Are Mandatory Flu Shots Really

Necessary? A Nursing Perspective

Angelique Kinyon
Ferris State University

Each year as influenza (flu) season begins, we are posed

with the question: To vaccinate or not. Healthcare
workers are faced with extra weight in this decision as
not only is their individual health on the line, but also the
health and well-being of their family, friends, and
patients. Flu shots have become an increasingly hot topic with the
implementation of mandatory policies in several healthcare facilities. Yet
voluntary programs continue to produce less than adequate results. Patients are
put in a position to trust healthcare workers to protect them from further harm
and provide an environment conducive to health. Because of this, decreasing
the risk of influenza needs to be a priority. This leads to the question: What is the
best way to protect vulnerable patients, healthcare workers, and the general
public during flu season? The only logical answer is to take a scientific, yet
ethical approach.

Influenza: Cause for Concern

Influenza causes thousands of deaths each year and hundreds of thousands of
hospitalizations. These numbers could easily be reduced through widespread
vaccination. The Centers for Disease
Control and Prevention (CDC)
Adults typically shed influenza
recommends all people get an annual
virus from the day before
flu shot unless contraindicated (2014). Of
symptoms begin through 5-10
particular importance are healthcare
days after illness onset.
workers as they come in close contact
with people infected with influenza and
(CDC, 2013)
in turn may easily infect vulnerable
patients.

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Flu Shots: Are Mandatory Vaccinations Really Necessary?

High-Risk Populations
Certain individuals have a particularly high risk of complications from influenza:
Children younger than 5
Adults older than 65
Pregnant women
American Indians and Alaskan Natives
Immunocompromised individuals (cancer,
HIV, chronic steroid therapy)
Individuals with chronic diseases: Asthma, COPD, CHF, Diabetes, etc.

In general, patients within healthcare facilities are not completely healthy. While
they may not have a chronic disease, they do have some sort of ailment or
undergo a procedure that could put them in a vulnerable state. Infected
healthcare workers may be spreading influenza before they even know they are
infected.

Background
Voluntary vaccination programs are ineffective for 4 main reasons: inadequate
staff education, refusal for ethical reasons, inadequate patient education, and
increasingly vulnerable patient populations.
All healthcare workers should be vaccinated for influenza annually. But nurses
may pose particularly strong threat as they account for the majority of direct
patient contact. Patients spend more time with nurses during an admission
than with any other profession in the hospital (Dempsey, Reilly, & Buhlman,
2014). Nurses are considered the most honest/ethical profession in America
(Gallup, 2014). Yet there continues to be resistance to annual vaccination.
Nurses have a professional and ethical obligation to be immunized it protects the health of the nurse, patients, and the community.
American Nurses Association
Of course, vaccination is not a feasible option for all individuals. Obvious reasons
for refusal include medical conditions and history of adverse reaction to a
vaccine. Other exemptions include religious beliefs and personal autonomy
(Nelson & Lahey, 2013).
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Flu Shots: Are Mandatory Vaccinations Really Necessary?

Options
Despite efforts of even the most ambitious
voluntary vaccination programs, influenza
vaccination of healthcare workers remains
below 65% (CDC, 2014). Because of this,
mandatory policies with alternative options
for exemptions should be implemented.

HEALTHY PEOPLE 2020 GOAL:

90% OF ALL HEALTHCARE
WORKER VACCINATED
ANNUALLY

As with every aspect of life there are

risks/benefits and pros/cons. These must be weighed in an effort to make the best
overall decision. In regard to mandatory vaccination policies, the benefits outweigh the
risks and the pros outweigh the cons on multiple levels.

Pros
Protection of self, patients, and family
Decreased morbidity and mortality rates
Promotion of ethical practice
Overall improvement of healthcare
environment

Cons
Initial push-back and possible animosity
from staff

Possible loss of employment for noncompliance

Current Situation
Without intervention, the current trends will continue. Vulnerable patients will be
put at risk and as displayed in the graph below, the number of deaths related to
influenza will continue to exceed the epidemic threshold (CDC, 2013)..

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Flu Shots: Are Mandatory Vaccinations Really Necessary?

Recommendations
Influenza continues to be a leading cause of
death despite the fact that it is a vaccine
preventable disease (Office of Disease
Prevention and Promotion, 2014). For every 15
healthcare providers who receive the influenza
vaccination, one fewer person in the
community will contract an influenza-like
illness (Association for Professionals in Infection Control and Epidemiology,
2014).
Instituting a mandatory vaccination policy has proven to be the best way to get
the highest percentage of employee vaccination. The policy should however
allow for ethical considerations for religion, medical conditions, and personal
beliefs. There should be an option to wear a mask instead of vaccination. Either
option should be made available at no cost to the employee (Nelson & Lahey,
2013). Also, education should be provided and include the side effects/risks
involved versus the benefits. In an effort to provide widespread protection, ALL
patients should also be screened for and educated on influenza and
vaccination with the option to receive the shot.
Health care professionals have obligations to do no harm, to do good, to
respect patient autonomy, and to treat all patients fairly (Ottenberg, Wu,
Poland, Jacobson, Koenig, & Tilburt, 2011). Annual vaccination is currently the
best option available for preventing the spread of influenza and while it may not
protect each and every person vaccinated, it will decrease the incidence thus
decreasing mortality rates and improving the overall healthcare environment
(CDC, 2014).

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Flu Shots: Are Mandatory Vaccinations Really Necessary?

References
American Nurses Association [ANA]. (n.d.) Immunizations. Retrieved from:
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessiT
hePractice/Improving-Your-Practice/Immunizations
Association for Professionals in Infection Control and Epidemiology. (2014) Study:
When hospital workers get vaccines, community flu rates fall. Retrieved
from: http://www.apic.org/For-Media/NewsReleases/Article?id=e0b94274-5340-47ca-b86f-fdb64c90e79e
Centers for Disease Control and Prevention [CDC]. (2013). CDC Influenza E- Brief
and Prevention. Retrieved from:
www.cdc.gov/washington/fluBrief/Sept2013FluBrief.pdf
Centers for Disease Control and Prevention [CDC]. (2014). Seasonal Influenza
(Flu). Retrieved from http://www.cdc.gov/flu/index.htm
Dempsey, C., Reilly, B., & Buhlman, N. (2014) Improving the patient experience:
Real-world strategies for engaging nurses. Journal of Nursing
Administration. 44(3):142-151. Retrieved from: Ovid Database
Gallup. (2014). Honesty/ethics in professions. Retrieved from:
http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx
Nelson, W. A., & Lahey, T. (2013). The ethics of mandatory flu shots. Healthcare
Executive, 28(6), 42-46. Retrieved from: Proquest Database
Office of Disease Prevention and Health Promotion. (2014). Healthy People 2020
Immunization and infectious diseases. Retrieved from:
http://www.healthypeople.gov/2020/topicsobjectives/topic/immunization-and-infectious-diseases/objectives
Ottenberg, A., Wu, J., Poland, G., Jacobson, R., Koenig, B., & Tilburt, J. (2011).
Vaccinating health care workers against influenza: The ethical and legal
rationale for a mandate. American Journal of Public Health, 101(2), 212-6.
Retrieved from: Proquest Database

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