My best friend has a B.A. already but she would love to be an R.N. She is very smart; received her B.A. with high honors and was on the dean's list all 4 years while at college. But most importantly, she is super caring not only with people, but also with animals, and even insects (literally she would never hurt a bee or a beetle!) She has been volunteering at our Nursing Home where I work. She truly feels for some of our residents who either don't have any relatives or are not visited often. She would talk to them and is sincerely interested in their stories and lives before they entered the facility. I just see her as one of the best nurses out there who would really make a difference! I spoke with her about it and there is just one problem that prevents her from starting working towards an RN degree, and that is she is EXTREMELY allergic to immunizations including TB test and strongly opposes to unnecessary x-ray exposure. She has always had a positive TB test because she is allergic to it. Her chest X-rays are of course crystal clear. She's been told by a doctor that it is an allergic reaction. She also strongly disagrees with the fact that as an R.N. or even to enroll into any nursing program she has to undergo a chest x-ray just because she is allergic to TB test. It doesn't make sense to her why she has to undergo unnecessary radiation exposure (that is cumulative) just to be proving that she doesn't have tuberculosis. I wonder if there are any other methods besides outdated TB test (that often gives false results), and yearly cancer-promoting x-rays?? Is there anything else that she, and anybody in similar situation, can do in order to show that they in fact are healthy and tuberculosis free? Anyways, any suggestions, experiences and insights about this subject would be appreciated! She will be reading your answers; I told her I'm posting a thread about her dilemma. Thank you all and best wishes!
mama.RN, Thank you for your insights and suggestions! You seem like you definitely know your stuff:yes:! Your guess is correct -- she did have a two step BCG vaccine administered in the Ukraine. After PPD test came out as positive, she had been thoroughly evaluated by an infectious disease physician. She did undergo CXR two times, three months apart. Each time they came out crystal clear. So, the conclusion was that a PPD is positive because of the BCG vaccine, and also possibly because of an allergic reaction in addition to that. The doctor told her not to have a PPD skin test ever again. BUT they did it routinely for all kids at the U.S. high school, and it became red and swollen. So, I don't understand the reason why it's required for ALL as part of a physical when enrolling into a nursing program or getting a job as an RN:no:.
Can you explain a little more about Quantiferon Gold or a T-Spot blood test?
She never had those done, only CXR have always been used to confirm her lungs are clear.
Also, about the vaccinations, she has all the necessary ones that have been required for children who immigrated to the U.S. back in 1998. I just wonder how many more she may need to get in order to work as an RN, and I mean the vaccines that average Americans not working in healthcare generally don't have. Is there any way to opt out? I am aware about the flu vaccine, but as far as I know, a face mask can be worn instead during the flu season:snurse:.
Specializes in Nurse Leader specializing in Labor & Delivery.
The quantiferon will either be positive or negative. If she's had exposure to TB, or has LTBI, it will be positive. Unlike the PPD, it will not be positive if she has received the BCG (although I've been told that after about 10 years, the BCG should not cause a "false positive").
The quantiferon will not differentiate between untreated LTBI and treated LTBI (meaning, if she has received the 6-9 months of INH, it will still be positive).
Most experts seem to agree that prior BCG vaccination (given more than 10 years previously) will not cause a >10-14mm induration in reaction to TST, even in the case of serial testing. But that is a moot point, as additional testing is required to verify anyways.
Hello there. Thank you for a useful insight. All the PPD skin tests she ever had received were definitely withing the time frame of 5 years of a BCG vaccine. She was always avoiding PPD skin test after the one administered at the U.S. high school. As she became more aware, she is just following a recommendation of the doctors to not have any more PPD tests due to the results being consistently positive.
So, I don't understand the reason why it's required for ALL as part of a physical when enrolling into a nursing program or getting a job as an RN:no:.
Also, about the vaccinations, she has all the necessary ones that have been required for children who immigrated to the U.S. back in 1998. I just wonder how many more she may need to get in order to work as an RN, and I mean the vaccines that average Americans not working in healthcare generally don't have. Is there any way to opt out? I am aware about the flu vaccine, but as far as I know, a face mask can be worn instead during the flu season:snurse:.
I'm not quite understanding why you don't understand that everyone needs this done. You are constantly exposed to many different types of people who are exposed to many things, one of which could be TB. Testing needs to be done to make sure you are not exposing sick and immunocompromised people to what you could have been exposed to. If you don't quite understand the implications of tuberculosis, I suggest you do some google research on the illness.
Vaccinations necessary for school include but are not limited to Hepatitis B, Varicella, tdap, flu, etc. Not all facilities allow the use of a face mask instead of a vaccine. I again emphasize that if she is so strongly against vaccines and the very minimal exposure a CXR will provide, she may want to NOT think about going into health care.
Specializes in mental health / psychiatic nursing.
If healthcare providers are required to be immunized why aren't volunteers? Seem to me they would carry the same risks of carrying something.
Where I volunteer we are required to have all the same immunizations and screening as staff including annual TB testing. A second volunteer position I've applied for (different hospital) has the same health requirements.
It's actually worked out great for me as the hospital I volunteer with covers cost for all the immunizations and testing if you get it done with them. I am up-to-date on everything and have solid documentation for when I apply to nursing school. (Some of my childhood immunization documents were a little sketchy so the hospital did titers and gave me a copy of my results.)
To the OP: I can understand your friend's paranoia about radiation exposure if she grew up near Chernobyl'. That conditions there are extreme and even now the clean up crews have little protection while they do their work, and incidents of cancer death are extremely high. That being said one x-ray a year is very, very little exposure, and parts of the body not being examined are typically shielded. Most people get an x-ray a year at the dentists even if they aren't healthcare professionals. If she is going to refuse all x-rays and continued immunization boosters then healthcare may not be the best career field for her whatever her other qualities are. There are lots of fields that could use an intelligent and compassionate individual.
I am aware about the flu vaccine, but as far as I know, a face mask can be worn instead during the flu season:snurse:.
Actually at my work unless you have a documented anaphylactic reaction to the flu shot itself you have to get the shot. For the employees that are allergic to the vaccine components (eggs), they had to go to our employee health office to have their flu shot and had to remain there for two hours for monitoring afterwards. There is no opting out and just wearing a mask. You either get the shot or don't have a job. We also have to wear a sticker on a name badge that says "flu shot" so everyone knows who has had their shot already. It's a large organization with thousands of employees and I can only recall seeing two people in mask because they were physically unable to get the flu shot.
When I first started I also had to have titers done and had to have my tdap updated. Again no choice in the matter. Either get the shot or don't have a job.
OP- you seem to have a lot of quick and detailed answers about your 'friend'. A little too quick and a little too detailed.
I am calling shenanigans here. Bottom line: Either get the REQUIRED vaccinations and screening tests, or don't become a nurse. Special snowflake syndrome does not exempt one from these requirements.
Specializes in Complex pedi to LTC/SA & now a manager.
My jobs are no flu vaccine you cannot work. Clients are too high risk, especially trach/vent pediatrics.
As far as the blood tests, bcg and Mantoux. Tb skin testing check out the CDC website regarding Tb.
There are no exemptions in nursing school positive titers and vaccines or step aside and someone else takes your seat. As far as work an anaphylactic or other severe reaction would be a covered exemption. Those who never have positive titers despite revaccination may work but are flagged and cannot work with patients who have or are suspected to have a disease the employee is not protected against and may be barred from units that have high risk/medically fragile patients.
Personal objection does not exist when it puts the lives of others at risk
I'm not quite understanding why you don't understand that everyone needs this done. You are constantly exposed to many different types of people who are exposed to many things, one of which could be TB. Testing needs to be done to make sure you are not exposing sick and immunocompromised people to what you could have been exposed to. If you don't quite understand the implications of tuberculosis, I suggest you do some google research on the illness
Of course I do understand what tuberulosis is, and that's the reason why we are confident she does not have it. It's been tracked down for about 17 years for her, since the first time she had PPD test and it came out positive.
I completely do understand that testing for TB has to be done for all working in healthcare, what I am disagreeing with here is the means of this testing. It's not safe and many times it's not accurate. In addition, as one of the persons correctly pointed out too many RNs are misreading PPD test and recording it as positive where in fact it is not.
Of course I do understand what tuberulosis is, and that's the reason why we are confident she does not have it. It's been tracked down for about 17 years for her, since the first time she had PPD test and it came out positive.
I completely do understand that testing for TB has to be done for all working in healthcare, what I am disagreeing with here is the means of this testing. It's not safe and many times it's not accurate. In addition, as one of the persons correctly pointed out too many RNs are misreading PPD test and recording it as positive where in fact it is not.
Just because she doesn't have it now doesn't mean she cannot acquire it/be exposed.
And saying testing is unsafe is a gross exaggeration, as has been explained to you and "your friend" repeatedly in this thread.
OP- you seem to have a lot of quick and detailed answers about your 'friend'. A little too quick and a little too detailed.
I am calling shenanigans here. Bottom line: Either get the REQUIRED vaccinations and screening tests, or don't become a nurse. Special snowflake syndrome does not exempt one from these requirements.
We discussed her situation over and over and OVER again, and by now I do know all the facts and details about this. As I became a little frustrated over the fact that all of that bureaucracy is in fact not helping us as individuals, neither does it benefit the society as a whole. So, ignorant people who are not really supposed to have PPD done if they had it positive before, do it anyways, and get a bunch of unnecessary x-ray exposure, yet they get the job ONLY because they are ignorant about their own health and well-being. On the other hand, people who ARE smart and educated and do care about their health, as well as about other people's health, get weed out. Doesn't seem fair to me.
We discussed her situation over and over and OVER again, and by now I do know all the facts and details about this. As I became a little frustrated over the fact that all of that bureaucracy is in fact not helping us as individuals, neither does it benefit the society as a whole. So, ignorant people who are not really supposed to have PPD done if they had it positive before, do it anyways, and get a bunch of unnecessary x-ray exposure, yet they get the job ONLY because they are ignorant about their own health and well-being. On the other hand, people who ARE smart and educated and do care about their health, as well as about other people's health, get weed out. Doesn't see fair to me.
Okay, I think that's enough. You and your "friend" seem to only want to hear what you believe. I'm not sure what the point of you coming here asking for advice is if you don't want to hear it.
You were told there is a blood test available. You were also told this is expensive and not often an option. You have had facts presented to you about the safety of chest xrays. You've also been told that testing is necessary for school/job and the reasons why.
If you/friend don't like it, she has every right in the world to not go to nursing school. There are a million people willing to get a CXR and take her place, all of them equally as caring/compassionate/the best nurse evaaarrrrr as your friend.
WE~DO~CARE
12 Posts
mama.RN,
Thank you for your insights and suggestions! You seem like you definitely know your stuff:yes:! Your guess is correct -- she did have a two step BCG vaccine administered in the Ukraine. After PPD test came out as positive, she had been thoroughly evaluated by an infectious disease physician. She did undergo CXR two times, three months apart. Each time they came out crystal clear. So, the conclusion was that a PPD is positive because of the BCG vaccine, and also possibly because of an allergic reaction in addition to that. The doctor told her not to have a PPD skin test ever again. BUT they did it routinely for all kids at the U.S. high school, and it became red and swollen. So, I don't understand the reason why it's required for ALL as part of a physical when enrolling into a nursing program or getting a job as an RN:no:.
Can you explain a little more about Quantiferon Gold or a T-Spot blood test?
She never had those done, only CXR have always been used to confirm her lungs are clear.
Also, about the vaccinations, she has all the necessary ones that have been required for children who immigrated to the U.S. back in 1998. I just wonder how many more she may need to get in order to work as an RN, and I mean the vaccines that average Americans not working in healthcare generally don't have. Is there any way to opt out? I am aware about the flu vaccine, but as far as I know, a face mask can be worn instead during the flu season:snurse:.