ED nurses may resist vaccination programs

When researchers at Grady Health Systems in Atlanta surveyed ED nursing staff’s knowledge, attitudes, and practices regarding pneumococcal vaccination, they found that nursing knowledge was limited, reports Jennifer Drew, MSPH, data manager/ analyst for the ED’s pneumococcal vaccine intervention project.

Almost 90% of respondents agreed that ED nurses share in the responsibility of addressing the disease prevention needs of their patients, she notes. However, only 41% of nurses surveyed indicated that pneumococcal vaccination would be welcomed by the ED nursing staff, and about half (49%) responded that giving vaccines would hinder patient flow.

"This suggests that there would be some resistance from the nursing staff regarding the implementation of a vaccine initiative in the ED," says Drew, whose ED currently gives flu and pneumococcal vaccines by protocol.

To help alleviate this problem, find an ED nurse to be the vaccine "champion," which will help generate buy-in from the nursing staff, she recommends.

In big EDs, it may be cost-effective to have a nurse whose only job is immunization, suggests David Slobodkin, MD, MPH, FACEP, assistant professor of health policy and administration at the school of public health at the University of Illinois at Chicago and an ED physician at Freeport (IL) Memorial Hospital. "That nurse might not need to come from the ED staff but could be from the local health department or hospital infection control or employee health," he says.

If the duty of checking a patient’s immunization status and administering vaccines falls to staff nurses, it may be overlooked, advises Sandra Cunningham, MD, FACEP, associate director of the pediatric ED at Jacobi Medical Center in Bronx, NY. "That job may become a nonpriority, so you may not be very successful," she says. "We were funded by the state department of health to hire an immunization nurse, which was her only duty."

If you perform a large number of immunizations, the program may pay for an immunization nurse, says Cunningham. In her case, the state department of health’s Vaccines for Children program pays for the vaccines, and Medicaid pays an administration fee. "Those fees would have paid for the nurse," she explains. "So if you are in an area with poor immunization rates, then you could theoretically support an immunization program financially."