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 think it's bullying. I'd like to see any data where it shows that there's been any measurable difference since instituting these kinds of policies. It's a horribly ineffective vaccine!!!

That's exactly what it is bullying!

[PedsRNWest]

Oh, I'm sorry, it seems YOU need to do a little research on the flu vaccine from credible sources. Here, I'll help you out.

From the CDC

What are the benefits of flu vaccination?

While how well the flu vaccine works can vary, there are a lot of reasons to get a flu vaccine each year.

Flu vaccination can keep you from getting sick with flu.

Flu vaccination can reduce the risk of flu-associated hospitalization, including among children and older adults.

A 2014 study* showed that flu vaccine reduced children's risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.

Another study published in the summer of 2016 showed that people 50 years and older who got a flu vaccine reduced their risk of getting hospitalized from flu by 57%.

Flu vaccination is an important preventive tool for people with chronic health conditions.

Vaccination was associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year.

Flu vaccination also has been shown to be associated with reduced hospitalizations among people with diabetes (79%) and chronic lung disease (52%).

Vaccination helps protect women during and after pregnancy. Getting vaccinated can also protect a baby after birth from flu. (Mom passes antibodies onto the developing baby during her pregnancy.)

A study that looked at flu vaccine effectiveness in pregnant women found that vaccination reduced the risk of flu-associated acute respiratory infection by about one half.

There are studies that show that flu vaccine in a pregnant woman can reduce the risk of flu illness in her baby by up to half. This protective benefit was observed for up to four months after birth.

Flu vaccination also may make your illness milder if you do get sick.

Getting vaccinated yourself also protects people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

As a nurse, if you aren't doing everything you can to protect yourself and your patients from VPDs and diseases in general, then you have no business being in this field. Period. Even a 5% efficacy rate gives you a better chance of not contracting it or a more mild case if you do than the 0% you'll have without it. And guess what, dihydrogen monoxide can kill you, but I don't see you telling people to consume it. In fact, DHMO kills more people daily than vaccines have ever. Look it up if you don't believe me. But as with everything, the dose makes the poison. If you took basic chemistry you would know that.

[GM2RN]

I understand that Wikipedia is not always the most reliable source of information, but it is a good place to go if you want an overview of the subject. I just got done reading about the "1918 flu pandemic" ~ and it was very interesting. Lots to think about there. Many unanswered questions. Thanks for mentioning it.

I have never had a flu shot, I have never gotten one for any of my children, and no one here has ever been diagnosed with influenza. If we've had it, we've been able to deal with it at home, apparently.

There is a list of vaccines that will be "required" if I make it into the fall nursing program, and an annual flu shot is one of them. This thread has given me a lot to think about. Thanks to all who have contributed. It's always interesting to hear the different research and points of view.

I have read of one or two students who have challenged this as well and won.

[Ruas61, BSN, RN]

. I find in rude that others don't respect everyone's right to not be vaccinated against the flu as well! Imho

You and your words lose any creditability when you start calling everyone 'sheep'.

[7SGBRN]

As s n RN for 40 years, having had the Swine flu shot in 1970's & getting deathly ill, I have refused any further flu shots. In the last years, I have been made to wear a mask while @ work. My question has never been answered -- I.e.,

why doesn't the hospital screen visitors for flu shot violations & have those violating visitors (who have not had a flu shot) wear these masks? Those visitors are putting patients (& me) in harm's way of getting the flu. The standard policy of "shot or mask" hospital institutions have adopted isn't a "standard" @ all. It seems very short sighted of a health business to institute such a lop sided policy.

[BethCNA]

So...if 50% of coworkers are vaccinated, then infection rates level off...that means freeloading off coworkers is OK?

[GM2RN]

So...if 50% of coworkers are vaccinated, then infection rates level off...that means freeloading off coworkers is OK?

"I'm getting one so you have to get one too!" What an argument.

[LadysSolo]

7SGBRN, I totally agree. I would be MUCH more agreeable to wearing a mask if all visitors either had to have the vaccine or mask. And all MDs have to have the vaccine or wear a mask too! (Let's see if THAT flies!)

[7SGBRN]

Having been an RN for 40 years in a hospital environment, who took the Swine Flu shot in the 1970's & got deathly ill, I've refused a flu shot ever since. I've been required to wear a mask since the institution of required "flu shot or mask" policy. My question has never been answered regarding this weak prophylactic measure. I.e., :

Is each & every visitor who enters a hospital screened for taking a flu shot? It seems they would be more likely to spread the flu to a patient as they aren't as particular about where they go in life or who they associate with by the very fact they don't work in a health institution (such as the health care worker would be). This "standard" of "flu shot or mask" policy isn't a standard @ all-- it's just a bandaid that makes the public think the health institution has their best interest @ heart & discriminatory toward the health care worker who doesn't (for whatever the reason) get a flu shot, while the visitor who hasn't had a flu shot is free to roam the halls mask-less.

[Wuzzie]

. I find in rude that others don't respect everyone's right to not be vaccinated against the flu as well! Imho

Nobody called you names or implied that they needed to simplify things in order for you to be able to comprehend. YOU did that. And by doing so YOU are not respecting those who choose to be vaccinated. It goes both ways.

[7SGBRN]

Oh yeah -- surgeons don't want to scrub or want isolation gowns when entering the NICU! The mask requirement requirement would really fly!

[GM2RN]

It statements that some of you have made that makes me abhor any attempt at "discussing" this issue anymore. I try not to use absolutes but I have literally never seen an attempt at debating vaccines but what someone didn't start the dissolution of the debate until there was nothing left but yelling and name-calling. I have no idea why this topic can't be discussed like PROFESSIONAL ADULTS that understand and respect that we each have a right to our opinions and choices. Nor to I understand the need to ASSUME the the other side hasn't done INDEPENDENT, LENGTHY AND INTENSE investigation of the subject. Not only that, but there are many, many people within and outside of healthcare with more education than anyone here who agrees with the so-call "pseudoscience."