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Subscribe to RSSPatients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.
"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.
Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.
Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.
In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.
Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.
Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.
"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."
Related stories:
CDC reports flu in 47 states
Bioethicist says: Don't be selfish, get the shot
Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."
Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.
"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."
For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.
A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.
At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.
The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."
The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.
According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.
The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.
Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.
Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.
Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.
Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.
Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.
While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.
Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.
Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.
Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.
"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.
Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.
Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.
Calhoun, the Illinois nurse, says she is unsure of her options.
"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."
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Online:
R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf
CDC: http://www.cdc.gov
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The three strains this year are H1N1, H3N2 and an unidentified B strain. The B strain is causing most of the illness because it was not included in the vaccine...
Going back to your response to my last post. Can you show me where I said that I believe you can get the flu from a flu shot? Don't put words in my mouth.
Getting a flu shot does not mean you won't spread the virus. It means you have a 60% chance of not getting the flu. You can still spread the disease by touching contaminated articles. The hospitals just want to make sure your Mercury level is increased.
if your immune system is primed by being presented an antigen beforehand, this decreases the amount of time you are sick and spreading flu.
This is immunology 101
It could also mean you could suffer from GBS! That is one hell of a lot worse than the flu. It could mean paralysis to and including a slow and painful death.
Eric, I suggest you go back and read what cunical actually said. His comment was an observation that even if you have the vaccine, even if you do not have the flu, when you are working in an area contaminated with patients who do have the virus it is then possible to still transmit it via touch, etc. He is absolutely correct.
Ken you would make a better point if your post was readable...
So is it retro active? Did'nt have to get the shot to get the job, but to keep it you have to get the shot? Because all think that is the thing to do. Sounds like the old bait and switch to me.
Never had a shot in my adult life and keeping it that way.
Sas68: Pretty close to my story. I'm 63, last flu shot was 32 years ago.
Last time I had the flu was......32 years ago. What a coincidence.
Why do some health care providers refuse to get a flu shot? Do they know something that the rest of us don't know? And why is it we only hear about nurses being let go because they refused a flu shot and not doctors?
because many docs are not employees of a hospital, but independent contractors. Furthermore, Id be surprised if docs refused the shot.
Google it, eric, and be prepared to be surprised. Lots of doctors won't get a flu shot and are vocal about why.
"Patients can refuse a flu shot"
can patients refuse to draw blood test?
last time my dad in hospital, they draw his bloods like every 12 hours!
If you are a competent adult, you are always within your rights to refuse ANY part of your treatment. HOWEVER, the doctors and nurses can be VERY persistent and FORCE things on people at times. If it is something major, you will have to sign a form stating that you know the risks of ending/refusing treatment, which usually is called 'Against Medical Advice' and basically means that they think you'll die or end up back in the hospital if you don't do what they say.
If Science spend more time in curing.But i do have a problem walking into the Drs office seeing people hacking and coughing all over the place with out a MASK on..Where is my protection from them? Flu shots does not protect you from the flu regardless of how they spin it..kudos to the medical nursing..Now would you please put the magazine back on the shelf after you hacked all over it?God knows what disease you fking carrying.
Also i know there Dr Shortage, is there going to be a Nurse Shortage next?
Does anyone really believe a flu shots helps prevent the flu! Does anyone really believe that something the government or a government agencey reccomends is for our benefit. It was our government who thought injecting people with syphilis was a good idea! More opportunitty for big pharma to make $$$$ and experient on the population at the same time.
This nonsense about personal rights is, in many cases, becoming a case of the tail wagging the dog, People like Ms. Calhoun need to understand that, when what they perceive as their rights infringes on the rights of others, they are wrong and need to re-think their position. The idea of "my body, my right to make a decision" is fine as long as the decision you make about your body affects you and you alone.
For a health care facility to demand that its employees are immunized against a potentially devastating disease like the flu is not nazism, but instead a logical and rational idea. If you don't want the flu shot, fine. Go get a job somewhere where your stubbornness (and stupidity) does not put countless others at risk.
As for the hospitals and other health care facilities who demand that their workers who get flu shots, thank you. I'm glad you take the responsibility of keeping your clients from being unnecessarily exposed to infection seriously.
Finally, if we follow the reasoning shown by those who oppose mandatory vaccination against disease by health care workers, the next step would be to allow airline pilots who are drunk to fly passenger aircraft while intoxicated. After all, it's their bodies, and if we tell them they can't drink and fly, we are infringing on their rights!
The decision to keep or abort a baby affects more than the woman carrying the baby....it affects the father of the child and the child. Yet we allow that life-and-death decision. Your airline pilot example doesn't work, taking or not taking the flu shot does not compromise your decision making ability in the manner of alcohol or drug use.
Not advocating for anything, just pointing out a flaw in the arguement and playing Devil's Advocate.
The vaccines for the other diseases (polio, Hep B, measles, mumps, etc) have proven themselves, over time, to be arguably effective and harmless. On the other hand, by the health systems own admission, the flu vaccine is a guess...an estimate...whatever you want to call it, on what strain they think will break out. If the polio vaccine was only 65% effective, would any of us be so eager to get it without question? I don't think so.
Ancedotal: (aka proves nothing, no science behind it, just one persons observation) I am a health care worker and my husband is active duty military. Every year he is forced to take a flu vaccine. Every year he gets the flu, even if it is the killed virus. Every year, I refuse the vaccine for me and our children. Every year, the children and I avoid contracting the flu. Coincidence? Possibly. Luck? Possibly. Good hygiene? Most likely.
Everyone should have a choice. Vaccine or mask is acceptable. Vaccine or job? Not so much. What if your employer had a weight standard? Or a mandatory fitness program that required you ran a minimum of x miles in y amount of time? What if your employer wanted to know your political affiliations? Would you want someone to stand up with you and protect your choices? I know I would. So when other people are having their choices taken away from them with the BS line of "Do xyz that invades your private life and choices or lose your job", I will say something. Just because we disagree, does not mean that we should have to give up the ability to support ourselves and our families.
Individual "rights" have gone too far. When individual "rights" threaten the safety and life of the community at large, individual rights stop, whether it's guns, cigarette smoking, or flu shots. First and foremost is the "right to life", of the community, the state and the nation. And religion is no excuse.
You should move to a socialst Country cantrolled by the Government where you will be Happy among your own kind and we will be Happy to see you leave
As nurse and one who works in the ER, I felt I needed the shot. But I will let you all know it is not the end all of shots=about 65% effective. I have seen both A strains and B strains so far this season, we test for both. So there is more than one out there. The other thing about the flu shot that no one here has addressed-Hospitals use it to decrease the amount of sick time they have to pay out. We have had several nurses in the ER get the flu-even after having the shot because it doesn't cover that particular strain. And if they hadn't gotten the shot the hospital was not going to pay them. But the worst thing out there is Norovirus-there is not shot for that yet its highly contagious and much more deadly than the flu-gather your bleach up for this one!
I do not think the Government or an employer should be allowed to mandate a flu shot if you do not want one.
I will not get into the about the effectiveness of the flu shot and the such; but I would like to point out that the comments about it being a "requirement of the job so, if you don't like it quit.." are quite lame and bogus. With that argument as a Dr, I could say that my patients well being was directly proportional to my full attention; which I can only give them when I am sexually satisfied, so please blow me. It is a job requirement, if you don't like it then quit. But wait, that would violate a persons right to do what they chose with their own body... ya good point.
http://en.wikipedia.org/wiki/Slippery_slope
Was a flu shot a condition of employment when the person was hired? If not, then the employee should not be forced to get one. I have an employee who refuses to get the company paid flu shot every year. He gets the flu every year then complains because he doens't have enough sick time. (sigh)
I dont' even know where to start. No one should be forced to have a shot against their will and threatening to terminate or actually terminating an employee for refusing to get a vaccine is beyond reprehensible and possibly illegal. You know who has more exposure to people than hospital employees? supermarket employees, church employees, mall employees, restaurant employees, warehouse employees....are these employers requiring vaccination?
not close contact loripuff. How many rectal exams do warehouse employees do?
Per the CDC--People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.
the operative word is can. Its more likely to be spread with direct contact. It can be spread other ways, though
Eric, you go ahead and get a flu shot and you won't have to worry about people like me who choose not to.
lori,
unfortunately, you spread it to people in whom the flu shot is not as effective
If you work in the midst of sick people whose immune system is already compromised, your employer has the duty to require you to get a flu shot. If you refuse, you're not qualified to do the job anyway. The shot works.
refriedbean,........"The shot works?"---The FDA has determined the vaccine is only effective 62% of the time in healthy individuals, and less so for those over fifty.
so, 62 is more than 0, right?
And an effective measure of making sure those over 50 don't catch the flu is helping to make sure they are not exposed by vaccinating others
This is a constitutional issue in so far as noone can command you to allow a foreign substance be injected into your body except a court of law.
Actually, teachers have to have TB tests done every 5 years or they will lose their jobs. I've never heard any complaints, we do what we need to do to protect ourselves and our students.
As a condition of employment, employers and the government (for the common good) have the ability to have workers immunized against a number of diseases. People working in zoos and animal hospitals are routinely required to be immunized against a number of zoonosis, including rabies. Trust me, the flu shot is nothing compared to the rabies vaccine.
As an over-70 consumer of healthcare services, here is my warning to doctors and nurses: given the undeniable statistical and scientific evidence favoring use of flu vaccine, and given your potential hands-on dealing with me while you would be infectious, I find it totally unconscionable that ANY of you would even contemplate putting yourself and your sworn duty and professional duty to your patients ahead of your personal predilections. Shame on those of you who would act so selfishly and inward-looking !! In fact, you risk getting sued by the family of an elder who dies of the flu, having contracted it from you. But it is a moral and ethical obligation you have, going beyond legal liability exposure. I fully support and encourage all hospitals that mandate doctors, nurses and staff who come into contact with patients, to get the flu shots each year.
OK, Mike. Then ask any caregiver you have contact with if they've had their flu shot.
If they say No, consider yourself free to leave.
Everytime I get the flu shot I get sick. I stay well when I don't get the shot.
Look at all the people getting sick now. Your flu shot isn't helping them. Why should I take a vaccine that is not
effective. There will always be a strain that gets through or gets missed by the medical scientists.
I say sue those who force the shots.
For all to know~ I have had my Aunt Virginia and 3 friends get a Flu Shot and almost DIE. My Aunt was in Intensive Care one month and in the hospital 3 months from a FLU SHOT. My 3 friends became so ill they were also hospitalized. Many are allergic to the chemicals in a FLU SHOT. And many know there is MERCURY and ALUMINUM in the FLU SHOT. Even the FDA discloses what is in it~ I would NEVER get a FLU SHOT EVER!!!!! And if forced to get one I would sue the company. You better not be allergic to any of the chemical's in a FLU SHOT as I'd rather get the FLU, than an allergic reaction and die. What is wrong with getting a cold or the FLU? Your fine in a few days. Rather than having MERCURY and or ALUMINUM shot into your body lasting a lifetime and maybe creating AlZHEIMER'S DISEASE~ or DEMENTIA. The pharmaceutical companies can not be trusted. The put things in drugs to create other diseases. Take CoQ10 and Omega 3, Vitamin C & D, Calcium, Potassium and Magnesium. Use Himalayan SALT daily and drink Club Soda with 1/2 Fresh Squeezed LEMON every day. STOP drinking Diet Soda's, Soda, Fried Foods, Limit Red Meat....eat ORGANIC VEGGIE'S and Exercise...Balance your HORMONES both men and women...it is very important.....Add 1/2 glass Red Wine at night with one oz. Dark Chocolate & You will be healthy.
I think IQ is inversely proportional to the number of words capitalized in a single post