NEW YORK (AP) — Hospitals and nursing homes in New York are bracing for the possibility that a statewide COVID-19 vaccine mandate for health care workers could lead to staff shortages when it takes effect Monday.

Doctors and nurses — and also support staff, like food service workers and cleaners — have been given until Sept. 27 to get at least their first vaccine shot in one of the nation's most aggressive plans to protect patients.

With just days left to go before the deadline, many still hadn't. That left the prospect of potentially thousands of health care workers being forced off the job next week.

With no sign of Gov. Kathy Hochul backing down, hospitals and nursing homes were preparing contingency plans that included cutting back on elective surgeries and, at one hospital, halting maternity services. Nursing homes were limiting admissions. The state’s largest health care provider, Northwell Health, was keeping thousands of volunteers on standby.

“We would like to see some more time to be able to comply and implement the vaccine mandate, because at the end of the day it’s a situation where we’re very concerned about our ability to care for the patients," said Tom Quatroche, CEO of the Erie County Medical Center Corporation, which operates a busy 573-bed hospital in Buffalo.

It anticipates that about 10% of its workforce, or 400 staff members, might still not be vaccinated by Monday. Under a contingency plan, the hospital said it would suspend elective inpatient surgeries, temporarily stop accepting ICU transfers from other institutions and reduce hours at outpatient clinics.

Hochul, a Democrat, held firm on the deadline Thursday, telling reporters at a news conference that there were “no excuses” for those refusing to abide by the mandate, announced this summer.

“Every single person who is in your care has the right to know that there is no chance they will be infected by the person in charge of protecting them and their health,” she said Thursday.

New York is not the only state to require health care workers to get vaccinated. But it has been especially aggressive in pushing for wider vaccinations to help limit the spread of the virus in a place that was once the center of the ongoing global pandemic.

Earlier this week, a judge refused to halt New York City’s plan to require teachers in the country’s largest public school system to get vaccinated, a mandate that is also to begin Monday.

That looming deadline was also raising concerns about potentially thousands of teachers and school staff being suspended Monday.

United Federation of Teachers President Michael Mulgrew on Thursday asked the city to delay the rule, saying “our schools are not ready.”

Mayor Bill de Blasio, a Democrat, said he was confident holdouts would get the shot this weekend rather than face a loss of pay. And if not, he said, “we have thousands and thousands of vaccinated experienced substitute teachers ready to go.”

The mandate for health care workers comes as hospitals are already reeling from staff shortages due in part to rising demand, workers retiring and weary employees seeking other jobs after 18 months of the pandemic.

There is one option for workers who don't want to get the shot, which is to apply for a religious exemption. That would buy them until at least Oct. 12, while a federal judge considers a legal challenge arguing that such exemptions are constitutionally required.

With time ticking down on the health care mandate, Northwell Health was trying to persuade thousands of holdouts to get vaccinated, including individual meetings with staffers. The system’s personnel chief, Maxine Carrington, said they're seeing a lot more appointments being scheduled.

“I’ve had personal conversations with team members, and I was asked by one: ‘Are you really going to fire us on the 27th?’ And I said, let’s put that aside for a minute and let’s talk about saving your life. Why don’t you want to get vaccinated?” Carrington said.

She said staff that refuse the inoculations will "no longer be qualified for employment.”

As of Thursday, about 90% of Northwell's 74,000 active personnel had been vaccinated. Still, the hospital system acknowledged that it did not expect full compliance and had more than 3,000 retirees, volunteers and health care students on standby, should they be needed Monday.

The University of Rochester Medical Center, in the state’s fourth largest city, announced a two-week pause in scheduling new elective procedures at its Strong Memorial Hospital beginning Monday. It also is temporarily closing two urgent care centers this week.

One wild card is no one knows if a burst of health care workers will simply wait until the last minute to get a jab.

One hopeful sign: New York-Presbyterian, one of the state's largest hospital systems, had imposed an earlier vaccination deadline on its workers — midnight Wednesday — and reported fewer than 250 of its 48,000 staffers had failed to comply.

Spokesperson Alexandra Langan said in an email: “For those who chose not to comply, they will not continue to work at NYP.”

New York state has been averaging just under 5,000 new COVID-19 cases per day with around 2,300 people hospitalized. That’s far worse than in late June, when around 300 people were testing positive each day statewide.