title: Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: a survey to assess employee perception.
abstract: The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009-2010 influenza season during the highly publicized pandemic of the H1N1 "Swine Flu." Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach.
authors.affiliation: CEP America, Kaweah Delta Health Care District, Visalia, CA, United States; University of California at Irvine and American University of Antigua, United States. Electronic address: loriwinstonmd@gmail.com.
authors.forename: Lori
authors.initials: L
authors.lastname: Winston
authors.affiliation: Infinity Healthcare, Sacred Heart Hospital Eau Claire, WI, United States.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wagner
authors.affiliation: Presence Resurrection Medical Center, Chicago, IL, United States; University of Illinois at Chicago, United States.
authors.forename: Shu
authors.initials: S
authors.lastname: Chan
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004651:Employment; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy; D006784:Hospitals, Teaching; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D037141:Mandatory Programs; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: H1N1 influenza; Healthcare workers; Mandatory; Penalty; Policy; Vaccine