The Debate Over Mandatory Flu Vaccines for Nurses

Just before the current flu season started last fall, the Massachusetts Nurses Association sued Brigham and Women’s Hospital over a new policy that made the flu vaccine mandatory for nurses as a condition of employment – in other words, nurses who refused to be immunized would be fired. Over the past few years, more and more hospitals have moved toward mandatory vaccinations as a way of increasing their rates of vaccinated employees. Brigham and Women’s reported to the press that offering flu shots solely on a voluntary basis had resulted in a worker vaccination rate of 77%, falling short of the CDC’s suggested goal of 90%

Research seems to show that mandatory policies are very effective at raising immunization rates among healthcare workers. According to the CDC, employers that required the flu shot saw average immunization rates of 88.8%, while those that merely recommended vaccination had an average coverage rate of 70%, while those that did not have a policy in place at all averaged only 44.3% coverage among healthcare workers.

Hospitals and long term care facilities have two goals in encouraging nurses to be immunized: Keeping patients safe from illness (particularly those who are elderly or immune compromised) and preventing nursing shortages that might occur if the flu spreads through the staff.

Two of the largest nursing unions, American Nurses Association and National Nurses United, have spoken out against mandated flu shots and the threat of termination of employment, while still supporting programs that encourage higher rates of flu vaccination among nurses and other healthcare workers.

Groups that oppose vaccination-as-a-condition-of-employment policies often cite several concerns. At the top of the list is the concern that such policies violate nurses’ freedom of choice, by dictating what they must put into their bodies. The argument is that since nurses ethically must advocate for the patient’s autonomy to make informed healthcare decisions, they should advocate for themselves in this area as well. When a nurse needs a job in order to support a family, the threat of termination becomes a form of coercion, which would arguably be unethical in terms of getting a patient to accept a medical intervention. And what happens when high numbers of nurses are fired all at once? Critics of mandated flu shots point out that a staff shortage may harm patients as much as exposure to flu.

There are also concerns about the vaccine’s efficacy, as it relates to the risk-benefit ratio. The flu shot typically has an efficacy rate of 60% or below, meaning that there are plenty of scenarios in which a vaccinated nurse could still come down with the flu and pass the virus on to patients before developing symptoms. Those who oppose mandatory vaccination say this gap in coverage means nurses must assume the risk of vaccination, no matter how small, without a clear benefit to patients. Some point out that it isn’t possible to do long-term safety studies on the flu vaccine because the formula changes every year. The CDC counters this argument with statistics that demonstrate the flu vaccine has an exceptional safety record nonetheless.

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