In an Indiana hospital, eight employees were fired for refusing the flu vaccine. This begs the question: should employees in a hospital who have direct patient contact be forced to get a flu vaccine?
I say yes. For sure, yes.
Tens of thousands of people in the United States die each year from the flu. Here's a shot that can greatly reduce your risk of being one of those people. Why wouldn't you take it?
But fine, I'm not going to say everybody in the country should be forced to get a flu shot. Most people who get the flu probably aren't going to die from it, after all. But if you're going to be around a vulnerable population of sick patients in a hospital or nursing facility who can't fight the bug as well as you might be able to, you have a moral obligation to get a flu shot.
And I don't see any reason why a hospital can't require all employees to get flu vaccines. It doesn't seem all that extreme. I am required to have a PPD placed in order to stay at my job. That ain't saline they're injecting into my forearm.
I once had an argument with a nurse about flu vaccines. She (much like the nurse in the story) was saying that she never gets the vaccine because a long time ago, she got the vaccine and subsequently got the flu from it. I said, "How would you feel if you got the flu and then several patients caught it from you and died as a result?"
Her: "How would you feel if you got the flu from a vaccine and several patients caught it from you and died?"
Me: "I wouldn't feel bad at all because you can't get the flu from a killed vaccine."
Honestly, I am always really surprised to hear a nurse say something like that. I have a lot of respect for nurses, and I would think they would be smarter than that about a medical issue.
There is this perpetuating rumour going around that the flu vaccine gives you flu-like symptoms after getting it.
ReplyDeleteAs the nurse who gave it to me rightly said when I asked her after if anyone does experience symptoms and she said that it's just coincidental that some people were destined to have a head cold that week anyway and they end up attributing it to the vaccine.
It just ends up correlation accidentally attributing causation. Enough people get the head cold every week, and get the vaccine around the same time of year, that of course some will get both at the same time.
For a small head cold to be enough to justify you not getting the vaccine (even though there isn't any causation shown) is selfish for medical professionals who could easily get over a runny nose and sneezing for a couple of days if it puts a greater risk of getting a life threatening illness to a population of vulnerable people who they work with every day.
It's also noted that medical culture looks down on staff who take off sick for simple things like a fever or flu, and anything less than full Norovirus vomiting you're almost expected to still work. It should matter more that your constant sneezing or coughing at work will put more patients at risk than the inconvenience to colleagues that you taking a day off would.
Even if you got flu-like symptoms for a couple of days, that STILL isn't justification in my mind for not getting it and jeopardizing patients.
DeleteThe same. I was having a conversation with an anti vaccine (as in, she doesn't vaccinate her kids either) nurse the other day. I was thinking, "You're a freakin' nurse. You're supposed to understand this stuff."
ReplyDeleteI can understand non-health people being scared about getting injected with "disease," but not healthcare professionals. As a nurse, she's likely to be exposed to all kinds of things she can bring home to her children.
On the other hand, I was once in a clinic where a nurse tried to sell all the patients we saw magnetic shoe inserts to "cure" all kinds of disease...so, I guess my view that healthcare professionals should be immune to medical woo and myth is completely unfounded...then there's Dr. Oz.
I try not to show how passionately I feel about this when I talk to people in real life. I just calmly tell them that it's impossible to get the flu from a killed vaccine.
DeleteBut I am especially shocked when a nurse says something like that. I recently overheard a nurse talking about which vaccines she was deciding to get for her kids, and I was like, "How about ALL of them that your pediatrician recommends??" How could any medical professional think that way.
Then again, I think a bit ago, I was arguing on MiM with a family practitioner who was clearly a little anti-vaccine. That scares me more than anything because that is the person making recommendations to parents about vaccines.
The "nurses" in most outpatient clinics aren't really RNs, but CNAs or LVN - they do not require the same kind of education (or the same amount) as an RN
DeleteYou'd be suprised how many RN's still believe vaccinations lead to autism in kids. The education level of a nurse widely varies.
DeleteMy friend's husband is a surgeon and he will not get a flu shot because he is convinced that he got the flu when he received a flu shot in the past. So even MDs do not have the facts straight about the flu vaccine.
ReplyDeleteoh boy, restraining myself from making comments about surgeons and general medical knowledge...
DeleteDepends on the surgeon. I know a few that I'd trust to be my internist.
DeleteAgree with Anon -- I know some brilliant surgeons. And some dimwitted internists.
DeleteEveryone is susceptible to bad logic. It frustrates me in this example because health care professionals should know better. But, in reality, the skills it takes to pass tests do not always lead to critical thinking in practice. As a nurse, I believe in looking at research and drawing conclusions based on facts, but some just stick with what they "know."
ReplyDeleteMy husband told me about this story, and all I can think was Duh... patient safety. Some of those people are seriously sick and are fighting to stay alive - why put them at risk. He mentioned for some it was religious reasons they were refusing the vaccine. Then temporarily work somewhere else - billing, intake. Anywhere you won't be a risk to patients. And in my mind, I was thinking I really hope they don't work in NICU.
ReplyDeleteCochrane group found "that vaccinating healthcare workers who look after the elderly in long-term care facilities did not show any effect on the specific outcome of interest, namely laboratory-proven influenza, pneumonia or deaths from pneumonia!"
DeleteMy program requires us to get the flu vaccine so they injected us all one day after lecture.
ReplyDelete4 of my (male) orthopaedic surgery co-residents cried because they said it hurt so much to get the vaccine.
(sorry, random story)
I am a medical professional, and I enthusiastically get a flu shot every year. Even if I changed jobs, I would still be first in line for a shot, because I am terrified of the flu.
ReplyDeleteI will say that every few years, I get mild body aches or a runny nose for ~24 hours shortly after getting the shot. I rarely get colds, have never called in sick, and the duration is much shorter than a real cold, so I do think it is because of the shot. But I also realize that it is my body's immune system reacting to the dead virus, is 100x milder than the flu, and I DID NOT GET THE FLU FROM THE FLU SHOT. If people think they had the flu because they had a little runny nose, they are in for a rude awakening once they actually get sick.
I just plan ahead for this by avoiding getting the shot right before I have anything big or fun planned. Problem solved.
I completely agree with your post. My hospital system wasn't firing anyone for refusing the flu vaccine, but they were withholding annual raises for employees that didn't get it. However, they included non-patient care employees in this as well, which I think is a little extreme. Should our tech support staff that work in a call center really be punished for not vaccinating themselves against a disease?
ReplyDeleteDo you have separate bathrooms/cafeterias/etc for non-patient care employees? For those more vulnerable patients/family members who enter the hospital, maybe more protection may be provided by herd immunity?
DeleteMy (hopefully soon to be ex) son in law refuses to get the flu shot offered to every healthcare worker in the UK because he's "entitled to time off sick". Mercifully, he isn't in front line healthcare. I keep hoping that one day he WILL get real flu and find out it isn't a fun few extra days off work with pay. And that he is well away from his daughter who has severe brittle asthma when he does.
ReplyDeleteWow... that’s rather an odd way to use up the sick days.
DeleteJust fake it if one is so darned inclined to use up all the sick days... geez.
It is NOT possible to get the flu from the flu SHOT. However, the inhaled nasal flu-mist CAN give you the flu (although the chances are very very low). The flu mist contains a live virus.
ReplyDeleteThis is similar to the polio vaccine (everyone used to get the live virus vaccine, but then there would be a few people every year who got polio from the vaccine). Now everyone here in the US gets the killed vaccine
I could definitely see people protesting if they had to get the live vaccine.
DeleteThis isn't entirely accurate. FluMist is a cold-adapted virus that can't replicate at body temperature. It replicates only in the slightly colder nasal passages. You can't get the flu from it, though it does lead to a higher incidence of upper respiratory side effects.
DeleteThis is the problem with big government, using tax dollars to make people have treatment against there will. The truth of the matter, as proven on many websites, is that the flu vaccine has nothing to do with disease. It injects microchips that lodge in your brain and change you into an Islamic socialist.
ReplyDeleteRecent KevinMD post by a doctor who has a problem with taking the flu shot, because "there is NO evidence that not taking a vaccine poses any risks to patients...."
ReplyDeletehttp://www.kevinmd.com/blog/2012/11/physician-takes-flu-vaccine-protest.html
I also find it interesting that very few of the comments under his post thought he was wrong.
And for the record, I do not agree with this guy and think health care providers should all get the flu shot.
The guy made a compelling argument, although he lost his credibility in my eyes by quoting Ayn Rand.
DeleteThe flu vaccine is probably harder to research than others, simply because it's different year to year. Some years it's very effective (this year is supposed to be one of those years) and other years not so much. But he admits that the overwhelmingly most likely consequence he'll suffer is a sore arm ... GBS is incredibly unlikely. If you're not willing to sacrifice a little physical discomfort for even the chance to protect your vulnerable patients, then I don't know what.
I am not so sure that this year's flu shot is so very effective. Here in Mass, we are having a near pandemic of flu, even among those who were vaccinated early on (like me who was vaccinated in October and who is currently posting from home wrapped in a quilt, shivering). The explanation given is that when they "tweaked" the vaccine this year to provide the greatest assumed coverage, they left out coverage for another strain, which is now running rampant. I believe in getting vaccinated because the flu - the real flu - is a bone-crushing, painful hell, but I also know that vaccines are not perfect. As a postscript, when I hear nurses saying things like the vaccine gives you the flu, I am embarrassed for my profession. I once had a nurse tell me that sudafed is not a decongestant. Tricia
DeleteInteresting. I expected this post to be controversial...yet everyone agreed with you!
ReplyDeleteIn any case, Fizzy, I would like to respectfully point out that "begs the question" does not mean "raises the question." (Begging the question is a logical fallacy in which an implicit premise directly entails the conclusion.) Sorry.
Why are you apologizing. Why wouldn't I love it when people nitpick the grammar of my informal posts? :)
DeleteI didn't mean to say "raises the question". The question has already been raised many times, including by the article itself. I initially wrote that and then changed it because it wasn't quite what I wanted to say.
Which is why I apologized. It's presumptuous to correct someone's writing unbidden. (The devil made me do it?) So let me apologize again and promise never again to do it.
Delete^has a tiger mom
DeleteI agree that practicing physicians should be required to have the flu shot, but they also shouldn't come to work if they're sick. Granted, I know the time between incubation, presentation of symptoms, and time in which a person is contagious varies- but, I have met plenty of doctors who aren't responsible enough to call of work when they're sick flu or no flu.
ReplyDeleteSorry missed and f in *off - blah!
DeleteIf that's the case, then medicine needs to develop a system of coverage which allows doctors to take time off when they're sick. As it is now, the more responsible choice is to work sick.
DeleteI love taunting the anti-flu-shot idjuts with the tale of the year I got a flu shot and got the flu a few weeks later. I was so sick and miserable, I came close to winding up in the hospital (due to a combination of health disasters).
ReplyDeleteWhen the idjits tell me that this is "proof" that the flu shots are useless, I smile sweetly and tell them that was a year that one strain of flu was more prevalent than they'd expected and the shot didn't cover it. So there was no way to know if the shot didn't prevent me from ALSO getting the flu strain(s) that actually were covered, which probably would have just outright killed me after being weakened by the first flu.
Makes 'em stop and think. Unless they're total idjits.
Let me guess -- 2003, right? I got the flu shot that year, and I *think* I also got the flu. It turns out they missed that year. The flu was so horrible though! I was sick for weeks. HORRIBLE. I will never *not* get the flue shot because of that experience.
DeleteWe'll get the shot. But next year they are telling us we have to get it from our hospital no where else or it won't count. A couple of us got the transdermal flu shot from walgreens. And they had a fit because it wasn't from them... and we'll get it from walgreens again next year, no muscle ache! We just think its I little rediculous they want us to get it from them. Im guessing they get money back if we get it from them or something.
ReplyDeleteWe have a doc and a nurse who like to commiserate on how much they hate the flu vaccine and it is stupid and doesn't work. Not like it is, you know, difficult to study in whole populations or anything - no, there isn't evidence that making hospital employees get the flu vaccine prevents hospitalizations in the community, how on earth would that be ethical to experiment with anyway? But they feel that way about most other medical treatments and prefer homeopathic remedies for their kids and such. Drives me up the wall.
ReplyDeleteOur hospital did the mandatory vaccinations (by which, you could only opt out for religious reasons signed by a clergy member or severe illness signed by a physician, the "I just donwanna" crowd faced termination), and the ratio of people who traditionally "never get that vaccine" getting it went up and the number of those getting sick did not change. Now we have been getting slammed by flu hospitalizations not covered by the vaccine this year, which has been making said people crow that They Were Right but I'm still enthusiastic about flu (and other) vaccines. I have to think about people other than myself, especially as a nurse, and even if we do come across years when this strain or that isn't as effective, I don't know if I could live with myself if I was the one who ended up killing my patients or extending their hospital stay in resp. distress because of a philosophical "I donwanna" to the flu vaccine.
I'm a NICU nurse in a hospital that requires ALL employees to have flu shots and TB testing. If you refuse a flu shot, you're required to wear a mask while in patient areas throughout flu season. I work with a very vulnerable population, so I gladly let them have my arm and poke it (I won't do flu mist). My pet peeve is that the staff is required to have it, but we don't really push it with the parents that much and we let siblings in during this time. We screen families and visitors, but I routinely see parents at the bedside clearly not feeling well. I ask them to put a mask on and suggest they not come until they are feeling better, but I can't force them. I feel that those families put their child at risk more than an unvaccinated health care professional. (as an aside, about 3 years ago, we got RSV on our unit and we ended up shipping three patients off to PICU and putting room where those patients were in under isolation for a week (they were all in the same room). One of those patients affected died up in PICU from RSV. Turns out siblings of the baby who died had all been sick with colds/low-grade fevers, but they came up to see sister anyway.)
ReplyDeleteAt our hospital it was approached the same way-all employees either got the shot or had to wear a mask in patient care areas from october to april, but NICU was mandatory basic and H1N1 shots. I think there should definitely be restrictions on ICU visitors who are not vaccinated but it would be hard to enforce.
DeleteAside from everything else, requiring staff to be up on their inoculations is developing (if not developed [past tense]) into standard 'o care.
ReplyDeleteSo if a hospital doesn't take a hard line on this and a patient gets the flu in hospital (no matter from whom)--it's lawsuit bait. What would they say in court? "We didn't insist that everyone take their shots because our policy in this matter is decided by whatever claptrap any hospital employee reads when she's web-surfing." ?
- Molly, NYC
In addition to flu shots, all who work with infants should be mandated to get the pertussis booster. It is an ugly way for a young infant to die, and I am speaking from experience.
ReplyDeleteI am an attorney working in the health care field. One of my clients is going to make the flu vaccine mandatory for all employees who come into contact with patients. My colleague has spent the last 6 months preparing our legal defense for when we get sued, or someone files a grievance with the union. Next flu season should be fun! ;)
ReplyDeleteMy employer offers the flu shot for free, on site, at the beginning of flu season. I love it.
To anon 5:36--I totally agree about mandatory pertussis. I work in NICU (as mentioned in a previous comment) and made sure when I started my job to get a pertussis booster. I also made my husband get one (I figure that since I work in NICU and he lives with me, it's his duty to help keep me healthy). Too many people don't understand the risks and think that vaccines are evil. I can guarantee that when we have massive outbreaks of these preventable diseases, lots of these people will be begging to be immunized!
ReplyDeleteMore dumbassery. One of our scribes was bitching about the flu shot and she always gets the flu afterwards. Before any of us could say anything, one of the OTHER scribes (mine) whips out his Micro textbook (they are mostly pre-med students) where he had the page marked. OWNED.
ReplyDeleteSo I took a look to refresh (it's been a while). Paraphrasing, this was a couple of months ago.
The shot is indeed a killed virus. The nasal spray is a live virus that's been genetically broken (effect on replication sequence AND the sensor spikes is the most common method). You can indeed get the flu from the live virus, but it's less than 1 in 100,000 chance. And yes, a little sniffle or ache the next day is common, as we've been telling pts for decades.
Nurses are required to take undergrad Micro here, is that not the case elsewhere?
I'm a huge anti-authority type but I'm with you on this one. Look in the book, get the shot and kindly STFU.
Or go work somewhere they don't mind a little liability, or covering you when you are bedridden 3-5 days with a preventable illness.
People have forgotten what having the flu is really like. It's not the cold. You are sick. When you have a cold, you are miserable, but can still (mostly) do things. When you have the flu, you are sick. (but not too sick to go complain at the clinic).
ReplyDeleteBut I don't care. It's their choice.
And also remember- the flu shot doesn't protect you 100% against the flu. But it's better than nothing.
A few of my favorites from Dr. Mark Crislip
ReplyDeleteNot every flu like illness is due to the influenza virus. In a given season the influenza virus may account for around 10-15% of flu like illness in the community, although during epidemics influenza can account for 60% of flu like illnesses.
Unfortunately those who need to be protected from the influenza virus are those most likely not to respond to the virus vaccine: the obese, the pregnant, the elderly and those with chronic medical diseases.
Influenza spread can be decreased by mechanical/environmental interventions: hand washing and masks, although these interventions have variable efficacy depending on the population studied. They are not as effective as not getting the virus.
Health care workers are particularly problematic. For a variety of reasons they are likely to come to work ill, influenza can be potentially infectious before people are symptomatic, and spread in the hospital occurs...
Because those in the hospital are particularly vulnerable to the ravages of infections, mortality from hospital acquired influenza is remarkably high: 25%.
I have little (actually none) respect for HCW’s who do not get vaccinated. We have a professional and moral obligation to place our patients first. I think those who do not get vaccinated, except for a minority with a valid allergy, are dumb asses.
http://www.sciencebasedmedicine.org/index.php/protect-yourself/#more-22914
I oversee a mandatory flu vaccination program for all employees in a large medical center- 14,000+ employees. We work very hard to educate our RNs ( only rn vaccinate employees) so that they can educate our staff. There are lots of myths and blatant lies out there. The best phrase I've heard was from one of our peds infect disease docs who said "as medical professionals our first duty is to do no harm...". We are working to make Tdap mandatory also.
ReplyDeleteOk, I'll be a dissenter...not necessarily totally, but I'd like to at least not go blindly along. I think hospital workers are different than the general population personally.
ReplyDelete1. Workers have their own health issues that might mean it's not right for them. We could argue if they should be working with the sickest of the sick, but that's a factor.
2. The adjuvants put in the flu vaccines scare the crap out of me. From mercury to aluminum etc. Some of the other adjuvants which make them stronger are banned in other countries. US gov isn't be best at filtering the science, they almost always side with industry. Be careful to screen which flu vaccine you get. Choose a single preloaded syringe vs multivial as the preservatives are then removed.
3. Flu might be good to get if your immune system is healthy (and no I don't want people to die, so hear me out). The flu produces fevers of 100-103 and while miserable stresses cells out. Healthy cells weather this storm ok, cancer cells do not. I think an interesting question is whether inhibiting all infectious disease is acutely ok, but has reprocussions on chronic illness. Meds to induce these ranges of fevers for the duration of flu are being used in clinical trials to treat cancer. Its an intersting thing to ponder.
BTW. dtap = good vaccine as is singles. Of course, dtap vaccine isn't as good as it was and here in the NW we are seeing a lot of vaccinated kids/adults still getting it.
DeleteLike someone said, there is a lot of myths and blatant lies out there.
DeleteI am a vehement libertarian, and any whisper of forcing someone to do something gets me apoplectic. And in this situation, I'm 100% in favor of canning any medical people who don't get the vaccine. Following the orders of your employer, however much you dislike them, is not coercion: you always have the right to quit and get a new job. And if you're a medical professional refusing something so clearly proven to save lives, then maybe you should rethink your career.
ReplyDeleteAnd anytime someone tells me they don't get the flu vaccine I point them to Dr. Crislip's "A Budget of Dumbasses" at http://boards.medscape.com/forums?128@226.FQNkaywQke5@.29f60079!comment=1
My master's prepared nurse manager still believes this but at least she gets the shot, since she can't very well tell us too if she doesn't! Several of us that did get the flu shot have gotten the flu, we were told the influenza A strain was not in the flu shot given this year. This is what most of our patients are testing positive for as well. Oh well. You win some, you lose some.
ReplyDeleteWhats a bit scary is that the the influenza A strain IS in the flu vaccine.
DeleteWhile I, too, am quite libertarian, I cannot imagine allowing someone who refuses the flu vaccine for anything other than a legitimate medical reason (like anaphylaxis) to care for patients. I have seen a previously healthy 13 year old have to go on ECMO from just influenza, and she died anyway. If I don't do everything possible to avoid passing that to my patients, I don't need to be around them.
ReplyDeleteYou can't see patients if you don't get a flu shot in my hospital. It's a new policy this year nd I think it's great.
ReplyDeleteI know that this whole flu thing is old news, but I am compelled to write again now that I can sit upright without being terribly dizzy. Yes, the flu vaccine should absolutely be mandatory for hospital workers. I am thinking that it should also be mandatory to stay home (even doctors) if you are still symptomatic.
ReplyDeleteAs I posted before, I got the flu vaccine, but I was exposed to the flu by a co-worker who had also been vaccinated, but who got the flu because some unvaccinated relatives dragged their sick kids to his house over Christmas! Are you kidding me? He, in turn, came back to work when he started feeling a little better, but was still coughing, etc.
One week later, I came home from work and realized that I simply could not do anything but lie down; the exhaustion was overwhelming. Then came the cough, the fever, the body aches, the head pain, and the dizzyness. NINE DAYS LATER and I finally feel like I might survive this. (I will confess that I, too, tried to work on day six when the fever was gone and I was sent home because I simply should not have been there.) All I can say is - Thanks a lot, John C. - you know who you are.
No one thinks you are dedicated, responsible, strong, or anything else by "toughing it out" and exposing the rest of us. This flu is particularly virulent. A 13-y.o. boy in Mass. just died from the flu. Please, please, please ... If you still have symptoms, even if your fever is gone, stay home or wear a mask.
As a postscript, there is an upside to all of this, though. I am having knee replacement surgery in a couple of weeks and one of the things that scared me is that I would be exposed to the flu by some well-meaning (?) care giver. At least now, I am probably immune so I can scratch that particular fear off my very long list.
Tricia