Government Should Act on Mandatory Flu Shots

The H1N1 flu is expected to hit hard this fall. Healthcare professionals, for obvious reasons, are particularly susceptible to falling ill at a time when hospitals are having a hard enough time finding adequate staff. With this in mind, it's time for states or the federal government to mandate vaccinations for healthcare employees with direct contact with patients.

Consider the case of Seattle-based MultiCare Health System. The four-hospital system recently ordered its healthcare professionals with direct patient contact to either get an H1N1 vaccination, use a flu mist, or wear a protective face mask.

MultiCare says the policy was implemented in the best interests of patient safety, and is based on the recommendation of a team of physicians, nurses, and infection control experts. "As always, our first priority is patient safety. We developed our flu policy to protect our patients, visitors, and staff during this heightened flu season," MultiCare says in a media statement.

This all seems reasonable enough.

Not so, says the Washington State Nurses Association. The 16,000-member union has filed a federal lawsuit against MultiCare, claiming that the health system was "unilaterally implementing a mandatory vaccination policy," threatening to fire employees who don't comply, and thus violating the bargaining agreement with the union. Barbara Frye, RN, WSNA's assistant executive director of labor relations, says the union was trying to negotiate a vaccination policy with the health system when it took the action on its own.

"MultiCare's unilateral implementation of this policy blatantly ignores their legal obligation to bargain with the union," Frye says. "Their refusal to bargain and to cease and desist forced us to take this extraordinary measure to seek relief from federal court."

WSNA says it fully supports a voluntary vaccination program and is urging its members to get vaccinations. The union is not opposed to mandatory vaccinations if they are uniformly applied. "We believe that any mandatory vaccination policy should be implemented on a federal or state level, not through a patchwork of hospital-by-hospital policies," says Judy Huntington, RN, executive director of WSNA.

WSNA is also questioning MultiCare's insistence on the use of masks for nurses who refuse to be vaccinated, even though the union says there is no evidence that the masks prevent influenza transmission.

"In fact, masks can give a false sense of security for nurses, patients, and their families. Unfortunately, MultiCare's focus on masks is not based on evidence or research," Frye says.

This too seems not unreasonable.

In fact, it's hard to find fault with either side in this issue. There are no black hats here.

Here's my take: First, let's acknowledge that MultiCare and WSNA believe they are acting in the best interests of patients and healthcare professionals.

Small picture: MultiCare is correct. It acted because of the seriousness of H1N1 and because there was no controlling authority above it to mandate vaccinations.

Other small picture: WSNA is correct. The union sued because a unilateral mandate on vaccinations violates the bargaining rights of employees and could set a mandate for future unilateral actions.

Large picture: A government mandate on vaccinations for healthcare workers is needed. Hospitals should not respond to H1N1 in a patchwork fashion. Not only is it confusing, it's ineffective.

This is an issue that won't pass when H1N1 runs its course. This year it's H1N1. Next year, who knows? Avian flu? Contagious disease experts have been saying for years that it's not a question of "if" but "when" the nation confronts a major influenza pandemic or epidemic. Healthcare workers will be on the front lines when that happens. They need to be protected, both for their own sake, and for the sake of patients. Let's take the patchwork out of this.