by Aaron86

Updated Nov 02, 2009 at 04:08 PM by Aaron86

Hey everyone,

I'm a recent graduate and got my first job as a PRN flu shot nurse. Anyone involved with flu shots this year is probably aware of the high public turnout and the issues with low supplies, but has anyone been involved with healthcare worker vaccination?

I have and, quite frankly, I'm disgusted!

Nurses and other educated medical professionals are declining to be vaccinated and most of them really have no good excuse for putting their patients at risk. At a time when people are standing outside clinics before sunrise for the chance to get an H1N1 vaccination, I find myself sitting in a hospital (and more recently taking the vaccine to the actual units) with a large amount of H1N1 fluMist and no one will take it!


In case you haven’t had a chance to look into it, the flumist is a live attenuated influenza virus (LAIV). It is only approved for use in healthy people ages 2 - 49 years. No pregnant women, no asthmatics, no diabetics, and no one who is taking anything that suppresses their immune system.
In short: none of the people at highest risk for influenza complications.

So why then does a healthy 30 year old mother in a critical care unit or emergency dept. decline? Why does the 22 year old perfectly healthy phlebotomist that visits hundreds of patients each day decline?

The most common thing I hear from people when I roll my cart onto the unit? "I'll wait for the injectible"
That is, except for the > 50 crowd who almost all seem to want the vaccine but can't get the nasal. From them I usually hear "Oh I see how it is, over 50 and left to die!" =)

I get the fears about it being a live attenuated virus, but I would expect these fears from the general public and not other nurses or healthcare professionals! I have the information from the CDC, I've educated myself on the various clinical studies and results and I share this with the employees and they still insist on waiting for the injectible.

What do you all think? Should these people even be allowed to have the injectible when they are otherwise good candidates for the much more widely available, but also more restrictive, nasal vaccine?

I say, save the injections for those that *really* need it and can't have anything else. Not the paranoid and uninformed.

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

Personally, I won't take the LAV. No more than I ever allowed them to vaccinate my son with the attenuated polio virus - which was supposed to be "safe" - or rather, "acceptable risk." I insisted on the killed vaccine, and will still do so. I have evidence-based practice on my side, too, in spite of your insulting remarks.

The only reported cases of polio in the US since the 1970's came from the vaccines. This is according to CDC reports. That's why there are no more LAV polio vaccines on the market.

My two year old daughter is recovering from a VI cranial nerve palsy that is vaccine-related - MMR, an attenuated virus vaccine.

So be insulting, call us paranoid, call us ignorant, whatever you like. Personally I find that to be non-therapeutic, but that's my side of the story, and you don't seem very interested in that.

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

Wow,...some pretty strong words from a recent grad,.....be ready!

I am the 40yr old mother in the emergency dept, and have already snorted that stuff up my nose and was sick for 3 days afterward,..so mute point for me,....but,....I'll play devils advocate for a minute here.

A few questions:
1. Why isn't the LAIV recommended for those under 2 or over 50 or who have chronic medical problems?
2. Am I more likely to give a pt the flu,.or am I protecting myself so that I can be at work to care for those that are sick?
3. How safe is it for me to be around a 3 day old 29wk preemie for the few days following the LAIV? (give me facts here)
4. How safe is it for me to be around 3week post op renal transplant pt or the 87y/o breast Ca pt undergoing chemo?
5. How much data is really available about the long term safety of the H1N1 LAIV?
6. Is my first responsibilty to the hospital and the pts I care for,...or to me and my family?

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

I don't intend to be overly insulting. Perhaps "ignorant" is too loaded a word to use -- how about "uninformed"?

I just find something wrong with a secretary perfectly eligible for the nasal vaccine telling me that she is going to wait for the shot when it is available.

I told her that we don't know when or how much of the injection vaccine we would receive and that when we did, it would go to those with conditions that make them ineligible for the intranasal form.
Her response? "Oh we always manage to get it here anyway."

Meanwhile im thinking of a nurse who I had to turn away last week. She works in a PICU overflowing with critical H1N1 cases. She has asthma. And she takes care of her mother who just underwent chemo.
She can't find a shot anywhere.


Personally, I think all those who can take the flumist but don't want to should sign a waiver and then the hospital should release their 6,000 doses of flumist to the public. Better that it does some good somewhere rather than sit in the fridge.

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

Originally Posted by TDFlMedicRN

Personally, I won't take the LAV. No more than I ever allowed them to vaccinate my son with the attenuated polio virus - which was supposed to be "safe" - or rather, "acceptable risk." I insisted on the killed vaccine, and will still do so. I have evidence-based practice on my side, too, in spite of your insulting remarks.

The only reported cases of polio in the US since the 1970's came from the vaccines. This is according to CDC reports. That's why there are no more LAV polio vaccines on the market.

My two year old daughter is recovering from a VI cranial nerve palsy that is vaccine-related - MMR, an attenuated virus vaccine.

So be insulting, call us paranoid, call us ignorant, whatever you like. Personally I find that to be non-therapeutic, but that's my side of the story, and you don't seem very interested in that.

:y eah::yea h:

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

RN CArdiac said


"How much data is really available about the long term safety of the H1N1 LAIV?"
Spot on

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

Originally Posted by RN-Cardiac

Wow,...some pretty strong words from a recent grad,.....be ready!

I am the 40yr old mother in the emergency dept, and have already snorted that stuff up my nose and was sick for 3 days afterward,..so mute point for me,....but,....I'll play devils advocate for a minute here.

A few questions:
1. Why isn't the LAIV recommended for those under 2 or over 50 or who have chronic medical problems?
2. Am I more likely to give a pt the flu,.or am I protecting myself so that I can be at work to care for those that are sick?
3. How safe is it for me to be around a 3 day old 29wk preemie for the few days following the LAIV? (give me facts here)
4. How safe is it for me to be around 3week post op renal transplant pt or the 87y/o breast Ca pt undergoing chemo?
5. How much data is really available about the long term safety of the H1N1 LAIV?
6. Is my first responsibilty to the hospital and the pts I care for,...or to me and my family?

First of all, Thank you for advancing discussion rather than latching on to a few poorly chosen words on my part.

From my understanding:

1: The intranasal vaccine is essentially geared to and marketed toward pediatrics. Children make up the majority of the market share for the manufacturers so it is just not economically feasible to extend clinical trials on proving the safety or efficacy on those people over the age of 49. (The clinical trials only included significant numbers of people up to age 49)

2. Theoretically its possible to pass on the LAIV to a patient. This is especially true during the first 48 hours. Vaccine virus shedding peaks at 48 hours and then drops off significantly, but can shed up to 2 weeks. This is however, much less likely to pass on to someone else let alone make them sick then say.. you got the actual wild type h1n1. in which case you are putting patients at risk for 48 hours+ while you are infectious but not symptomatic.
Since there is a chance a nurse will be working with a patient who has a weakened immune system and neither know about it, our hospital system has instituted a policy of wearing a mask if you will be in patient contact areas in the next 48 hours. This is a major sticking point with nurses who otherwise were ready to take it. Their concern is not with the LAIV or anything like that... they just don't want to wear a surgical mask for 48 hours while at work.

3. If you had a 39 wk old premie I would turn you away. A premie falls under the category of the immune compromised. However low the risk of transmission of vaccine virus is, it hasn't been adequately studied in those with severely weakened or under developed immune systems.

4. See above. You would also be a rule out. If you went ahead with it I would recommend masking while around this person and limiting contact. Think: protective isolation.

5. The answer here is "enough". Honestly, there is never enough data to be absolutely sure and there are many other medications out there on the market approved for use with higher risks and dubious benefits. Yet receive far less scrutiny. There are hundreds of studies cited in the CDC's guidelines and I am slowly working my way through them. (its not exactly exciting reading and this is during my free time!)

6. I'm really trying not to hedge here, but this one is an ethical dilemma and you have to decide for yourself. Personally I see it as somewhat of a catch-22. You are putting your family at risk by simply working in the hospital. No matter the precautions you take, you might still carry something home. At the same time, if you are working in the hospital, it is ethical, moral, and professional to minimize the danger to those entrusted to your care.
Personally, if I had any of the rule-out conditions ( a premature infant, a parent on chemo, etc.) my responsibility is to my family.

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

I refuse certain vaccines for myself AND my kids. I don't consider myself to be ignorant or uninformed. I feel I'm the exact opposite...hence the reason I don't give certain vaccines. If you feel confident in a vaccine that was made a couple months ago is safe, then by all mean...stick yourself. So you know why people refuse, well I can't speak for everyone but I refuse mainly because of the ingredients in the vaccines. I'm prolife and won't give any grown in aborted fetal tissue. I also don't think mercury, formeldyhyde, etc is safe to inject in the body....especially a childs body that is still growing. My other reason for refusal is these diseases are extremely rare and treatable, so I'm confident in taking my chances. You believe healthcare workers are putting their pts lives in danger? Well...as good as a nurse that I may be someday, MY health comes first. The chance of a pt coming in contact with something is higher walking with a cart around wal-mart then catching anything from me, one single person.

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

Originally Posted by Aaron86

I don't intend to be overly insulting.

Just sufficiently insulting?

Adequately insulting?

Marginally insulting?

Personally, I chose the killed virus for myself and my child over the FluMist because I consider the attenuated virus to be of somewhat higher risk for complication - as evidenced by the restricted subset of populations for which it's deemed suitable.

I know that we both tolerate the killed virus injections very well because we've been getting them for years (me, for decades). I chose the path that I considered in the best interests of myself and my child.

Re: Ethical Issue- Nurses not getting flu vaccine when they could!

Originally Posted by CrunchyMama

I refuse certain vaccines for myself AND my kids. I don't consider myself to be ignorant or uninformed. I feel I'm the exact opposite...hence the reason I don't give certain vaccines. If you feel confident in a vaccine that was made a couple months ago is safe, then by all mean...stick yourself. So you know why people refuse, well I can't speak for everyone but I refuse mainly because of the ingredients in the vaccines. I'm prolife and won't give any grown in aborted fetal tissue. I also don't think mercury, formeldyhyde, etc is safe to inject in the body....especially a childs body that is still growing. My other reason for refusal is these diseases are extremely rare and treatable, so I'm confident in taking my chances. You believe healthcare workers are putting their pts lives in danger? Well...as good as a nurse that I may be someday, MY health comes first. The chance of a pt coming in contact with something is higher walking with a cart around wal-mart then catching anything from me, one single person.

Again, I was probably too hasty in how I presented the topic and that leaves it open to misinterpretation.

My issue here is not with people who refuse vaccinations.
My issue is with nurses and others who want to get vaccinated for h1n1 insisting on consuming only the most limited of resources. And they appear to be doing so for no reason other than, what I consider to be, conveniance.