When Your Employer Won’t Take No For an Answer

English: This is CDC Clinic Chief Nurse Lee An...

English: This is CDC Clinic Chief Nurse Lee Ann Jean-Louis extracting Influenza Virus Vaccine, Fluzone® from a 5 ml. vial. (Photo credit: Wikipedia) You go, girl!

The recent firing of 8 healthcare workers who refused to get a flu vaccination at Goshen Hospital in Indiana is not surprising. As influenza season kicks into hyper-drive, hospitals unleash the latest public relations strategy in making patients believe they are safer – mandatory flu vaccination for healthcare workers. The reasoning is that hospital inpatients are already vulnerable to infection and preventing healthcare workers from infecting them, because the healthcare worker has immunity due to the flu vaccine,  will save lives.  This mindset has a few flaws.

First, the flu vaccine is not 100% effective. That’s not to say I don’t get one myself, but, as the Centers for Disease Control (CDC) website points out:

“The effectiveness of influenza vaccines varies from season to season, and depends upon a number of factors. One factor is how well the vaccine strains match the viruses that actually circulate during the season. In addition, vaccine effectiveness is affected by the recipient’s age, immunocompetence, and previous exposure to influenza viruses.”

No 100% guarantee there.  In fact the CDC notes,  “Recent RCTs (Randomized Control Trials) of inactivated influenza vaccine among adults under 65 years of age have estimated 50-70% efficacy during seasons in which the vaccines’ influenza A strains were well-matched to circulating influenza A viruses,” “a study of Dutch community dwelling people aged 60 years of age and older reported a vaccine efficacy of 58%” and “study among 92 healthy adults aged 18–41 years, the efficacy of inactivated and live attenuated influenza vaccines in preventing laboratory-confirmed influenza was 71% and 85%, respectively.”

With the average age of registered nurses at 46 and doctors at 51, I’d guess the vaccination effectiveness is in the 50-70% range. Oh, and did I mention if you’re going to get immunity,  it can take up to 2 weeks after the shot to get immunity?

Even if it did confer immunity to 100% of the healthcare workers who received it, they are not the only carriers of influenza. Since the infected are able to infect others one day BEFORE getting symptoms and up to seven days AFTER getting sick, think of all of the other traffic in a hospital including visitors, admitted patients, and vendors. Are they all vaccinated against flu? Who knows. Can hospitals require them to receive vaccination? I’m guessing the answer is no. This means in a perfect world, with every healthcare worker not only immunized but also immune, there would still be potential flu carriers wandering the halls every single day. Since the flu can be spread to others up to six feet away, a vendor or visitor at the nurses station can infect a patient who is walking nearby for physical therapy. Unless hospitals go into lock-down at the start of flu season, a strategy of mandatory vaccination leaves plenty of room for infection.

Forcing people to get immunized for flu or lose their job is easy. In my book, proving that it is the best and most effective option to save patient lives is a little bit harder. Having worked in a number of healthcare institutions, I know most healthcare workers work sick for a number of reasons including managers who penalize them and co-workers who resent working short-handed. I also know that hand hygiene, considered the baseline measure to prevent the spread of disease, is nowhere near 100% in organizations. Instead of picking the low hanging fruit of vaccination, organizations should look toward preventing all healthcare acquired infections. I’d love to see someone fired for not washing their hands.

Instead, Goshen Hospital fires 8 out of 1300 people who refuse vaccination. It makes me wonder about the 1292 workers who didn’t get the vaccination, but were allowed to keep their job. Maybe the excuse was they don’t provide direct patient care. Maybe the hospital couldn’t take the financial hit of losing certain positions, such as doctors, surgeons, and top administrators.  Firing front line staff, such as nurses, therapists, housekeepers and food service workers,  has always been easier than the politics of firing the rainmakers of healthcare.

Perhaps this is just the first salvo organizations will fire in the crusade to show their commitment to patient safety. Imagine a hospital website proclaiming, “100% flu vaccination rate” instead of “71% rate of compliance with washing hands between patients.”  The illusion of safety provided by mandatory immunization shouldn’t be confused with the reality of 1.7 million hospital-acquired infections and 99,000 associated deaths each year.

For now, firing a few employees for show will have to do. I know I feel safer.

Fired red stamp

Fired red stamp (Photo credit: Wikipedia)

The Healthcare of Politics, Post Debate

First off, I have no issue with anyone who uses their faith to inform their personal life and decisions. I do it. I believe you should, too.

Paul Ryan’s faith believes life begins at conception, therefore abortion is murder. But, if we’re going to allow religious faith to play a role in healthcare, let’s consider all religions and their beliefs.

Jehovah’s Witnesses can legislate against blood transfusions.

Christian Scientists can legislate for prayer instead of medical treatment.

Scientologists can legislate for introspection rundowns instead of antidepressants.

The bottom line is every religion has traditions and prohibitions that impact the healthcare experience of their followers. These items don’t need to be legislated, they are a choice. The Catholic Church and Paul Ryan has no more business making my healthcare choices than my employer does.

Wait. Ryan and the faithful believe that employers should be able to financially restrict an employee’s access to birth control, sterilization, and abortion in the name of religious freedom. Guess religious freedom means religious employers can make the decisions usually best left to a patient and doctor. Today, birth control and sterilization; tomorrow, restrictions on blood transfusions or psychiatric care?

Because if we want to allow faith to legislate healthcare, let’s not stop with the Catholic Church’s agenda. Let’s champion the beliefs of all religions. Sounds good, doesn’t it?

But, taking away healthcare choice from the individual and investing it in the hands of a religious organization is akin to setting up “death panels,” except instead of deciding if an individual is worthy of medical resources, these panels would decide what medical resources are worthy of being used.

As much as I believe in religious freedom, I don’t think your faith should impact my ability to access medical care and procedures. Do you?

Keep Your Merit Badge, I’m Not a Boy Scout

Portrait of Miss Georgina Pope, head nurse of ...

Portrait of Miss Georgina Pope, head nurse of First Canadian Contingent during the Boer war. Possibly in her nurse’s uniform from Bellevue Hospital, New York (Photo credit: Wikipedia)

Last week Nurse K posted on her blog about a patient‘s last phone call. Read it here.

After wiping away some stray moisture from my eyes and clearing my nose (allergy season, you know), I thought about the moments that define us in our healthcare role.

Hospitals seek out touching stories to bolster their application for Magnet status or adorn their website. Their stories of how the healthcare staff went above and beyond to help a patient usually end up being fairly run of the mill. More in the vein of “the nurse took the time to ensure I knew how to make the bed go up and down” and “the food service staff cheerfully exchanged my tray to accommodate my gluten-free diet” than “someone did something totally unexpected and above/below their pay grade that mattered.” In my hospital experience of being on the receiving end of management’s praise, I’ve found the successes I’ve been credited with are the ones that least define who I am as a nurse.

I was acknowledged once for my help in cleaning up flooded exam rooms after someone left a faucet running over a weekend. The sad truth was administration had made deep cuts in the housekeeping department and there was no one available to clean up the mess. I picked up a mop and started in because we had a waiting room of patients to be seen. Eventually the housekeeping supervisor, embarrassed at his lack of employees, showed up to help. Administration congratulated our team effort to fix the problem. I got official recognition for going above and beyond and a free lunch in the cafeteria. Rather than being thrilled with the “honor,” I was incensed. Of all of the things I did in my job that were truly worthy of recognition, I got an attaboy for pushing a mop for two hours. Two hours I wasn’t available to triage or educate patients. Two hours I didn’t use any of my nursing skills. That is what administration deemed worthy of recognition.  It didn’t go over well when I told them instead of praising me, they should be asking themselves why they didn’t have enough housekeeping staff to handle emergencies.

Instead of addressing the underlying problem many of us face, too much to do with too little time and staff to do it, hospitals try to boost morale with meaningless honors and remain oblivious to the day-to-day things that really matter. And though we are more than willing to share our crazy stories, commiserate over the sad ones, and bemoan the incompetence of administration, we’re not willing to let down the walls and talk about the parts of our job that hit us in the gut and the situations that make us turn our heads so the patient can’t see our tears. We’re professionals. That stuff isn’t supposed to get to us.

But, it does. It stays with us.

And they are the moments I don’t offer up to the public relations machine of the hospital and I suspect many others do the same. Moments that remind us there is more to our job than tasks and checklists and documentation. Moments when we know that our lives will go on, but our patient’s will be changed forever. Because sometimes, in the confusion, turmoil and noise of our professional lives, we take a step back and do the right thing.

Those are the moments that define us.