NZNO's Blog

Mask up or ship out?!


maskThe issue of vaccinations and the flu vaccination in particular has been on our agenda over the past few months, as it has been for the sector.  In 2015, despite improved uptake of the flu vaccination amongst DHB employees, one DHB (Waikato) has still taken a punitive approach to non vaccinated staff, insisting they wear masks when in direct patient contact or risk suspension and disciplinary procedures.

We felt at this time it might be appropriate to discuss the role of NZNO in this matter. Amongst our membership we have the full spectrum from those passionately in favor of vaccinations, to those equally against.  So should the union even have a view and if so on what basis?

So starting with the right not to be vaccinated – we all have that right.  Being injected against our will is assault, pure and simple.  In addition, when in receipt of healthcare, everyone is covered by the HDC Code of (patient) Rights.  This provides for the right to informed consent and the right to say “no”.  It also provides for the right to be treated with respect.  Given one role of NZNO is the legal protection of member’s rights, enforcing the right not to be vaccinated goes without question.

The issue of vaccination largely comes down to an individual view (I do or do not wish to be vaccinated because I…) or a collective one.  On the latter, there is both a public health good derived from vaccinations and an employment one. The former relates to the reduced spread of disease and therefore harm, especially amongst those in our communities who are most vulnerable, and the latter, lack of staff to treat the sick due to staff themselves being sick. And yes for the DHBs fewer sick days and so less cost, is attractive.

Evidence confirms that whilst not a perfect remedy, vaccination is the best mechanism we have to prevent the spread of disease and the human toll that disease represents. Herd immunity, where vaccination rates are high enough to stem the spread of disease and therefore protect a community, is the goal.

The flu vaccine is not 100% effective. Each year the vaccine must be reconstituted to capture the new strains of flu that emerge.  The flu virus is a nasty little beast that genetically morphs from year to year, hence its success as an organism!  As impressive as this may be, lets not forget, it also kills. Regardless of your view on vaccination, this virus is not the common cold we can all expect to suffer most years.  It is a serious and life threatening virus that has caused millions to die.

When the unions and DHBs (in the forum known as NBAG) collectively came together to investigate the issue what became clear was that a positive, educative and supportive approach to the issue of vaccinations was far more successful than punitive, threatening or negative.  If the overall motivation is community good through protection from disease, having people “on board” is going to more effective than the resistance a negative approach inevitably engenders.  This is not so much about vaccinations per se, but about how we approach the issue.

Acknowledging that employees can’t be required to be vaccinated, what about the DHBs ability to decide what to do with the non vaccinated staff?  In fairness NBAG didn’t even go there (at that time).  We agreed a positive and constructive approach was better and looked (amongst other things) to whether the unions had a role in leadership on this issue, thereby in effect avoiding a negative reaction that some DHBs might have in the face of non vaccination. The answer was yes: better to keep members out of trouble whilst recognising everyone has rights.

NBAG put out guidelines to the DHBs supporting a positive and educative approach, rather than punitive. And the unions agreed to support engagement with members on this issue.

So far so good. Unions avoided the punitive and inevitably adversarial approach DHBs might take against members: DHBs got our support on the vaccination process.

Interestingly, for all the concerns expressed by the DHBs, the uptake of vaccination by management was no different from the rest of the staff, confirming that we are dealing with a wider and more intrinsic issue than superficial review might suggest.

So why did Waikato DHB ignore NBAG advice and fail to engage with us on the issue?

Well Waikato DHB has an already evidenced poor culture when it comes to employee engagement, so probably no surprises there. It is sad, but this DHB continues to have a poor attitude towards their own employees on a number of fronts, including bullying.  And again, regardless of their personal views about vaccination, members have been almost universally concerned at how Waikato DHB is handling this matter.

We have made an application to the Employment Relations Authority to test the DHB’s policy on the basis of a failure to adequately consult prior to implementation. Not only is the issue of ignoring considered national advice on the matter concerning, a whole lot of other issues have arisen that, had proper consultation occurred, would probably have been worked through.  And these issues do need to be resolved, including:

  • What is “direct patient contact”?
  • How effective is mask wearing, including how often we need to change masks to be effective?
  • What of the effect on patient – staff communication through a mask?
  • Distribution of personal health information (vaccination status is health information).
  • What of patient and visitor vaccination status? Visitors can equally spread the virus (remembering the flu is communicable up to 14 days prior to symptoms emerging) so what is the point of just concentrating on staff?
  • If the patient is vaccinated, should the staff member have to wear a mask?
  • If such a public health issue, consistent application of measures are surely required? If that means short staffed areas being left without staff and services interrupted as a result, what is the balance between non vaccinated staff on duty and no service?

We could go on….  Waikato DHB’s approach is also causing resistance amongst staff, and could be self defeating. It is also exacerbating a prevalent negative culture in this DHB which is corrosive, damaging to staff and in need of change all issues of concern to us and our members.

So in summary:  Why are we involved?

  • Because members have rights and we are tasked legally with preserving those rights.
  • Because we also have a role to play in avoiding conflict and progressing matters on an evidence based and reasonable basis.
  • Because Union leadership is evidenced as being instrumental in assisting with positive change on issues such as this (and our own experience supports this).
  • Because at the end of the day our members want what is in the interests of not just themselves but their patients and communities. However as with most things in health, this is a more complex issue than a superficial glance might suggest, and we need to do the best we can to get it right.

18 thoughts on “Mask up or ship out?!

  1. Good explanation of the issues involved and NZNO’s approach to it all. Thank you.

  2. Southern dhb has just created a policy that sounds similar to Waikato, taking into effect next year. Of you choose not to be vaccinated you will need to read evidenced based information on vaccination and then you may be required to wear a mask for all patient contact during influenza season

  3. A very well written article, it shows that you have been out gathering information and are truly acknowledging how staff are feeling. I look forward to seeing how this goes. I can’t even express how pleased I am with the NZNO right now! Well done for being amazing advocates.

  4. Thanks NZNO for a great explanation and for supporting members who are being treated appallingly by their employers.

  5. What about the vulnerable children and patients we are meant to be caring for?

  6. if it comes down to the wire, staff should enmasse refuse to acknowledge or deny that vaccination has been given. If everyone groups together then strength is the greater ruler than the bully who will then back down.. If they use this as a power play, then what other issues will they then attempt to use bully tactics with. It wont just stop with vaccinations

  7. Congratulations on your stand on this issue. I totally support a persons right not to be subjected to mass vaccination. Its nice to have our rights acknowledged if nothing else. How many of the general public who visit and cohabit with these ” vulnerable patients” have been vaccinated? how would anyone know? Its easier to browbeat a captive work-group.

  8. Whilst I support vaccination of staff I think that it is important to keep the following in mind:
    1. Following vaccination, if you develop immunity it is not immediate but takes approximately 2 weeks.
    2. Less than 70% of those immunised will develop immunity – so don’t presume you are protected even if you are vaccinated.
    3. The annual vaccinations only contain 2-3 strains of influenza – the most prevalent in the northern hemisphere in the previous season. There are more strains of influenza in the community that you will not have been vaccinated for.

    Medical personnel have a poor uptake of free vaccinations. This is time when RDA, SMO, PSA and the NZNO should be standing to together to ensure all staff regardless of role are treated equally.

  9. Why don’t the DHB’s question staff as to why they choose to decline the flu injection?
    I have started to read the research articles not published by the money making pharmaceutical companies.
    They don’t know what the long term side effects are of having this injection every 12mths. Can it really be good for us having this injection of chemicals every year?

  10. I think it’s disgusting the DHB has been able to literally force employees to have a medication against their will.
    The comment about how waikato dhb has a record of bullying concerns me. I left the dhb at the start of year because of the way I was treated by my manager. I thought it was an isolated incident but obviously this dhb is getting a bad reputation.

  11. Hi, well written article.
    Firstly, how many sick days have been used by nurses, and hospital staff who have had the vaccine. ?
    No amount of mask wearing will protect staff from the sickness of the patients . We , as nurses have improved our hygiene standards with regards to hand washing, wearing protective gear etc , our approach to patients who come in to be isolated for various things has improved remarkably.
    What we as front health professionals face everyday from various patients to protect ourselves and those admitted, cannot come in the form of a vaccine.
    Being faced with incontinent patients, verbal and physical abuse, being vomited upon, coughed on, spat on, a vaccine does not protect from these things .
    The health boards should also take into account the mount of unpaid overtime, the missed breaks , the missed toilet stops the nursing staff go without everyday, to look after the patient…..I like to wear a mask to protect me from the patient, who sometimes have not been educated in standards of hygiene.

  12. I had the flu vaccine at the beginning of the flu season , and I am home sick today with flu like symptoms. This is the first year I accepted a flu vax, and the first time I have been sick with these kinds of symptoms for about 20 years. Just a bit of food for thought.

  13. Could this be an opportunity to test the theory that vaccinated staff will spend less time sick? As there is some polarity it seems a great opportunity to recruit a decent sized study nation wide. While we are there, why not do some regular blood tests on all the nurses involved in the study (vaccinated and unvaccinated) to see if the vaccinated nurses actually do sero-convert effectively, and record how many become infected (perhaps include lifestyle data, ie: smokers/non-smokers, drinking, diet, day/night shifts,etc) – and, establish if unvaccinated nurses have acquired immunity (early in the season and then later), and record the number that become infected also. We are in almost constant contact with common viral infections when working on the frontline and it would be a valuable study. It seems to make more sense to get the good science than to use ridiculous bully tactics that still leave patients vulnerable to vaccinated nurses who may be overconfident about their immune status. It may well be that unvaccinated nurses may be more cautious due to their awareness of vulnerability both for themselves and their patients?

  14. I totally endorse the previous comments by Jocelyn. I would like to know where the evidence for the effectiveness of this vaccine is and how robust a study (if any) has been. God knows there are,and have been, problems. Even WebMD admits incidence of GB Syndrome and the continued use of thimersol in vaccines.

  15. This command was first used in the U.S. World War II. When a soldier was told to “shape up or ship out,” it meant that he needed to do a better job or he’d be shipped overseas to a combat zone.

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