With some trusts taking a more punitive approach to flu vaccination, we unpick the RCN’s recent advice to safety reps
A new briefing on flu vaccination for RCN reps advises that organisations should “adopt a jointly agreed strategy which takes an incentivised as opposed to a punitive approach and which protects staff from any detriment in the workplace.”
Kim Sunley, RCN National Officer, says: “Partnership working is absolutely crucial when it comes to flu vaccination. We know that a lot of safety reps are already really involved in the planning stages and throughout the vaccination period.”
However, despite effective collaboration between managers and unions in most organisations, the flu jab continues to cause controversy in some workplaces.
One Kent trust recently suggested withholding sick pay for nursing staff who decline the vaccination. The proposal was dropped in the face of opposition from the RCN and other unions.
We need to be driving home a simple message about vaccination. It’s important to have it and if you can have it, do
Lesley Pallett, Vice Chair of the RCN Safety Representatives Committee, says: “We need to be driving home a simple message about vaccination. It’s important to have it and if you can have it, do.”
Offering incentives
Periodic suggestions that flu vaccination should be compulsory for NHS staff always generate debate.
Kim says: “There are lots of examples of organisations using an incentivised approach, which the RCN supports. Some have entered vaccinated staff into draws for prizes or extra annual leave.”
But elsewhere the RCN has been made aware of instances of bullying behaviour by managers who are intent on ensuring all staff are vaccinated, which Kim says is never OK.
There are lots of examples of organisations using an incentivised approach, which the RCN supports, such as entering staff for prizes
In a recent letter to chief executives, NHS England said staff who decline the vaccination should be treated with dignity, and the RCN asks reps to encourage members to report any instances of bullying behaviours and to respond to such reports on a case-by-case basis.
If there’s evidence of widespread organisational bullying, then it should be escalated through the appropriate trust channels.
The RCN’s briefing makes it clear that withholding sick pay from unvaccinated staff would be unlawful and should be challenged.
Lesley says that where managers do try to adopt heavy-handed approaches, reps should explain that encouragement is more effective than enforcement.
“If you don’t have the flu jab, you can still practise,” says Lesley. “We also need to recognise that some people might not be able to have the vaccine if, for example, they’re allergic to one of the constituent components.”
Protecting patients
NHS England advises that “more robust steps” should be taken to protect patients in higher-risk clinical environments by limiting their exposure to unvaccinated staff.
It says managers should consider redeploying staff working in these settings who have not been vaccinated to lower-risk areas, with those who have been vaccinated moving to fill the gaps.
Such settings include haematology, oncology, bone marrow transplant and neonatal intensive care.
Kim says: “We don’t oppose such redeployment but it should be without detriment to the staff member’s employment rights, including terms and conditions, and working arrangements.
We don’t oppose such redeployment but it should be without detriment to the staff member’s employment rights
“It must be a temporary move with the length specified, and redeployed staff assured that they have the right to return to their substantive post at the end of the defined period.”
The RCN's briefing for reps also points out that although nurses have a duty under their professional code to put the interests of their patients first, employers are responsible for ensuring they have sufficient, appropriately qualified staff to provide a safe service.
The briefing adds that it is reasonable for a staff member to refuse to move to an area where they could put their patients – and their registration – at risk.
Mounting pressures
It seems that with every passing year, flu and its effects become a target for increasingly concerted containment efforts. That is partly because of new emerging strains but also because the infection hits at a time when the NHS is exposed to massive strain.
“Flu forms a key part of the winter pressures,” says Lesley, “and it’s one way for employers, potentially, to address those pressures. Every year, there are the same issues – not enough staff, patients who are very poorly, nowhere to put them. So, flu vaccination becomes one of the key arguments – we’re prepared for winter pressures if we’ve got as many people vaccinated as possible.”
Flu forms a key part of the winter pressures and it's one way for employers, potentially, to address those pressures
A study published three years ago in BMJ Open Respiratory Research confirmed that staff attitudes to flu vaccination were strongly associated with its uptake. For some, a key reason for refusing vaccination was the belief that it would make them unwell. This year the RCN’s campaign Beat the Flu offers resources to help debunk such myths including a poster for reps to use in their workplaces.
Vaccination rates are moving in the right direction but uptake figures for England for 2017-18 show that only 64% of frontline NHS staff chose to be vaccinated. In some organisations, however, there is up to 90% uptake so clearly more can yet be done to ensure frontline nursing staff get the message.
Words by Daniel Allen
More information
The advice Briefing for RCN Workplace Representatives on Flu Vaccinations 2018/19 has been sent by email to RCN reps. It's also available online on the RCN reps hub.
