Flu Vaccination

Mandatory Influenza Vaccination for Healthcare Workers: A Health Policy Brief

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Most healthcare professionals take the oath, “First, do no harm.” They take responsibility for maintaining and promoting a safe environment of care. Yet often, they fail to recognize the role they play in influencing their patients’ behaviors. By supporting mandatory influenza vaccinations, their behavior communicates to patients, “Do what I do.” There is a coherent message between a treatment plan and healthcare workers’ behavior.

Consider the facts. The CDC estimates that up to 20% of Americans are affected with influenza yearly and 226,000 people are hospitalized with flu-related complications or die as a result. Yet the rate of flu vaccinations for healthcare workers remains constant, less than 50%, even though many of their patients, especially the young and elderly, are suffering from the flu.

Current Impact and Status

Healthcare workers are at higher risk of infection when inflicted with influenza (Backer, 2006). The CDC estimates that $6.2 billion dollars is lost in productivity and $10.4 million in medical costs for healthcare workers, who are affected by influenza (Molinari et al, 2007). Employees attempting to work with flu-related symptoms have poorer work performance. Many studies show employees ill at work from influenza have a 40% decline in their time to perform work-related tasks (Keech & Beardsworth, 2008). For those 18 to 64 years of age with influenza, it causes 75 million days of work absences and 200 million days of decreased productivity (Nichol, 2001).

In 2009, RAND Corporation surveyed over 5000 people regarding influenza vaccination. They found that among those recommended to get flu vaccines, only 49% of workers received the vaccination, with 39% having no intention of getting one (Harris, Maurer, & Lurie, 2009). Reasons cited for not receiving the vaccine included the following: not needing it, not believing in it, others need it more, and many others (Harris, Maurer, & Lurie, 2009). Even if individuals do not care about their own health, what about the health of those they treat? Healthcare workers with influenza put patients at risk for exposure, disease complications, and spread to other vulnerable populations. In fact, a reluctance to obtain a flu shot is pushing the issue into a mandate status.

Ethical Obligation

The ethical concept of beneficence and nonmaleficence indicates that we should do what is best to not harm others and improve the condition of society (Guido, 2010). Precedents for employment in health institutions mandate vaccination against hepatitis B or proof of immunity. Yet the flu, a condition that has been a pandemic concern for years, allows optional autonomous preventive measures. This creates a conflict of social and distributive justice. In medicine, we preach about our obligations to provide best treatment options. But with influenza vaccinations, the concept of autonomy has over-ruled the safety of society. Relational ethics teaches us that healthcare workers and government entities need to view the rights and responsibilities they have towards developing beneficial action-oriented outcomes. Some people may even feel as though the paternalistic measures imposed may violate their right to autonomy. However, when dealing with matters that can pose local, state, and global threats to society and individuals the safety of all patrons must be considered.

Future Solutions for Prevention

Since 1984, the CDC has recommended seasonal influenza vaccinations for employees. Nationally, 70% percent of major employers host flu clinics for their employees, yet only 15% participate in receiving the vaccination (Singleton, Poel, Lu, Nichol, & Iwane, 2005). This is below the vision and goal established by Healthy People 2020 that 80% of healthcare workers receive the influenza vaccine, an initiative established by the United States Department of Health and Human Services (HealthyPeople.gov, n.d.). It also indicates a need for mandates for influenza vaccinations for healthcare workers to prevent disabilities and financial constraints that result from influenza. Agenices that establish health policy also promote mandatory flu vaccinations, such as the Advisory Committee on Immunization Practices (Backer, 2006), the National Foundation for Infectious Diseases, and the Society for Healthcare Epidemiology of America.


As professionals, we need to focus on our duty and obligation to provide quality care. Despite multiple arguments to the contrary, influenza vaccinations provide protection for both the healthcare provider and the patient. We need to encourage the 50% of healthcare professionals who fail to get a flu shot to think of the health of the rest of us who do. In the long run, a simple flu shot can generate positive patient outcomes, increase revenue, and elevate public health. Sometimes coercive action is necessary to protect society and show an initiative to evoke leadership and safety.

Tonya Sawyer-McGee, MSN, ACNP-BC
Bluitt-Flowers Health Center
Dallas, Texas
Published on October 16, 2012

Tonya Sawyer-McGee is an acute care nurse practitioner at Parkland’s Community-Oriented Primary Care Clinic (COPC), Bluitt-Flowers Health Center in adult internal medicine in Texas. Prior to working in the community outreach clinics, Mrs. Sawyer-McGee, was the first nurse practitioner hired as the pre-surgery testing evaluation practitioner at the Parkland Simmons Ambulatory Surgery. She has been practicing as a nurse and practitioner for over 13 years and specializes in medical and acute care of patients. She is currently studying for a doctorate in nursing.



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