The Influence of the Influenza Vaccine:

Getting the Influenza vaccine, as a healthcare provider, is an interesting conundrum: there are recommendations from the CDC that are made to promote healthiness, but then there are hospital mandates. I would lose my job if I didn't get vaccinated, so I do, without a true informed medical decision. When medical interventions are required, hospital policies seem a little too invasive.

The Influence of the Influenza Vaccine:

According to the CDC, in the US, deaths from influenza (flu) can hit up to 49,000 annually. As nurses, we all work really hard at preventing transmission of infections within the hospitals through diligence with hand washing, aseptic technique with IV access, and contact precautions for patients with C. Diff, MRSA, and VRE because we care about our patients and we are also helping them heal from their current illnesses. Why does it feel different to protect our patients by getting a vaccine that is required by the hospital as opposed to following all of the other policies and protocols that are imposed upon us? Yes, we are taking a medication, an injection, created to prevent an illness that is easily spread and can have devastating effects to our patients...either through infecting them or infecting other staff members and leaving us without adequate staffing to take care of said patients.

It does seem to take away our ability to make an informed decision: How do you know what YOU think is best when the information from the CDC recommends that basically, everyone should get the flu vaccine, of which there are a few different kinds of vaccinations that you can get, and then there are always hospital policies about flu vaccinations that can also have an impact on when and what type of flu vaccine you obtain?

How the Vaccinations Work

This year all of the vaccinations are either trivalent or quadrivalent to protect against the two strains of influenza A and either 1 or 2 strains of Influenza B that research indicates will be most virulent this season. You can be vaccinated two different ways, either by nasal spray or through an actual injection; two weeks after vaccination, your body starts to create antibodies against the flu that will help prevent you from getting infected, and if you do, it will be a very mild form, like a cold, but you will not have the true flu.

The injection is an inactivated form of the virus, and, being injected with the inactivated strains of the flu, means that you aren't actually infected with the live virus so you won't get the flu from the vaccine. After the injection, there may be some redness at the site, soreness, and low fever that can last 1-2 days.

The nasal-spray vaccine is made with living, but weakened, flu virus that does cause an immune response, but you don't get as sick as you would with the actual flu after use. It is not suggested for pregnant women or asthmatics (there can be an acute respiratory reaction from the live virus directly reacting with the lungs.) After the nasal-spray vaccine, the side effects are a little more than the injection: runny nose, headache, sore throat, and cough that last just a few days. This gives your immune system a real challenge because you are actually getting the virus, so you do feel unwell for a few days.

What are the Types of Vaccines?

Trivalent:

Standard- dose injection: can be given to anyone 6 months old to 64 years of age.

Intradermal injection: a dose given with a smaller needle into the skin instead of intramuscularly and can be given to patients aged 18 years to 64 years.

High dose injection: is recommended for adults over the age of 65 years because of a diminished immune system, the injection has more antigens prevalent to help prevent the flu.

Recombinant egg-free injection: for those with an egg allergy and it is approved for adults over 18 years.

Quadrivalent:

Standard-dose injection: can be given to anyone 6 months to 64 years of age.

Nasal Spray: can be given to anyone 2 years through 64 years, however, it is emphasized for children 2 years to 8 years that have no other medical conditions that could be complicated by the flu.

Who should get vaccinated?

According to the CDC, basically everyone 6 months and older should get vaccinated (which I tend to agree with!)

The "high risk" list for definite vaccination:

  • Pregnant women (injection only)
  • Children younger than 5 years old (especially those in pre-school activities, daycare, etc.)
  • Anyone > 50-years-old
  • Anyone with chronic medical conditions
  • People who live in nursing homes or long-term care facilities
  • People who live with or care for those at high risk (healthcare workers, family members of those at high risk, and family and caregivers for those less than 6 months old.)

Who might need to discuss their risk further with their healthcare provider?

  • Anyone with an allergy to chicken eggs (if the non-egg injection is not available)
  • Anyone who has had a severe reaction in the past (i.e. anaphylactic reaction)
  • Anyone who has had Guillain-Barre syndrome within 6 weeks of a flu vaccine
  • Children under 6 months of age (their immune systems are too immature to respond appropriately)
  • Anyone who actively has a fever or is unwell.

How does hospital policy work?

Patients: Where I work, and in most of the surrounding hospitals (I don't want to say all because there are a lot of hospitals and I haven't discussed with each one), every patient is screened within 24 hours of admission and offered the flu shot. Every single one. And this screening allows everyone on the healthcare team to be a part of the conversation (whether patients rule in or out) and we educate and discuss with patients their own risks.

Staff: When it comes to the staff, our policy is that all staff that work in direct patient care, are required to have a flu vaccine (which is offered free of charge to all staff), and it needs to be documented by mid-November each year, as a contingency of employment. If you are medically unable to have a flu shot, it needs to be documented annually. It is part of a safety initiative to prevent the spread of disease and protect patients. If you get the vaccine from the hospital, you get the injection that is offered.

I appreciate that they offer kiosks to get my flu shot, and they collect the paperwork to file away for me; it couldn't be easier. But once I started doing some research for my family members who had questions about which vaccines they should get, I realized that I put zero thought into receiving a vaccine. I would never take a medication without knowing the side effects, dose, type, etc. but because it is policy, and easy, without a medical consult, I got the injection. I honestly didn't even know all of the options that I had for flu vaccines! I would have gotten it anyway, I am a believer in the flu vaccine, and I always have been, but I am not sure how I feel that I let hospital policy blind me from going to my own healthcare practitioner and making a truly informed decision that might be best for me.

What do others think about getting the flu vaccine mandated at work? Does it make you feel like you made a medical decision with little to no actual thought about it?

I know the flu shot is best practice to protect our patients and ourselves...I just wish there was a way to make me feel like I was making an informed medical decision about getting a vaccine, as we encourage all of our patients to do, even though it is mandated.

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Bridgid Joseph

About Bridgid Joseph, BSN, MSN, APRN, CNS

Clinical Nurse Specialist, Emergency Cardiovascular Specialty: Surgery,Critical Care,Transplant,Neuro

14 Articles   67 Posts

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Specializes in SICU, trauma, neuro.

I don't feel like they're making a medical decision for me 1) because I appreciate the reduced risk of exposure to influenza, 2) I'd get it regardless (getting influenza twice--both years when I happened not to get the vaccine--are all the convincing I need for the decision TO get it. So much pain and fatigue I wished I could sleep those 3 weeks until I was better...second time I was very close to going to the hospital when my SOB subsided. If there is ANYTHING I can do to avoid getting the flu again, bring it on!!), and 3) it's no different than any other policy. I mean we're required to get the Hep B series too...at least wherever I've worked or gone to school, and odds of exposure to influenza are WAY higher than exposure to Hep B. I'm not sure why the unique opposition to flu vaccines but not other EOHW policies.

Hospitals where I've worked haven't mandated the vaccine, but they've mandated wearing a mask 100% of the time on the floor from October through April if we don't get it. We have the choice to get vaccinated, wear a mask, or look for a different job. They have the choice to enforce their policies.

As for education, our EOHW nurse gives us the CDC handout on the flu vaccine, same as what the private clinics do when we ask for information. So no I don't feel like I've made the decision w/ no information. If they took the attitude of "Just roll up your sleeve like a good employee," if I had a question, of course I'd oppose that.

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Specializes in Surgery,Critical Care,Transplant,Neuro.

As for education, our EOHW nurse gives us the CDC handout on the flu vaccine, same as what the private clinics do when we ask for information. So no I don't feel like I've made the decision w/ no information. If they took the attitude of "Just roll up your sleeve like a good employee," if I had a question, of course I'd oppose that.

We are mandated where I work, and I agree completely with getting the flu vaccine (I have fallen prey once in my life and I never want that experience again!) I guess my concerns was I got a flu shot, and I wasn't offered perhaps the BEST vaccination for my PMH....and I didn't know all of my options. I could've gone to my own HCP and been more informed, but I was just a little mindless organism that did roll up my sleeve. I wish I had been given more information (I don't even know if I received trivalent or quadrivalent!)

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Very helpful info but I hate the fact that the flu vaccine contains mercury :(

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Specializes in Complex pedi to LTC/SA & now a manager.
Very helpful info but I hate the fact that the flu vaccine contains mercury :(

Not all versions contain mercury. The single use vials do not. This is the anti microbial version not the same as the toxic heavy metal aka quicksilver

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Specializes in Nurse Leader specializing in Labor & Delivery.
Very helpful info but I hate the fact that the flu vaccine contains mercury :(

Many do not. If you get a single-dose vial or prefilled syringe, it does not contain thimerosal.

You're exposed to more mercury from the environment than you are from vaccines.

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Specializes in cardiac, ICU, education.

About 10 years ago, I had 3 flu shots in 3 years and every time I had very bad reactions, last one requiring hospitalization. I am glad that my hospitals do not require shots for those who cannot have them. I think it is unfair to those who have medical issues and work in hospitals that have actually said no flu shot - no job. I have never had the flu, however, so I am very grateful.

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Specializes in Surgery,Critical Care,Transplant,Neuro.

And around 2/3 do not contain Thermisol, which is a good trend!

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Specializes in Surgery,Critical Care,Transplant,Neuro.
About 10 years ago, I had 3 flu shots in 3 years and every time I had very bad reactions, last one requiring hospitalization. I am glad that my hospitals do not require shots for those who cannot have them. I think it is unfair to those who have medical issues and work in hospitals that have actually said no flu shot - no job. I have never had the flu, however, so I am very grateful.

If people cannot have flu shots for medical reasons, they can have a medical waiver signed :)

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Specializes in Nurse Leader specializing in Labor & Delivery.
About 10 years ago, I had 3 flu shots in 3 years and every time I had very bad reactions, last one requiring hospitalization. I am glad that my hospitals do not require shots for those who cannot have them. I think it is unfair to those who have medical issues and work in hospitals that have actually said no flu shot - no job. I have never had the flu, however, so I am very grateful.

As the OP mentioned, even at facilities that require it for continued employment, they do offer a medical waiver for those who truly have a medical contraindication.

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This is an excellent article. Kudos to Bridget Joseph! There are also many other deeper issues here as well.

Here are some questions to ponder:

--If they do not tell you all the side effects and all the options, is it truly informed consent?

--Does the person administering the shot not have the same duty of care to you (as a patient and not just as an employee) as any provider in your facility has to the patients brought in?

--Is there a conflict of interest with the person administering the shot or the company that you work for providing the shot (similar to the conflict of interest in treating family members)?

--Do you have to sign the standard "consent to treat" form?

--If you have an adverse reaction, are you covered by workers' comp, the facility's/person administering the shot's malpractice, or both?

I think that this problem is indicative of a much larger problem that exists in healthcare with informed consent and patient autonomy. By having the kiosks, not providing you with all the facts, options, etc., is this not just convenience and efficiency being put ahead of patient rights?

I don't even know why the issue of mercury is even brought up.... After all parents who are worried about the effects of mercury on their children whose bodies are still developing are told that there is nothing to worry about, so why should adults whose bodies (for the most part) are fully developed worry about it? After all, the multi-billion dollar lobby for the manufacturers say it is safe. Aren't people who refuse to immunize their children considered "kooks?"

After all, isn't this just about patient safety and what is best for the patient? It has absolutely nothing to do with Medicare not covering hospital acquired infections or insurance companies reimbursing facilities on "population health." It is not like the healthcare system is putting money first. It is not like some actuary at an insurance company came up with this idea....

I think that there needs to be an re-examination of "best practices" and "standards of care." What about the interests of the patient? Here is an extreme example:

A "radical double mastectomy" has a 100% prevention of the reoccurrence of breast cancer, yet it is not imposed upon women who have indications for it. The reason is that it does not align with the patient's own interests, definition of self, or autonomous choices of direction of life.

There is definitely a push towards this procedure as a best practice, even as a preventative measure (source: American Cancer Society). Some surgeons do push this very hard. This has been highlighted in the media (Angelina Jolie).

There is also the fundamental question of what right an employer has over your own body?

If you think that these issues of "one's own self" are going to end with the Influenza vaccine, you are sadly mistaken. With healthcare today being transformed to the corporate "Healthcare Industrial Complex (HIC)" driven by profit (National Institutes of Health citation:).

This article advocates one's own genetic information contributes to health. Currently, the Genetic Information Nondiscrimination Act (GINA) will provide federal protection from genetic discrimination in health insurance and employment. I do not see any protection in there for healthcare. So how long before the HIC will circumvent GINA because they find that they can save $0.0005 per employee by determining a genetic predisposition to developing a disease in the future?

Don't believe me, look at healthcare workers' views on career satisfaction. How do you rate your employer/facility, not your actual job (duties)?

The solution: I am not going to point out the problems as well as the future problems without giving a solution. This is not a question of employee rights, this is not even a question of patient rights, it is a question of human Rights. The right we have over our own bodies.

Even the standards of care have to adhere to higher standards, like the US Constitution, the Bill of Rights, English Common Law, and the UN's The Universal Declaration of Human Rights, to name a few. For example: it is English Common Law's Castle Doctrine that gives us the idea that we have the right to determine what happens to our own bodies.

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Specializes in LTC, Medical, Rehab, Psych.

You've forgotten something that may help you with informed opinion:

There are TWO parts to the immune system and they are never talked about regarding vaccination. A healthy person has the ability to isolate and kill any pathogen that enters them. To bypass this mechanism for the second result (long-term immunity) is not how our bodies are intended to work. Immune cells encounter live pathogen, kill it, then others relay for the long-term.

Should we discuss probiotics here? All of those gut bacteria are part of our immune system. We are more than WBCs.

We so often hear that when a person is exposed to something like the flu, they are infectious during an incubation period (before symptoms are felt), but what we forget to mention is that a virus needs to replicate faster than our immune system can kill it in order for us to ever become sick, infectious (shedding) and symptomatic.

Naturopathy relies on the body's own defenses to stave off illness. This is real preventive care. Flu vaccine is MEDICINE. And it should hardly be recommended for everyone. There are very many things an individual can do to stay well.

My god, a pharmacist can prescribe and give you vaccines. Your employer can prescribe and give you vaccines. Unbelievable.

Do what I do- get a note from your provider that says it is not recommended that you receive any vaccines at this time (I see an ND). Or sign a declination form, if able. You have the right to make your own (informed) health care decisions. The aluminum or mercury preservative alone (in larger vial sizes) should be deterrent enough (often the REAL reason people say they got "the flu" directly after vaccination).

Another thing that is never discussed, each blood group has natural immunity to particular flu virus. So to receive vaccination for something that if contracted, would result in a very mild case of flu, is not necessary. Again, the adjuvants in vaccine alone may possibly put some at risk for autoimmune or neurological disorders later in life.

Too often nurses and other providers are guilt-tripped into sacrificing their own health for the sake of their "patients." BS. Take your health into your own hands. Gov't agencies don't care about individuals. Who are we kidding??

I think the real reason nurses sign up to take the needle is that 1) they don't understand how the immune system works, making them easy targets with guilt and faulty facts/logic, 2) they have been taught to believe that vaccines work. That's another thread entirely.

I urge all nurses to go pick up an old textbook and really dive into this immune system thing that is glossed over in nursing school. And please don't pick a nursing textbook. If you see anything in it that recommends vaccination, find another one.

And for all of those nurses that my words won't convince (since I'd have to actually explain it all to you here and I can't do that in a post), stop your self-righteous health propagandizing; every time I hear you going on about "protecting patients" I recognize that you don't have a clue as to what you're talking about.

And I'm not logging back in to read any f/u posts so you can lambast me all you want. I do this because there are fundamental health divides in this country and I am clearly on the side of opposition, advocating for REAL health care. I truly hope that this was the intention of the OP.

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