Flu Shot or Mask?
Many healthcare facilities are requiring nurses to either get an influenza vaccination or wear a mask for the entirety of flu season. What do you think about this policy?
Recently at the nurse's station at work, I was talking with Lisa. Lisa was wearing a surgical mask. To keep her job, she has to wear a mask until flu season is over because she declined to get a flu vaccination this year.
I asked how it felt to wear a mask for 12 hours. She said, “Well...it’s kinda claustrophobic, but I’m getting used to it. What’s really weird is people keep asking me to repeat myself.. It’s like they can’t hear me if they can’t see my lips moving. And when I smile at patients, I have to try really hard to smile with my eyes.”
The American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), a CDC panel of medical and public health experts that advises on vaccine use, all align in recommending flu vaccines for healthcare workers with allowable exceptions for religious and/or medical reasons.
National Nurses United (NNU) opposes mandatory flu shots as fostering an atmosphere of distrust. Likewise, they oppose masking on the basis of stigmatizing the individual.
Masking: the Science
The influenza virus is transmitted by direct contact, large droplet spray (like a sneeze or cough, distance of about 3 feet), and by aerosolization (smaller particle aerosols).
The rationale for masking is that unvaccinated asymptomatic persons can shed the influenza virus for 24 hours before symptoms appear and up to 5 days after the onset of illness. However, minimal data regarding aerosol shedding and infectiousness of aerosol particulates exist.
The effectiveness of N95 respirator masks in preventing transmission of airborne viruses has been shown but the results of studies on the efficacy of surgical masks are mixed.
Many surgical masks are not certified as protective against respiratory infections and are loose fitting. There are no clear guidelines on how frequently surgical masks should be changed.
According to the CDC, there are no definitive studies to show that surgical masks worn by health-care workers reduce influenza transmission.
State law, state Departments of Health, and county health officers have the authority to mandate flu shots and/or masks. For example, California state law (Health & Safety Code §1288.7 / Cal OSHA §5199) requires either flu vaccination or the signing of a declination statement for all acute care hospital workers and most health-care personnel, including clinic and office-based staff.
Additionally, many county health officers in California mandate that health care workers either receive an annual flu vaccine or wear a mask during the flu season.
Many acute care facilities have adopted coercive “flu shot or mask” policies. In some cases, healthcare workers have been fired for refusing to be vaccinated.
Legally, most employers can require flu shots as a condition of employment as most employees work under an “at-will” work agreement.
However, the research used by employers to justify mandating flu vaccines for healthcare workers may be flawed and insufficient. Four such studies cited by employers were conducted in long-term care facilities and have not been proven to be generalizable to acute care settings.
The ANA maintains vaccination is a public health concern and nurses should role model illness prevention through immunization. Nurses have a responsibility to not place their patients at risk.
Vaccination is for the greater good, but individual rights must also be considered. Sometimes the ethical principle of preventing harm is in direct conflict with the ethical principle of autonomy.
Protective or Punitive?
When I see a co-worker wearing surgical mask I cringe a little. My core values of justice and fairness are triggered. Is this really about protecting patients based on robust evidence or is this about shaming the nurse?
I believe in doing what is best for the greatest good but I also believe in autonomy. It comes down to personal rights versus social responsibility. I am pro-vaccination but stop short of supporting “flu shot or mask” policies.
For me, it would take irrefutable evidence of patient benefit to justify overriding personal rights and I don’t believe we have that.
The rush to disregard individual freedom over scanty evidence concerns me more than the thought of Lisa not wearing a surgical mask.
Do you believe nurses should be required to get mandatory flu shots or mask? Why or why not? I'd love to hear your view.
More thought-provoking articles by Nurse Beth:
Ageism in Nursing is Real
Why Do Nurses Quit?
Booth, C. M., Clayton, M., Crook, B., & Gawn, J. M. (2013). Effectiveness of surgical masks against influenza bioaerosols. Journal of Hospital Infection, 84(1), 22-26.
CDC. Interim Guidance for the Use of Masks to Control Influenza Transmission.2009. Accessed January 2017 Interim Guidance for the Use of Masks to Control Influenza Transmission
| Health Professionals | Seasonal Influenza (Flu)
Serres, G., Skowronski, D., Gardam, M., Lemieux, C., Yassi, A., Patrick, D., Krajden, M., Loeb, M., Colignon, P., Carrat, F. 2017. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLOS.org. accessed January 2017 Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of EnforcementLast edit by Joe V on Oct 20, '17
About Nurse Beth, MSN, RN
Nurse Beth blogs at https://nursecode.com
Nurse Beth has '20+' year(s) of experience and specializes in 'Med Surg, Tele, ICU, Ortho'. Joined Mar '07; Posts: 1,200; Likes: 3,604.Feb 4, '17I cannot get a flu vaccine due to allergy to the preservatives used (same problem with annual TB test - in fact it was apparently the TB test that sensitized me.) But I have a larger problem with mandating - the efficacy of the flu vaccine varies wildly year to year. In the nursing homes I go to in my practice, this year nearly every resident got the vaccine, and IMHO efficacy (due to the number of residents with the flu) is 10% or less. If it was regularly 80-90% effective as most other vaccines are, my opinion would be different. And no, I won't mask. And for those who will say too small a sample - I am in 14 - 20 nursing homes weekly. That's a lot of residents.Feb 4, '17Quote from LadysSoloThat's really interesting. I am going to have to read up on that- the efficacy in elderly residents.I cannot get a flu vaccine due to allergy to the preservatives used (same problem with annual TB test - in fact it was apparently the TB test that sensitized me.) But I have a larger problem with mandating - the efficacy of the flu vaccine varies wildly year to year. In the nursing homes I go to in my practice, this year nearly every resident got the vaccine, and IMHO efficacy (due to the number of residents with the flu) is 10% or less. If it was regularly 80-90% effective as most other vaccines are, my opinion would be different. And no, I won't mask. And for those who will say too small a sample - I am in 14 - 20 nursing homes weekly. That's a lot of residents.Feb 4, '17I can't take the vaccine either. I will not mask , its discrimination. Although masking does help protect me from the patients that received the vaccines and are now in the hospital with sepsis and other viruses they are floating around!Feb 4, '17In New York State, as if 12/28/16, when the NYS Health Commissioner declared influenza to be "prevalent" in the state, we have no choice. You either get the vaccine or wear the mask in areas where patients are typically present. I always get the vaccine, so I have no problem with it, but I notice many colleagues wearing the mask this year. One of the ID docs I know ALWAYS wears a mask in the ED, regardless of the time of year! I don't 100% agree with the mandate for wearing the mask if you haven't been vaccinated, but that's the rule so we all have to abide by it or find another line of work.Feb 4, '17I can't take the vaccine either. I will not mask , its discrimination. Although masking does help protect me from the patients that received the vaccines and are now in the hospital with sepsis and other viruses they are floating around!
So you're willing to wear a mask to protect yourself from your patients, but you're not willing to wear a mask to protect your patients from you? Maybe I misinterpreted....Last edit by dbabz on Feb 4, '17 : Reason: mistakeFeb 4, '17Quote from RN/WII'm sorry, but would you clarify this statement? It sounds like you are saying that you believe vaccines are making your patients sick and you're willing to protect yourself from sick patients but not protect patients from what you could possibly spread to them.Although masking does help protect me from the patients that received the vaccines and are now in the hospital with sepsis and other viruses they are floating around!Feb 4, '17I have never taken a flu shot as a nurse (10 years) and will never accept another vaccine of any type. I do not agree with masking (of healthy individuals) or mandated vaccines. I do, however, believe in (fully) informed consent and the right of the individual to receive vaccines if they choose to. Nurses do not abdicate their rights as individuals when they get that degree or pass the NCLEX and MY health and that of MY FAMILY'S health will always come first.Feb 4, '17I'm unable to get the flu vax either due to a chronic health condition. I work from home, therefore never see a live patient in the flesh any more, but every year - every single year - my rheumatologist has to write a new note "excusing" me as if something may suddenly change.
Last year a work friend chastised me for not receiving a flu vax (I didn't share the reason for not receiving one) stating she hadn't had the flu since 2007 - 2 months after getting the vax she became deathly ill with the flu. The scary thing about this scenario was she hadn't been protected after all having also received the pneumovax at the same time.
The flu vax isn't a magic bullet, and viruses are tricky little buggers, evolving faster than we can keep up.Feb 4, '17As a nurse, it is MY job to ensure my patient's safety to the best of my ability. That includes doing things like making sure I am completely vaccinated by getting the flu vaccine each year (even in years where it is a poor match). So I wholeheartedly stand behind the mandatory flu vax or mask if you are working in any setting where you can have patient contact. Hospitals, clinics, LTC, etc., but if you're working as a telephonic nurse and never visited patients then it's not as crucial (although if you've ever had the REAL flu you I can guess you would know enough to never want to get it again). If you're not willing to stay UTD on vaccines (those who don't believe vaccines work or are anti-vaxxers, not those with legit allergies) then maybe you should find another line of work, because medicine/nursing does not go hand in hand with pseudoscience.
I would love also to see further studies done to determine what best use of mask would be as discussed in the article.Feb 4, '17You are suppose to advocate for all of your patients rights. If you can't advocate for them maybe you should be looking at a new profession. Influenza is a virus, it can't be replicated. Flu shot is a sham for pharmaceutical money. I had a friend in healthcare that was healthy and died of sepsis after the mandate for work. I'd like you to speak this crap in front of her family. They would. E sure to educate the uneducated health care worker and make a professional.
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