H1N1 Vaccination—The Implications for RNs

As the incidence of H1N1 increases and the vaccine supplies begin arriving, many nurses have questions about whether employers can mandate vaccination.  Following is information intended to provide answers to frequently asked questions.

 

Information from ANA on H1N1 >>

 

Ohio Department of Health Info >>

 

 

Introduction

Getting vaccinated is the best defense against H1N1 for nurses and other health care workers.  Nurses have been identified as one of the high priority groups to receive the H1N1 vaccine that will be provided free-of-charge courtesy of the federal government. 

 

The American Nurses Association (ANA) supports implementation of aggressive AND comprehensive influenza vaccination programs for registered nurses (RNs) that aim for 100% participation.  ANA also recommends an opt out provision that includes completion of an informed declination form.

 

Any vaccination program should exempt RNs based on:

• Severe egg allergy
• Severe allergy to any component of the vaccine
• History of Guillain-Barre Syndrome
• Medical and/or disability for which exemption status is the only reasonable accommodation
• Religious or spiritual belief that prohibits vaccination
• Other basis—When the exemption is for “other reasons” the employee should receive computer-based or other training opportunities regarding vaccination and should also have opportunities for discussion of the exemption with medical staff or infection control officers.

In some cases, it is recognized that individuals who are not immunized may be required to wear protective masks when in close contact with patients.

 

Frequently Asked Questions

 

1. Can my employer require me to be vaccinated against H1N1?
It depends.  Generally, an employer can require vaccination unless there is a state law prohibiting the mandate.  No such law exists in Ohio.  For nurses covered by a collective bargaining agreement, the issue of H1N1 vaccination is a mandatory subject of bargaining.  If you are not covered by a collective bargaining agreement, you have little recourse in the face of such a mandate.  In the absence of a collective bargaining agreement, an employee who refuses to comply with an employer mandate could face disciplinary action.

 

2. Do federal laws require mandatory vaccination of health care workers?
No, there are no federal laws that impose this mandate; however, Joint Commission does require accredited organizations, as a condition of accreditation, to offer vaccinations to staff members who have close patient contact. New York has imposed a state-wide mandate requiring health care workers to be vaccinated against seasonal flu and H1N1.  Currently, that is the only state law requiring vaccination. Update: Union Wins Temporary Restraining Order Against Mandatory Vaccinations

 

3. Can my employer require me to wear a face mask if I refuse to be vaccinated?
It depends.  ONA believes this issue is a mandatory subject of bargaining, though employers and unions are currently fighting to resolve this issue in the courts. If the courts determine that a face mask requirement is a mandatory subject of bargaining, that will apply only to nurses covered by collective bargaining agreements.  Again, in the absence of a collective bargaining agreement, or a legitimately bargained policy (for nurses covered by a collective bargaining agreement) an employee who refuses to comply with this mandate could face disciplinary action up to and including termination.

 

4. Will wearing a face mask make any difference?
That depends.  Preventive measures are emphasizing non-pharmacologic approaches such as hand hygiene; covering coughs or sneezes appropriately; and social distancing, including avoidance of close contact with people who are ill (staying home when experiencing influenza-like illnesses).  When workers cannot avoid close contact—such as RNs—they may wear a mask; however, that precaution is imperfect at best, and no research exists to support the effectiveness of face masks in protecting the wearer.

 

There are several different designs of disposable face masks, but none are intended to protect against breathing in very small particle aerosols that may contain viruses. Face masks should be used once and then properly thrown away.  Further, masks should be disposed of immediately upon becoming wet.  Some experts recommend that masks be worn no longer than 15-20 minutes at a time before disposal.

 

Respirators (N95 or higher filtering face pieces) are designed to protect against breathing in very small particle aerosols that may contain viruses.  Respirators are harder to breathe through and must fit snuggly and properly, which can only be determined through fit-testing, to be effective.  They may also cause skin irritations.  The CDC recommends that health care providers who are non-high risk individuals wear respirators, while high risk people should be re-assigned if possible.  Most of the employers considering mandating face masks are not generally talking about respirators; therefore, the effectiveness of a face mask mandate is questionable.

 

5. What arguments support mandatory vaccination of health care workers?
Overall health care workers vaccination rate is low—approximately 40%.  Increasing vaccination rates among health care workers has been shown to limit incidence of influenza.

 

6. What are the arguments against mandatory immunization?
Vaccination is no guarantee of immunity.  Mandatory vaccination provides a false sense of security resulting in less emphasis on a comprehensive program.  Information and education campaigns have proven to be effective at significantly increasing the rate of voluntary vaccination among health care workers.

 

7. What should a comprehensive program include?
A comprehensive program should have the following components:

• Broad employee education and training prior to vaccination
• Availability and use of appropriate respiratory protection devices (N95) after medical clearance, fit testing, and training
• Meticulous hand washing and glove use
• Non-punitive sick leave for symptomatic workers, including active medical management programs that encourage symptomatic workers to report to employee health.
• Free and voluntary immunizations available during work hours
• Provision of anti-viral medications once exposure is suspected
• Written procedures and training for handling suspected and documented cases of H1N1.

 

Conclusion
Nurses are at the frontline of health care, a fact that carries with it certain responsibilities.  The public often looks to nurses for information about disease processes/prevention etc.  With all of the media attention being given to H1N1, nurses should take special efforts to be informed about the facts and not the myths or scare tactics associated with H1N1. 

 

Nurses must have close contact with the public in the course of providing care.  It is important that no unnecessary harm be done to patients.  Nurses must, therefore, take all reasonable precautions to ensure that the influenza virus is not transmitted as a result of their actions or in actions.  Voluntary vaccination is one tactic; but, vaccination alone is not enough.  Similarly, wearing a face mask does not guarantee that a patient will be safe from harm.  Nurses are encouraged to educate themselves about H1N1, including preventive measures, and to take all the steps they believe are appropriate to ensure they meet their obligations to the patients entrusted to their care. 

 

Employers should be willing to educate about, rather than mandate, H1N1 vaccinations.  While face masks can be required, employers should take into account nurses’ concerns in this regard and work with them to ensure effective compliance.  Policies regarding wearing of face masks should be communicated and implemented in a way that ensures it is not perceived as a punitive measure, but instead is understood to represent reasonable efforts to protect patients and nurses.

 

Additonal Resources >>

Caring for the Sick at Home (Adobe PDF File)
Medications to Help Lessen the Symptoms of the Flu (Adobe PDF File)