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To get immunized or not to get immunized

Every year at this time, Nurse.com readers ask about flu shots.

Do I have to take the flu shot that my employer is requiring?  

Will I get fired if I refuse?  

Can I get some sort of waiver so I don’t have to get the shot?  

I’m rarely sick so can’t I just take my chances and not get immunized?  

Don’t I have a right to refuse the immunization?

Those at risk

Nurses work with patients of all ages and in various settings. If not protected as best as can be with the immunization, nurses may unknowingly expose a patient to the influenza virus. If not vaccinated, nurses may be exposed to the virus by a patient, a patient’s family member or a colleague. If a nurse is exposed, he or she then takes the virus home, where the nurse’s family members are at risk. Family members can then expose others to the virus, and on and on it goes.

So, immunizations are one key to keeping the public healthy.

How employers react

Some healthcare employers strongly recommend, rather than mandate, that employees get a flu shot. Such a recommendation goes along with the positions of the CDC and the American Nurses Association on healthcare workers and flu immunizations.

Many healthcare employers require employees, including nurses, to get a flu shot. According to the Immunization Action Coalition’s Honor Roll for Patient Safety, more than 500 hospitals, healthcare systems and long-term facilities across the U.S. require the immunization for employees. Position statements supporting mandatory immunization by professional organizations such as the American Academy of Pediatrics, the American Public Health Association and the Infectious Diseases Society of America are on the increase.

Impact on immunization rates

An employer’s stance on whether flu shots are voluntary or mandatory has a clear impact on employee immunization rates.

Data from the CDC’s Sept. 18, 2015 report, “Influenza Vaccination Coverage Among Health Care Personnel—United States, 2014-2015 Influenza Season,” points out vaccination coverage was lowest, at 44%, among healthcare employees where employers did not require, promote or provide vaccination.

Healthcare personnel in long-term care setting were more likely to report employers did not require, provide\or promote vaccination (30%) compared to only 2.6% of those working in hospitals who reported the same.

During 2014-2015, healthcare workers whose employers required vaccinations had the highest influenza coverage that year, 96%, according to the CDC.

Exceptions to immunization rules

There are exceptions to employees being immunized either voluntarily or mandated. One is an objection based on a sincerely held religious belief. However, voicing one’s objection is not always easy.

Many employers accept such an objection while others may not. If the employer questions the sincerity of the objection, it may ask for adequate, objective documentation of the employee’s basis for opposing the immunization.

A second exception to immunization is a medical contraindication. The ANA suggests if such a contraindication is present, the employee should provide documentation “from the appropriate authority” to support the request.

Generally, if an exemption is granted for a sincerely held religious belief, under Title VII of the Civil Rights Act of 1964 your employer must accommodate the request. The same is true for medical conditions that would be covered under the Americans With Disabilities Act. The accommodation may result in a change of a nurse’s practices at work to lessen the chance of transmission of the flu to patients and others with whom the nurse works and comes in contact with while there.

Legal precedent

If a nurse is a member of a union, the ability to challenge a mandatory flu shot policy might be successful. In 2007, in Virginia Mason Hospital v. Washington State Nurses Association, 511 F. 3d 908, the hospital established a mandated vaccine policy without consulting the union. The union successfully sued, alleging the policy was not valid because the bargaining agreement with the hospital required the employer to bargain with it over terms and conditions of the nurses’ employment.

These and other legal issues notwithstanding, you have a choice in getting immunized. That choice may result in the loss of your job, or your choice may not adversely affect your job status at all.

Whatever your choice, it should be based on a thoughtful analysis of your personal beliefs, your obligations to your patients and your responsibilities to adhere to applicable nursing codes of ethics, including the ANA’s Code of Ethics for Nurses with Interpretive Statements.

Your turn

How do you feel about mandatory immunizations in healthcare settings? Please share your thoughts and experiences.

Note: Nancy Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice.

By | 2020-04-06T10:53:04-04:00 October 21st, 2015|Categories: Nursing careers and jobs|1 Comment

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

One Comment

  1. Avatar
    Suzie Que March 4, 2019 at 12:03 pm - Reply

    I absolutely DO NOT support any organization FORCING a health care employee to inject themselves with substances they object to, either based on a question of personal safety or for religious reasons, etc. There are plenty of other reasonable options and this should be one’s PERSONAL CHOICE, not one based on whether or not they will be terminated from their employment. Ridiculous vaccines like the flu virus does not protect others from getting it (and may not protect the receiver either!). The fact of the matter is, NO vaccine is 100% safe and therefore, the decision to take them should be voluntary and made by only one person — the employee alone!

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