Abstract
BackgroundDespite studies demonstrating that the annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients, vaccination rates remain very low, particularly in nursing staff. Educational programmes have failed to improve rates, which has led to a diverse range of enforced approaches being advocated and implemented.ObjectivesTo examine the attitudes of non‐vaccinated nursing staff towards various enforced measures aimed at increasing rates of influenza vaccination.MethodsSemi‐structured qualitative interviews with a purposive sample of 18 non‐vaccinated nurses, working in units with high‐risk patients at two hospitals in Switzerland. Analysis of interviews was done using conventional content analysis.ResultsNurses were critical of enforced measures. However, measures that include an element of choice were perceived as more acceptable. Declination forms and mandatory vaccinations as part of the employment requirements were found to be the most accepted measures.ConclusionThe perception of choice is crucial to the acceptance of a measure. Respect for choice and autonomy has a positive effect on behavioural change.Mandatory influenza vaccination as a condition of new (and perhaps ongoing) employment could be a feasible, effective and ethical measure to increase vaccination rates among nurses who oppose vaccination.
Highlights
Despite studies demonstrating that the annual influenza vaccination of healthcare workers reduces morbidity and mortality among vulnerable patients, vaccination rates remain very low, in nursing staff
The aim of this study was to explore the attitudes of non-vaccinated nursing staff, working in units with patients at high risk of morbidity and mortality of influenza towards various enforced measures aimed at increasing rates of influenza vaccination
Our study found that the perception of choice was crucial to the acceptance of enforced measures
Summary
Despite long-standing recommendations by public health authorities and studies stating that annual influenza vaccination of healthcare workers (HCWs) is associated with a reduction of morbidity and mortality among patients,[1] influenza vaccination rates among HCWs remain low internationally.[2,3,4] Vaccination rates among nurses are typically lower than those of physicians.[5,6] While studies show interventions focusing on providing information and easier access to the vaccine have increased vaccination rates among physicians, they seem to have very little effect on nursing staff.[7,8] This has led a number of hospitals to implement more authoritarian approaches, including declination forms, mandatory wearing of masks, unpaid leave during influenza season, switching to another lower-risk unit, and mandatory vaccination for nurses declining influenza vaccination.[9,10,11,12,13,14,15,16] Declination forms and mandatory masks for non-vaccinated HCWs alone have. Mandatory influenza vaccination as a condition of new (and perhaps ongoing) employment could be a feasible, effective and ethical measure to increase vaccination rates among nurses who oppose vaccination
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