Preventing Influenza:

Mandatory Vaccinations for

All Healthcare Workers
By: Emily Alpers & Sarah Bricker

Introduction
Seasonal influenza is seen as the leading
cause of vaccine preventable diseases
associated with hospitalization (Chean,
Ferguson, & Stuart, 2014). This issue stems
from the healthcare workers (HCW)
increased risk of contracting the illness and
then further transferring that illness to
coworkers and vulnerable patients. There
are numerous pros and cons to this issue.

Learner Objective
Examine mandatory influenza vaccines
from a systems framework and aid the
learner in a greater understanding of
the pros and cons of mandatory flu
vaccination.

Assessment of Healthcare Environment

Policies and research: The flu virus can be
transmitted before symptoms even develop
(Galankis, et al., 2013). HCW flu
vaccination has been shown to prevent the
spread of the flu virus in hospitalized
patients (Galankis, et al., 2013). The
addition and implementation of mandatory
programs in the United States has yielded
promising results.

Assessment Continued
Financial and resource: The cost of the flu
vaccine given to HCW is negligible compared to
the healthcare cost of treating the flu, namely
in the acute care setting. For this reason, the
use of the flu vaccine is a much greater
allocation of resources.
Nursing practice and quality and safety: It is
the practice of the nurse to keep the patient
safe, and help the patient achieve a quality life
through the provision of quality healthcare.

Assessment Continued
Political and ethical: Mandatory policies
regarding vaccination are meant to have
defined consequences for HCWs who
decline. However, there remain exemptions
within these programs. Although opponents
believe that no one should be forced to
take medications, proponents argue that
the end justifies the means when it comes
to protecting patients.

Root Cause Analysis

Side
Effects

Lacking
Evidence

Cost
Not enough
vaccinated
HCWs
Violation of
Civil Liberties

Negative Effects on
Employer-Employee
Relationship

Inferences and Implications

Does the evidence support the effectiveness
of the flu vaccine? Yes. As already noted,
vaccination of HCWs has been shown to
decrease the spread of the flu among
hospitalized patients (Galankis, et al.,
2013).
Does the evidence support the effectiveness
of other interventions in flu prevention?
Only partially.

Inferences Continued
Does a vaccine mandate actually increase
compliance? Yes. Studies have shown that
mandates have risen compliance by
significant percentages.
Does mandating vaccination negatively
impact the employer-employee relationship
significantly? It could, but even those who
agree that mandates are coercive believe
that they are necessary to protect patients.

Inferences Continued
Mandatory flu vaccines are
probably here to stay. In
Michigan, the percentages
of hospitals with mandatory
flu vaccine policies has
risen. No doubt this number
has continued, and will
continue to rise.

Recommendations
Recommendation: Flu vaccination is
evidence based and encouraged for nurses.
Recommendation: Those in positions of
management should carefully consider the
implications when writing and executing
policies.
Consideration: You must ponder the
personal ethics of accepting or declining
vaccination for yourself.

Conclusion
The belief held by most healthcare workers and
organizations is that it is morally justified for
HCWs to be voluntarily vaccinated. However,
for those opposed to mandatory policies, it is
preferable for higher uptake rates to be
achieved through consensus rather than
coercion, as coercive policies would bear the
cost of conflict and mistrust, devalue HCWs and
thus alienate important allies and have longterm detrimental effects (Galankis, et al.,
2013, para. 24).

References
Awali, R., Samuel, P., Marwaha, B., Ahmad, N.,
Gupta, P., Kumar, V., & Ellsworth, J. (2014).
Understanding health care personnels attitudes
toward mandatory influenza vaccination. American
Journal of Infection Control, 42(6).
Chean, R., Ferguson, J.K. & Stuart, R.L. (2014).
Mandatory seasonal influenza vaccination of health
care workers: a way forward to improving influenza
vaccination rates.Healthcare Infection, 19,4244.
http://dx.doi.org/10.1071/HI13041
Feemster, K., Prasad, P., Smith, M., Feudtner, C.,
Caplan, A., Offit, P., & Coffin, S. (2011). Employee
designation and health care worker support of an
influenza vaccine mandate at a large pediatric
tertiary care hospital. Vaccine, 29(9).

References Continued
Galanakis E, Jansen A, Lopalco PL, Giesecke J.
Ethics of mandatory vaccination for healthcare
workers. Euro Surveill. 2013; 18(45).
MHA. (2014, November 4). HCP vaccination
policies. In Michigan Health & Hospital Association.
Retrieved February 6, 2015, from
http://www.mha.org/mha/vaccinations.htm
Pitts, S., Maruthur, N., Millar, K., Perl, T., & Segal,
J. (2014). A Systematic Review of Mandatory
Influenza Vaccination in Healthcare Personnel.
American Journal of Preventive Medicine, 47(3).