Mandatory Flu Vaccines for Nurses: The Wrong Choice
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
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%
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
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
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
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
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.
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. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=23.
Accessed September 15, 2013.
2. American Nurses
Association. ANA Urges Registered Nurses to Get the Seasonal Influenza Vaccine:
Supports Comprehensive Prevention Plan. http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2010-PR/ANA-Urges-RNs-Get-Seasonal-Influenza-Vaccine.pdf.
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.
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.
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.