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Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative
Po-Jen Kung1, Ching-Min Chen2, Esther Ching-Lan Lin2
1School of Nursing, Johns Hopkins University, Baltimore, United States; Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Background:
Mandatory vaccination policies have sparked global ethical debates, particularly in the context of COVID-19. Among healthcare workers, nurses-the largest segment of the frontline workforce-face distinct tensions between professional responsibilities and personal autonomy. Yet, the ethical challenges these policies pose from nurses' perspectives remain insufficiently examined.
Aim:
This review examines the ethical challenges of mandatory vaccination from nurses' perspectives, informs ethical policymaking, and provides insights to navigate similar future scenarios.
Design:
A mixed-methods systematic review guided by the Joanna Briggs Institute methodology.
Data Sources:
Final searches of five databases-Embase, MEDLINE, CINAHL, Web of Science, and Scopus-were conducted in September 2025. Additional records were identified through citation tracking and supplementary searches.
Methods:
Empirical studies published from 2019 onward were screened for relevance and assessed for methodological quality using standardized critical appraisal tools. Studies were included if they examined nurses' experiences, attitudes, or ethical perspectives regarding mandatory vaccination. A narrative synthesis approach was applied to integrate qualitative, quantitative, and mixed-methods findings.
Results:
Twenty-eight studies were included (19 quantitative, 5 qualitative, and 4 mixed methods). Four themes emerged: (1) Walking a Tightrope-Between Vaccine Safety and Effectiveness; (2) Silent Burden-Navigating Stigma in the Shadows; (3) Navigating the Fine Line-Balancing Rights and Public Health in Times of Crisis; and (4) Strengthening Leadership and Communication.
Conclusions:
While mandatory vaccination policies may serve public health goals, they can also generate ethical distress, undermine trust, and increase stigmatization among nurses who remain unvaccinated. Future policies should move beyond enforcement toward fostering ethical alignment through education, open dialog, and respectful engagement.
Registration:
PROSPERO registration number: CRD42024551112, registered 03/06/2024.
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