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Nurse fights mandatory flu shot on principle

As a critical-care nurse, Carrie Calhoun has to respect the wishes of her patients, even when they refuse lifesaving treatment. Now Calhoun thinks her right to make her own health care choices is under threat by her employer - and she is prepared to lose her job over it.

(MCT)-- As a critical-care nurse, Carrie Calhoun has to respect the wishes of her patients, even when they refuse lifesaving treatment.

Now Calhoun thinks her right to make her own health care choices is under threat by her employer - and she is prepared to lose her job over it.

Calhoun said she intends to defy a new requirement by Alexian Brothers Health System that all its employees get flu shots or face terminations, with few exceptions.

"Something that I uphold and honor so deeply is being taken away from me," she said. "It's an argument of patient safety over patient rights."

The move toward mandatory flu shots for health care workers is part of a nationwide trend. More than half of hospitals surveyed nationally and in the Chicago area have added the requirement in the past few years.

Public health officials say that while the mandate might rankle some hospital employees, it's the wave of the future to protect vulnerable patients from the people who care for them.

"Across the industry, you have a very strong movement to say, 'Look, if we're going to protect our patients, we've got to make sure were not spreading disease,' " said Mark Frey, president and CEO of Alexian Brothers Health System, based in Elk Grove Village, Ill.

Influenza kills an estimated 36,000 people per year, often the elderly and those with chronic illnesses, and in some cases people who contract the virus in hospitals. Some hospital-based outbreaks have been traced to low immunization rates among workers, and the U.S. Centers for Disease Control and Prevention found that higher vaccination rates translate to lower infection rates.

For years, hospitals have tried to increase employee vaccination rates through voluntary programs, education, free shots on site and financial incentives. But the vaccination rate remains low, the CDC reports, with one-third of all health care workers typically going unvaccinated (though the vaccination rates for doctors and nurses are considerably higher).

To address the issue, hospitals began requiring flu vaccines. The trend began with two hospitals in 2005, according to the CDC, and has grown to more than 400 hospitals nationally, with the support of numerous medical groups such as the American Academy of Family Physicians.

The move toward mandates also follows a period of unprecedented skepticism over vaccinations. Critics have long derided medical researchers, vaccine manufacturers and family doctors over claims that they try to profit from requiring vaccines, and have warned of the adverse reactions that some people get.

The flu shot, which has varying degrees of effectiveness depending on whether doctors match the vaccines to each year's various strains, commands even less respect than other vaccines. Though the vast majority of Americans get required childhood inoculations, barely one-third of the public bothers to get flu vaccines.

The CDC states unequivocally that flu vaccines are safe, with serious problems being very rare. The public health agency says flu shots cannot cause the flu, though they might cause flulike symptoms such as low-grade fever and aches.

Some medical workers don't believe the CDC. When New York became the first state to order flu shots for all health workers during the swine flu outbreak of 2009, unions demonstrated and went to court to fight it, arguing that the vaccine hadn't been tested enough for safety and efficacy. State officials backed off the requirement, though Rhode Island recently enacted a similar law, prompting a union lawsuit.

In Washington state, unions won a federal court ruling that required a hospital to make the flu shots part of collective bargaining. And in Cincinnati this fall, 150 workers with TriHealth hospitals reportedly faced termination for failing to get the shot. A spokesman wouldn't say how many ended up losing their jobs but said many just needed time to get their paperwork in.

Calhoun, the nurse, said she generally believes in vaccines and encourages her patients to get them. Married and raising children in Crystal Lake while working part time, Calhoun said she has never gotten the flu shot in her 11 years as a nurse at Alexian Brothers Medical Center. She said that whether the shot is safe or effective is beside the point.

The Illinois Medical Patients Rights Act states that patients have the right to refuse any medical treatment, and Calhoun said she believes that also gives her the right to refuse the flu shot. If hospitals can force workers to inject themselves with a foreign substance, she wonders, what might other businesses someday require?

Like most hospitals, Alexian allows exemptions for medical or religious reasons. But medical exemptions are restricted to specific conditions, such as severe allergies to vaccine ingredients like eggs, and they must be verified by a doctor. Religious objections must be detailed and signed by clergy. Those with exemptions must then wear surgical masks while near patients.

Since Alexian instituted the policy, Frey said, the rate of vaccination among its workforce of 6,700 has gone from about 60 percent to 99.9 percent. The hospital's vaccination deadline is Friday.

Despite the numbers, Calhoun claims many co-workers share her opposition but are too afraid of losing their jobs, so they either get the shot or falsify documents. Calhoun refuses to lie, and that leaves her facing a lonely fight. Alexian officials said they believe she is their only employee to flat-out refuse.

"Everybody is like, 'I believe in what you're saying, but I've got to feed the kids,' " Calhoun said.

Officials counter that medical workers hold a special responsibility to the public. For that reason, the state Department of Health requires hospitals to establish employee health programs that include required immunizations for other diseases.

In 2009, Loyola University Health System in Maywood and Rush University Medical Center in Chicago became the first hospitals in Illinois to make flu shots mandatory for employees. Officials at both facilities said the programs have worked well with little push-back. Dr. Jorge Parada, head of infection control at Loyola, estimated that maybe a dozen people have left or lost jobs because of it.

He compares the flu shots with a host of higher standards for medical workers, such as strict hygiene for treating people with AIDS. Many careers come with safety mandates, he pointed out, likening it to construction workers wearing steel-toed boots or hard hats.

"Not everyone has the same rights and responsibilities," Parada said. "A nurse is not your average Joe, no matter how much she may wish she was."


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