The state of New York is requiring health care providers to get flu vaccinations, a move that is causing considerable controversy within the nursing profession.

It also could end up costing nurses their jobs.

Effective Aug. 13, an emergency regulation adopted by the state Department of Health (DOH) requires all hospital, home health and hospice staff members to receive annual flu vaccination by Nov. 30.

In a letter addressed to health care facility administrators Aug. 26, state officials said exceptions only exist for those allergic to the vaccine or in the event the state determines there is an insufficient supply of vaccine for the year. At least for 2009, the required flu vaccination regime will immunize against H1N1, which is expected to be made available in October.

Health care workers have contacted ADVANCE claiming the new rule is a violation of their civil rights as U.S. citizens, since the state expects those who don't comply to be staffed only in areas where they wouldn't pose a health risk to patients should they contract the flu and be disciplined in a manner similar to someone who's unwilling to follow protocol - which some are led to believe means a fast track to termination.

"I am a registered nurse who is being told [by my facility, via letter] that I will be fired if I do not get a flu vaccine," said Marie-Dominique Toussaint, RN, a New York hospital nurse. "I have never gotten the flu. I have never taken a flu vaccine. I am relatively healthy and choose not to be vaccinated knowing I may or may not get the flu someday. It's a 'risk' I take and it's mine to take."

Fight Against Flu Shots
Toussaint said she's unsure if she will acknowledge and meet the deadline. She's reportedly not alone.

Officials with the New York State Nurses Association (NYSNA) told ADVANCE they've been inundated with phone calls from members who have refused to be vaccinated to date.

Though NYSNA officials oppose the mandate, they say they are in a precarious position when suggesting how nurses should proceed.

"We cannot recommend our nurses to go against state law," said Tom Lowe, health and safety representative for the NYSNA. "But we've not been able to have the rule sundown, expire or be rescinded, as we would like."

Speaking on behalf of the NYSNA's 37,000 registered nurses, Lowe and Renee Gecsedi, the association's director of education practice and research, provided testimony before the state's Hospital Review and Planning Council Codes and Regulations Committee Sept. 17 in New York City, urging that while they agree flu vaccination should be recommended and expected of healthcare providers, they don't agree anyone should be forced to be immunized as a condition of employment.

"The Patients' Bill of Rights includes the right to refuse medication," reads the official statement by the NYSNA on its Web site. "The dedicated workers providing care should have the same rights as their patients."

Also of particular contention with NYSNA is that DOH members themselves are reportedly not required to get vaccinated.

"If only nurses and other health care personnel had this choice," the statement continues. "President Barack Obama stated there is no intention to make the H1N1 vaccine mandatory. Nurses and other healthcare personnel are being bombarded with conflicting messages: Is there an emergency that requires mandatory vaccination or is there not?"

Educational Efforts
Instead of requiring healthcare staff to be vaccinated, the NYSNA and New York Committee for Occupational Safety and Health (NYCOSH), a nonprofit coalition of 200 local unions and more than 400 individual workers, physicians, lawyers and other health care and safety activists, argue the state should be focusing its efforts on flu education and staff training.

"The way [the state] is going about this is ill-advised and unproductive," said Joel Shufro, executive director of NYCOSH. "We're not opposed to [health care providers] getting vaccinated; we're opposed to it being mandatory. Staff should be educated and offered training programs that would allow people to make their own decisions.

Additionally, Lowe suggests a need for more education among the general public first.

"Efforts should be spent in the community, not at the end of the health care continuum," he said. "We've been told that the state has exhausted all means [in preventing mandatory vaccinations], but we weren't involved in any discussions. This all came as a complete surprise. And our nurses are angry that they didn't have any input. As it stands, it seems to make nurses a public-health enemy, and is against their rights to choose their own healthcare.

Not everyone agrees.