Flu Shot or Mask?

Many healthcare facilities are requiring nurses to either get an influenza vaccination or wear a mask for the entirety of flu season. What do you think about this policy? Nurses General Nursing Article

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

Just a question for some people refusing the vaccine. Many if you say, well I got the flu once and I have refused ever since, that doesn't make sense to me and I'm wondering the reasoning behind that?

We all know there are many strains of the flu and the flu shot is a guess based off of what is going around Southeast Asia the year before. But it will protect you from that particular strain. I'm just not understanding the reasoning of not at least trying to protect your patients. Especially those that could die from the flu. Those that can't be vaccinated. I find it hard to understand a nurse who doesn't want to protect their patients.

I feel if you don't vaccinate, you should wear a mask. It's about protecting our patients, not about civil rights or the fact you got the flu once. I got H1N1 years ago. It doesn't stop me from getting vaccinated.

I also agree that when you start the name calling such as sheep, you lose all credibility. I'm also curious to the national committee one poster sits on. I would like to know the specific research you have done and your results. You can link the peer reviewed, study.

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.

I declined the flu shot this year (chemo plus virus, contraindicated in my case,) but I will likely continue to decline in upcoming years (several reasons - I am not anti-vaxx, but believe we vaccinate too much). We had a large breakout this year and for about 2 weeks I chose to wear a mask, changed it when it became dirty or roughened along the outside. I did have a short cold with a fever, cough, congestion that lasted about 2-3 days with persistent nasal issues afterward. A doctor asked me if I got tested, nope, symptoms were mild, don't want tamiflu (prefer to let my body handle it if I can.) You just have to go with with​what you know. Wearing a mask can protect you, honestly why wouldn't you use a droplet approved mask? (Surgical mask is not approved, I don't support that.)

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

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With my employer, you'd be enjoying your "civil rights" at home on the sofa. If you don't have an acceptable (to them) reason to refuse, refusing means termination.

And then your employer could very well find themselves involved in a lawsuit. Nurses are no longer sitting down for this. Many are fighting back and winning big.

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I personally feel requiring the flu vaccine us an infringement on my rights. I went for years without receiving a flu shot and NEVER got the flu. Three years ago, I began working for a new employer and when I attempted to refuse the flu vaccine I was told I would be required to wear a mask from October through May. I was STRONGLY advised to get the vaccine, and I eventually caved to the coercion. I've researched the efficacy of flu vaccines for myself. First off the influenza virus mutates and every year the developers of the vaccine "guess" as to how the virus will mutate. In studies of adults in long term care facilities the vaccine was shown to only have a 1% efficacy rate. I think it is wrong to require healthcare workers to receive a vaccine that may not offer any significant protection against the virus. And I feel I should have the right to refuse.

I don't know that LTC is a valid environment for gathering data on vaccine effectiveness. If they are all vaccinated for particular strains and someone catches a strain that is a different mutation, of course none of them are protected. They are all in close quarters with staff milling from resident to resident, often without so much as hand hygiene between. Everybody gets everybody's germs in LTC.

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I don't know that LTC is a valid environment for gathering data on vaccine effectiveness. If they are all vaccinated for particular strains and someone catches a strain that is a different mutation, of course none of them are protected. They are all in close quarters with staff milling from resident to resident, often without so much as hand hygiene between. Everybody gets everybody's germs in LTC.

Hand hygiene should have nothing to do with it if the vaccine is doing the job that it claims to do. How does environment have anything to do with vaccine effectiveness? Either it works or it doesn't.

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Hand hygiene should have nothing to do with it if the vaccine is doing the job that it claims to do. How does environment have anything to do with vaccine effectiveness? Either it works or it doesn't.

"Either it works or it doesn't." Um.

As I already said, the vaccine protects against particular strains of the flu. If a resident contracts a different strain, of course the other residents aren't protected from that strain either.

Hand hygiene is always relevant when talking about infection control. People in closely shared spaces who have others running around assisting to spread the virus are going to get sick in high numbers.

I'm saying a bunch of people in a small shared living space isn't representative of the general population.

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

Not agreeing with a policy is not the same thing as speaking to others with words that are demeaning, immature and unprofessional. You were just flat out rude and demeaning. I hope you don't speak to the people at work with such unprofessional speech.

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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

The author says these claims only apply to "Jesus peeps," and not "Nominal (in name only) Christians" or non-Christians. I don't think I'm a Jesus peep, so it doesn't really apply to my decision-making.

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And then your employer could very well find themselves involved in a lawsuit. Nurses are no longer sitting down for this. Many are fighting back and winning big.

I don't have the luxury of spending months or years unemployed and thousands of dollars on attorney fees because "I don't wanna" is my reason for not getting the flu vaccine. I don't necessarily support 100% mandatory vaccination but I'm not going to throw myself on a sword for the principle. Vaccines have the potential to cause harm, but viruses cause more harm.

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Specializes in Adult Internal Medicine.
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.

What did you learn and where did you learn it from, please share your ideas and your sources so we can all discuss.

The head of every major religion has ok'd the use of vaccines. Additionally the influenza vaccine does not use human cell lines.

Citing a blog from a website which features blogs with the title "How to get a vaccine religious exemption like a boss" doesn't help the concern for conformation bias that is the common theme through the blog that you linked.

Here is a good peer-reviewed publication on the topic:

Grabenstein, J. D. (2013). What the world's religions teach, applied to vaccines and immune globulins. Vaccine, 31(16), 2011-2023.

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Specializes in Adult Internal Medicine.
With my employer, you'd be enjoying your "civil rights" at home on the sofa. If you don't have an acceptable (to them) reason to refuse, refusing means termination.

Again, this isn't "forcing", it is a condition of employment at a place you choose to work. No one is tying anyone down and injecting them.

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"Either it works or it doesn't." Um.

As I already said, the vaccine protects against particular strains of the flu. If a resident contracts a different strain, of course the other residents aren't protected from that strain either.

Hand hygiene is always relevant when talking about infection control. People in closely shared spaces who have others running around assisting to spread the virus are going to get sick in high numbers.

I'm saying a bunch of people in a small shared living space isn't representative of the general population.

. Of course, it's a given that IF it's effective, it will be against the strain that the vaccine is designed for. My point is that FOR THAT STRAIN, it either works or it doesn't and hand nygeine should make no difference. Contrary to what some believe, vaccines don't always produce immunity. Case in point: I was required to get the hep B series during my nursing program. I knew that I had already had it but couldn't produce records so I had titers drawn. They were negative so I sumbitted to the shots again. I again had titers drawn after the vaccines were supposed to have produced antibodies and therefore immunity, but they were still negative. This is not an uncommon phenomenon.

As for the close quarters of LTC, if the vaccine (again, as outlined above) can't protect people in close quarters, why would it be anymore effective in other populations? For the strain that it's given, close quarters or not, effectiveness rates should be the same.

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I don't have the luxury of spending months or years unemployed and thousands of dollars on attorney fees because "I don't wanna" is my reason for not getting the flu vaccine. I don't necessarily support 100% mandatory vaccination but I'm not going to throw myself on a sword for the principle. Vaccines have the potential to cause harm, but viruses cause more harm.

Seriously? You honestly think that ANYONE refusing the vaccine doesn't have a reason other than "I don't wanna?" Besides, nobody asked you to throw yourself on a sword. You made a statement of fact and I was refuting it, not trying to convince you to refuse the vaccine. That's your choice, regardless of your reason, and I should be afforded the respect to exercise my right to refuse, regardless of my reasons. Any information that I CHOOSE to share, here or anywhere, is up to me, but I am under not obligation to justify my decision.

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