Nurses Express Safety Concerns About H1N1 Vaccine

By Jacob Molyneux, blog editor

Nurse blogger Not Nurse Ratched has written a post on her decision not to get the H1N1 vaccine shot until she is more convinced of its safety.

I’m just urging caution against the knee-jerk fear reaction that is, no doubt, going to make hordes of people swarm out to clamor for this vaccine. I’ll be watching for more data on it and might modify my decision, but for now I’m going to just say no.

Judging from responses to a recent post we ran on the topic (“cancel my subscription” appeared more than once), the loudest clamor may be from those who are driven by fear of the vaccine rather than fear of the H1N1 virus. In the post in question, Doug Olsen, a nurse ethicist, examined the ethical side of the question of whether or not nurses should get vaccinated. 

(Whether or not you agree with Olsen’s guarded conclusion in favor of vaccination, his post demonstrated how a professional ethicist uses a set of concepts as tools—not to come up with a definitive answer that can be called “right” or “wrong” but instead to examine the moral dimensions of a decision. We hope that some of the concepts he used will be seen as tools to help nurses make their own informed decisions.) 

By way of update, here’s an addendum we received from Olsen that addresses some of the concerns about vaccine safety expressed in the various comments:

Any obligation of nurses to protect the patient by getting flu vaccine depends on trust in the science and in the system for doing and reporting the science. Reasons for not trusting the system run the gamut from easily dismissed conspiracy theories to healthy, well-founded skepticism. My own skepticism is at an all-time high after my cat’s experience (as described in my previous post). Despite this, it’s my personal feeling, based on a trust of the system, that the risks to self are outweighed by the apparent risk to others from an uncontrolled pandemic—making vaccination the right thing to do.

I deliberately did not answer the question of whether vaccination should be forced, as this is a very different issue (for a bit more on that, see my 2006 article, “Should RNs Be Forced to Get the Flu Vaccine?”). It may be worth noting that other forms of vaccination are required as a condition of employment, and some states require seasonal flu vaccination for nurses.

I agree with “lin, rn,” who commented that the danger in presenting ethical decisions as risk-to-benefit calculations is that it gives an appearance of simplicity to decisions that are anything but simple or mathematical. Assessment of risks and benefits is subjective and related to our nonquantifiable values. Futher, there is never enough “data” or certainty to reduce the decision to math. I believe that in ethics, “risk-to-benefit decisions” are more metaphor than math.

With H1N1 likely to spread more widely this fall, and the possibility of more pandemics in the future, this is a topic we should be thinking and talking about. Finding the right balance between personal freedom and professional obligation is not easy, but it deserves our attention.

We hope you’ll join the conversation on this important topic as the dangers actually posed by the H1N1 virus become clearer and a new vaccine is closely monitored for possible adverse effects.

(Update, September 21: As New York State mandates H1N1 flu vaccinations for health care workers, experts and health care workers continue to have a widely varying set of responses on the topic . . . Update, October 27: AJN‘s poll about whether nurses should be mandated to receive the vaccine had some pretty one-sided results. Our most recent post on the topic, which looked at one of the several reasons nurses have given for not wanting the vaccination to be mandatory, also notes that last week a New York State judge temporarily halted the mandatory vaccinations.)

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Amy Deimel January 15, 2013 at 11:04 am

    Cochrane Database Syst Rev. 2010 Jul 7;(7):CD001269. doi: 10.1002/14651858.CD001269.pub4.
    Vaccines for preventing influenza in healthy adults.
    Jefferson T, Di Pietrantonj C, Rivetti A, Bawazeer GA, Al-Ansary LA, Ferroni E.
    Excellent objective review of current state of influenza vaccine data…conclusions currently reveal that flu vaccines are ineffective at preventing flu symptoms.

  2. […] posts: (automatically generated)Vaccine Wars Ensue as H1N1 Mutates – Just Alarmist Sci-Fi Fantasy?Nurses Express Safety Concerns About H1N1 VaccineMid-October Rainy Thursday Web RoundupCampuses Buckle Down for Long Flu […]

  3. AJN Vaccine Poll Results « Off the Charts October 21, 2009 at 1:31 pm

    […] from comments we received in response to this and other posts about the H1N1 vaccine, we surmise that not every nurse who answered no is actually opposed to […]

  4. Dave October 19, 2009 at 8:11 am

    Nobody is being forced to get H1N1 vaccine. It is simply being made a requirement of certain workplaces. Don’t like it ? Don’t work there.

  5. rn in michigan October 5, 2009 at 12:24 pm

    You need to read what is in the vaccines before taking them. Read the package is scary). Why did the pharmaceutical companies have to get immunity if they were not concerned about safety of their products effects? Ever read Russell Blaylock’s (a neurologist) comments on what happens to your body as a result of vaccination? If someone told you to take a dose of mercury, would you do it? In most vaccinations, that is what you are taking…year after year. There has been peer reviewed research done also showing that since people typically have less vitamin D in their systems during this time of year (less sun exposure) their immunity drops and they have more of a propensity to get the flu or colds. Vitamin D does not make money for the pharmaceutical companies. Vaccinations do. Now it is out that since people who took the flu shot (research in Canada) they may have less resistance to the h1n1 virus.

  6. […] Nurses Express Safety Concerns About H1N1 Vaccine Is It Ethical for a Nurse to Decline the H1N1 Vaccine? […]

  7. emily September 27, 2009 at 7:25 pm

    I have been getting the seasonal flu vaccine for 6 years now and will continue to get it but I will not be forced into getting the H1N1 vaccine. I do not believe that it has been tested well enough and forcing healthcare workers to do something that they do not believe in is an infringment on their rights.

  8. Lucy, NY RN September 25, 2009 at 5:00 pm

    I have taken the flu vaccine for several years and have never had a problem with it. However I do have more concern about the H1N1 vaccine and would like to see more research. The problem is NY State has MANDATED that I take it and may be FORCED to do so before that research is in. Our hospital administration hasn’t decided what action they’ll take if employees refuse the vaccination, but many are concerned they will lose their jobs. We also find it interesting that doctors are of course excluded from this mandate as they are not “employees” of the hospital even thought they are exposed to far more patients then we are in the course of their work week. People feel their rights are being trampled on and there is a lot of talk about hiring lawyers. Given the safety of this vaccine has not yet been truly established, is it fair to expect us to give over to the government the right to decide this for ourselves?

  9. […] Editor’s note: for a follow-up post on this topic, with more reader comments, click here. […]

  10. jm September 17, 2009 at 12:38 pm

    A good question. According to the latest news release from the U.S Food and Drug Administration (FDA) about the vaccine approval (two days old now), “People with severe or life-threatening allergies to chicken eggs, or to any other substance in the vaccine, should not be vaccinated.” Here is the full document from which I took this quote.
    -Jacob Molyneux, blog editor

  11. Judy Alexander September 16, 2009 at 2:54 pm

    No body has ever mentioned the effects if the person is allergic to eggs, as with the regular flu vaccine. Does the H1N1 have the same effects? Does it mean that that person should not have it?

  12. jm September 16, 2009 at 12:58 pm

    An excellent and reliable source, BMJ, has an article that’s worth a look. The article is called “Swine flu vaccine a ‘thousandfold’ safer than the virus, say experts.”
    -Jacob Molyneux, blog editor

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  14. Peggy September 9, 2009 at 7:18 pm

    I would get the seasonal flu vaccine if requested by my employer but prefer not to get the H1N1 vaccine until futher testing has been done.

  15. ninjanurse September 9, 2009 at 6:11 pm

    I work in home care. Last winter several of our clients got pneumonia. It was a very bad year for colds, and people at both my jobs were coughing and calling in.
    This year I’ll get the vaccine. I haven’t had the flu in over a decade, but seeing how vulnerable my clients are makes me think it’s a good bet.
    My daughter is in school, and I’ll recommend her to get it too. She doesn’t have time to be sick for weeks.

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