With ultimatums taking effect this week in states like New York, California, Rhode Island and Connecticut, the fear is that some employees will quit or let themselves be fired or suspended rather than get the vaccine.

“How this is going to play out, we don’t know. We are concerned about how it will exacerbate an already quite serious staffing problem,” said California Hospital Association spokesperson Jan Emerson-Shea, adding that the organization “absolutely” supports the state’s vaccination requirement.

New York health care employees had until the end of the day Monday to get at least one dose, but some hospitals had already begun suspending or taking action against holdouts.

In New York, hospitals reported 84% of their roughly 450,000 workers were vaccinated as of Wednesday, up from 81% on Sept. 15. That left the future employment of about 72,000 hospital workers unclear. The percentage of nursing home staff receiving at least one dose of COVID-19 increased to 89% as of Sunday, up from 83% on Wednesday — meaning about 16,000 of the 145,000 total nursing home workers statewide had yet to comply.