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

[DH88]

I wish masks were more protective because I feel like they could be more useful than shots. We know that the flu shot is unreliable and a mask could protect everyone. It can be intimidating to see medical staff wearing masks all day but it would be for the greater good. I don't think shots should be mandatory but staying home sick should be. I'm disturbed by the amount of co-workers at my hospital that don't stay home when sick. One tested positive with flu A despite being vaccinated. I'm scared of the flu so I would probably vaccinate and wear a mask if possible. Health care workers don't seem to get flu very often despite the high risk profession. They must be doing something right.

[WestCoastSunRN, MSN, CNS]

I am not anti-vax. That said, my experience has taught me that there is often a better/healthier/more efficient way of accomplishing healthcare goals than whatever the current practice is. An example of this is the current childhood immunization schedule we use in the U.S. While there are a few things to consider with that, the biggest arguement supporting it revolves around parental compliance. It is a challenge to be sure, but there might be a better way.

I think that is probably true for this particular FLU/MASK issue. I do question the efficacy behind yearly flu vaccines. I DO think we need to be extremely mindful about vaccines. I do NOT ascribe to the "more-is-better" philosophy of vaccination. We have an impressive number of vaccines in circulation with more on the horizon. I think we could be playing with fire. And for me, and I am guessing for most of us with direct patient contact, patient safety is of utmost importance.

As an anecdotal, this last flu shot I got (to keep in compliance with my employer) left me with some minor nerve damage in my arm. Never had that happen before, and I know it's rare -- and wasn't necessarily due to the specific vaccine .... but nonetheless it's a bummer, right? The truth is I would not have chosen vaccination, but did so to be in compliance despite my serious questions regarding efficacy and if it is really making my patients safer.

[mrl3fnp]

The head of every major religion has ok'd the use of vaccines.

What's your point?

Religious protections in the workplace are not defined solely by a place of worship or organization. Religious protections also include observance, practice, and individual beliefs. In addition, an employee may change their religious beliefs daily and still be protected under the law (Civil Rights Act of 1964).

[Here.I.Stand, BSN, RN]

I don't think shots should be mandatory but staying home sick should be. I'm disturbed by the amount of co-workers at my hospital that don't stay home when sick

THANK YOU. That makes me nuts. I don't know that I've ever gotten sick from caring for patients. I have (as far as I can tell) gotten sick from sick colleagues.

[mrl3fnp]

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.

So, if I'm understanding you correctly, I think your point is that an employer has the legal right to set its own policy, even if the policy doesn't allow the employee to freely practice their religious beliefs?

If so, then I assume you also agree the same goes for the employer as it does for the employee? For example, I assume then that you agree with the Supreme Courts decision in Burwell vs. Hobby Lobby and that Hobby Lobby has a legal right to make policy based on their religious beliefs?

[Daisy4RN]

I think that the questions that should be asked are: how many patients have contracted the flu from staff, why do nurses work while sick, and what is the efficacy rate of the flu vaccine. Take all three of these and come to a conclusion. Personally I am against mandatory vaccines and masks. I think that as professionals we know when we should wear a mask, and if hospitals "allowed" for sick days nurses wouldn't feel pressured to work if sick. I agree with other posts that it doesn't make sense for nurses to wear masks when other staff and/or patients do not, and most hospitals allow patients and visitors (even children) to hang out in hallways etc. with no mask. Also, the efficacy rate of the vaccine from year to year is usually low, so as professionals we know that the risk vs benefit factor should be considered.

[BostonFNP, APRN]

So, if I'm understanding you correctly, I think your point is that an employer has the legal right to set its own policy, even if the policy doesn't allow the employee to freely practice their religious beliefs?

If so, then I assume you also agree the same goes for the employer as it does for the employee? For example, I assume then that you agree with the Supreme Courts decision in Burwell vs. Hobby Lobby and that Hobby Lobby has a legal right to make policy based on their religious beliefs?

It has nothing to do with my point or even my personal beliefs. I am not sitting on the SCOTUS; they have ruled on many things, this included, and whether I like it or not, or agree or not, that's the way the law is interpreted.

[Horseshoe, BSN, RN]

So, if I'm understanding you correctly, I think your point is that an employer has the legal right to set its own policy, even if the policy doesn't allow the employee to freely practice their religious beliefs?

If the employee is given the choice between vaccination and wearing a mask, religious beliefs have indeed been respected. No one in that scenario is forced or even coerced into getting a vaccine.

[Ankh]

Mask 💯

[Ankh]

To clarify I was working in NY where the mask is mandated for those who decline flu vaccine. I do not believe in vaccination for me but was ok wearing the mask though doubtful it offered much protection for patients. I'm on the alternative health spectrum and do not fully accept the germ theory as fact but merely a perspective. I respect those who choose to vaccinate from an informed perspective. However i believe it is my right as an RN to practice AND abstain from vaccines so long as I engage in proper self care and avoid contact with patients if I am sick.

[anna7hanna]

When my employer mandates a policy, especially one that mandates I inject potentially harmful substances, I want it to be supported by evidence-based practice...........No, I demand that it is supported by evidence-based practice. I think most of us can agree that mandating flu shots doesn't feel right inside......There is a reason for that feeling.......Because there is no evidence that flu shots work. In contrast, there is evidence that masks work. Follow the money if you want to explain why there are flu shot mandates because the efficacy of mask wearing is undeniable.

I appreciate the facts you have stated in your past postings it makes it more understandable and is far better than the inflammatory argument presented earlier I understand your view point and it makes sense.

[anna7hanna]

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.

Love, if you were trying to persuade anyone that you were more than just inflammatory, rude and rebellious you have failed. (Of course I don't know you personally I am describing what your actions display on this post.) If you were trying to get people to understand your view point so that they could be enlightened there are better ways to do it than ridiculing others for their opinions . Now if your goal was to come on and close further the minds of others on this issue than I must applaud you, you have done an outstanding job.