Winter is coming. (Apologies to Game of Thrones).

In Australia, summer is over and the deciduous trees are losing their leaves.

And workplaces are offering the annual vaccination for influenza to their employees.

The annual influenza vaccination of health care workers leads to a reduction of mortality among the patients they care for.

Incredibly, vaccination rates among health care workers is very low.

In some instances, it is only 4% with the highest rate of vaccination being only 40%.

Nurses have a lower rate of vaccinations than physicians, despite having a closer patient contact.

When asked why they decline the influenza vaccination, health care workers cite as reasons;

  1. adverse reactions, 
  2. perceived lack of susceptibility, and 
  3. lack of vaccine effectiveness.

The obvious response is that educational intervention would fix these concerns.

But being provided with educational sessions about vaccinations that address these concerns and being provided with easier access to the vaccine, nurses have still shown an alarming resistance to being vaccinated.

One study asked nurses to further explore the reasons why they decline the vaccination.

In a qualitative study, nurses cited three connected themes:

i. To maintain a strong and healthy body

Some nurses did not perceive influenza as a threat to them personally and did not think that a vaccination was necessary.

Others felt that the vaccine would not promote their health due to a lack of efficacy, or would cause negative side-effects, or weaken their immune system.

ii. Maintain decisional autonomy

Pressure from superiors to be vaccinated lead to a perverse response in some nurses that they would not be vaccinated as their superiors were considering the patients before them.

They also wanted to protect their body’s integrity by deciding for themselves whether they would be vaccinated. 

Some also argued that it was their right to fall ill, if that is what they wanted.

iii. Experience an untrustworthy environment.

Nurses had a lack of trust in the efficacy and safety of the vaccine.

As well as a lack of trust in the health authorities promoting the use of the vaccine.

The study said that

“Some nurses argued that there was more than one virus and the viruses undergo mutations. Since the composition of the vaccine was only based on assumptions of what this season’s influenza virus would look like and the fact that the development and production of the vaccine had to happen very quickly every year, they thought the vaccine would unlikely be effective…”


“ …the vaccine is not perceived as beneficial but in contrast even seen as a potential danger to their health. Many of the interviewed nurses for example believed people regularly became sick because of vaccination, contrary to the evidence on this issue.” 

The view was also expressed that the vaccination was a scam and a conspiracy.

Disgracefully, nurses had little awareness about why the vaccination would protect vulnerable patients.

The study concludes

“Nurses tend to rely on conventional health beliefs rather than evidence based medicine when making their decision to decline influenza vaccination. “

As the profession who has the most contact with vulnerable patients, nurses lose creditability when views are expressed about vaccination that are at odds with evidence based practice.

Picking and choosing facts are not options if nurse’s behaviour causes unnecessary harm.

To learn more about unnecessary harm:

Pless, Anina, et al. “Reasons why nurses decline influenza vaccination: a qualitative study.” BMC nursing 16.1 (2017): 20.