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

[RN/WI, ADN, BSN, MSN, RN, APRN]

I don't wear a mask. I was trying to keep it simple for the sheep.:)

[RN/WI, ADN, BSN, MSN, RN, APRN]

I wish I was on a computer right now and not a phone. Too difficult to type. I do not believe in mandated vaccines, period! I have been on a research team in 2008- influenza vaccine did not work. I have in fact seen sepsis, death, and claims for harm paid big time for the vaccines harm!

[JayHanig]

I always get the flu shot and so far have avoided ever getting the flu. As I age, the potential consequences of the disease become greater and greater and I have no desire to take that chance. I don't want to catch it from a coworker and I don't want to catch it from a patient. Nor do I want to be the vector for an outbreak.

I am very much aware of the flu pandemic of 1918 which killed between 20 and 40 million worldwide; more than the body count of WWI. Like the black plague, an experience better read about than undergone.

I have been immunized for many things in my life, going back to smallpox, polio, DPT, Hep B, and more recently shingles and pneumonia. If there's a way to avoid any of those diseases, I'll take it. I count my lucky stars that I have no drug allergies and have never reacted poorly to a vaccine. No doubt I'd feel very differently if I did.

All of that being said, we have a special responsibility to our patients to protect them to the best of our ability. I would ask my fellow nurses to let that be their guide as to whether to protect themselves and others, particularly if the real issue for them is that they don't like being told what to do. Hey, get over it. We get told what to do all day long. We ought to be used to it by now.

[JayHanig]

I wish I was on a computer right now and not a phone. Too difficult to type. I do not believe in mandated vaccines, period! I have been on a research team in 2008- influenza vaccine did not work. I have in fact seen sepsis, death, and claims for harm paid big time for the vaccines harm!

Have you seen 20-40 million of them? That's how many died in the flu pandemic of 1918-1919. You might want to reconsider your thoughts on this. We're not necessarily talking about a cold with muscle aches; we're talking about a disease capable of killing otherwise strong and healthy children, young adults as well as the stereotypical old folks.

[BSN16]

I 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!

Wearing a mask protects you from sepsis?

[RN/WI, ADN, BSN, MSN, RN, APRN]

Believe what you would like. I am glad I have a masters in nursing and have spoken to many. I sit on a national committee for vaccination as well. Not something I wanted to do but had to , to protect family friends and the public from voices of healthcare in the recent years that either have no solid research base or need to advocate for their patients. Have any of you taken care of patients with sepsis? If so please define it and then research when your patient received their last flu or pneumonia vaccine. This is an argument you won't win. I have better things to do so will not be back today. Research get some good healthcare experience on the floor then years later start talking about it. I stated earlier I personally know of deaths that were close to me, so do more people than you think. Believe what you want, the majority of Americans have spoken and lived personally through the research and no longer believe in the good vaccines because of the sham of the influenza vaccines.

[GM2RN]

As 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.

Protecting a patient's safety does NOT mean that anyone else has to put themselves at risk to do it.

[Kooky Korky, BSN, RN]

I 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 can't take the vax and you refuse the mask. What does your employer say? Some threaten to fire and maybe do actually fire staff who take your approach.

[BSN16]

Oh you have a choice, it's a civil rights violation to mandate!

Actually no. It's REQUIRED by an employer and you do not follow these regulations they just as easily have the right to terminate you for not abiding.

[RN/WI, ADN, BSN, MSN, RN, APRN]

Not true! talk to a civil rights attorney. Many nurses have won the case against a mandate. The nurses I know of actually were fired, brought suit on the hospitals and won a great deal of money. We are not research subjects and neither are the patients, unless consent is willingly obtained. I have a compact, California, and Minnesota active license. My refusals and physician documentation is always honored! It is your right to refuse any medical intervention that you do not believe or consent to. There are many that are allergic to the vaccines and as previously stated enough paid out to these families that have been injured and lost loved ones. I will advocate for any pt or co worker that can not receive or will not consent. A close friend healthy of 22 who never took the vaccine died after she was mandated by the hospital to have the flu vaccine. That was one tragedy to many for her loved ones friends and myself to ever question another again!

[mrl3fnp]

A study recently performed by the Interscience Conference of Antimicrobial Agents and Chemotherapy, in 2015, showed once the rate of influenza-vaccinated healthcare workers reaches about 50%, there is no further reduction in the rate of patients with hospital-acquired influenza” (Johnson, 2015). "At a certain point, you don't have a real return on vaccination for reducing nosocomial flu, and we should look to things like hand-washing, better screening of patients, and better isolation precautions" (Johnson, 2015).

During the five flu seasons from 2010 to 2015, there was a significant increase in the rate of vaccinated healthcare workers at the University of New Mexico Health Sciences Center (P

Johnson, K. (2015). Benefit of Healthcare Worker Flu Shots Questioned. Retrieved from Benefit of Healthcare Worker Flu Shots Questioned

[LPN_FTW]

I don't believe the vaccine will prevent viral shedding from us after we are exposed to the virus. No doubt, the virus takes time to replicate within our body before our immune cells discover it and beats it, so I feel like the policy should be mandated masking for all employees on the front line if there will be any policy at all. The vaccine gives a false sense of security, especially during those years where the efficacy is low.