Why Nurses Are Rising Up Against a Shot in the Arm

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Editor's note: UPDATED -- 3:30 p.m. Friday, October, 16: A judge today halted enforcement of a New York State directive requiring that all healthcare workers be vaccinated for the seasonal flu and swine flu. Justice McNamara scheduled a hearing on the case for Oct. 30. 

As the campaign to inoculate America against the H1N1 virus started to ramp up last week, so did the controversy. Reports of hospitals and health systems mandating all employees receive H1N1 vaccines brought cries of civil rights infringements. In particular, the decision by the New York state Department of Health requiring all hospital, home health, and hospice workers receive the vaccination by November 30 caused widespread protests from nurses in the state. The New York state Nurses Association has been deluged with calls and emails, and a protest rally in Albany attracted several hundred people.

With the H1N1 virus spreading across the country, the uproar leaves many nursing leaders scratching their heads. Considering the safety of our patients, why won't nurses just get the shot?

Myths and misperceptions
The reasons fall into two categories, which broadly intersect: a simple dislike of being forced to do something, and legitimate concerns about the new vaccine's safety and efficacy.

The nurses protesting in Albany cited the infringement of their civil rights, but concerns about safety were behind much of their fervor.

These issues contain some genuine concerns, along with a good chunk of misinformation. I was thinking about this as I sat with a group of moms in my neighborhood on Saturday. As the kids ran around playing, talk inevitably turned to H1N1.

"There's no way I'm going to get it or get my kids vaccinated," announced one mom. She "enlightened" the rest of the group the vaccine is made with things the FDA hasn't approved for use in vaccines and it was likely to cause Guillain-Barré Syndrome. And just like that, we were all a little bit more concerned based on what turns out to be bad information.

Many of the misperceptions and fears prevalent in the community at large are equally common among healthcare providers. There are also misconceptions surrounding concerns that the vaccine is new, and long-term efficacy has not been demonstrated. I talked with a nurse the other day who said it wasn't that she didn't want to have the vaccine at all. She just wanted to wait until it had been out for a few months and she saw what happened.

Focus on education
Faced with the lack of knowledge about the vaccine and the many sources of hysteria or gossip, it is critical that healthcare organizations focus on staff education to ensure employees understand the facts about H1N1 and the vaccine.

Any imformation distributed to staff should include information from the CDC that the vaccine is not untested. It was created the same way as the seasonal flu vaccine that is routinely given to hundreds of millions of people, and rapid clinical trials showed the same lack of serious side effects in H1N1 vaccine as with the regular flu shot.

The concern about Guillain-Barré Syndrome dates back to the 1976 strain of swine flu (which many of your employees may vividly remember), when a vaccine was associated with some instances of the syndrome. But since that date, no flu vaccine has been clearly linked to Guillain-Barré Syndrome, and certainly not H1N1.

Eileen Dohmann, MBA, RN, NEA-BC, vice president of nursing at Mary Washington Hospital in Fredericksburg, VA, says her organization's focus on education has resulted in increased seasonal flu vaccination rates, and they plan to follow the same tactic for H1N1.

Staff who reject a seasonal flu vaccination fill out a form explaining why, allowing the hospital to analyze the reasons and provide additional education on common concerns.

When the H1N1 vaccine becomes available in their region, Dohmann says they will offer it to staff based on priority. Nurses in the ED and labor and delivery, for example, will receive highest priority.

"We are not making it mandatory," says Dohmann. "The issue is allowing people to protect their right to choose whether they want to take it or not. We will be strongly encouraging them to do so. I see our role as the employer is to make sure they're as educated as we can get them to be, that we give them the information so they can make an educated decision."

Some organizations are restricting caregivers who have not received the vaccine from direct patient contact. Other organizations have considered issues such as whether pregnant nurses should not care for H1N1 infected patients.

Dohmann says her organization has chosen not to go down that path. "We're supposed to be practicing universal precautions on every patient anyway. Are we suddenly going to say now for flu we're going to treat it differently?"

Dohmann remembers when universal precautions were first identified. "Patients can always have something that you don't want to catch. And so the best way for you to protect yourself and other patients is to follow universal precautions. And so that's where we spend much more time and effort."

Dohmann advises that hospitals should focus on hand washing and increase reminders for clinicians to coach each other and monitor one another's compliance.

Nursing leaders can provide employees with education about H1N1 and the vaccine in many different ways, such as articles and quick tips in newsletters, on the Internet, and on social media sites such as Twitter and Facebook.

Dohmann notes that the gradual delivery of the vaccines may even prove to be a good thing. As the first round of people are vaccinated, those who were initially concerned will see few side effects and generally good results—and hopefully be the first standing in line for the next batch of supplies.