Friday, February 28, 2014

Is It Ever Okay For Nurses To Forge Patient Documents?

-Angela Quinn, RN, Member of Nurses Who Vaccinate     

On February 13, 2014, Alaskan newspapers reported that a retired school nurse from Alaska plead guilty to a class A misdemeanor for forging signatures on her student’s immunization records. The school nurse forged a parent’s signature on a religious exemption form indicating that the student had not received the hepatitis A or B vaccines when in fact the student’s parents report that the student did receive both of them. The nurse reportedly destroyed the student’s original immunization record and forged her parent’s signatures on four documents.

     The nurse’s attorney indicated that she filled out forms for parents if they were not filed on time and that he speculates “99.9 percent of all school district nurses in the state have done this.” While no harm was done in this situation considering that the student did not receive any vaccinations against the family’s wishes, an ethical concern has still been raised:

Was it okay for the school nurse to forge a document even though she knew that no harm would be brought to the patient?

The answer is no. It is not okay for a nurse to ever forge any documents for a patient even if she thinks it is a matter of life or death or that it will not change the outcome in any way. Forging a patient document not only violates the ethical rights of the patient but violates the legal rights of the patient.

     The American Nurses Association’s Code of Ethics provision 3 calls upon nurses to protect the health, safety and rights of their patients. Not only is it unethical to forge any type of patient document, but it strips that patient of their right to make an informed, self-derived medical decision and robs the patient of their autonomy. We as nurses are patient advocates and we must honor, respect and protect the rights and privacy of our patients.

     Nurses must practice with veracity and fidelity when providing patient care; we must honor their rights. We must also recognize that the care we provide must be beneficial to the patient according to the rights of the patient rather than the personal thoughts of beneficence on the part of the nurse. Even if the nurse knows that the patient will positively catch a vaccine-preventable disease and die, it is still never okay for a nurse to administer a vaccine or forge a document to do so without the patient’s explicit authorization. It is actually ethically-responsible in this situation to allow the patient to succumb to the illness rather than to violate his right to make his own medical decisions.

     In this situation with the school nurse in Alaska, no physical harm was brought to the student. However, nurses take an oath of non-maleficence, which means they will do no harm to a patient. When the nurse chose to forge medical documents, she violated the ethical principles of the nurse-patient relationship and may have put the student in a situation to receive medical care against their own free will.

Angela Quinn is a registered nurse in New York City. She is passionate about public health, patient safety and patient education. Angela volunteers with organizations like Nurses who Vaccinate to contribute positively to the world of nursing.

Wednesday, February 12, 2014

A Pediatric Nurse's Quest to Dispel Vaccine Information (The Need for Nurses Who Vaccinate)

Taken-2013 ANCC Magnet Conference
I wasn’t always an adamant advocate for public health and immunizations. I viewed vaccines in the same light as any other medication that nurses distribute and administer. I studied immunizations in nursing school, knew the history of infectious diseases and read about outbreaks occurring in medical news updates. But it wasn’t until I was pregnant with my third son during the H1N1 outbreaks, that I really started paying closer attention.

During the 2009 H1N1 outbreaks, I was very hesitant to get the “new” flu shot that was being discussed constantly in the media. In my home state, New York, there were plans to initiate a bill that would mandate all healthcare professionals to get the influenza vaccine or face being fired. Though I was a nurse and had the educational background, I was scared and overwhelmed by the scare reports I saw on the evening news and anecdotal stories I was reading on the Internet. However, I was also concerned about protecting my unborn baby, and I knew I wouldn’t be able to escape having contact with the flu virus, especially with my current nursing unit containing >60% influenza patients. I was really torn in my decision to vaccinate or refuse and lose my job as a pediatric nurse.

It was a conversation I held with my clinical nurse educator that opened my eyes to the dangers of Internet misinformation and pseudoscience. The discussion started with her expressing concern that I was one of the high-risk candidates eligible to receive the H1N1 influenza vaccine shot. She advised that I should get it as soon as possible – being pregnant placed me in a high-risk category for complications. I replied that I had read the opposite on the Internet. The articles I read said it was dangerous for pregnant mothers. I informed her I was opposed to the New York State mandate and being forced to get the H1N1 vaccine.

My clinical educator, being fully aware of the risks involved with a pregnant mother refusing a flu shot, took the time to review the sources I was basing my decision on. I pulled up the different websites and articles, and one by one she was able to debunk the incorrect claims, explain why certain websites lacked credibility to provide medical information, and explain that anecdotal stories are not evidence-based research. I was shell-shocked and angry that I had been duped and swindled. I was a Registered Nurse, with a college education, and nursing certifications, yet I was being misled by conspiracy sites and parenting blogs. She then showed me accurate medical studies on the safety and effectiveness of not just the H1N1 vaccine but also the annual influenza vaccine. She was able to demonstrate that the influenza vaccines were indeed safe, effective, and vital to protecting myself, my baby, and my patients.

My youngest son (top of slide) now 3,
followed by my 20 month old daughter,
5 year old son, & 9 year old son
When my hospital finally had a supply of the influenza vaccine, I was one of the first to receive the shot, thanks to my colleagues and educators who took time to answer my questions and clarify misconceptions. Unfortunately not all pregnant mothers had early access to the H1N1 vaccine and as a result of contracting the flu, many, including a dear friend of mine, lost their children when they suffered miscarriages.

My experience encouraged me to ensure my patients and their families knew the true risk influenza posed for pregnant mothers, infants and the immunocompromised, as well as the importance of pregnant mothers getting flu shots during pregnancy in order to protect the baby and themselves.

I was just beginning to see the need for nurses to implement critical thinking skills and properly analyze news updates and educational information about immunizations, not just at the workplace but also for personal medical decisions. But it wouldn’t be for another year and another pregnancy, that I would get the push to create the organization, "Nurses Who Vaccinate”.

Let's Go Islanders!
Working nights meant that I was usually tired and with four kids I needed ways to stay awake. I took to using social media as a way to vent, stay awake and expel crankiness. I quickly discovered that there was plenty of shenanigans and misinformation on the Internet for me to call out and refute.It was during one of these all-day shifts that I stumbled across the anti-vaccination movement. At first I was alarmed by their claims that vaccines were dangerous, harmful and causing a bulk of the earth’s problems. After all, I had been vaccinated as a child and for nursing school, my children were all fully up-to-date with their immunizations, and it was a part of my profession! How could something so effective be so bad? And that’s when the frustration started. After trying to learn more about these claims, I started to notice that all the websites with this shocking information had similar themes and tones to the ones that had initially scared me about the H1N1 vaccine. I looked into their sources deeper and they always came from similar obscure publications and researchers. A rock geologist was certified to discuss child development? A discredited and unlicensed doctor was privy to secret medical information? A Facebook page called Nurses Who Don’t Vaccinate? It was the latter that caught my attention. Nurses Who Don’t Vaccinate was very anti-vaccine, accusing nurses of being part of a conspiracy to hurt and harm patients, and it promoted dangerous misinformation and medical advice.
I searched for an antidote, a Facebook page run by nurses that supported immunizations, and discovered that none existed. There was the ANA Immunize Facebook page, but it wasn’t updated as frequently as the NWDV, and it wasn’t out there on the front lines dispelling the myths sprouted by the anti-vaccination advocates. That’s when I decided to roll up my sleeves and tackle this issue: I created the Facebook page "Nurses Who Vaccinate." The plan was to provide visitors with current evidence-based information on immunization and its benefits. The page was designed to alert visitors to immunization-related educational opportunities and promote immunization programs and activities such as the Orange Noses Day.

After creating the page, I started a Nurses Who Vaccinate Blogspot and a Nurses Who Vax Twitter account. I did this to access the different platforms of social media, particularly when I realized the misinformation was so incredibly widespread and found all over the internet.
I used Nurses Who Vaccinate to respond to, and address, online parenting forums that presented misinformation about vaccines. Eventually my Internet information initiatives attracted the attention of The Wall Street Journal,which quoted me in a story about protecting infant children from pertussis, or whooping cough, a highly contagious bacterial infection of the upper respiratory system.

Due to my efforts, I was invited to participate and partner with other pro-vaccine organizations that encourage immunization. Such organizations include Every Child by Two’s "Vaccinate Your Baby" and “Shot of Prevention;” both are great sources for vaccine information and a lead social media voice for promoting immunizations. It was through ECBT that I was introduced to Shot@Life, a movement that protects children worldwide by providing life-saving vaccines where they are most needed. In 2013, I was nominated to be a Shot@Life Champion, a role I was incredibly honored and proud of. Shortly afterward, I found myself on Capitol Hill with fellow inspiring Global Health Champions campaigning and promoting continued access to vaccines within third world countries.

One of my favorite organizations I am equally proud to be a part of is called Voices for Vaccines. VFV is a parent-driven organization supported by scientists, doctors, and public health officials. It provides parents clear, science-based information about vaccines and vaccine-preventable disease. It is also a forum and opportunity to join the national discussion about the importance of on-time vaccination. I serve on the Parent Advisory Board and help to create easy-to-use toolkits for parents to educate their families and communities about the importance of vaccinating themselves and their children.

While the original “Nurses Who Don’t Vaccinate” no longer exists, there is a recently created Facebook page that has popped up called “Nurses Against Mandatory Vaccines.” Much like its precursor, it shares misleading articles that spread lies and misinformation about vaccines, and belittle the dangerous diseases that vaccines protect people from. It has amassed a large following which unfortunately allows the group to spread its misinformation to a larger audience. The existence of this group illustrates the need for pro-vaccine nurses and health care professionals to stand up, speak out, and take action. When I come across poorly educated nurses who deny the science behind vaccines, it is a reminder of the ongoing need for Nurses Who Vaccinate to exist.

However, I’m quite proud of the progress Nurses Who Vaccinate has made. We’ve recently become a member-based organization and we have big plans for this year. Vaccines are truly life-saving, and they represent the best defense against diseases such as measles and pertussis. This year alone, vaccines will prevent 33,000 deaths and 14 million infections. But, if the anti-vaccinators and pseudoscience organizations are the only ones talking about vaccines, they’re going to create a large audience of vaccine-wary listeners who may end up forgoing vaccines. As health care workers, we are designated vaccine ambassadors and we must continue to do our part in educating and promoting vaccines. Whether it’s on a Facebook page, on the playground, or at a family dinner, health education and preventing disease is a 24 hour job for all of us.

This post originally appeared as a guest blog post for Vaccines Today on February 10, 2014.

Nurses Who Vaccinate are nurses who care about themselves, patients and communities.
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Monday, February 10, 2014

NWV Has Been Named a CDC Flu Vaccination Digital Ambassador!

Nurses Who Vaccinate is proud to announce we have been named one of CDC’s Flu Vaccination Digital Ambassadors!

CDC’s Flu Vaccination Digital Ambassador program recognizes on-line publishers who commit to posting about flu vaccination multiple times throughout the season. The Flu Vaccination Digital Ambassadors are integral to raising awareness about the importance of flu vaccination among the general public as well as individuals at high risk for severe complications from flu. From doctors and nurses, to pregnant women, to the elderly, to people with conditions like cancer and heart disease, Digital Ambassadors help spread vaccination messages to all.

For more information on influenza and how to protect yourself and others visit:

Sunday, February 9, 2014

Nurses Who Vaccinate Has an Official Website!

Have you heard the news? Nurses Who Vaccinate has an official site! 

At the website you'll find out more information about the nurses who run Nurses Who Vaccinate, the mission, upcoming events and action alerts.  Intended to be a Web portal that provides free information for those looking to research vaccines, stay up to date with data, and prevent illness, the website has a lot to offer nurses, healthcare workers and the public

The website now offers supporters and friends of Nurses Who Vaccinate to become official members!

Membership is free and open to all nurses, healthcare providers, students, parents and immunization advocates. Becoming a member provides unique opportunities to gain knowledge that will improve patient care, improve education techniques and influence vaccine advocacy at the international, national and state level.

Membership give you access to:

  • the official Nurses Who Vaccinate newsletter
  • the Nurses Who Vaccinate Online Community
  • Action Alerts
  • Special Events 
  • Professional development programs (workshops, conferences, webinars, etc..) 
  • and much more.