Flu Shot or Mask?

[Nurse Beth]

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."

Position Statements

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.

Legislation

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.

Employee Rights

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.

Ethics

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 a 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?

References

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 Enforcement

[BostonFNP, APRN]

How can we have a productive discussion if you continue to ignore my questions and deflect? I am still waiting for you to provide me with unbiased and uncorrupted evidence that shows the flu shot to be more efficacious than mask-wearing.

I am providing peer-reviewed data, including the Cochrane Library report that is widely considered one of the most critical publications on influenza vaccine efficacy from the global standard in international and independent reviews.

You are, thus far, providing opinion. Because authors of a study have disclosed interests does not invalidate the study, if you have evidence to data manipulation than please share it. We are waiting for your sources.

So here's another meta-analysis published in a non-American major peer-reviewed journal including 34 RCTs over 47 seasons and almost 100,000 patients including two independent reviewers which rated each RCT for bias.

Tricco, A. C., Chit, A., Soobiah, C., Hallett, D., Meier, G., Chen, M. H., ... & Loeb, M. (2013). Comparing influenza vaccine efficacy against mismatched and matched strains: a systematic review and meta-analysis. BMC medicine, 11(1), 153.

[Guest849204]

I say get the shot because its a lot easier, free/inexpensive, and there is a wealth of scientific data that demonstrates the flu shot is safe with no serious risks.

Also, I think it makes the profession look bad when nurses don't get the flu shot because we are supposed to practice evidence based practice, and the evidence says get the dang shot!

That said, as long as studies show that wearing a mask does not put patients in any greater danger than getting the shot, it should remain an option.

[LovingLife123]

I have never gotten a flu shot but I have had others. Most people my age, even many younger, have received vaccines until we learned more about them, at which time we made the decision to stop vaccinating.

Both of you think the non-vaccinated should wear a mask. What about the vaccinated who are still at risk for getting the flu? This view of only the non-vaccinated wearing a mask is nonsensical since many vaccinated still get the flu. Why don't we just mask and gown-up for all of our patients since they are all at risk for c-diff, TB, e-coli, etc.? Why don't we make everyone walking through the door wear a mask since they are more likely to be sick than we are? It makes no sense at all to me to make asymptomatic, otherwise healthy nurses to wear a mask just because they didn't get a vaccine if the rationale is to protect patients! I could understand a healthy nurse wanting to wear a mask to protect herself, but not the other way around.

There are several reasons for not taking a any vaccine, not just the flu vaccine. I'm not willing to spend a lot of time on this because I have never seen a pro-vax person change his/her mind, but I will post an article that addresses ONE of the reasons that I have decided to refuse any future vaccines:

God Does Not Support Vaccines - Living Whole

What exactly have you learned? Hopefully not information from sites like you linked.

[LovingLife123]

Do you think it's moral to receive a flu shot knowing it only protects you against 3 or maybe 4 strains of influenza while leaving your patients at risk for the transmission of 100s if not 1000s of other strains of influenza from your direct contact with them? In contrast, if a nurse refuses the flu shot and wears a mask, evidence has shown that they are doing more to protect their patients from the transmission of influenza than you! So who is actually more moral and who is actually advocating more for their patients? Arguing that those who do not wish to inject themselves with potentially harmful substances are somehow not your moral equivalent has no value because it is not supported by evidence.

Here's the problem with your argument, your argument is not about the science or safety of patients, it's about YOUR so-called rights being violated. You are more concerned as what you perceive as somebody trying to make you do something, than the safety of the public.

I'm sorry, but you come off as a rebellious teenager than you do a person who is actually concerned over vaccines and their affects. This is not about you. It's about when you go to work, you are not infecting the public. If you don't care about the people you care for, why are you in this field? Just wondering.

[StarletRN1]

I refuse the flu shot and wear the mask if there's an outbreak. I haven't had the flu in 22 years while some of my co-workers get the flu right after getting the vaccine. I'm ok with wearing the mask and believe that it's protecting patients more than a vaccine that may or may not work. I think the vaccine gives a false sense of security. Not to mention, there's not enough information out there to tell us what the accumulation of vaccines is doing to us over the long haul.

[Guest849204]

Not true, we have a wealth of information on what the "accumulation of vaccines is doing to us over the long haul" and the consensus is that it is doing nothing but protect us from disease. I recommend you start by reading the following 21 page summary of said research and implore you to refrain from spreading misinformation and fear to your patients.

[StarletRN1]

Not true, we have a wealth of information on what the "accumulation of vaccines is doing to us over the long haul" and the consensus is that it is doing nothing but protect us from disease. I recommend you start by reading the following 21 page summary of said research and implore you to refrain from spreading misinformation and fear to your patients.

I leave it up to my patients to make their own decisions regarding the flu shot, and I have the right to do the same for myself. I am also someone's patient, after all. There's also a "wealth of information" showing a link between the flu vaccine and neurological disorders. Misinformation would be telling my patients that the flu vaccine is perfectly safe.

[StarletRN1]

For anyone interested:

[BostonFNP, APRN]

There's also a "wealth of information" showing a link between the flu vaccine and neurological disorders. Misinformation would be telling my patients that the flu vaccine is perfectly safe.

First off, nothing is perfectly safe, including both being vaccinated and not being vaccinated.

Second, please share some of the wealth of information regarding the flu shot causing neurological disorders.

[mrl3fnp]

To argue for or against the efficacy of the flu shot is futile when the other person doesn't recognize or understand statistical power, bias, and financial corruption. But, I regress because my argument is not relating to the efficacy of the flu shot........It's relating to mask-wearing being more efficacious compared to the flu shot and the hypocrisy of nurses and healthcare organizations when it comes to patient safety.

[BostonFNP, APRN]

To argue for or against the efficacy of the flu shot is futile when the other person doesn't recognize or understand statistical power, bias, and financial corruption. But, I regress because my argument is not relating to the efficacy of the flu shot........It's relating to mask-wearing being more efficacious compared to the flu shot and the hypocrisy of nurses and healthcare organizations when it comes to patient safety.

More sources, less opinions. Can you cite the trial comparing mask use to influenza vaccine in preventing confirmed influenza?

bin‐Reza, F., Lopez Chavarrias, V., Nicoll, A., & Chamberland, M. E. (2012). The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza and other respiratory viruses, 6(4), 257-267.

[klone, MSN, RN]

scientific vigor.

(rigor)

Keep going - I'm enjoying this exchange. :)