NEW YORK NURSE: April 2010

RNs at work

Mandated flu vaccine

Q.: We understand that our hospital is planning to mandate the flu vaccine for nurses next season on the basis of our “professional and ethical obligation” to protect patients. We agree that we have a professional and ethical obligation to protect our patients, but is mandating the vaccine the best approach?

A.: Nurses have a professional and ethical obligation to provide the best care for their patients. Most nurses would agree that the flu vaccine can help reduce the spread of the flu virus. The New York Sate Nurses Association strongly recommends that every nurse who is able, voluntarily receive vaccination, barring a medical contraindication.

The concern about mandating the flu vaccine as the best approach is well-founded. Everyone can agree that the best approach is one that provides for a consistent and effective method to protect patients. In years when there is a well-matched vaccine to the circulating virus, the vaccine is protective in only about 80% of healthy adults and only 40% to 60% effective in the vulnerable population of 65 years and older. Moreover, in years when the flu vaccine is not well matched to the circulating virus, effectiveness falls to less than 50%. (ACOEM, 2008)

Another problem with relying on a mandate to curb the spread of influenza illnesses is that even a well-matched vaccine to the circulating virus is only effective against an estimated 13% of all influenza like illnesses. (ACOEM, 2008)

Therefore, mandating the flu vaccine for infection prevention on the basis of a professional and ethical obligation is not a valid argument because the method is neither consistent nor effective.

The belief that mandating all nurses to become vaccinated as the most effective way to curb the spread of the virus ignores other factors that contribute to its spread, such as:

Vaccination is not 100% effective: “Annual trivalent vaccine is variably effective against influenza.” (ACOEM, 2008)
Even with vaccination, a nurse can still contract the flu and spread the virus.
A false sense of infection prevention from getting vaccinated can lead to lapses in other protective measures. (ACOEM 2006)
Visitors, sales people, contractors and vendors who are not vaccinated, or enter the facility when they are sick can spread the virus.
When patients already infected with the flu are placed in rooms with non-infected patients.
Ineffective or non-existent engineering controls and infection prevention policies.
Inadequate infection prevention hygiene and housekeeping practices.

Mandating the vaccine also has many negative and dangerous unintended consequences, including:

The mandatory issue focuses energy on fighting the mandate, rather than collaboratively establishing a strong infection prevention program. (American Journal of Public Health, 2009)
Qualified and experienced nurses, nearing retirement, will opt to retire rather than submit to taking the vaccine.
Qualified and experienced nurses who refuse to be vaccinated may be terminated. (NYC-HHC, 2009)
Early retirement and forced termination will further exacerbate the nursing shortage and jeopardize safe patient care. (JCAHO, 2009)
When there is not enough vaccine to meet demand, a mandate can cause the diversion of needed vaccine away from the vulnerable target populations.

The concern to provide the most effective and consistent patient care to meet professional and ethical obligations is best served by working with employers to create a total comprehensive infection prevention program.

This can be accomplished successfully with a well-designed program consisting of voluntary, free and convenient influenza vaccinations for all staff; a strong educational program with a community outreach component, management commitment and employee involvement; effective use of engineering controls, work practices and administrative policies that specifically address airborne transmissible diseases; and a comprehensive respiratory protection program. (NFID, 2009)

The NYSNA EGW Program receives many inquiries each month from members who have problems in their workplaces. If you have a question about labor relations at your facility, contact your NYSNA nursing representative. If you have a question you think should be featured in this column, send it to: RNs at Work, NYSNA, 120 Wall Street, 23rd Floor, New York, N.Y. 10005.