Guidance for LTC Leaders Planning to Implement an Influenza Vaccination Requirement Policy for Health Care Personnel to Improve Influenza Vaccination

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

While implementing a mandatory influenza vaccination policy for health care personnel is not required by the federal government or any regulatory agency, employers can influence the vaccination status of their employees.  “Influenza vaccination requirements work; they are the only intervention that have consistently raised influenza vaccination rates of the staff to near universal coverage.  In a national survey of health care providers, it was reported that HCP are most likely to be vaccinated when it is a work requirement (88.4%), followed by when a vaccine is recommended by an employer (65.1%). Vaccination rates are lowest when the employer does not require or issue a recommendation for vaccination (29.8%).  As of February 2018, 18 states have influenza vaccination requirements for all health care workers in LTCFs. Other health care systems have already required influenza vaccination. Many states have upheld these policies when they have been challenged in courts.”

The above comments are excerpted from a guidance document prepared by the Influenza Working Group of the National Adult and Influenza Immunization Summit as well as an adaptation from the Colorado Hospital Association’s Guidance for Developing a Mandatory Influenza Vaccination Program: and Roberta Smith, RN, MSPH, CIC, Infection Preventionist, Department of Epidemiology, Children’s Hospital Colorado (2011).

Guidance for Leaders/Administrators in Long-Term Care Facilities Who Plan to Implement an Influenza Vaccination Requirement Policy for Health Care Personnel to Improve Influenza Vaccination Coverage is an excellent tool for nursing homes, rehabilitation facilities, inpatient behavioral health facilities, assisted living facilities and long-term chronic care hospitals.

  • The purpose of this document is to provide guidance and information for leadership and administrators of long-term care facilities (LTCFs) who have made the decision to develop and implement influenza vaccination requirements for health care personnel (HCP) working in their organization and/or facility.
  • This document provides a framework (but not an exhaustive list) for major areas that should be considered when adopting a policy requiring influenza vaccination. In this document, specific policies may be included under an “influenza vaccination requirement”, such as making annual influenza vaccination a condition of employment for new hires and/or a requirement for existing HCP to either be vaccinated or wear a mask at all times during the scheduled shift (with the exemption of scheduled breaks out of resident living areas) for the duration of the influenza season.
  • The intended audience for this document is LTCF leadership and administrators, stakeholders and other staff responsible for policy implementation in LTCFs.

This 35-page document is a rich source of information and guidance on implementing a mandatory influenza vaccination policy.  In my humble opinion, this is an absolute must-read for all post-acute providers and leaders charged with the health, welfare and safety of all that live and work (clinicians and non-clinicians) in our country’s LTC facilities.  Influenza takes lives and greatly impacts absenteeism and productivity every year.  “Since at least the 2010–11 influenza season, HCP in long-term care settings have had the lowest reported influenza vaccination rates among all HCP.”

Here’s a thumbnail look at the table of contents:

  • Policies Requiring Influenza Vaccination of Health Care Personnel: Rationale and Supporting


  • Implementing an Influenza Vaccination Requirement Policy
  • Employee Engagement
  • Ethical Considerations for Implementing an Influenza Vaccination Requirement Policy for Health Care Personnel
  • Additional Resources
  • References
  • Frequently Asked Questions
  • Sample Policy
  • Sample Exemption Form

Additionally, there are links to policy statements supporting influenza vaccination requirements for health care personnel from the AMDA, American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Nurses Association, American Pharmacists Association, American Public Health Association, Association for Professionals in Infection Control and Epidemiology (APIC), Infectious Diseases Society of America, National Foundation for Infectious Diseases, National Patient Safety Foundation and the Society for Healthcare Epidemiology of American (SHEA).  One need look no further to see the value of requiring influenza vaccinations for HCPs!!

Take advantage of the information provided in this guidance document as we enter this and future flu seasons.