Nurses Refusing to Administer COVID-19 Vaccinations!? | Nurses Week Contest

[SafetyNurse1968]

Month-Long Nurses Week Celebration Starts Today! Nurses Week Contest #4

Healthcare professionals have expressed vaccine hesitancy due to fear, mistrust, and misinformation. Although nurses are entitled to their opinion, should this influence them when it comes to administering vaccines? Should nurses be allowed to refuse to administer COVID vaccines? What do YOU think? The best Pro or Anti Vaccine read will win $100 Amazon Gift Card courtesy of allnurses Ebooks. Contest rules are found below.

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Vaccine Controversy

There’s a lot of controversy about the COVID-19 vaccines. I’ve seen articles about how it causes infertility, autoimmunity and even death. Almost 50% of my students have expressed vaccine hesitancy due to fear and misinformation. Some of them have told me they are immunocompromised, and one said that their religion forbids vaccination.  Most of them said, “I just want to wait and see if it’s safe.”

Are vaccinations safe?

There’s been a huge debate for years over whether vaccines cause health problems. When I was about to give birth back in 2009, I did my own research to be absolutely sure that vaccinating my newborn was the way to go. I found no evidence then that vaccination causes autism, and there’s even more evidence now that there is no link between autism and vaccines or any of their ingredients (like thimerosal, which was removed from all vaccines except multi-dose flu vaccines by 2001)¹

The flu shot gave me the flu…

You’ve probably heard someone say, “I got the flu vaccine once, and it gave me the flu – I’m never getting it again.” What they don’t realize is that 1) the flu vaccine cannot give you the flu and, 2) in these cases, the person had already been exposed to the flu when they got vaccinated. The development of the flu would have occurred regardless of the vaccination. Modern vaccines are constructed in such a way that they cannot cause the disease for which you are being vaccinated against.

What about the COVID-19 vaccines?

As I stated in the summary, there’s a lot of misinformation about the COVID-19 vaccines including that they cause infertility or autoimmunity.^2,3 In addition I have read that they contain a tracking chip and that the RNA from the Moderna and Pfizer vaccines can modify your genes. There is no evidence that any of these assertions are true.⁴ Though there may be small, isolated cases of side effects occurring with vaccines, they do not outweigh the very real danger of becoming significantly ill from COVID-19. Right now, all the vaccines being used in the US (Moderna, Pfizer and Johnson & Johnson) have 100% efficacy in preventing hospitalization and/or death from COVID-19. Millions of people have been safely vaccinated against COVID-19, and while the evidence is still out as to whether those of us who have been vaccinated can give it to others, we do know that it is working to prevent hospitalization and death from COVID-19.

mRNA technology such as that used in the Moderna and Pfizer vaccines has been around for over a decade. You may recall from A&P or biology that mRNA is made in your body from DNA. The way it works in your body is: Segments of your DNA (called genes) code for mRNA (transcription) and then mRNA codes for proteins (translation). An mRNA vaccine enters your body and is translated into proteins that elicit an immune response. There’s no machinery or ability for your body to incorporate the mRNA into your genetic code. Once it’s translated, the mRNA just gets destroyed by catalytic enzymes.⁵

It’s also important to note that despite the vaccines being offered under emergency use authorization (EUA), “For this EUA, the FDA required significantly more data on safety and efficacy than usual,” said Janis Orlowski, MD, chief health care officer at the AAMC.⁵

No serious health problems were reported by the tens of thousands of people who received their vaccines during clinical trials. The most common side effects — fatigue, headaches, chills, and muscle pain — lasted about one day and most often occurred after the second dose. Since the vaccine rollout began in the U.K. and U.S., there have been sporadic reports of severe reactions in people with histories of significant allergic reactions to some foods and drugs.⁶

Our duty as nurses

The American Nurses Association supports that all nurses get vaccinated for COVID-19.⁷ The Code of Ethics for Nurses Provision 3 states, “The nurse promotes, advocates for and protects the rights, health and safety of patients.” Not getting a flu vaccine can result in increased risk of contracting flu for patients, co-workers and yourself. Despite this, nurses do refuse to take the flu vaccine – usually due to religious, medical or philosophical objections. Only 21 states have a law that requires healthcare workers to get flu vaccinations and even those laws require exemptions be allowed. Many employers mandate a flu shot, but also allow exemptions. About 1/3 of states require hospitals to offer employees flu shots and track their vaccination status. In many of these states, employees can decline a flu shot without an exemption.⁸

But what about the COVID-19 vaccines? Can those be required? The federal government says that COVID-19 vaccination can be required, but so far no healthcare organizations have taken this confrontational stance.^5,6

I believe we have a duty as nurses to get vaccinated against COVID-19 to protect our patients and coworkers and also to prevent mutations/variations in the vaccine. We all need to work together to eradicate COVID from the planet.

My Question: Can a nurse refuse to GIVE the vaccine?

In nursing school, I recall an ethical debate on whether or not a nurse could refuse to care for a patient having an abortion. We decided that nurses should have the right to refuse to take part in an abortion based on moral objection, though once the pregnancy is terminated, the nurse should no longer be able to refuse to give care. Does that translate to giving vaccinations? If a nurse is morally opposed to vaccinations, can they refuse to give them?

I googled “Can a nurse refuse to administer vaccines” and all I came up with was a list of articles about how many nurses are refusing to get the vaccine. It’s hard to find information on this topic. 

What do you think? Should a nurse be allowed to refuse to give vaccinations? Should the reason for that opposition play a role (religious, ethical, moral, philosophical)?

Contest Rules

1. Open to registered allnurses.com members only. (Free and quick to Register)
2. Participate in the Poll.
3. Answer 'Should a nurse be allowed to refuse to give vaccinations? Why?'
4. One winner will be announced.

This contest is sponsored by allnurses Ebooks.

Quality Nursing Ebooks. Anytime. Anywhere. Our ebooks are created by nurses, educators, students, and healthcare professionals. We have one goal - To help you succeed in your nursing career.

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References

¹ Autism and vaccines
² Why the vaccinations do NOT cause infertility
³ Vaccine myths
⁴ The vaccine does not cause autoimmune disorders
⁵ Association of American Medical Colleges: What health care workers need to know
⁶ COVID-19 vaccine safety
⁷ ANA position statement on vaccines
⁸ Becker’s flu shot requirements

[macawake, MSN]

6 hours ago, speedynurse said:

I am one that I feel like education should be provided and then everyone should be allowed to make an educated decision - this applies to anything in the healthcare field.

6 hours ago, speedynurse said:

I do think there needs to be a level of understanding with concerns whether pro or wariness of the vaccine because it WAS approved for emergency use. There are many meds out there with full FDA approval that were recalled years later because of MI tendencies, higher risk of cancer development, etc. I think this is an area where everyone has to use their own judgment- be kind and try to understand everyone’s viewpoints.

I have to admit I don’t understand this line of thinking. First of all, is it an educated decision to be more fearful of the vaccine than a Covid infection? 

I dislike paternalistic medicine. If a patient wants a vaccine that is legal to give and understands the risks and that there might be unknowns, how is it ethical to deny them a vaccine? I’m not trying to be mean here, I genuinely don’t understand why a nurse would think that their personal fears or needs trumps the needs and wishes of the patient. 

I noticed that you specialize in pre-Op and PACU. I work the in-between. What if I would tell my patients that I’m sorry, but I really can’t administer anesthesia. While anesthesia-related mortality is very low, it’s not zero.
So should I tell my patient that I’m not comfortable with the risk involved? Sure I realize that from the patient’s perspective there is a lot of benefit from the various drugs used and that the patient would really, really like to have them before and during their surgery, but I can’t live with the risk. I guess I could offer them a couple of aspirin instead? No wait.. Can’t do that either because aspirin could cause severe side effects. Don’t even get me started on oncology nurses who administer chemotherapy. 

If every nurse starts to unilaterally decide which legally prescribed medication or treatment he or she is comfortable administering, where does that leave the patient?

I think that if an informed and consenting patient wants to accept a legal treatment/med that a provider has prescribed, we have to give it if it’s within our scope to do so. Or seek employment somewhere you don’t ever have to give medication x or treatment y. 

I absolutely think the student has the right to choose not to apply for a job in a vaccination clinic, but doesn’t have a right to veto a patient’s autonomy. 
 

I do agree with you on two things. I too can’t wait for Covid to be over and I think you’re right that kindness is important, especially in trying times like the one we’re living right now. 
 

Take care ?

 

[Tenebrae, BSN, RN]

Its sort of like abortion in that if you don't want to give a vaccine, don't work in an area that requires you to give vaccines. don't sign up to work in that area and then state you won't give vaccines. 

Personally I could never work in an area that provides abortions based on my own personal feelings, doesn't mean I'd stand between a woman obtaining an abortion or not refer them onto a service that could help

Provaccines, and when the covid vaccine is avaliable at work I'll be signing up to get it. 

[2BS Nurse, BSN]

Many times I had to administer IM Rocephin when I didn't think it was necessary. One provider may deem the antibiotic beneficial and order it. A second provider may choose to order oral antibiotics. A third provider may choose to let an illness run its course without ordering any medication. How is refusing to administer the Covid vaccine any different than refusing to administer any other medication?

[JKL33]

3 hours ago, macawake said:

If a patient wants a vaccine that is legal to give and understands the risks and that there might be unknowns, how is it ethical to deny them a vaccine? I’m not trying to be mean here, I genuinely don’t understand why a nurse would think that their personal fears or needs trumps the needs and wishes of the patient. 

I would agree with this if a random nurse refusal meant that someone would be denied the recommended care. I am not sure how often that has ever been the reality, though I admit it could theoretically result in that.

***

Re: the OP question at hand. I voted no, sort of for devil's advocate reasons but also a bit of a very broad application of the question. I have indeed refused to give an ordered medication before, but not for moral, political or philosophical reasons; it was that I had very good reason to believe that the med/plan of care was both unnecessary and dangerous as well as somewhat off the beaten path. So, as a last resort I decline and invited the physician to administer it  if they really thought it was a reasonable plan (they decided to change their mind instead). And I would like to retain my "right" to exercise my nursing judgment to do that same thing again, which is what I would do.

With the covid vaccine specifically, I do think that the few people whom I've heard say they wouldn't administer it, they seem to be exercising a...sudden intensity of concern and nursing judgment...that is...uncharacteristic.

****

9 hours ago, speedynurse said:

There is an article out now that a vaccine site is being shut down in NC for investigation of adverse effects.

Sounds like they're going to be back up and running since the CDC investigated the batch/lot and found no cause for concern.

https://abc7chicago.com/adverse-reaction-to-johnson-and-shot-jj-covid-vaccine-side-effects-north-carolina-pnc-arena/10501577/

 

[BSN-to-MSN, ADN, BSN, RN]

On 4/8/2021 at 7:44 PM, SafetyNurse1968 said:

I believe we have a duty as nurses to get vaccinated against COVID-19 to protect our patients and coworkers and also to prevent mutations/variations in the vaccine. 

No, nurses are also people with opinions, and getting a COVID vaccine is a choice, not a duty.

16 hours ago, Tenebrae said:

don't work in an area that requires you to give vaccines.

agree

[MaxAttack, BSN, RN]

How have so many people voted yes on this??

Would you refuse to administer an antibiotic? Tylenol because you don't like Johnson & Johnson? Taking a job that includes administration of vaccines and then refusing to administer them cannot be twisted into some noble deed any more than the pharmacist that purposefully destroyed over 500 doses of the covid vaccine.

We have an obligation to critically think and and use our judgement to a point. For those of you that think you can unilaterally determine the risks vs benefits and essentially write or d/c your own orders need to seriously review nursing laws and scope of practice because you won't be the first to lose your license thinking you ultimately decide what a patient should and should not receive.

[MaleNursing1218, LVN]

I understand not wanting to GET the vaccine but not wanting to GIVE the vaccine is a total different ball game. It’s absurd. Many of us have gotten vaccines when we were infants polio/varicella/MMR. Vaccines aren’t anything new. What’s also sad is that covid has been used for political gain which has been a huge factor in vaccine hesitancy. Leave your personal beliefs at home. It’s not about you it’s what’s best for the patient.

“How very little can be done under the spirit of fear.”

-Florence Nightingale 

[JKL33]

1 hour ago, MaxAttack said:

How have so many people voted yes on this?? 

Would you refuse to administer an antibiotic? Tylenol because you don't like Johnson & Johnson? [...]

The question did not ask if responders would refuse to give the vaccine.

[MunoRN, RN]

On 4/9/2021 at 12:56 PM, Gillyboo said:

Actually, federal law prohibits employers mandating any emergency use vaccine, prior to FDA approval. The reasoning is mostly because efficacy is not especially clear yet, and neither are side effects. Additionally, the drug maker is immune from liability, during the time that EUA vaccines are administered. 

https://www.statnews.com/2021/02/23/federal-law-prohibits-employers-and-others-from-requiring-vaccination-with-a-covid-19-vaccine-distributed-under-an-eua/

That said, it is not unprecedented to mandate what we would now call EUA vaccines. In 1905, smallpox was killing a lot of people, a was mandated even for employees. The benefits simply outweighed the risks to take a cowpox vaccine back then. Smallpox wasnt eradicated until more than half a century later. It's the only disease that has been totally vanquished. Smallpox in the Variola Major variety (the kind that left pockmarks) averaged only a 70% survival rate. So, at the time, cowpox were truly a Godsend. 

With Covid-19, there is generally a 96% survival rate for adults and a 99% survival rate in children. Not a super small number, but clearly small enough to make some people feel they are better taking their chances and not getting vaccinated. 

We could easily wait to get the shots. 

I am fully vaccinated, myself, but I do like to argue the less popular opinion, just for a bit of a challenge, if nothing else. Ha ?

 

Outside of that article, the prevailing view is that employers can indeed mandate Covid vaccination, even while it's under an EUA.

Here's an article in response to the one you posted, Employers can require authorized Covid-19 vaccines.  And others: Can an employer mandate covid vaccinations? Experts say yes. - The Washington Post  

Can employers mandate the COVID-19 vaccine? | Legal Blog (thomsonreuters.com)

Can your employer require a vaccine? Probably. So can a restaurant or hotel - The San Diego Union-Tribune

Basically, the statute does not prohibit vaccination requirements, you're free to chose to not be vaccinated but you're job is protected.  The statute does allow for the head of HHS to add language that would offer some level of protection to employees who refuse vaccination, but HHS has not utilized that part of the statute.

[macawake, MSN]

On 4/9/2021 at 7:33 PM, JKL33 said:

I have indeed refused to give an ordered medication before, but not for moral, political or philosophical reasons; it was that I had very good reason to believe that the med/plan of care was both unnecessary and dangerous as well as somewhat off the beaten path. So, as a last resort I decline and invited the physician to administer it  if they really thought it was a reasonable plan (they decided to change their mind instead). And I would like to retain my "right" to exercise my nursing judgment to do that same thing again, which is what I would do.

I have also put off giving an ordered medication and instead contacted the prescribing physician first to ask questions/make my point. Usually because the person who ordered the medication appeared to had missed absolute contraindications or if something about the patient’s status made me think the med choice was ill-advised. 

However, I don’t think that refusing to give a Covid-19 vaccine to a patient who wants to be vaccinated qualifies as using ones nursing judgment. It would have to be based on factual nursing knowledge and not merely on personal fears and misgivings in order to qualify. 

On 4/9/2021 at 7:33 PM, JKL33 said:

With the covid vaccine specifically, I do think that the few people whom I've heard say they wouldn't administer it, they seem to be exercising a...sudden intensity of concern and nursing judgment...that is...uncharacteristic.

That’s exactly it. A surprising amount of nurses appear to have been affected by blatant disinformation that has been making the rounds on social media. That’s not science-based. I expect that licensed healthcare professionals base their decisions on the available scientific data and not on theoretical and frankly outlandish ”what-ifs”. 

I wonder if the 42% who’ve answered that a nurse should be allowed to refuse administering a Covid-19 vaccine also think that I should be allowed to refuse to administer general anesthesia?

If not, then why not?  The patient understands both the benefit and risk involved and accepts it. The patient wants the medications. The benefit for the patient is clear. The risk, however small, is also real. So why shouldn’t I have the right to say that I’m not comfortable risking that the patient dies due to medications I’ve administered? Why am I not allowed to make this all about me instead of the patient?

https://www.scientificamerican.com/article/how-to-debunk-misinformation-about-covid-vaccines-and-masks/

[MaxAttack, BSN, RN]

15 hours ago, JKL33 said:

The question did not ask if responders would refuse to give the vaccine.

"Can nurses refuse to give ordered care?

1. Should a nurse be allowed to refuse to give the COVID vaccine?"

?

[MaxAttack, BSN, RN]

2 hours ago, macawake said:

That’s exactly it. A surprising amount of nurses appear to have been affected by blatant disinformation that has been making the rounds on social media. That’s not science-based. I expect that licensed healthcare professionals base their decisions on the available scientific data and not on theoretical and frankly outlandish ”what-ifs”. 

THIS. It's a cycle of conspiracy theories and misinformation picked up by healthcare professionals who then post about it which is then linked to by others as "proof" that the original nonsense was right - from masks causing dangerous hypoxia to hcq being the magical cure to vaccines being linked to literally anything that goes wrong in someone's life. People look to us for advice and information and unfortunately not all of us can keep our personal feelings and politics out of the way or can't be bothered to do the research to form an educated opinion.