Background <p>Pneumococcal vaccination coverage among at-risk adults remains low in France. Our objectives were to assess pneumococcal vaccination coverage before and after implementation of a nurse-led vaccination program in a French university hospital day-hospital, to describe reasons for refusal, and to assess the duration of the nurse intervention as an indicator of feasibility in routine practice.</p> Methods <p>We conducted a retrospective observational study using health records from the day-hospital unit where pneumococcal vaccination was systematically offered to unvaccinated patients during a three-week period in 2023. The nurse-led program encompassed identification of vaccination indications, patient counseling on vaccination, and immediate on-site vaccine administration when accepted. Multivariable penalized logistic regression was used to study factors associated with vaccine acceptance.</p> Results <p>A total of 102 patients were analyzed (median age, 68 years [56–75]; 66% women). At baseline, pneumococcal vaccination coverage was 39%. Among unvaccinated patients (<i>n</i> = 62), two-thirds accepted vaccination, increasing overall coverage to 79%. Patients who accepted vaccination were older (aOR per 10-year increase, 1.98; 95% CI, 1.15–3.87) and more frequently male (aOR, 15.4; 95% CI, 1.6–501). Counseling duration was shorter among patients who accepted vaccination, with 61% completing the interview in less than 5&#xa0;min. The most common reasons for refusal were insufficient knowledge and concerns about side effects, nearly half explicitly referring to COVID-19.</p> Conclusion <p>A nurse-led program for pneumococcal vaccination in a day-hospital substantially increased vaccination coverage, with most accepted vaccinations completed within 5&#xa0;min, supporting the feasibility of this strategy in routine care.</p>