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ADVANCE Perspective: Nurses

Mandatory Flu Vaccines for Nurses: The Wrong Choice

Published September 8, 2014 2:22 PM by Guest Blogger

By Priscilla Ngo, BSN, RN, a staff nurse on critical care staff unit in Philadelphia and Family Nurse Practitioner student at the University of Pennsylvania School of Nursing.

For many years, the flu vaccine has been recommended for healthcare workers, especially nurses who have direct patient contact, to prevent the spread of the influenza virus from healthcare workers to their patients.

Recognizing the importance of vaccination, Healthy People 2020 has created a goal to increase the percentage of healthcare personnel who are vaccinated annually against seasonal influenza to 90%.1

Unfortunately, there has been difficulty with getting healthcare workers vaccinated, as vaccination rates have been as low as 45.5% in 2008.1

Getting desperate, hospitals and other healthcare facilities have started implementing policies mandating vaccination of their healthcare workers as a condition of employment. Many research studies do show that having mandatory vaccination policies are very effective in raising vaccination rates to above the 90% goal.

 However, instituting a mandatory vaccination policy is a drastic measure that is unnecessary.

Getting vaccinated is indeed a good way to protect yourself and your patients and should be encouraged for everyone, especially healthcare workers – but there is a big difference between encouragement and mandating.

Flu vaccination should be heavily encouraged, not mandated.

Freedom of Choice

Mandating flu vaccination violates freedom of choice for healthcare workers. Healthcare workers should have the autonomy to make their own informed decisions regarding their own health.

We as nurses are constantly advocating for our patients’ autonomy to make their own informed healthcare decisions, so why are we not advocating for ourselves?

Even the American Nurses Association came out with a statement saying that they do not support mandatory vaccination and that we “need to protect the rights of nurses to ensure that they are treated fairly and have the necessary workplace protections”.2

Voluntary Programs

Mandatory vaccination policies are not necessary because voluntary vaccination programs can be successful on their own.

Research studies have shown a significant increase in healthcare worker vaccination rates in voluntary programs over time. In one study, vaccination rates jumped from 61% in 2010 to 85% the next year in 2011.3

Research studies have also been conducted exploring the specific components of a vaccination program that are most effective in increasing rates of vaccination.  Some of the most effective components include emphasizing accountability to the highest levels of the organization, weekend access to the vaccine, and train-the-trainer programs.4

Using this information, we can strengthen voluntary programs. We can also strengthen voluntary programs by using research conducted on why healthcare workers decline vaccination. One study found that the most common reason was concern about side effects.5 If we provide better education regarding the side effects of the flu vaccine (which are not serious), then perhaps more healthcare workers’ fears would be allayed and vaccination rates would increase.

Another study found that a common reason among nurses for declining the vaccine was that they objected to being coerced or pressured into vaccination.6 If nurses do not like being coerced or pressured into vaccination, then clearly they would disapprove of mandatory vaccination policies.

Instead of enforcing a mandate that would create resentment among nurses and staff, a comprehensive voluntary vaccination program can be created using all of the research gathered regarding most effective components and reasons for declination.

With time, vaccination rates can reach the proposed goal of 90% with these strengthened voluntary programs.

Effectiveness of Flu Vaccine Questioned

After all this discussion on the flu vaccine, you have to wonder – exactly how effective is the vaccine?

We all know that the flu vaccine only protects against certain strains of the influenza virus. The Center for Disease Control and Prevention (CDC) takes an educated guess on what strains will be most prevalent during any given year, and creates a vaccine based on that information.

But really, how protected are we?

According to a recent large meta-analysis study, the flu vaccine was only 59% effective for adults aged 18-65 years old.7 This means that vaccinated healthcare workers can still potentially get the flu and transmit it to their patients. Instead, emphasis should be placed on encouraging healthcare workers to stay home when experiencing flu-like symptoms without any repercussions.

Too often, healthcare workers encounter problems when wanting to call out sick – for example, not having enough sick time or strict policies against calling out sick more than a certain number of times a year. These policies regarding calling out sick are ridiculous – if a staff member is feeling sick, there should not be any roadblocks to allowing them to stay home. Keeping sick healthcare workers at home is truly the best way to prevent the spread of the flu virus to patients.

Drastic Measures

Mandatory flu vaccination for healthcare workers is a drastic measure that is unnecessary and should not be implemented. It violates the rights of healthcare workers.

A comprehensive voluntary program using all the research that has been done in the past several years can be used instead to effectively increase vaccination rates. In addition, the flu vaccine isn’t guaranteed to be effective – more emphasis should be placed on allowing healthcare workers to stay home when feeling sick.

Certainly, mandating flu vaccination as a condition of employment can be the fastest and easiest way to increase vaccination rates to goal. But, after giving it some thought, is it really the right choice?

1.  Healthy People 2020. Immunization and Infectious Diseases.  Accessed September 15, 2013.
2.  American Nurses Association. ANA Urges Registered Nurses to Get the Seasonal Influenza Vaccine: Supports Comprehensive Prevention Plan.  Accessed September 15, 2013.
3.  Modak RM, et al. Increasing Influenza Vaccination Rates among Hospital Employees without a Mandatory Policy. Infect Control Hosp Epidemiol. 2012;33(12):1288-1289. doi: 10.1086/667384
4.  Talbot TR, et al. Factors Associated with Increased Healthcare Worker Influenza Vaccination Rates: Results from a National Survey of University Hospitals and Medical Centers. Infect Control Hosp Epidemiol. 2010;31(5):456-462. doi: 10.1086/651666
5.  Palmore TN, et al. A Successful Mandatory Influenza Vaccination Campaign Using an Innovative Electronic Tracking System. Infect Control Hosp Epidemiol. 2009;30(12):1137-1142. doi: 10.1086/648084 
6.  Ribner BS, et al. Use of a Mandatory Declination Form in a Program for Influenza Vaccination of Healthcare Workers. Infect Control Hosp Epidemiol. 2008;29(4):302-308. doi: 10.1086/529586
7.  Osterholm MT, et al. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:36-44. doi:10.1016/S1473- 3099(11)70295-X. 


I can't help wondering if these mandatory flu vaccines are turning people off of going into nursing.

I know of several anecdotal stories of kids of friends of mine who wanted to go into nursing, but ended up choosing acupuncture, massage therapy, or other alternative treatment education because they had reactions to the flu vaccine in the past and figured they would not be able to work in a hospital as a nurse without it.

Lola, RN May 30, 2018 6:20 AM

I choose to live a healthy lifestyle. Do hospitals screen staff members for STDs? Drug use? Then, don't screen me! I haven't had the flu in over 40 years, and I haven't had a flu shot either.

It's time for nurses to protect infants and children from vaccines. Do the research on autism and other neurological impairments. Why are Americans so sick?

Joyce Holman, RN March 2, 2015 8:16 PM
Harrisburg PA

ADVANCE Perspective: Nurses : Mandatory Flu Vaccines for Nurses: The Wrong Choice

October 23, 2014 5:41 PM

ADVANCE Perspective: Nurses : Mandatory Flu Vaccines for Nurses: The Wrong Choice

October 22, 2014 9:08 PM

ADVANCE Perspective: Nurses : Mandatory Flu Vaccines for Nurses: The Wrong Choice

October 15, 2014 4:59 PM

Know-nothing bureaucrats are always telling nurses what to do, just because some dumb "patient" might get "sick" and "die".  Why exactly are the needs of these so-called 'patients' always put ahead of hard-working nurses?

Always we implement these drastic measures that make no sense.  Like, syringes- do we really have to use new one EVERY time?  It just seems wasteful. And all this hand washing!  Do they realize how bad that is for the skin?  

Brendan October 3, 2014 9:21 AM

Mandatory influenza vaccines aren't just for nurses- they are implemented for the staff that comes in contact with patients. They have been installed because the data shows that for every one nurse vaccinated, twenty members of the community are protected from influenza. A flu shot is no different from a hard hat worn by a construction worker or a seatbelt worn by a truck driver.  Flu shots protect the nurse, patient and community.

MelodyRN, Pediatrics - RN, Nurses Who Vaccinate October 2, 2014 5:12 PM
Lindenhurst NY

If side effects are not serious, why did I spend 24 days in the hospital with a flu vaccine reaction.   24 days in the hospital, 180 days in physical therapy, at times 4 hours a day, 4 years with no feeling in my legs and a blood clot on my brain, but I guess the blogger doesn't consider these things serious.  And why was the flu shot added to the Vaccine Compensation Program.   The court conceded my case before trial and settled with me.  But hey, there are no serious side effects to the shot.  

The blogger also neglects to mention that hospitals are mandating the shot to achieve a 90% vaccination rate so they can receive higher Medicare reimbursement rates.  

Lisa October 1, 2014 9:47 PM

I only disagree that side effects are not serious.  Caring for patients on a ventilator due to the flu vaccine is quite serious.  Many healthcare workers also note that hospitalizations for flu are greater among vaccinated people.  Nothing can refute personal testimony.

connie crowley, respiratory therapy - respiratory therapist, vibra hospital October 1, 2014 6:00 PM
auburn IL

Yes some of us have had bad side effects with flu vaccine! But like so much of this push vaccines.. Let's just say follow the money! They should not MAKE anyone take it or lose your job over this! Not in the USA !

Val, Tech September 9, 2014 9:16 PM

I think that bringing up the ¨policy barriers¨ is very important; hands down, the number one reason my coworkers (in the ED) are still coming to work while sick is because the very sad truth is that there ARE repercussions (sometimes serious ones!) for missing work, no matter how sick you are. We need to change the culture if we want to change the rate of transmission of these diseases!

Catherine, Nursing September 8, 2014 10:05 PM

Incorrect statement: side effects of flu vaccine are not serious.  I personally know several people that have had very serious reactions to flu vaccine.  Otherwise, I agree with this article.

Jay September 8, 2014 9:07 PM

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