Declination forms sticking point in flu vaccine debate
ACOEM says requiring forms could be coercive
The debate over whether health care workers with direct patient contact should be required to receive flu shots rages hotter and hotter as flu season draws closer and some concern that we are in danger of a pandemic grows. One component to that debate is whether workers who refuse the shot should be made to sign declination forms.
Those who oppose mandatory shots, favoring education and voluntary vaccinations, say requiring a declination form in lieu of a vigorous education program could turn what should be a positive health decision into one pitting employee against employer.
Those in favor of the forms say they are another tool in educating and encouraging employees to get vaccinated and to protect the employer when workers choose not to have the shots.
"There are published studies showing that you can double flu vaccination rates with good interactive flu vaccine workshops where workers have a chance to have their questions answered and numerous myths dispelled," says Bill Borwegen, MPH, occupational health and safety director for SEIU.
And even among the best educated health professionals, there are misconceptions, he points out.
"I know that a recent study found that even [some] registered nurses think they can get the flu from the inactivated flu virus," he says. "I worry that requiring declination before prescribing a comprehensive educational campaign is putting the cart before the horse. That's why ACOEM [the American College of Occupational and Environmental Medicine] has come out against theses bureaucratic, time-consuming records."
Forms can be viewed as coercive
The goal behind a declination form is to record that the employee was offered the flu vaccine (declination forms are used for other types of vaccines, as well, including hepatitis) and, after being informed of the risks to him or her, as well as others, declined it. (See sample form.)
ACOEM, in a position statement on mandatory flu vaccines issued in the summer of 2005, doesn't argue the merits of employee-sponsored vaccination, but does come out against mandating flu shots.
"Ample reasons exist for employers to sponsor influenza vaccination programs for their employees and to vigorously pursue strategies to maximize participation," ACOEM stated. "However, the ACOEM believes that mandatory influenza vaccination for health care workers is not justified for several reasons — the vaccine itself is variably effective; vaccination does not preclude the need for other controls; and a coercive program has the potential to harm the employer-employee relationship."
Declination forms could be seen as part of a coercive program, ACOEM says.
"It has been suggested that health care organizations should require employees who refuse vaccination to sign declination forms," the ACOEM statement continues. "Influenza control can be successful with creative programs that employ the 'carrot' rather than the 'stick,' while still respecting the rights of both patients and employees."
More paperwork to deal with
As with any other new level of documentation, there's the paperwork question. Hospitals with a few thousand employees foresee hours of work to document and store the declination forms.
"Our space is limited, and to have these additional pages filed to every chart every year — not to mention the time required to sort and file them," says Kristen L. Steivang, RN, MSN, APRN-BC, APNP, an employee health services nurse practitioner at St. Mary's Hospital Medical Center in Madison, WI. "[It's a] great idea in theory, but have all the logistics been sorted out?"
ACOEM also views declination forms as an unnecessary burden on occupational health departments.
"There is no evidence to suggest that such programs will increase compliance, and the burden of requiring compliance from those who have already chosen not to participate would tax employee occupational health resources that could otherwise be devoted to positive reinforcement for compliance," ACOEM stated.
The debate over whether health care workers with direct patient contact should be required to receive flu shots rages hotter and hotter as flu season draws closer and some concern that we are in danger of a pandemic grows.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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