As the flu season kicks into high gear, healthcare organizations are grappling with the reality that not all their employees are willing to roll up a sleeve and accept an influenza immunization — or any other vaccine for that matter.

The big question is: Can you require your staff to get vaccinated? The answer is deeper than just knowing the immunization laws for healthcare workers, but that’s a good place to start.

What Are the State Immunization Laws for Healthcare Workers?

Because healthcare workers frequently come in contact with patients who are either infectious or immune compromised —putting them at risk of flu-related complications — the Centers for Disease Control and Prevention (CDC) recommends an annual flu vaccine for all healthcare workers.

This spans everyone from the physicians and nursing staff and anyone who comes in contact with patients, to maintenance and security workers who aren’t directly involved in patient care but could be exposed to infectious agents. Beyond recommending, many facilities are mandating that their employees are vaccinated, and not just for influenza.

The laws vary by state and differ by facility type and staff role. Other inoculations also being required are Hepatitis B, Measles, Mumps, Rubella (MMR), Pertussis, Pneumococcal, and Varicella. You can find the varying state immunization laws for healthcare workers here and here, including whether the state allows medical, religious, or philosophical exemptions.

For example, the state of California (CA) requires all hospital workers be immunized for Measles, Mumps, and Rubella, allowing medical and philosophical exemptions, but not religious. The state of New York (NY) does not require hospital employees to be immunized with the influenza vaccine, although hospitals often offer incentives to their employees and promote the vaccine via other methods. On the other hand, NY does require hospital employees to be inoculated against MMR.

Can Healthcare Providers Require Employee Vaccinations?

If you decide to make influenza or any other immunization mandatory for your healthcare workers, use caution. This type of mandate can cause conflicts with workers whose religious beliefs prevent them from accepting the immunizations. And they’ve often got the Equal Employment Opportunity Commission (EEOC) on their side. Title VII of the Civil Rights Act of 1964 prohibits employers from hiring, firing, or discriminating employees based on sex, race, color, national origin or religion. A sincere religious belief against a vaccination is protected under this act.

In 2016, while other employees received medical exemptions, six employees from Saint Vincent Hospital were fired because they refused flu shots due to religious beliefs when the hospital implemented a mandatory flu vaccination policy for all employees. The EEOC claimed Saint Vincent violated Title VII of the Civil Rights Act of 1964 when it fired the six workers, and they were eventually rehired and given back pay.

However, not all employees win the exemption battle — some lose their jobs. In 2016, in Robinson vs Boston Children’s Hospital, Leontine K. Robinson was terminated from Boston Children’s Hospital after she refused a flu vaccination based on religious beliefs. BCH houses some of the most critically ill children in the world and deemed the flu shot mandate reasonable to protect their most vulnerable patients from infection and fatality.

BCH made a reasonable accommodation by offering Robinson a pork-free vaccination option and she still refused. In the end, Robinson wasn’t allowed a religious exemption from the requirement that all employees who worked with patients get a flu shot. Do this: If you’re going to implement a mandatory policy, back it up with sound policy and reasonable accommodations for employees’ exemption requests to hold up in court should you face litigation.

Can Incentives Prompt Vaccine Acceptance?

If you’re reluctant to enforce a mandatory vaccination policy for your healthcare employees, incentives are a viable alternative. While they may fall short of achieving the vaccination rates you’re hoping for, an incentive-based solution will keep the EEOC off your case and could still maintain amicable vaccination rates—as well as employee morale. Consider these options for an incentive based vaccination campaign that worked for Christiana Care Health System in Newark, Delaware taking their vaccination rate from 66% to 92%:

• Plan ahead and promote your campaign to employees as a positive way to reduce the spread of communicable disease.
• During vaccination time set up stations in main areas for employees to receive vaccinations on site. Make sure to have the vaccinations available for all shifts over the course of multiple days to give all employees ample time to make a decision.
• Offer a monetary bonus per vaccinated employee if vaccination rates hit a certain percentage.
• Require your workers to don a sticker on their badge indicating they’re vaccinated. You can also require employees who don’t get vaccinated to wear a mask when in a patient care area.

Takeaway: The combination of convenience, peer acceptance, and monetary incentive is a low-risk alternative to having lawsuits.

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