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More employees at health care facilities around the United States are facing a choice: Get the flu shot or look for a new job. Some health professionals are saying they agree that health care workers should receive the vaccine—but that they shouldn’t be forced to do so. And at least one court and one government agency agree with those health workers.
More than 150 hospitals and health care systems in the United States are requiring their workers to be vaccinated against the flu, according to the Immunization Action Coalition, an organization that works to increase immunization rates. In many cases, if the worker refuses to be vaccinated, he or she might have to wear a mask for the duration of the flu season, might be reassigned away from patient care, or might be fired.
Requiring such vaccinations is endorsed by the National Business Group on Health (NBGH), a nonprofit that advises large employers on health care issues, and it is strongly encouraged by the National Vaccine Advisory Committee (NVAC), an advisory group to the Department of Health and Human Services (HHS).
In a news statement, NBGH President and CEO Helen Darling said, “Transmission of seasonal influenza between health care workers and patients is a significant patient and worker safety issue. Failure to prevent the transmission of seasonal flu between health care workers and patients also increases health costs.”
Support from Employers, Some Governments
NBGH is recommending that hospitals require annual flu vaccination as a condition of employment unless employees can demonstrate a medical contraindication or religious objection. Workers who cannot receive the vaccine should stay away from patients or wear a mask at all times while on duty during the flu season. Employees who refuse the vaccine for any other reason should be fired, NBGH said.
Many professional organizations support mandatory flu vaccinations, including the American Academy of Pediatrics, American College of Physicians, American Hospital Association, the Department of Defense and National Patient Safety Foundation, according to a statement from NBGH and other sources.
NVAC has published voluntary recommendations that stop just short of mandating vaccinations. In support of Healthy People 2020, a group of HHS goals for health promotion and disease prevention, NVAC members said health facilities should have at least 90 percent of their workers vaccinated. If they can’t reach that level, they should strongly consider requiring flu vaccinations. Other recommendations focus on education on preventing flu transmission, incorporating flu vaccination programs into occupational health programs and improving ways to track flu vaccination rates among health care workers.
Similar legislation and regulations are popping up in Colorado and Oregon. According to The Denver Post, the Colorado state board of health was scheduled to vote in February 2012 on rules that would require medical facilities to attain a 90 percent flu vaccination rate among their workers. And an Oregon bill would require health care workers to provide their employers with evidence that they received a flu shot or a declaration that they declined it. The measure has cleared the Oregon state Senate and was being considered by the state’s House Committee on Health Care, according to Oregon Capital News.
Mandatory Means More Vaccinations
The Centers for Disease Control and Prevention (CDC) reported in November 2011 that 63.5 percent of health care workers reported receiving the flu vaccine during the 2010-2011 flu season. In hospitals and health care systems that required them to do so, 98.1 percent reported being vaccinated against the flu.
The CDC found that about 13 percent of the health care workers it surveyed worked for an employer that required the vaccine. During the 2009-2010 flu season, 11 percent of respondents worked for employers that made vaccination mandatory.
Also during the 2010-2011 flu season, 37 percent of health care workers reported experiencing influenza-like illnesses, lasting on average seven days. But the workers missed less than a day of work—0.7 days—because of the illness, the CDC reported.
The CDC recommended that everyone age 6 months and older receive the flu vaccine, stating, “The flu vaccine is the single best way to prevent the flu.” People most at risk of severe health complications because of contracting the flu are those with chronic medical conditions, infants and children, pregnant women, and seniors. The flu causes between 3,000 and 49,000 deaths each year and more than 200,000 hospitalizations, the CDC reported.
OSHA and Nurses Not on the Bandwagon
While many employers and professional groups promote mandatory flu vaccination, opposition has arisen from the federal government and unions representing nurses.
Jordan Barab, deputy assistant secretary for the Occupational Safety and Health Administration (OSHA) in the U.S. Department of Labor, submitted comments to the NVAC in January 2012 saying mandatory vaccinations are not necessary and arguing against employees being fired for not receiving the flu shot.
OSHA strongly supports “efforts to increase influenza vaccination rates among health care personnel in accordance with the Healthy People 2020 goals,” Barab wrote. However, “at this time, OSHA believes there is insufficient evidence for the federal government to promote mandatory influenza vaccination programs that may result in employment termination.”
While vaccination protects health care workers from the flu, scientific literature does not support vaccinating the workers in order to protect patients, Barab wrote. “High [health care personnel] influenza vaccination rates are generally desirable, but we are unaware of any evidence to support the notion that such a high influenza vaccination rate is also essential to protect patients, and should thus be mandatory.”
Barab urged NVAC to rewrite its recommendations to remove references to firing employees who refuse the influenza vaccine. Instead, OSHA encourages employers to offer the vaccination to employees, educate them on the benefits and risks of the shot, and allow employees to sign statements declining the shot if that is their preference.
The National Nurses United union agrees with OSHA’s stance. Nurse DeAnn McEwen, vice president of the National Nurses United Executive Board, told SHRM Online thatthe union strongly recommends that all nurses receive all recommended vaccines. But any vaccination program “should include extensive education on risks and benefits with an emphasis on patient protection,” she said. And nurses should have the right to refuse any treatment, including a vaccination, for religious or health reasons, she added.
Instead of making the flu shot a condition of employment as a means of preventing flu transmission, McEwen said, nurses and health care professionals should receive education and easy access to the vaccine, education on hygiene and hand washing to prevent spreading the flu, and sufficient sick leave so that ill health care professionals can stay home and not pass the flu to co-workers or patients.
In addition, the nurses’ union objects to forcing employees who decline the vaccine to wear a mask. “There’s not good science to recommend masking,” she said. “Masking is also targeting the individual for exercising her rights to refuse medical treatment and, I think, violates privacy laws. It’s not good policy for hospitals, for patients seeing everyone wearing masks—it’s a facade of protection that doesn’t really benefit the public.”
Some nurses who are fighting against vaccination as a condition of employment have won a major battle: In January 2012, a United States District Court ruled in favor of the Washington State Nurses Association, representing more than 600 registered nurses at Virginia Mason Medical Center in Seattle, in upholding an arbitrator’s decision that stopped the hospital from forcing nurses to receive the flu shot. The hospital was one of the first health care systems to have a mandatory flu vaccine policy, starting in 2004, according to NurseZone.com.
“HR professionals should look at this as an employee satisfaction issue, and what the public’s perception of the employer will be, on how it treats its employees,” McEwen said. “Opt on the side of being professional and evidence-based, providing education and incentivizing employees” to receive the shot. “Avoid being coercive and mandatory. No sound policy supports that.”
Beth Mirza is senior editor for HR News. She can be reached at Beth.Mirza@shrm.org.
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