February 1, 2012 --The flu vaccine is widely available this time of year, from doctor’s offices to pharmacies to work places. For most people, it’s a choice, but for healthcare workers in Oregon and around the country, that choice is becoming increasingly threatened.
Recent flu seasons and the previous threat of an H1N1 (swine flu) pandemic have led policymakers across the country to focus on programs to protect the public health. New York, Washington, Colorado, Nevada, and other states have all grappled with policies to ensure that healthcare workers are the last stop to spread the flu. Oregon is now considering that approach.
The Oregon Nurses Association (ONA) believes that all nurses and healthcare workers should get an influenza vaccination, but not as a condition of employment. Currently Oregon law (ORS 433.407) says that facilities that employ healthcare workers must offer vaccines, but cannot require people to get vaccinated as a condition of employment.
The ONA supports legislation, introduced by the Senate Healthcare Committee (Senate Bill 1503) that would require employers to educate their employees about vaccines, give them the option to decline, and protect their decision in a private health record.
Access to vaccinations and education, when combined with other methods to prevent influenza transmission, are sufficient and effective in protecting patients and workers, according to Jack Dempsey, the ONA’s director of government affairs.
The legislation also has the support of labor unions and the Oregon Health Care Association, but is opposed by the hospital association (the Oregon Association of Hospital and Health Systems), which wants individual hospitals to be able to decide what’s best for them.
“We support repealing the language from current statute (that prevents healthcare facilities from requiring vaccinations) to allow for flexibility, community by community, hospital by hospital, provider by provider,” said Andy Van Pelt, its director of communications. “Oregon is the only state that has language in the statutes that prevents the vaccination from being a condition of employment.”
But Dempsey said this approach misses the mark. “If we go that route, what’s going to happen is that a few facilities will take extreme measures while the vast majority will be able to continue to do nothing (to encourage healthcare workers to be vaccinated). “An education approach is better than a threat.”
The hospital association doesn’t support a blanket mandate, and, similar to the ONA, wants to see vaccination rates increase among healthcare workers, Van Pelt said.
But, allowing individual healthcare facilities to decide what works best for them makes more sense, he added. “We think it’s (changing the language of the law) a first step and allows for some conversation about what works best.”
The ONA has evaluated strategies that have and haven’t worked at individual healthcare facilities that have implemented a variety of procedures and policies related to influenza vaccinations for their healthcare workers.
“We’ve seen the scarlet letter approach, the shame approach, and the masking approach,” Dempsey said. “But for the most part we’ve seen that these facilities haven’t been able to implement their approaches to increasing vaccination rates fairly. They tend to exclude physicians and target nurses.”
Nationally, 63.5 percent of healthcare workers received the vaccine during the 2010-11 flu season, according to the Centers for Disease Control. A website for the Oregon Legislative Workgroup on Healthcare Workers states that in 2009, about half of Oregon healthcare workers were vaccinated for influenza.
A 2010-11 survey conducted by the Office for Oregon Health Policy and Research showed that 69 percent of employees in Oregon’s hospitals and 52 percent of employees in long-term care facilities were vaccinated during that same time period. The Healthy People 2020 goal for vaccination of healthcare workers is 90 percent.
The Senate bill also includes a data collection component allowing officials to monitor vaccination rates among healthcare workers, assess why they aren’t getting the vaccine and thus respond accordingly.
“This (SB 1503) approach raises rates and cuts back on animosity.” Dempsey said. “It’s a first step. We might find that we need to do something more heavy handed, but it’s not necessary or effective at this point.”
The Oregon Nurses Association was recently award a mini-grant from the Department of Human Services Oregon Immunization Program and is actively promoting nurses to become immunized, educating them through social media, and electronic and print media.
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