Practice Matters

What Works: Improving influenza vaccination compliance in an academic medical center

The Centers for Disease Control and Prevention (CDC) recommends all healthcare workers receive the influenza vaccination. The Post-Baccalaureate Nurse Residency Program and the Employee Health Department at the University of Colorado Hospital (UCH), an academic medical center, partnered to create a successful collaborative program to meet this goal. The program also sets up UCH for continued success because Colorado health authorities will make 100% compliance for vaccination mandatory by 2014. Although the influenza vaccination will be a state mandate, it also represents the course that responsible healthcare workers should take to protect patients, themselves, and their communities.

“Herd immunity”

The strength of any vaccine is in “herd immunity.” If everyone is vaccinated against the strain of influenza for which the vaccine was designed, the strain has limited ability to spread. Herd immunity is weakened significantly when even a small number of individuals are not vaccinated. A given strain has a chance to take root in an unvaccinated person, and even evolve into a different strain that would make everyone who comes in contact with this person vulnerable to influenza again. We are following evidence-based, best practice by implementing a 100% compliance expectation with influenza vaccination for all hospital employees and clinicians.

Nurse residents contribute to success

The chief nursing officer recognized that allocating resources for this endeavor would be challenging. She knew our hospital would be hiring a cohort of new graduate nurse residents just as the vaccine campaign began and offered the services of this cohort group to the campaign. The nurse residency program coordinator worked with the employee health director to create a collaborative opportunity for the new graduate nurse residents to help with the vaccination program.

The October 2012 cohort of nurse residents was divided into four groups of eight residents. The residents attended a 4-hour influenza vaccination clinic during their first few weeks of clinical orientation. An employee health RN, who led the group, discussed vaccination technique and required documentation. The sessions were held in a stationary influenza clinic, and the RN traveled with a roving cart through the hospital to reach staff members unable to leave their respective units. In addition to the new graduate residents, student nurses on rotation at the hospital also assisted with vaccine administration.

Return on investment

The return on investment favored this joint effort. New graduate nurse residents were paid for 4 hours as a part of clinical orientation. As nurse resident RNs, they are paid entry-level salaries and are therefore the most budget-friendly staff. Their participation in administering vaccines also reduced the amount of overtime hours that would have most likely been incurred by employee health staff. In addition, because the new graduate nurse residents were still on orientation, they did not play a role in the unit staffing numbers and therefore had no detrimental effect on the unit budgets or staffing patterns.

Clinical experience with intramuscular injections (IM) is not heavily emphasized in undergraduate nursing education, so helping with vaccines also gave the new graduate nurse residents an opportunity to practice a skill that is an expectation of a RN. A secondary gain realized by this program was articulated by an employee health nurse, who was impressed with the leadership role that some of the new graduate nurse residents provided to the student nurses. The new graduate nurse residents took advantage of the opportunity to mentor nursing students, which is an important quality for professional growth. In addition, involving new employees in a hospital-wide endeavor creates the feeling of unity and teamwork. One of the nurse residents said, “The recipients didn’t even realize that we were new graduates, but rather experienced nurses; we already felt a part of the hospital in the first few weeks of employment.” Finally, the new graduate nurse residents gained insight into the life-long career of service in dedicating time to a hospital-wide program from their home units.


Organizational support

Hospital-wide programs such as this require support from all levels of an organization. Part of the success of the process was in the clear and concise communication that preceded the program. Once the dates were confirmed by both employee health and the nurse residency program coordinator, each unit clinical educator was asked to place their residents in a 4 hour time slot. The schedule, located on the hospital intranet for easy access, was completed several weeks before the first clinic so each unit and the employee health department knew well in advance the influenza clinic staffing. The new graduate nurses were informed of their role and schedule during their first week in clinical orientation.

As of this writing, University of Colorado hospital has reached a compliance rate of 97.1% including 1080 faculty and house staff. The October 2012 cohort was able to administer in excess of 3000 vaccinations in a total of 16 hours of clinic time. This collaborative program has proven to be a great success measured not only by the high number of vaccinations provided by the nurse residents, but also the added benefits of contributing to the experience and skill acquisition for new graduate nurses and students. This successful collaborative endeavor will most likely continue each year during influenza season.

For more information, contact Mandy Moorer at Amanda.Moorer@uchealth.org.

Amanda Moorer is post-baccalaureate nurse residency coordinator, Carolyn Sanders is vice president of patient services and chief nursing officer, and Deborah Jones is program director for employee health and wellness. All work at University of Colorado Hospital in Aurora.

Selected references

Centers for Disease Control and Prevention (CDC). Seasonal influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Available at http://www.cdc.gov/flu/professionals/acip/. Accessed on July 10, 2013.

Colorado Department of Health and Environment: February 15, 2012 Board of Health ruling regarding influenza vaccinations for health care workers. Available at: http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22Board+of+Health+ruling+regarding+influenza+vaccinations+for+health+care+workers.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251856506922&ssbinary=true. Accessed on July 10, 2013.

Community Immunity (“Herd Immunity”). Available at: http://www.vaccines.gov/basics/protection/index.html. Accessed on July 2, 2013.

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