Flu jab: every nurse’s moral duty, or no one’s business but yours?

Strong views on mandatory staff vaccination show opinion in the profession is polarised

• Nursing Standard survey finds some nurses would rather quit their job than be forced by their employer to have a flu jab
• Others say being vaccinated is the duty of any responsible practitioner
• Find out what nurses on each side of the debate are saying – plus some basic facts about flu immunisation

Almost half of nurses who responded to a Nursing Standard survey (46%) revealed they back mandatory flu jabs for healthcare staff.

But as the annual flu vaccination campaigns gear up for winter, more than a third of respondents (36%) oppose the idea of being compelled to have the jab.

The flu vaccine is offered to all NHS staff to reduce their risk of catching and spreading the potentially fatal virus.

• RELATED: Compulsory flu jab for NHS staff – moral duty, or morale wrecker?

On average, 8,000 people die from flu in England each year, and in some years that figure is much higher, according to Public Health England. In 2017-18 for example, it is estimated 26,000 deaths were associated with flu in England alone. 

Opinion divided about mandatory flu jabs for healthcare workers

Comments in the Nursing Standard survey, completed by more than 2,243 nurses, show the extent to which the issue polarises opinion in the profession, with responses revealing strong feelings for and against.

Many respondents stressed the jab was a simple way to protect patients, colleagues, themselves and their own families. But others were vehemently opposed to any suggestion jabs should be compulsory. Some went as far as saying they would quit if compelled to have the vaccination.

• RELATED: Nurses divided over mandatory flu jab, and the right to refuse it

‘It should be the same as hepatitis  – no jab, no job’

One survey participant told us: ‘It should be part of our requirements as responsible practitioners for our well-being and our patients’ safety.’

Another said: ‘We work with vulnerable people. [It] should be the same as the hepatitis jabs – no jabs, no job.’

‘It is scary how little some nurses know, and [so] embrace pseudo-science’

Nursing Standard survey respondent

Some nurses felt frustrated by what they saw as a poor understanding of the vaccination among colleagues. ‘We know the data, have the jab,’ one said. ‘[For] some nurses, it is scary how little they know and embrace pseudo-science.’

Last year, 70% of front-line NHS staff in England were vaccinated, the highest uptake ever, according to Public Health England. The rates in Scotland and Wales were 51% and 56% respectively. Staff in Northern Ireland lagged behind, with a rate of 40%.

‘My husband has been in hospital several times for lymphoma; he contracted shingles and was very ill. If a member of staff had given him flu as well he may not have survived’

Nursing Standard survey respondent 

But some want coverage to be closer to universal. Sir Bruce Keogh, former national medical director for NHS England, ignited the discussion last year when he called for a ‘serious debate on mandatory flu vaccination’.

• RELATED: Flu vaccinations: should they become mandatory for NHS staff?

RCN prefers persuasion over compulsion

The RCN recommends all staff have the flu jab in order to protect vulnerable patients, but it stops short of calling for vaccination to be made mandatory.

The college points out that healthcare staff have a responsibility to protect their patients, and for nurses this is enshrined in the Nursing and Midwifery Council code.

RCN professional lead for public health nursing Helen Donovan says: ‘If the vaccination was to become mandatory, while some of our members would be really supportive, there would be an equally big number who would rebel.

• RELATED: Flu jab: nurses lag behind doctors in uptake of seasonal vaccine

'Rather than becoming a decision about what is right, it would become a decision on human rights and choices.’

Instead, she says, the focus needs to be on improving understanding and NHS workforce awareness.

‘We need staff to be well informed, we need evidence to be out there and we need to have time to spend with staff to address their concerns.

'But the nursing workforce crisis can make it difficult to find this time. We have also seen some great incentives, such as a London trust that last year gave a pound for each vaccination to a homelessness charity. That kind of action really speaks to nurses.’

The employer that is leading the way

Staff at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust in South Yorkshire have won awards for the effectiveness of the flu jab campaigns – with an 82% employee uptake last year.

Rates of staff vaccination have been rising steadily over recent years, and the employer aims to reach a 75% target in the fastest time possible. Last year it was 21 days.

‘We find there is no cynicism from staff about it. We push the message it is about protecting not just patients, but also colleagues, and this seems to be effective’

Richard Parker, chief executive of Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

Richard Parker, chief executive and nurse, said that the idea of vaccination is enthusiastically embraced by the trust’s staff.

Members of staff become flu peer vaccinators, going to wards and departments with an administration employee to offer jabs. This year there will be 102 vaccinators, including Mr Parker. This is up from 42 last year.

‘We find there is no cynicism from staff about it,’ he says. 'We push the message that it is about protecting not just patients, but also your colleagues, and this seems to be very effective.

‘The trust is one of the largest employers in the area, and so looks after a lot of the employees’ families, so everyone is really happy to get involved.’

A campaign is run each year based on a pun on the name of a film, and staff in fancy dress go around the hospital to raise awareness. This year’s will be Scooby Flu.

Hopes are high that the total number vaccinated will beat the 4,000 members of the 6,600-strong team last year.

‘We get a lot of information out there and have managed to increase our total each year,’ Mr Parker says.

Flu inoculation and NHS sickness absence

Some survey respondents pointed out that the vaccine may help prevent the need for people to take sick leave.

A 2017 Imperial College London study looked at approximately 800,000 staff across 223 NHS employers across four influenza seasons from 2011.

• RELATED: More nurses having flu vaccination could cut absence rates, study shows

The report determined that a 10% increase in flu vaccination rate would be associated with an equal fall in the staff sickness absence rate. 

Nurses’ fears for their own loved ones

Nurses who have health problems or family members with serious health conditions said inoculation was particularly important to them.

‘I have a long-term condition and would be upset if I contracted flu from a colleague who had not had a flu jab,’ one nurse told the survey.

Another said: ‘My husband was recently in hospital several times having treatment for lymphoma. He managed to contract shingles and was very ill. If a member of staff had given him flu as well he may not have survived.’

Others suggested that if the vaccine were to be mandatory, this should be confined to higher-risk practice areas such as high-dependency units and care of older people.

The case against compulsory flu jabs – what nurses told us

A clear message from the survey is that many nurses are firmly – even angrily – opposed to mandatory vaccination. 

‘They are ineffective and [there is] too high a risk of side effects,' one nurse said.

‘It would be morally wrong to force this risk on to healthcare staff, or anyone else,’ one nurse said. ‘I choose to support and boost my immune system in natural ways. It has worked for me for over 20 years. If flu vaccination would be made mandatory it would be the final straw for me. I would leave nursing for good.’

Many claimed that receiving the flu jab had made them feel unwell, that they had still contracted flu, or believed the inoculation had exacerbated an existing health condition.

Side effects

NHS advice is that serious side effects of the injected flu vaccine are rare. However, it can cause a mild fever and aching muscles and soreness around the injection site.

There was also a significant cohort of respondents who said they support the vaccine, and always have it, but did not feel comfortable with the idea of it being mandatory.

• RELATED: Are efforts to increase flu vaccination rates among front-line nurses excessive and impractical?

Some suggested it contravenes a nurse’s human rights to compel them to have a vaccine. ‘I feel all staff who have no contraindications should have vaccine, however do believe in freedom of choice,’ one said.

There are contraindications to the vaccine, and one respondent said they were unable to have it and found that difficult.

'If the nurse receiving the flu vaccination has only given consent because of pressure from their employer or others, consent would not be legally valid'

Marc Cornock, nurse, lawyer and Open University academic

Another said the use of pork gelatine as a stabiliser in flu vaccines conflicted with their choice to be vegan.

‘I am unable to receive the flu vaccine… What happens then? I already feel guilty and singled out every year,’ they said.

No one can force a nurse to be inoculated

Nurses cannot be placed under pressure to receive the flu vaccine, according to nurse and lawyer Marc Cornock.

• RELATED: Legal advice: My boss is trying to pressure me into having the flu jab. Is this legal?

The Open University academic has previously stated: ‘For a person to receive a procedure, including a flu vaccination, they must provide valid consent.

'This has to be given freely and without any undue pressure or coercion. If the nurse receiving the flu vaccination has only given consent because of pressure from their employer or others, consent would not be legally valid. 

'Although all front-line staff members should consider receiving the flu vaccination, legally they can refuse.’

• RELATED: Flu vaccine: NHS trusts remain silent on how they manage staff who refuse it

Survey respondents questioned how they could encourage the public to embrace the vaccination programme if they had not received the injection themselves.

As one put it: ‘We need to set the precedent for the public. If we as healthcare professionals don’t take the vaccine how do we expect the public to do so?'

Find out more

• RCN Beat the flu campaign
• Public Health England Time to Get Your Flu Jab 2019-20 campaign 

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