INFLUENZA VACCINATION BY REGISTERED NURSES 2004
This Position Statement was approved by ARNNL Council in 2004.
Influenza Vaccination by Registered Nurses Immunization programs are recognized to be one of the safest and most effective types of health prevention strategies available (Canadian Nurses Association, 2001). In particular, the influenza vaccine has been scientifically proven and universally acknowledged as an intervention which: reduces medical visits and hospitalizations for respiratory problems, reduces antibiotic use, decreases mortality rates in people living in institutions, and lowers adult work absenteeism rates (Health Canada, 2003b). Adverse reactions are reported to be rare and primarily occur in individuals who have egg allergies. Health Canada encourages all individuals to protect themselves and their dependents from influenza by getting the flu shot and adhering to recommended infection control practices, including diligent hand washing. In particular, the Canadian Immunization Guide, (Health Canada, 2002) identifies a goal to immunize at least 90% of the high risk population. Unfortunately, only about 45% of the high-risk population receive influenza vaccination annually. With the emergence of SARS, the definition of high risk and the desired percentage of the population to be vaccinated may expand (Health Canada, 2003a). Immunization is an approved competency within the scope of practice for Registered Nurses in Newfoundland and Labrador. ARNNL believes that nurses play an important role in supporting safe, cost-effective influenza vaccination programs in a variety of settings including: community, long-term and acute care facilities, and occupational health programs. Increasing public accessibility is a benefit of nurses providing influenza immunization as: 1. Nursing services are available and accessible in all regions of the province. 2. Nurses are trusted and recognized for their role as educators and client advocates. This may increase public acceptance by allaying fears or dispelling myths. The following guidelines provide information to direct quality, safe nursing practice in this area. Guidelines Competence RNs are expected to practice in accordance with the Standards for Nursing Practice in Newfoundland and Labrador (ARNNL, 1995). Therefore all nurses administering the influenza vaccine must have the necessary knowledge, skill and judgment required to competently perform this function. In particular nurses require: Knowledge of the principles of infection control. Knowledge of the vaccine, risks and benefits, recommended schedules. Knowledge of target populations. Knowledge of documentation policies. Competence to administer the vaccine and to manage reactions. Competence to provide education to clients and families so they can make informed choices, recognize reactions or complications, and act appropriately. Individual RNs make current, evidence based decisions on immunizations by following recommendations from: the National Advisory Committee on Immunization (NACI), provincial immunization guidelines, employer policies, and relevant product monographs. Quality Professional Practice Environments support safe and competent nursing practice in the provision of the influenza vaccine by having mechanisms in place to assist nurses to identify their learning needs and attain required competencies. 1 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) 753-6040 1 (800) 563-3200 Fax: (709) 753-4940 info@arnnl.ca ARNNL.CA
Association of Registered Nurses of Newfoundland and Labrador Authority The authority for the Newfoundland and Labrador immunization program comes from the Department of Health and Community Services through the Communicable Diseases Act, 1998 (Government of Newfoundland and Labrador, 2002). The provincial Medical Officer of Health, in collaboration with an advisory committee, makes decisions about seasonal vaccination programs in consideration of the National Advisory Committee on Immunization recommendations. Immunization programs are then implemented within the Regional Health Care Boards under the authority of the local Medical Officer of Health and/or the identified person or committee within the specific board or program (e.g. Medical Advisory Committee, V-P medical services, program/site medical director/advisor). Client specific prescriptions are not mandatory as the influenza vaccine is listed as a schedule II product in the Newfoundland and Labrador Drug Schedules (Newfoundland Pharmaceutical Association Regulations, 2003). However, the accepted approval process for nurses to administer the vaccine within employing agencies should be identified in nursing policy. In community health settings approval is often validated by communication from the local Medical Officer of Health. In acute or long term care settings approval may be provided in a variety of formats such as client specific orders or through pre-approved medical directives or standing orders. In some institutionally based ambulatory nursing clinics where there are no physician services, agency policy can authorize client requests, as acceptable authority for nurses to administer the vaccine. Quality Professional Practice Environments support safe and competent nursing practice in the provision of the influenza vaccine by articulating the parameters for immunizations. This includes identification of the accepted vaccine for the season, dosage, target populations, contraindications, guidelines for addressing adverse events, and the accepted process for administration approval. Consent As with any aspect of nursing care, informed consent is necessary before administration of the influenza vaccine. Quality Professional Practice Environments identify the parameters of a valid consent, including whether it is to be written or verbally obtained and by whom. ARNNL supports nurses, with the necessary competency and authority within their employing agency, obtaining informed client consent for the influenza vaccine. 2 ARNNL.CA 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) 753-6040 1 (800) 563-3200 Fax: (709) 753-4940 info@arnnl.ca
Influenza Vaccination by Registered Nurses References Association of Registered Nurses of Newfoundland and Labrador [ARNNL], (1995). Standards for Nursing Practice. St. John s: Author. Canadian Nurses Association, (2001). Nurses and immunization: What you need to know. Nursing Now: Issues and Trends in Canadian Nursing, November (12). Ottawa: Author. Government of Newfoundland and Labrador, (2002). Immunization Manual. Disease Control and Epidemiology, Department of Health and Community Services, St. John s: Author. Health Canada, (2003a). Learning from SARS: Renewal of public health in Canada. Ottawa: Author. Health Canada, (2003b). National Advisory Committee on Immunization: Statement on influenza vaccination for the 2003-2004 season. Canada Communicable Disease Report-CCDR, August 15, (29). Ottawa: Author. Health Canada, (2002). Canadian Immunization Guide, 6th ed. Ottawa: Author. Newfoundland and Labrador Pharmaceutical Association, (2003). Regulations: Drug Schedules I, II, and III. St. John s: Author. Resources College of Registered Nurses of Manitoba, (2002). Immunization: Fact Sheet. Winnipeg: Author. Saskatchewan Registered Nurses Association, (2003). Guidelines for immunization administration and immunization programs. Regina: Author. www.hc-sc.gc.ca/pphb-dgspsp/drd-dmr/index.html www.hc-sc.gc.ca/pphb-dgspsp/naci-ccni/index.html www.healthy.nf.ca/ www.influenza.cpha.ca/ 3 55 Military Road St. John s NL Canada A1C2C5 Tel: (709) 753-6040 1 (800) 563-3200 Fax: (709) 753-4940 info@arnnl.ca ARNNL.CA
55 Military Road St. John's NL Canada A1C 2C5 Tel (709) 753-6040 1 (800) 563-3200 (NL only) Fax (709) 753-4940 info@arnnl.ca arnnl.ca