As the state prepares for the upcoming influenza season, the Massachusetts Nurses Association (MNA), the state's largest union of registered nurses and health professionals, strongly opposes a new policy being implemented by a number of hospital and health care employers calling for mandatory masking of healthcare workers as a component of a flu prevention program, and threatens to fire nurses who don't wear the mask throughout the hospital all day.
"Rather than focus on systems and policies that actually prevent flu transmission, many institutions are now focused on setting a misguided and ineffective policy which mandates that healthy healthcare workers wear a mask for eight to twelve hours while on duty if unvaccinated," according to a position statement approved today by the MNA/NNU Board of Directors. "We encourage nurses to become educated on the risks and benefits of the influenza vaccine and decide whether to vaccinate, but there is no medical evidence that the masking of nurses or healthy workers prevents the transmission of influenza."
"No one cares more about protecting the public health than nurses as we are on the frontlines in protecting our patients from all types of illnesses, including the flu, every day," says MNA/NNU president Donna Kelly-Williams, RN. "But we cannot and will not support useless policies, especially policies that are only designed to coerce nurses into doing something against their better judgment and policies that may cause them personal harm, with absolutely no benefit for any patients."
"The medical evidence shows that surgical masks are designed to prevent dispersion and are not designed to prevent inhalation of airborne particles containing virus, therefore masks would be more effective if placed on people who are coughing or sneezing, whether patients or workers," says Margaret O'Connor, an occupational health and safety specialist with the MNA/NNU. "Masking an asymptomatic nurse is neither preventive in the spread of infection nor appropriate."
O'Connor adds, "Under hospital masking policies, patients, visitors and vendors, who are more likely to be vectors of illnesses, are free to walk around facilities unmasked while nurses and others are forced to wear masks, with no benefit to the patient population."
The MNA/NNU position is strongly supported by a nationally recognized expert on the issue. "Mandatory masking in lieu of vaccination of healthcare workers as is being implemented in Massachusetts makes no sense and will do little to stop the spread of infection," says William Buchta , MD, MPH, who is a Fellow with the American College of Occupational and Environmental Medicine, and a medical director of employee occupational health Service at Mayo Clinic, and who was in Massachusetts two weeks ago to speak about flu prevention and vaccination programs. "There are a number of proven means of reducing hospital infections that need to be implemented, but this is not one of them."
In the last month, a number of hospitals have implemented the mandatory masking policy, including Anna Jaques Hospital in Newburyport, UMass Memorial Medical Center in Worcester, Lawrence General Hospital, Boston Medical Center to name a few. Since the policy has been implemented, the MNA/NNU has received dozens of calls and emails from nurses raising concerns about the policy. The organization has also received reports of nurses who have had negative reactions to the vaccine.
A case in point occurred a few weeks ago after the implementation of the mandatory masking policy at Boston Medical Center. Karen Higgins, RN, a critical care nurse with a history of asthma who has had negative reactions in the past to the flu vaccine, wrestled for days with the decision to take the vaccine or, if she refused, to be forced to wear a mask all day every day.
"I know that with my asthma, there was no way I could withstand wearing a mask for that long without compromising my health," Higgins explains. Higgins is a former president of the MNA/NNU and is the current co-president of National Nurses United, the nation's largest nurses union. "I was placed in an untenable situation. I decided to take the vaccine or face disciplinary action. The results were disastrous."
The day after taking the vaccine, Higgins began to feel ill, the following day, while at work she developed severe respiratory distress and was sent to the emergency department, and later she was admitted to her own intensive care unit, this time as a patient to restore her breathing. She was out of work for the next four days.
"I was incensed," Higgins says. "I was just lucky that I was in the hospital when I had the reaction. If I was at home alone, I could have died. This never should have happened, and no nurse should be forced to make this choice, especially when we know that masking provides no real benefit to our patients."
Healthcare facilities throughout the country are required to meet a 90 percent influenza vaccine rate among employees or risk losing a portion of Medicare reimbursement. The MNA/NNU believes that the practice of mandating a mask is a punitive, coercive way of bullying workers into vaccination to avoid being penalized for failure to reach the required vaccination threshold.
The Massachusetts Nurses Association recommends that all healthcare workers become educated about the benefits and risks of the influenza vaccine and consider immunization unless contraindicated for health or personal reasons. The organization supports the current voluntary influenza immunization program as directed by the Massachusetts Department of Public Health which has proven to be highly successful, increasing rates of flu vaccination in healthcare facilities.
In response to the masking policies, the MNA/NNU has been demanding to meet with management of facilities considering the policy to try and convince them to take a more balanced approach to flu prevention. In cases where hospitals have refused to discuss nurses' concerns, the MNA/NNU has filed grievances, pursued arbitration over the issue (in the case of the policy implemented at Anna Jaques Hospital), and pursued unfair labor practice charges with the National Labor Relations Board.
This week, the MNA/NNU filed a charge against Lawrence General Hospital, which unilaterally changed its policy, moving from a highly successful voluntary masking policy to a mandatory policy.
"There was absolutely no reason to move to the more punitive approach," says Patricia Rogers-Sullivan, RN, a nurse at LGH and chair of the nurse' local bargaining unit. "We had a 95 percent vaccination rate already with a voluntary policy. But now they want to intimidate our nurses into doing something that has no value to them or to their patients."
In opposing the masking policy, the MNA/NNU position statement outlines a number of steps hospitals can and should be taking to protect against the flu and many other infections.
Those processes should include:
- Ensure Safe and appropriate RN and support staff levels that allow for proper care of patients and infection control procedures. In fact, inadequate staffing is a major cause of all types of hospital acquired infections. Understaffing of RNs and other staff makes it more difficult to maintain appropriate hand washing and infection control procedures. Cuts in housekeeping staff make it more difficult to maintain sanitary conditions that will prevent the spread of infection in hospitals.
- Educate all staff to appropriate infection prevention practices.
- Practice good hand hygiene.
- Educate all patients, employees, vendors and visitors about the flu vaccine (VIS).
Voluntary Flu Vaccination -- The influenza (flu), vaccine is partially protective against three viruses. The published effectiveness rate of this vaccine gives individuals approximately a 50 chance of contracting the flu, but there are other influenza like illnesses (ILI), for which there are no vaccines. The current flu vaccine protects against the three viruses that are highly virule percentnt. The vaccine helps protect high risk patients, healthcare workers and the community.
- Establish and enforce guidelines by Environmental Services (housekeeping and food service staff), to include cleaning surfaces and disinfecting patient rooms. The staff need education on when, where and how to clean to prevent the transmission of influenza.
- Screen patients in the Emergency Department and mask patients-who are positive for influenza. After appropriate treatment, they may be well enough to be sent home to recover. If patients require admission, they need an isolation room with appropriate precautions.
-Isolate infected patients in private rooms, with air filters to prevent the spread of infection.
- Restrict visitors and vendors from close patient contact, or have them wear personal protective equipment when visiting a patient.
- Create better illness prevention policies! Nurses and health care workers need to be allowed to utilize sick time and stay home if they are ill, as recommended by the Center for Disease Control and Prevention (CDC). Nurses should not be disciplined for taking the time necessary to recover.
"With proper staffing and a commitment to many of the strategies recommended by infection control experts that we have included in our position statement, hospitals could really protect our patients and we support all those measures," says Kelly-Williams. "It's time for the industry to stop bullying nurses and to start listening to them so that our patients receive the care they deserve."
Source: Massachusetts Nurses Association