questions and you know, okay, they come with their paperwork. And I'm like, well, you just went to the doctor's office, your health care provider, but why don’t you ask those questions there, except, well, I trust you to give me the real information. I'm like, thank you. But also, I think serving on community advisory boards as well. Which I do serve on a few. I'm talking with community members and saying I've had the vaccine, and they can actually see me on these Zoom kind of files if you will. And knowing that I'm okay you know, as well, and of course, with National Black Nurses Association, which I am a member, and I'm a chapter president, you know, at the local level, we volunteer with other professional nursing groups on education, as well as vaccinations, clinics, and then also at our national level, there has been conversations with other professions as well about it. 

SARAH: And as you said, if it's someone you trust, then that's the message. Right? That's, it's about the messenger. So, you know, we, we've seen that people are being encouraged by official public health sources to share those personal stories. And we're seeing that from celebrities and politicians, and then also friends and relatives. So, you know, how are you approaching this? Do you encourage people to share? And if so, do you have best practices for how they should share? 

MONICA: I think sometimes my life is an open book. So I definitely do share maybe sometimes overshare. But also, you know, I do encourage others to talk about, you know, just let's, let's just say some real talk, you know, about vaccines, about health care in general, about being a good citizen as well. This pandemic has given me an opportunity to also think differently about things that I take for granted. You know, whether it's that herd immunity, you know, why we don't see certain diseases anymore. You know, thinking about messaging, you know, I'm thinking a lot about that, and really fidelity, not only to the science, but then also to how people take in information, and in my role, you know, as the nurse to be able to facilitate that. And also working with students, you know, as they are moving into their careers, you know, different levels, and, you know, them thinking in getting beyond just the task of nursing, but really getting at the heart, you know, what we do is nurses, and I, you know, I think the public has a better understanding of what nurses do, I would like to see more than just the acute care being highlighted because I think that was highlighted mostly throughout this pandemic, but then understanding that nursing, you could be in the breadth and the depth of areas, and practice settings. 

MARIA: So I'm not good at social media, I just use social media to laugh at dogs and cats. That's what I do. But I think that it's important to be, we are nurses, and we are the most trusted medical professionals. So that means that we have that responsibility of whatever we put there have to be backup by reliable information and good reasoning. So I think that's important. That's the only thing that I tell to my nurses, you know if you're going to post something, make sure that you can back that up, and that you have a good reason for saying, don't vaccinate, don't get the vaccine, What's your reason, give the information, because yeah, you are in power, even if you don't feel that you are that powerful, you are, and people are going to listen to you. If you have a nurse in your social media name, somehow there, then people are going to look for that information from you. So I think that's important to make sure that whatever we say we're not just saying it lightly, that we have information for that. 

SARAH: Absolutely. And there's trust again. Do either of you have strategies for how you address misinformation? What is sort of the best practice there when someone that you're talking to is relying on information that you that you know not to be true? 

MARIA: Yeah, that's a tough one. Because you know, you believe what you see. And sometimes you don't go to the other side of the road, you just want to stay there. That's what you know, that's what's comfortable. And so one thing that I learned with the political climate that we live was to, to hear them out to, you know, get more information, and to understand why they believe what they were believing. And then, like I said, when I brought the information, they were more resistant to listen. But then when I said, Oh, yeah, I hear what you're saying. So what do you mean is this and this and that, and put it in a way that they, you know, didn't expect, then they may feel like, No, that's not what I mean. And then starting that conversation with them, just to get to have that debate without being you know, getting into a fight. But with the clients, I think that's a little different because we always say that they're experts on their own life. So I'm just asking, we have these that we talk about, ask, provide, ask. So we ask what the information they want, or what do they know about this, how much they know about something, and then provide information and then ask if that information was helpful. So just as a matter of fact, not trying to have an agenda that the client may not be ready for that agenda. And I think that that's, that's the best way because we cannot force anybody to change their thoughts. 

MONICA: It's just the facts. Right. And I think that's what people want, they want to know that they can trust the information that is coming from you. But then also, as Maria was saying that you respect their decisions as well. And I think that's important, everyone's autonomous. And they want to feel that power if you will. So that's all you can do is provide the education and support the decisions that are made. 

SARAH: Where does it seem like clients or colleagues, where are they getting the incorrect information, if you could just speak to that a bit more directly? 

MONICA: I think social media definitely plays a part. But also, I think history. Of course, when we talk about those of African descent, we always think about Tuskegee, the syphilis experiment. And I also as a native of Philadelphia, and I think about the Holmesburg prison experiments as well. You know, it's just that, history has taught us that there are some not so kind people in the science arena, and in the name of science, you know, they do some things that aren't so great to people. And I think, you know, those traumas are still very much in the forefront of people's minds. So I'm very cognizant of the fact that as an African American nurse, you know, I do represent an institution, healthcare delivery system, that does not always treat those that look like me well, right. And as those that work within the system, as well as outside of the system. And so, the idea of being at the forefront, being at the table, as well is not lost on me. And being vocal, when I do see things that aren't quite right, or intervening in a way they make sense for those that look like me. 

SARAH: In many ways, we are just beginning the vaccine rollout. But in other ways, we're pretty far along. So any lessons that you've learned so far, that that you think will inform your future practice? And how you look at the healthcare system, more broadly, in the future? 

MONICA: I think as a representative of the healthcare community, is that I have to be cognizant of how I look to other people, you know, you are an example, you know, it's almost like your life is the example. So I can't tell people to do things that I'm not comfortable doing myself. And really having that honest conversation saying, I struggled with this decision as you may be. This is what I used to be more confident in my decision. Also becoming more aware and up-to-date on information as well. And I've always been comfortable with saying, I don't know. This is what I do now. But also finding that information and coming back. And that's important, I think to community members, you know, as well. So I think, as people ask, have you had this shot, and I don't like the term shot. I'll be honest, because I think for some communities that are plagued with violence, that's a negative. So I do make it a point to say injection, or I say vaccination or immunization. And I'm very deliberate in my speech as well, because I also want to be inclusive. And I don't want one word to be the defining factor between someone's you know, saying, No, I'm not getting this or Yes, I'm confidently going to get this vaccine. 

SARAH: How about you, Maria? Any overarching ways that this vaccine rollout is impacting you and how you think about health care?  

MARIA: Yeah, and I just want to say that I love how Monica said that, you know, being honest and saying, Yeah, I struggle with this decision. And this is what worked for me to get to the decision. I really love that. Just being honest. So for me is everybody has their own reasons to do the things that they do or think they make those decisions to, when they want to get vaccinated, or if they want to get vaccinated. And I feel like, this just taught me how important it is to listen to not judge people, because you have to know where they're coming from, and what they are experiencing, to be able to be there with them and support them in whatever decision they make. And, it could be lack of information. But it could be also so many other things that you don't get to know until you sit down and have that conversation. And another thing is that we are very resilient, nurses and clients, and we're here, we're doing this work together, one year after the start. And so I feel like that's really powerful to take on and say, Hey, if we made it so far, then this is not going to stop us. And we were able to work this out together. So vaccinations are not going to be what breaks it off, it's going to be actually something that it's going to be, you know, something that we are going to be working together to get to that goal, and whatever is for each one. 

SARAH: And I think that those comments also reflect this growing awareness that our health care workers need our support, and that we need to take care of our of the people that we're charging with taking care of us. And we've known that in the health policy space, we talk about the quadruple aim. But I don't think that it had permeated mainstream society in the way that it has now of how are we taking care of our frontline providers? How are we looking at our essential workers, so even beyond health care, in that example, But also resilience doesn't just isn't something we can take for granted that we really do need to take care of each other. 

Anything that you would add about self-care? We were just talking about resilience, and taking care of each other. Is there anything to share in terms of for our listeners, who, who maybe are struggling, who maybe have had a lot of difficult conversations about vaccines, even in this moment, how can we be supporting those listeners? 

MONICA: I think that self-care is different for everyone. So, you know, my idea of what helps to refuel me and I think NFP uses that, refueling is different from what maybe you use to refuel you, you know, aside from I think, you know, the eating properly to getting a proper amount of rest, hydration, you know, just those other things, you know, whether it's just spiritual, keeping that mind body and spirit balance is important, you know, taking stock of today, you know, as well, and I think I'm actually living more on purpose now, with my career and what I say yes, to what I say no to, and being okay with what I'm saying no to, as well. You know, so I think if nothing else does pandemic has taught me that if I'm not working at my best self, then I can't possibly give the best care and you can’t have the best health care outcomes. You know, we're all a part of this system. And if one part is deficient in any way, then the whole system is. 

MARIA: We all take things differently. What may be stressful for one person may be nothing for the other. So it is important to know that too that I'm just asking, all the time that question, how are you? But really, how are you? And yeah, taking the time to do what you need to do to have that energy back, and that mental health state to be able to continue with your work and your life. And there was a meditation thing that I did that says, letting go, but it doesn't mean because I always listen to that, like letting go of the things that you cannot change. But at the same time, they said, letting go, but not for forgetting those things, just letting go for now, until you get to a place that you can grab them again and make that change. So I think that that's really helpful, at least for me, just knowing that if you can’t change something now, and that's okay, you can wait and see if you can do it later on when you have that strength back. So similar to what Monica said, if you are not in that place, then how could you be changing or doing different things? So just get back to your own and then help others or change the world. 

SARAH: This has been really, really wonderful. And I just want to applaud all of the work that you are doing actively every day to support your clients, who are nurses are working with clients and patients in schools and community all of those things. I mean, it really is phenomenal to do that. And then to also make time for this podcast, so just want to say thank you for that.  

MARIA:  Thank you for having us. 

MONICA: Thank you.


SARAH: Special thanks to Monica Harmon and Maria Mazzocchi for taking the time to talk with us.

For more about the PA Action Coalition and our current outreach efforts, visit us online at And you can always follow us on social media @PAAction.

Stephanie Marudas of Kouvenda Media is our producer and we had production assistance from Brad Linder.

I’m Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.

This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.