1. Child Health Evaluation and Research Unit
Division of General Pediatrics, University of Michigan
Nurses’ Knowledge, Attitudes and Practices Related to Influenza Vaccination
                                                                                                              
Sarah Clark, University of Michigan
Anne Cowan, University of Michigan
Pascale Wortley, CDC

2. Background Influenza vaccination of healthcare personnel recommended
Vaccination rates are low
                                                                                                              

3. Learning Objectives
Identify reasons that nurses do not receive influenza vaccine
Identify worksite policies related to influenza vaccination

4. Methods – Study Design
Mailed survey of licensed 2000 RNs in four states (CO, FL, MO, PA)
Random sample of 500 RNs from licensure file of each study state

5. Methods – Survey Instrument
17 questions on the following:
Receipt of influenza vaccine/reasons why
Worksite policies on influenza vaccine
Relevant knowledge and attitudes
Demographic characteristics

6. Methods – Survey Administration
Data collected Jan-Feb 2006; questions referred to influenza season
Two survey mailings
Overall response rate 72%
72% CO, 65% FL, 76% MO, 76% PA

7. Results Practice Characteristics Total CO FL MO PA
Provide Inpatient Care
73%
75%
78%
69%
70%
Influenza Risk Level for Primary Patient Population
High-risk patients
52%
49%
59%
50%
53%
Medium-risk patients
33%
32%
28%
36%
34%
Low risk patients
15%
19%
13%
14%

8. Results Influenza Vaccination Status State Variation 59% vaccinated
41% not vaccinated
State Variation
CO and MO: 64% vaccinated
PA: 56% vaccinated
FL: 48% vaccinated

9. Results % Vaccinated by Respondent Characteristics Age < 50 years
54%
0.0007
50-64 years
64%
 65 years
78%
Have Chronic Condition No
56%
<0.0001
Yes
73%
Patients’ Influenza Risk Level
Low-risk
38%
Medium-risk
High-risk
67%

10. Results Primary reason(s) for vaccination
95% protect myself from illness
74% protect my patients from illness
19% member of target group for vaccination*

11. Results Primary reason(s) for vaccination
95% protect myself from illness
74% protect my patients from illness
19% member of target group for vaccination*
9% local epidemic/bad flu season
3% workplace mandate
15% other (e.g., protect family from illness)

12. Results Primary reason(s) against vaccination
39% concern about adverse reactions
19% small chance of contracting influenza
18% limited contact with high-risk patients
18% vaccine is not effective enough

13. Results Primary reason(s) against vaccination
39% concern about adverse reactions
19% small chance of contracting influenza
18% limited contact with high-risk patients
18% vaccine is not effective enough
17% too busy/forgot
6% contraindications
24% other (supply/access, “don’t want one”)

14. Proportion that “Strongly Agree” Among Those…
Results
Attitudes of Vaccinated vs Not Vaccinated RNs
Proportion that “Strongly Agree” Among Those…
Vaccinated
Not Vaccinated
Influenza and its complications can be serious
71%
50%
Benefits of flu vaccine outweigh risk of side effects
51%
16%
Flu vaccine is effective in preventing influenza-related hospitalizations in vaccinated persons
36%
15%
Systemic side effects from flu vaccine are rare
27%
10%

15. Proportion that “Strongly Agree” Among Those…
Results
Attitudes of Vaccinated vs Not Vaccinated RNs
Proportion that “Strongly Agree” Among Those…
Vaccinated
Not Vaccinated
HCW vaccination can prevent the spread of influenza to patients
53%
23%
HCWs have a professional responsibility to get an annual flu vaccine
39%
10%
HCWs are at higher risk of getting influenza than the general public
46%
26%
Hospitals / practices should track whether HCWs receive flu vaccine
41%
17%

16. Results Worksite recommendation on influenza vaccination
55% strongly recommended
19% recommended
25% somewhat or not recommended

17. Results Vaccination status and worksite recommendation
68% vaccinated when strongly recommended
37% vaccinated when not strongly recommended

18. Results Vaccination availability 95% vaccination available on-site
50% available during all work shifts
29% not available during all shifts
21% unsure

19. Results Vaccination status and availability
71% vaccinated when available during all shifts
47% vaccinated when not available during all shifts

20. Results Locations of on-site vaccination
55% employee/occupational health clinic
16% other fixed locations (ER)
38% congregate areas (cafeteria, conferences)
27% mobile carts, within units

21. Results Vaccination status by worksite options
72% vaccinated of those with multiple locations
56% vaccinated of those with single location
23% vaccinated of those with no worksite option

22. Conclusions Influenza vaccination rates higher among RNs who
Are in target groups for vaccination
Care for higher-risk patients
Believe vaccination will protect them and their patients from disease

23. Conclusions Influenza vaccination rates lower among RNs who
Are concerned about vaccine side effects
Believe the vaccine is not effective
Do not feel a professional responsibility to receive influenza vaccine

24. Conclusions
Worksite policies to promote influenza vaccination among nurses should:
Include a strong recommendation for vaccination
Make vaccination available during all work shifts
Provide multiple locations for vaccination