Dissatisfaction with working conditions associated with lower vaccine confidence, commitment and behaviors among nurses: A large scale cross-sectional survey in France

Background

Before, during, and after the COVID-19 pandemic, doctor shortages led many countries to expand nurses' role in their mass vaccination programs. Nonetheless, nurses often express marked vaccine hesitancy. Simultaneously, their working conditions have been deteriorating.

Objectives

To study 1) the association between nurses' perceptions of their working conditions and their vaccination-related behaviors (vaccination recommendations to their patients), and 2) the mediating role in this associations of their trust in health authorities, vaccine confidence, and vaccine proactive efficacy.

Design

A cross-sectional survey.

Settings

Salaried, community (self-employed) and mixed nurses in France.

Participants

18,888 nurses registered with the French national order of nurses (ONI, registration is mandatory) (N = 439,323).

Methods

In February 2023, this cross-sectional study used an online questionnaire to survey the nurses mandatorily registered with the French national order of nurses. Seven items adapted from models of psychosocial risk factors at work assessed their satisfaction with their working conditions. The international short version of the Pro-VC-Be (health professionals, vaccine confidence and behaviors), a validated instrument measuring psychosocial determinants of health-care professionals' vaccine behaviors) evaluated their vaccine-related attitudes and behaviors. Multiple group mediation analysis with structural equation modeling measured the associations between satisfaction at work, trust in health authorities, vaccine confidence, proactive efficacy (commitment and self-efficacy) in vaccination, and vaccination recommendations (against seasonal influenza for those with a chronic disease and against COVID-19 among adults).

Results

Among the 18,888 participants, satisfaction at work had generally deteriorated, and only 47 % considered vaccines safe. Among salaried nurses (61 %), satisfaction at work was statistically significantly associated (p < 10⁻³) with trust in health authorities (β = 0.26 [0.24; 0.28]), vaccine confidence (total effect: β = 0.35 [0.31; 0.38]), proactive efficacy (total effect: β = 0.18 [0.16; 0.21]), and, to a smaller extent, with seasonal influenza and Covid-19 vaccine recommendations (total effect: β = 0.13 [0.09; 0.16]). Trust in health authorities played a statistically significant role (p < 10⁻³) mediating the associations of satisfaction at work with vaccine confidence and proactive efficacy. These three dimensions in turn mediated the relation between satisfaction at work and frequency of vaccination recommendations. These relations were similar among community nurses.

Conclusions

Satisfaction at work appears to enhance nurses' vaccination attitudes and behaviors, which are likely to reinforce their capacity to promote their patients' vaccination. Significant improvement in their working conditions is needed to enable them to accomplish this role serenely.