Expert Response 6

Updated: July 20, 2020

A policy like this is tricky, as it is clearly patient-centered in the effort to keep patients safe. However, the issue of personal autonomy must also be taken into consideration.

Patient autonomy is a hallmark of the medical profession, and nurses are – at times – patients themselves. The idea that patients should be active members of their own health team, and that they should never have a treatment imposed on them against their will is critical in ensuring we maintain ethical standards. While nurses have a particular occupation in health care, they are also people (and patients) outside of their labor, and those who come down on the side of autonomy hold this as central. As well, there are some people who are unable to receive the influenza vaccination for health reasons, and some nurses may be among these.

On the other hand, health care professionals aren’t necessarily just like any other person or patient, because of the close contact that they have with already-vulnerable people – those who are ill, vulnerable, or in a weakened state. The possibility of transmission can be higher for nurses and other health care providers, simply because of the nature of their jobs. When working with people who are immuno-compromised in any way, with infants and children, with the elderly, and so on, the safety of those patients must be maintained at all costs.

With that said, there is any number of viruses and bacteria that can be transmitted from nurses to patients, for which there are no vaccines. This is why there are such exacting protocols around sanitation in healthcare settings. In my opinion, we should try to maintain the autonomy of nurses, but every effort should be made to encourage the influenza vaccine. Reminders of the unique nature of nurses' work, and the ease with which influenza can be transmitted, must be made very clear, must come from places of authority that are respected in the workplace, and easy access to the vaccine must be prioritized each year. However, if someone is unable to be vaccinated due to specific health reasons or personal convictions, they should be able to opt-out. Additional sanitation protocols should be enacted for such individuals, and they could perhaps be asked to sign a contract stating that, should they contract the influenza virus, they will voluntarily take time off work as they heal, to reduce the possibility of transmission to patients. This may not be viable in all contexts, for example, the NICU or in nursing home facilities. Having an open conversation with nursing staff about their concerns and the needs of patients would likely be the best way to come to an agreeable solution for all.

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