I live in PA, my stepchildren live with my husband and I. Their mother, who just became a licensed RN in December of 2008, lives in Maryland. When they came home this past Sunday, my stepdaughter complained of pain in her right arm. When we asked her what was wrong, she said that before leaving the house that morning, her mother gave her three shots, one for the flu, one for pneumonia, one for HPV. My step son, about 1/2 an hour later, came into the room, also complaining that his arm was sore from shots. I asked him if they'd gone to the doctor, he replied, "NO! My mom is an RN, she can buy the shots from the hospital and give them to us at home." My question to you is, IS THIS ETHICAL? Is it legal? Can you 'buy' your vaccinations at your place of work and give them at home without a doctor's orders? I have looked a bit on the internet, and especially with the HPV vaccination, it says that a doctor has to administer it, and it's a series of three shots. Something about this whole thing doesn't sit right with me. I thought I'd throw it out there to the professionals. Any advice?
Where is your source that 3 shots should not be given at the same time? I work in an immunization clinic, and we either give all of the shots indicated, or we have to have the parents sign a waiver stating they decline.
Here is from the CDC:
I've heard people talk about "simultaneous" and "combination" vaccines. What does this mean? Why are vaccines administered this way?
"Simultaneous vaccination" is when multiple vaccines are administered during the same doctor's visit, usually in separate limbs (e.g., one in each arm). A "combination vaccine" consists of two or more separate vaccines that have been combined into a single shot. Combination vaccines have been in use in the United States since the mid-1940s. Examples of combination vaccines in current use are: DTaP (diphtheria-tetorifice-pertussis), trivalent IPV (three strains of inactivated polio vaccine), MMR (measles-mumps-rubella), DTaP-Hib, and Hib-HepB (hepatitis B).
Giving a child several vaccinations during the same visit offers two practical advantages. First, we want to immunize children as quickly as possible to give them protection during the vulnerable early months of their lives. Second, giving several vaccinations at the same time means fewer office visits, which saves parents both time and money and may be less traumatic for the child.
Is simultaneous vaccination with multiple vaccines safe? Wouldn't it be safer to separate combination vaccines and spread them out, vaccinating against just one disease at a time?
The available scientific data show that simultaneous vaccination with multiple vaccines has no adverse effect on the normal childhood immune system. A number of studies have been conducted to examine the effects of giving various combinations of vaccines simultaneously. These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects. Consequently, both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend simultaneous administration of all routine childhood vaccines when appropriate. Research is underway to find methods to combine more antigens in a single vaccine injection (for example, MMR and chickenpox). This will provide all the advantages of the individual vaccines, but will require fewer shots.
Another advantage is that combination vaccines result in fewer shots and less discomfort for children. In addition, spreading out the administration of separate vaccines may leave children unnecessarily vulnerable to disease.
Here is more from the CDC (from the myths about vaccines section)
Myth number 6:Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.
Children are exposed to many foreign antigens every day. Eating food introduces new bacteria into the body, and numerous bacteria live in the mouth and nose, exposing the immune system to still more antigens. An upper respiratory viral infection exposes a child to 4 - 10 antigens, and a case of "strep throat" to 25 - 50. According to Adverse Events Associated with Childhood Vaccines, a 1994 report from the Institute of Medicine, "In the face of these normal events, it seems unlikely that the number of separate antigens contained in childhood vaccines . . . would represent an appreciable added burden on the immune system that would be immunosuppressive." And, indeed, available scientific data show that simultaneous vaccination with multiple vaccines has no adverse effect on the normal childhood immune system.
A number of studies have been conducted to examine the effects of giving various combinations of vaccines simultaneously. In fact, neither the Advisory Committee on Immunization Practices (ACIP) nor the American Academy of Pediatrics (AAP) would recommend the simultaneous administration of any vaccines until such studies showed the combinations to be both safe and effective. These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects. Consequently, both the ACIP and AAP recommend simultaneous administration of all routine childhood vaccines when appropriate.
There are two practical factors in favor of giving a child several vaccinations during the same visit. First, we want to immunize children as early as possible to give them protection during the vulnerable early months of their lives. Second, giving several vaccinations at the same time will mean fewer office visits for vaccinations, which saves parents both time and money and may be less traumatic for the child.
Here is one specifically related to HPV vaccination from the MMWR (March 12, 2007):
Simultaneous Administration with Other Vaccines
Although no data exist on administration of quadrivalent HPV vaccine with vaccines other than hepatitis B vaccine, quadrivalent HPV vaccine is not a live vaccine and has no components that adversely impact safety or efficacy of other vaccinations. Quadrivalent HPV vaccine can be administered at the same visit as other age appropriate vaccines, such as the Tdap and quadrivalent meningococcal conjugate (MCV4) vaccines. Administering all indicated vaccines together at a single visit increases the likelihood that adolescents and young adults will receive each of the vaccines on schedule. Each vaccine should be administered using a separate syringe at a different anatomic site.
Not to be completely obnoxious, but again, please give me one REPUTABLE source that states you should not give simultaneous vaccines to children. It has nothing to do with inexperience - it has more to do with evidence-based practice. At the current time both the CDC and the American Academy of Pediatrics (and ACIP) recommend simultaneous vaccination of children.
I think the OP is looking for a way to get the newly lic nurse/ex-wife in trouble!! Instead of looking up info on the internet of the legalities of admin a vaccine to her step kids- I am sure she has more constructive things she could be doing. This was her 1st post and I doubt she will be back on to even read the replies.
Well, you're wrong there. I am back, and I am reading,and quite frankly up until this one, am kinda satisfied with what I see. I am asking these questions, because their mom, the professional RN, did NOT tell us what she had done and instead left it up to the children to tell us. This has been her M.O. and quite unfortuneately, she has been caught doing MANY other illegal things. I just wanted to make sure this was okay, and so far it is. Thanks to the other Nurses who answered my questions, without trying to bash what I was trying to do.
Add me to the list- I gave my kids their flu and hepatitis shots etc. (Our doctor knows and approves- got them from work, signed their vaccination sheets )
Just make sure you keep records in case the school need to know
she has been caught doing MANY other illegal things. .
Wow good luck with that---but this one was not illegal. Hopefully your encouraging of your step kids to have a good relationship with thier mom. I am hoping you only say positive things about thier mother to them. Nothing worse than hearing negative statments about your own parents.
Specializes in Vents, Telemetry, Home Care, Home infusion.
In my neck of the woods, employee health only administers work related immunizations...no clinics at our hospital for staff. However, did get to use last dose of Flu vaccine from my employer instead of being discarded 2 years ago during shortage to administer to my Dad with order from PCP...
Sons all taken to Dr Maddy's office for their shots; however, Mom gave their desenitization shots to them while at summer camp---along with about 25 other kids shots as employeed as Camp RN.
Forwarning you re immunizations would have been professional courtesy...along with being good mom wanting to make sure no followup issues.
Wow good luck with that---but this one was not illegal. Hopefully your encouraging of your step kids to have a good relationship with thier mom. I am hoping you only say positive things about thier mother to them. Nothing worse than hearing negative statments about your own parents.
I do say only positive things. I am not an evil stepmom, and I only have their best interests in my heart. This issue worried me, to say the least, and is only one more thing at the top of a big pile over the years. I stay farrrr away from her, and can't be all that bad if they wanted to live here with me and their father. The only thing that bothers me, however, is that not ALL of you are saying it's okay. There were a few people who couldn't believe the rest of you were doing this. Not that I'm saying it's a bad thing, but I'm wondering if there's different rules in different states? Anyhow, thank all of you for your thoughts, it helped ease my mind a little.
I'll bet this Mom feels bad enough not having primary custody of her kids. The lines of communication obviously are not very open if she and stepmom aren't collaberating regarding the kids. My advise to the OP would be for her to encourage parent to parent communication without having to rely on the poor kids as go betweens. Please avoid fingerpointing and blame, especially in front of the kids. It's very very hurtful and harmful to the children, take it from me, I've lived through being a child of divorce and it gravely harmed me.
I do say only positive things. I am not an evil stepmom, and I only have their best interests in my heart. This issue worried me, to say the least, and is only one more thing at the top of a big pile over the years. I stay farrrr away from her, and can't be all that bad if they wanted to live here with me and their father. The only thing that bothers me, however, is that not ALL of you are saying it's okay. There were a few people who couldn't believe the rest of you were doing this. Not that I'm saying it's a bad thing, but I'm wondering if there's different rules in different states? Anyhow, thank all of you for your thoughts, it helped ease my mind a little.
Your post oozes of disdain for your children's bio mom, very sad. She may not be perfect but she obviously cares for her children and was trying to help them in some way. There are always two sides to every story, maybe she visits this site and will give us hers.
The only thing that bothers me, however, is that not ALL of you are saying it's okay. There were a few people who couldn't believe the rest of you were doing this.
Well nurses are certainly not infalliable....The important thing to look at here is that no one saw a problem with an RN administering vaccinations at home. The difference of opinion came when people started talking about simultaneous vaccinations, and the few people who disagreed were simply misinformed. I think LaneyB pretty much settled this. She posted several replies, each with good information mainly from the CDC [which is pretty much the definition of a reputable source]. In case you didn't see it, here is her closing post:
Not to be completely obnoxious, but again, please give me one REPUTABLE source that states you should not give simultaneous vaccines to children. It has nothing to do with inexperience - it has more to do with evidence-based practice. At the current time both the CDC and the American Academy of Pediatrics (and ACIP) recommend simultaneous vaccination of children.
There you have it. I don't see how you can continue to find a problem with the simple matter of an RN administering vaccines, unless you really are just looking for a way to create trouble for the kids' mother.
LaneyB
191 Posts
Where is your source that 3 shots should not be given at the same time? I work in an immunization clinic, and we either give all of the shots indicated, or we have to have the parents sign a waiver stating they decline.
Here is from the CDC:
I've heard people talk about "simultaneous" and "combination" vaccines. What does this mean? Why are vaccines administered this way?
"Simultaneous vaccination" is when multiple vaccines are administered during the same doctor's visit, usually in separate limbs (e.g., one in each arm). A "combination vaccine" consists of two or more separate vaccines that have been combined into a single shot. Combination vaccines have been in use in the United States since the mid-1940s. Examples of combination vaccines in current use are: DTaP (diphtheria-tetorifice-pertussis), trivalent IPV (three strains of inactivated polio vaccine), MMR (measles-mumps-rubella), DTaP-Hib, and Hib-HepB (hepatitis B).
Giving a child several vaccinations during the same visit offers two practical advantages. First, we want to immunize children as quickly as possible to give them protection during the vulnerable early months of their lives. Second, giving several vaccinations at the same time means fewer office visits, which saves parents both time and money and may be less traumatic for the child.
Is simultaneous vaccination with multiple vaccines safe? Wouldn't it be safer to separate combination vaccines and spread them out, vaccinating against just one disease at a time?
The available scientific data show that simultaneous vaccination with multiple vaccines has no adverse effect on the normal childhood immune system. A number of studies have been conducted to examine the effects of giving various combinations of vaccines simultaneously. These studies have shown that the recommended vaccines are as effective in combination as they are individually, and that such combinations carry no greater risk for adverse side effects. Consequently, both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend simultaneous administration of all routine childhood vaccines when appropriate. Research is underway to find methods to combine more antigens in a single vaccine injection (for example, MMR and chickenpox). This will provide all the advantages of the individual vaccines, but will require fewer shots.
Another advantage is that combination vaccines result in fewer shots and less discomfort for children. In addition, spreading out the administration of separate vaccines may leave children unnecessarily vulnerable to disease.