What is a “Nurse Against Mandatory Vaccines”?

Surgeons against mandatory time-outs.

Aerospace engineers against mandatory pre-flight safety checks.

Animal Rights Activists Against Mandatory Spaying and Neutering.

Okay, that last one might actually exist. The first one results in the wrong limb being amputated. The second results in the Challenger Disaster. Nurses Against Mandatory Vaccines (NAMV) is going to result in people losing their jobs, and possibly result in the death of patients.

According to the Google, “Nurses Against Mandatory Vaccines was formed to help healthcare workers and other working adults avoid and speak out against forced and mandatory …” (the preview ends there, and I cannot find  those words repeated elsewhere). NAMV had a website, (which appears to be down, but NAMV has a blog that is still active) where “Members pay a $20 yearly membership fee.”  NAMV raised $644 selling t-shirts . NAMV also has a Facebook page that makes for interesting late night reading, especially if you support science based medicine.

As a RN I was disturbed by “Nurses Against Mandatory Vaccines,” as anti-intellectualism in nursing is deeply troubling to me. Not wanting to jump to conclusions, I went to the Facebook page and what I found was far worse than nurses who do not want to be told what to do. There is dangerous propaganda on that page and I believe it violates the “Nursing Code of Ethics,” specifically:

“Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, or community…

Provision 3: The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” (ANA, 2001)

So what did I do? I found out who was running NAMV and sent her a message. I explained my concerns, particularly the violations of The Code of Ethics for Nurses with Interpretive Statements, with specific examples from the Facebook page. She banned me from the Facebook page, blocked me on Twitter, and started scrubbing her affiliation with NAMV from the internet. This was over a year ago.

Why am I bringing this up now? It is another flu season, and another chance for NAMV to get free publicity, as they did last year when I first became aware of the group. I have seen healthcare workers proudly sporting their refusal to get the flu vaccine on the page. The 2015 campaign is hash-tagged #showmeyourmask. It is a brilliant piece of propaganda, because it is impossible to claim these healthcare workers are endangering patients. After all, they are wearing their mask.

The woman behind this group had a blog that was linked from the Facebook page. That has since been scrubbed, but her status as founder and CEO of NAMV is still available online. This is the person in charge of NAMV. I first noticed that she has not been a nurse for very long, receiving her Associate degree in 2010 after a year at Excelsior. Thereafter she went to Western Governors University, and received her BSN in 2011. She obtained Her MSN from the same institution in 2012. She then attended Kaplan University with the expectation of graduating and an “Adult Geriatric Nurse Practitioner” in 2015, before switching to Touro University Nevada for her Doctorate in Nursing Practice.

I wondered, how many years of experience does she have working on the floor as a nurse in an acute care setting? What was her specialty? Did she ever see patients on oscillating vents or nitrous due to influenza? I noticed that she was a LPN (license #4703103254) before she became a RN (License #4704282245). I was wondering what she did while taking all those online classes, before becoming an entrepreneur, selling T-shirts. Therefore, I looked up her work history.

She has been a Director of Nursing Education for CHE Trinity Health (2013-2014), a Case Manager for Hospice of Michigan (2012-2013), worked for Spectrum Health at an Urgent care clinic (2012), and worked “with the public inebriate program of Grand Rapids” for Mel Trotter Ministries (2011-2012). She worked for project Rehab (2010-2011) and was a LPN at the Salvation Army (2009-2010). It appears she also worked in Long Term Care, both as a CNA and LPN from 2004 – 2008.

So What? Other social media users regularly advocate against not only the influenza vaccine, but against childhood immunizations as well. They use their professional titles to spread misinformation and pseudoscience, resulting in decreased rates of immunization and increased chances of morbidity and mortality due to preventable disease.

I think it will take more than traditional public health models to combat this misinformation, since traditional models do not include the epidemiological view of social media. In this age, ideas go viral. This results in actual cases of disease transmission, as we have recently seen with pertussis and measles (Leask, 2011; Poland, & Jacobson, 2011; Salathe, & Khandelwal, 2011; ).

A woman with no acute care experience whatsoever heads the organization known as Nurses Against Mandatory Vaccines. She has been a registered nurse for less than five years. Meanwhile I have been working in the Intensive Care Unit seeing people die of influenza. It took me three years to obtain my Associates Degree over ten years ago (degree requirements). It took two more years to obtain my BSN at a State University. It took three years to obtain my Masters degree from the same university. The whole time I was employed full time as a Registered Nurse in an acute care hospital. I worked there for eight long years.

There are numerous well-researched evidence-based articles regarding the safety and efficacy of the flu vaccine. There are also valid reasons why healthcare providers should be vaccinated (Crislip, 2014; Cortes-Penfield,2014). The Facebook page “Nurses Against Mandatory Vaccines” is perpetuating myths, and silencing critics. This is not professional behavior.

There are physicians doing this as well. have “Doctor Bob” Spears, “Doctor” Gordon, and various other “Doctors” (Reiss, 2015; Tracy, 2015; Lah, & Brumfield, 2015) going on major media outlets, which purport to present the “other side” of the vaccine “argument.” The science says there is no other side and there is no argument (I could develop and cite this thesis but it would be a dissertation- for my Doctorate).

We, as nurses, are used to  advocating for our patients. We need to start doing it publicly (Orac, 2015). We also need to hold our colleagues responsible for spreading misinformation. I once worked with a nurse who said she was not getting the flu shot because she did not want to “put all those chemicals in her body.” I do not work with her anymore, but I wish I had said something when I had the chance. Crislip, (2014) or this (if you do not have a subscription to Medscape) is a good start. I got my first flu shot after realizing that I was one of those to whom Crislip was referring.
References

American Nurses Association. (2001).Code of Ethics for Nurses with Interpretative Statements.  (2010, November 15).  Silver Spring, MD: American Nurses Association. Available from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Cortes-Penfield, N. (2014). Mandatory influenza vaccination for health care workers as the new standard of care: A matter of patient safety and nonmaleficent practice. American Journal of Public Health, 104(11), 2060-2065.

Crislip, M. (2014, October 6). Budget of Dumb Asses: 2014 Edition. Medscape. Retrieved from http://boards.medscape.com/forums/?128@@.2a794c48!comment=1

Lah, K. & Brumfield, B. (5 February, 2015). Anti-vaccine doctor Jack Wolfson goes silent. CNN. Retrieved from http://www.cnn.com/2015/02/05/health/anti-vaccine-doctor-jack-wolfson/

Leask, J. (2011). Target the fence-sitters. NATURE, 473(7348), 443-445.

Orac. (2015, January 27). Quoth Katie Tietje: Stop being mean to non-vaccinators!. Respectful Insolence. Retrieved from http://scienceblogs.com/insolence/2015/01/27/quoth-katie-tietje-pro-vaxers-are-so-mean/

Poland, G. , & Jacobson, R. (2011). The age-old struggle against the antivaccinationists. The New England Journal of Medicine, 364(2), 97-99. Retrieved from http://www.nejm.org/doi/full/10.1056/nejmp1010594

Reiss, D.R. (2015, January 18). Dr. Robert Sears misleads parents about measles and vaccines. Skeptical Raptor. Retrieved from http://www.skepticalraptor.com/skepticalraptorblog.php/dr-robert-sears-misleads-parents-measles-vaccines/

Salathe, M. , & Khandelwal, S. (2011). Assessing vaccination sentiments with online social media: Implications for infectious disease dynamics and control. Plos Computational Biology, 7(10), e1002199-e1002196. Retrieved from http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1002199

Tracy, B. (2015, January 27). Doctor explains why he lets kids avoid the measles vaccine. CBS Evening News. Retrieved from http://www.cbsnews.com/news/doctor-explains-why-he-lets-kids-avoid-the-measles-vaccine/

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The good ole days weren’t always good..

A recent blog posted here urged readers to “SUPPORT NICHOLE BRUFF AGAINST THE BRAVE NEW NURSING WORLD.” Along with this request was a list of opinions with which most nurses working today would probably agree. The lines that particularly resonated with me were at the beginning, and they are a masterful hook:

“Nursing has entered an authoritarian nightmarescape. It bows to the hegemony of corporate enterprise. Nurses’ every decision is controlled and pre-conditioned. Conformity to the nursing hierarchy’s dictates brings harmony and agreement. No one who lives in the Brave New Nursing World questions authority by raising alternative ideas. Nurses are produced on an assembly line of uniformity. All the basic rules of the nursing hierarchy are expected to be carried out by every nurse.”

As an iconoclast who has never been particularly fond of cliquishness, I immediately felt sympathetic to the protagonist of this story. I too was ostracized in school, including nursing school, and I too have never “fit” within the corporate hegemony that nursing has become. The more education I attained the harder it was to fit in with demands that I behave as an automaton, doing things “because they have always been done this way.” In my master’s program, I became particularly fond of the concepts of “positive deviance” and complexity science, ideas that ended up forming the basis for my thesis (Clancy, 2010, Gary, 2013). Having established my defense, I have to admit that many of my problems are my own. I am bookish, easily intimidated, and extraordinarily inept in social situations. I am also quite opinionated and never shy away from argument. This is not conducive to success in nursing, much less gainful employment. This however is not my story.

Something about this story was a little too familiar. The problem with supporting one person against the brave new world of nursing is that we risk throwing all of our support behind someone with an agenda that does nothing to further the profession or the nurses having to endure what it has become. Remember Amanda Trujillo? No? Such is the nature of the internet. I will leave readers to look her up and formulate their own opinions (Clavreul, n.d. Kennedy,2012).

Who is Nichole Bruff (Rolfe)? An internet search leads to many less than reliable sources touting her as the poster child of patient advocacy who was unfairly expelled from nursing school in 2013 for opposing vaccinations. As of 2015, she is suing the college (Ridley, 2015, Apr 9). She bemoaned a traffic ticket in 2014 (Devereaux, 2014, Apr 9). She also ran for county commissioner in 2010. Her LinkedIn profile lists her obtaining an Associate Degree in Nursing in 2011, but that she works for a car dealership.

So, what, besides vociferously opposing vaccines, has she done for the profession of nursing? Has she urged nurses to advocate for safe staffing ratios? Was she unfairly targeted for noting that nurses are increasingly burdened by meaningless metrics or policies and procedures that are not evidence-based? Was she fired for mentioning unionization?

We have a bigger problem in nursing, a problem that is hindering our ability to do our job and resulting in increased morbidity and mortality. Stories like this are a symptom of that problem. The conformist, hierarchical, servile tenets of nursing are not the “brave new world,” they are as old as Nightingale. This is the brave old world of nursing, reinforced by the use of patient satisfaction scores to determine reimbursement (Robbins, 2015).

Nurses are working twelve-hour shifts with one 30-minute break, caring for higher acuity patients than ever before. We are routinely yelled at, spat on, punched, kicked, bitten and cursed, and forbidden from defending ourselves. We deal simultaneously with antiquated technology that does not capture nursing workflow and innovative technology that does not improve outcomes. We have to lead doctors to the right decisions without them knowing it was someone else’s idea and sometimes risk our careers to achieve the best outcomes. We have to placate families who at best have no clue what is happening and at worst are getting their medical advice from Dr. Google. All of this has been going on since the beginning of nursing, except for the internet. Now we also have patient satisfaction, IE HCAHPS, which, according to Brookes & Fenton (2014, 11 Jun), has resulted in the following:
“analysis of data from more than 50,000 adult patients indicating that the most satisfied patients (highest patient satisfaction quartile relative to the lowest quartile) were 12% more likely to be admitted to the hospital and had both total healthcare expenditures and prescription drug expenditures that were 9% higher. Most perplexing to many readers at the time, these patients were also 26% more likely to die.”

The original study can be found here. We have a powerful new tool at our fingertips, the ability to communicate the value of nursing to the widest possible audience. We have the ability to advocate for our patients in an unprecedented way. We can fight for safe staffing (National Nurses United, 2015). We can advocate for a more efficient EHR. We can put an end to bullying.

Until nurses reject anti-intellectualism, and embrace science based medicine, we will be at the periphery of healthcare, relegated to increasing HCAHPS scores instead of what we have entered this profession to do. When we, as a collective, align ourselves with those of dubious claims, who are using the ephemeral internet hate machine to gain their fifteen minutes of fame, we denigrate nursing. Nursing is not about you. It is not about me. If you want to change the brave old world, instead of spending our energy on individual trials and tribulations, advocate for “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2015).

References

American Nurses Association. (2015). What is Nursing? Retrieved from http://www.nursingworld.org/especiallyforyou/what-is-nursing

ArgusPress.com (2010, May 13). Nichole Bruff releases candidacy information. Retrieved from http://www.argus-press.com/news/community/owosso/article_e7cc4b76-5e9a-11df-b568-001cc4c002e0.html

Brookes, L. & Fenton, J.J. (2014, 11 Jun). Patient Satisfaction and Quality of Care: Are They Linked? Medscape.  Retrieved from http://www.medscape.com/viewarticle/826280

Clancy, T. R. (2010). Diamonds in the rough: positive deviance and complexity. Journal of Nursing Administration, 40(2), 53-56.

Clavreul, G.M. (n.d). The Curious Case of Amanda Trujillo and the Arizona Board of Nursing. Retrieved from http://www.workingnurse.com/articles/The-Curious-Case-of-Amanda-Trujillo-and-the-Arizona-Board-of-Nursing

Devereaux, B (2014, Apr 9). New insurance, new leadership: Village of Oakley looks to move away from controversy. Retrieved from http://www.mlive.com/news/saginaw/index.ssf/2014/07/oakley_works_to_define_new_lea.html

Fenton, J.J.; Jerant, A.F.; Bertakis, K.D.; & Franks, P. (2012). The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Archives of Internal Medicine 172(5):405-411. doi:10.1001/archinternmed.2011.1662. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=1108766

Gary, J. (2013). Exploring the concept and use of positive deviance in nursing. American Journal of Nursing, 113(8), 26-35.

Kennedy,S. (2012, Feb2). The Case of Amanda Trujillo. Retrieved from http://ajnoffthecharts.com/2012/02/02/the-case-of-amanda-trujillo/

National Nurses United. (2015). Ratios: Implementation. Retrieved from http://www.nationalnursesunited.org/pages/ratios-implementation

Ridley, G. (2015, Apr 9). Baker College instructor told students to threaten patients into vaccinations, lawsuit claims. Retrieved from http://www.mlive.com/news/flint/index.ssf/2015/04/baker_college_taught_nursing_s.html#incart_river

Robbins, A. (2015, April 17). The Problem With Satisfied Patients. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2015/04/the-problem-with-satisfied-patients/390684/

A new cancer

The recent vote to defund Planned Parenthood is interesting because most of what Planned Parenthood does is prevent unwanted pregnancy and provide care to pregnant women.

It seems that some of our representatives in Congress and others in our State legislatures want more unwanted pregnancies, carried to term. Meanwhile, the same people attack the social safety net (ACA, SNAP, TANF, etc).

Therefore, some of our representatives in Congress and others in our State legislatures want more unwanted pregnancies, carried to term, without prenatal care or support for the children that result. Meanwhile, educational funding in the form of grants is being cut, forcing those who seek higher education to rely on loans or forgo education altogether

The same representatives who want to defund Planned Parenthood, repeal the ACA, and slash welfare programs also enact legislation making it more difficult to unionize. These representatives also oppose increasing the minimum wage.

What can this possibly accomplish? A vast underclass that cannot advocate on their own behalf.

I do not think this is a “vast right wing conspiracy,” I think that this is what is happening, perhaps not by design, but through intent. Add to this the prison-industrial complex and the school to prison pipeline as aspects, and we have a situation. Our representatives in Congress and others in our State legislatures are not intentionally doing this, it is happening by accident, due to their policies.

This underclass will have only two choices left: work for corporations that pay the absolute minimum or join the military. Therefore, not by edict, but piece by piece, our representatives in Congress and others in our State Legislatures are trying to abolish the Thirteenth Amendment to the US Constitution.

Note that our representatives in Congress and others in our State Legislatures have actively campaigned for abolishing the Fourteenth Amendment, on which Roe vs. Wade is based.

Our representatives in Congress, and others in our State Legislatures, are attempting the reinstatement of slavery in this country.