When Teri Orton took over as nursing director at a Sauk Rapids assisted living center, only 10 percent of the staff got annual flu shots.
Four years later, in 2007, it was up to 90 percent.
The trick, said Orton, was offering the employees free vaccines, then painstakingly shooting down all the excuses they could come up with for avoiding them.
The payoff has been a sharp drop in absenteeism, she said, and "a lot less illness" among workers and elderly residents.
Now, as flu-shot season begins, the Sauk Rapids center is being touted as a national success story. Officials around the country are debating whether to make flu shots mandatory for health care workers because of the concern they can spread the virus to the sick and elderly, who are especially vulnerable to deadly complications.
For the most part, doctors, nurses and other health workers are free to choose whether to get flu shots. But now hospitals and health groups across Minnesota are trying to make it tougher and tougher for them to say no.
They're enticing health workers with free vaccines delivered right to their workstations, day or night, and bombarding them with e-mails and reminders.
Some are requiring those who refuse flu shots to sign forms explaining why. A handful of hospitals in other states made shots mandatory.
A Mayo Clinic doctor is leading a national effort to require flu shots for everyone in medicine. "I just think there are ethical or moral standards you live up to as a health care worker," said Dr. Greg Poland, an infectious-disease specialist who heads Mayo's vaccine research program. "Because patient safety trumps whatever your personal preferences may be."
Nationwide, about 42 percent of health workers get flu shots, according to government estimates. That means roughly six out of 10 don't, which Poland calls indefensible. If your mother or daughter were in the hospital in January, he asks, "would you want the nurse taking care of her to be immunized? ... The universal answer is 'Of course!'"
In Minnesota, the "rates are slightly above average, but they're still abysmal," said Kris Ehresmann, who heads the Minnesota Department of Health vaccine program. Last year, her department announced a goal of vaccinating 90 percent of all health workers in Minnesota.
Why would a majority of medical workers ignore advice to get their flu shots?
"There's a list as long as your arm," said Poland. "Most of it centers around misperceptions and fears that are simply not true." They're the same reasons, he notes, that other people avoid flu shots: inconvenience, fear and a vague idea that the flu is no big deal.
"Everybody thinks they know what 'the flu' is," he said. But people often mistake it for the stomach flu, instead of a respiratory illness. "One in every 8,000 Americans who is alive right now is going to be dead a few months from now of influenza and its complications. That number stuns people. As much as they know, even doctors and nurses, about flu, they do not realize it is a killer virus."
Getting to 90 percent
At Ridgeview Place Assisted Living in Sauk Rapids, Orton said she spent months "dispelling myths" among her staff, including a widespread belief that the shot itself can cause flu. Not possible, she notes.
"Sometimes a lot of them are just scared to death to have a shot." To break down resistance, she held workshops on the dangers of influenza. She offered the vaccine during work hours, for free, to all employees. She persuaded her fellow managers to get the shots first "to set the example."
Orton even used paydays to reinforce the message. "If they're coming in to get their paychecks you just detain them a little while."
Last year, Ridgeview reached the 90 percent vaccination mark, and was recognized as a national model for its "best practices" by the National Influenza Vaccine Summit.
Some of the same strategies seem to be working at hospitals and clinics throughout the Twin Cities. "We make it very convenient for our employees," said Dr. Lisa Ide, medical director for employee occupational health at Fairview Health Services.
Last year, 64 percent of Fairview employees got flu shots. At Regions Hospital in St. Paul, the number jumped from 53 percent in 2006 to 63 percent last year. At Children's Hospitals and Clinics, an estimated 80 percent of employees got their shots last year. Park Nicollet says it's hit 90 percent.
One of the latest twists is requiring holdouts to sign a "declination form" if they refuse the vaccine. Ehresmann, of the health department, calls it a "step below" a full mandate.
"It says, look, either you have to get the vaccine, or account for the fact that you're not getting it," she said. She believes it's one reason vaccine rates are going up among health workers. "I think that's because people just can't brush it off anymore."
Making it mandatory
Few have gone as far as Virginia Mason Medical Center in Seattle, which decided to require all employees to get the flu vaccine.
"I can tell you that four years later, it's really changed our culture," said Dr. Joyce Lammert, chief of medicine. Today, the vaccine rate among its 5,000 employees is 99 percent (there are exemptions for medical and religious reasons).
It wasn't trouble-free, though. The nurses union challenged the rule as an unfair labor practice, Lammert said, and won an exemption for its 600 members. But the rule applies to everyone else. "The first year we ended up having to terminate about seven people who just didn't want to do it," she said. "Now we tell people at the time of employment ... It's just not a big deal."
In Minnesota, there seems to be little appetite for rigid mandates. Last year, officials at Children's Hospitals and Clinics debated the idea and decided against it, said Patsy Stinchfield, director of infection control. "I personally wasn't all gung ho about [it]," she said. It wasn't worth risking an employee backlash, she said, when they're making so much progress voluntarily. "We have managed to get our rates up and not let them slip back so far."
But Poland, of the Mayo Clinic, says voluntary isn't good enough. "We've done that experiment ... and the experiment has failed," he said. "The needs of the patient come first, period. If I can't adhere to that, then I don't think I should enjoy the privilege of taking care of people."
Maura Lerner • 612-673-7384