Many are predicting that this season will be one of the worst influenza virus seasons in modern history. Does that mean nurses are morally bound to vaccinate themselves against the flu? The question has sparked vigorous debate in health care facilities and on the Internet. In August the state of New York passed an emergency regulation requiring health care workers to be immunized against the seasonal flu. The regulation, which may extend to pandemic (H1N1) 2009 (swine flu) if a sufficient supply of-vaccine is available, offers exemptions only for those workers who have no patient contact or who have medical contraindications. (The regulation does not apply to nursing home employees because such a requirement would require state legislation.)
The New York State Nurses Association (NYSNA) opposes the regulation, stating that although it encourages nurses to be immunized, it rejects the notion that vaccination should be mandatory. Nancy Webber, director of communications for the NYSNA, calls the measure "punitive" and says nurses shouldn't "be thrown out of their job because they don't want a vaccine." Furthermore, she says, the vaccination of health care workers won't, by itself, stop the spread of influenza; emphasis should be placed on infection-control measures such as isolating patients with confirmed or suspected cases of the flu and making N95 respiratory masks available for staff having contact with such patients.
Of concern to many is the fact that the regulation offers no exemption for religious or philosophical objections. Some of those staffing the NYSNA's hotline, which receives about 25 calls a day about the new regulation, suggest that the mandate could have an impact on New York's nursing workforce; some worried callers have even said they plan to leave the state.
Whether such isolated reactions would have a major effect on the state's nursing workforce remains to be seen, as does the question of how the regulation will be implemented and enforced.
As of this writing, New York was the only state that had passed a regulation of this sort; other states may follow suit, and individual health care facilities might also adopt mandatory policies. In West Virginia, for instance, the Charleston Area Medical Center has become one of the first U.S. hospitals to require flu immunization for all its employees. Meanwhile, the Association for Professionals in Infection Control and Epidemiology (APIC) has issued a position paper recommending that health care facilities require flu vaccination for all employees with direct patient contact. Citing a Centers for Disease Control and Prevention statistic that only 40% of health care workers are vaccinated against flu annually and reports that the pandemic (H1N1) 2009 virus could infect as much as half of the U.S. population this year, the APIC is calling immunization especially important.
Mandatory vaccination is a hard sell, however, given the controversy surrounding the pandemic flu vaccine. Fear that it has been rushed to market and hasn't been adequately tested has fueled debate among health care professionals over the best approach to containing the virus.
"Concerns about new vaccines are common," says Linda R. Greene, lead author of the APIC's position paper and director of infection prevention and control in the Rochester General Health System. "But in the trials [for the H1N1 vaccine], they've seen very few if any adverse effects. The news is very encouraging." And the APIC considers the alternative-a population with no immunity to pandemic (H1N1) 2009-to be the far more serious risk.
Regardless, many nurses feel that education and access are better routes to ensuring compliance than vaccination mandates. Ann Converso, president of the United American Nurses, AFL-CIO, which, like the NYSNA, opposes any regulation that makes flu immunization a condition of employment, recalls the successful program at her own workplace, the Veterans Affairs hospital in Buffalo, New York. There, infection-control nurses were asked to follow up with employees who weren't vaccinated and find out why. "They're great people to help a facility in these endeavors," she says. "They've got the knowledge, can answer questions, and are viewed as advocates for both nurses and patients."
Greene argues, however, that even facilities with very successful voluntary programs rarely get compliance rates higher than 80%. "And that's not quite good enough."
Does all this mean that nurses who stand their ground and refuse vaccination, for whatever reason, are bound to lose their jobs? That will depend on the policy of the individual workplace. "For some, it's a condition of employment," says Greene. "Others will say, okay, you can wear a mask during the flu season, or we'll reassign you to an area where there's no patient care. There are always ways to be compliant and sensitive to the needs of individuals."
Laura Wallis