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Flu Vaccine Mandates Increase

By Jennifer Thew RN  
   June 04, 2018

70% of hospitals now require that employees receive flu vaccines.

Though there's a temporary reprieve from the illness over the summer, the flu will be back again in a few months, and hospitals and health systems will begin their annual vaccination campaigns with the goal of protecting staff, patients, and visitors against the virus.  

While mandatory flu vaccines have long been controversial, a new study shows the percentage of hospitals requiring flu shots rose from 44% to nearly 70% from 2013 to 2017. However, during this same time frame, flu vaccine mandates at Veterans Affairs hospitals only rose by 1%.

“In just four years, the non-VA hospitals have really stepped up on requiring the vaccine, rather than just encouraging it,” says Todd Greene, PhD, MPH, the University of Michigan and VA researcher who led the study. “Studies have shown that vaccination mandates, coupled with an option of declining vaccination in favor of wearing a mask, are most effective in reaching high percentages of vaccination.”

To Vaccinate or Not To Vaccinate

While it does not have a flu shot mandate, a national VA directive last fall set an expectation that employees would get vaccinated or wear a mask when caring for patients during flu season.

But all hospitals without a mandate do not have such clearly established directives, the study finds.

  • Only 41% of non-mandate hospitals required unvaccinated workers to wear a mask during patient interactions in flu season.

  • Only 21% had penalties for non-compliance with the hospital’s policy.

  • Two-thirds of non-mandate hospitals had a formal policy outlining how workers could officially decline to get vaccinated.


However, all hospitals with vaccination mandates had formal declination policies in 2017. 

Hospitals with mandates:

  • Allowed medical contraindications and/or religious reasons as allowable reasons to decline vaccination

  • Under 13% allowed workers to give any reason for declining

  • Nearly 83% of hospitals with mandates required unvaccinated healthcare workers to wear masks during patient interactions.

  • Nearly three-quarters of hospitals with a mandate had penalties in place for non-compliance for those who did not get vaccinated or sign a declination form

The researchers also looked at differences by hospital-level characteristics.

  • Nonprofit hospitals were much more likely to mandate flu vaccination.

  • One-third of the non-VA hospitals were teaching hospitals, but they were no more likely than non-teaching hospitals to require flu vaccination by 2017.

  • 80% of the VA hospitals were teaching institutions.

Under the Hospital Inpatient Quality Reporting Program, hospitals were required to tell the CDC what percentage of their healthcare workers were vaccinated against the flu. The results were posted online starting in October 2014, and showed that 90% of workers at participating hospitals were vaccinated.

The researchers note that some VA hospitals have made special efforts to increase vaccination by bringing vaccines to workers on inpatient floors or even offering extra time off for workers who get vaccinated.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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