2-25-2017Leadership Personal Action PlanMy preference is ENF.docx

2-25-2017
Leadership Personal Action Plan
My preference is ENFJ. I believe this is the personality type
that goes with my leadership style. With this personality type,
my primary focus is external. I deal with issues in accordance to
how I feel about them. I also like things or people who fit
within my value system at the personal level. My secondary
focus is internal meaning that I use intuition when dealing with
things. As a leader, I feel that my major strength is focusing on
people. I always believe that people can achieve so much when
they come together. My major strength is in people skills, for
this reason I have a unique ability of bringing people together
to accomplish a given task. With these skills, I believe I will be
an excellent team leader because I will help people bring the
best in them out there. This means that decision-making within
the organization and team management will be easy because it
will be easy for me as a leader to bring people together and
brainstorm for a solution.
This personality however has its downsides because leaders
with these traits are known to be manipulative of people under
them. For the most part, ENFJs are pushy and relentless until
they get the results they want. As a leader with these qualities it
may be difficult to spend time alone because most of the time
they are externally focused. For this reason, it will be easy to
fill my life with activities that involve working with other
people. On the downside, I might find myself putting the needs
of other before my own why I still attempt to keep track of my
needs to ensure that I do not forget them.
Another weakness for this type of personality is that people
tend to be reserved when it comes to expressing their opinions
especially when they know their thoughts especially when such
thoughts may controversial to the extent of pushing people
away. Because my major strength is in people skills, it will be

important that I blend in with people so to be a change catalyst.
In this approach, it is impossible for this type of leaders to be in
a group as individuals because they are always doing their best
to bring the best out if the team.
As a leader with a preference for E category of personality
characteristics, I have definite opinions and values, which will
only be expressed if they are not too personal. This could have a
negative impact on my relationships with people because I may
not be able to speak my mind in the fear that it may affect group
dynamics. I will therefore, need to improve on group
communication to determine how to remain vocal when
important issues that are important to my leadership role.
Recognizing gifts and strengths of my personality type, which
make me unique is important in ensuring that I maximize on the
strengths that bring the best out of every situation. For this
reason, I will capitalize on my people skills to ensure that I
achieve success in people management especially in team
management. Embracing the ability to inspire others and making
them feel valued is an important strength that is vital for a
leader. Additionally, seeing positive outcomes from human
situations and finding solutions that maximize outcomes from
human interactions are strengths that as leader I have to note.
Being expressive when voicing my opinion will also be crucial
in ensuring that people under me understand my position
regarding a given issue. The gift of understanding and getting
down to the level of people’s feelings and being empathetic will
be important in understanding where people are coming from
and helping them apply experiences effectively. The most
important strength is turning ordinary situations into magical
solutions. The ability to use to bring around a situation will be
the main point interest for me.
There are weaknesses in this type of leadership preference. As a
problem solver, I have to ensure that my weaknesses do not
water down my strengths. As a result, I will keep watch of
extraverted feelings, which mostly lead people with these
characteristics, too much value in the world. The first step is

assessing the needs of people around me to ensure that the
needs of others do not mislead my needs or affect my role as a
leader. I must ensure that the need to look out externally for
value does not affect performance or overlook other important
matters. By limiting the extraverted feeling of judging
situations as well as discriminating situations I will be able to
avoid being subjective or rigid in value judgement. Avoiding
acquiesce will also be important in ensuring that as a leader I do
not support subjective agenda of retaining control. This
approach will be important in ensuring that I can find the true
feelings and values of people, which supports my people skills.
Report Components: See chapter 11 of text and example report
on Moodle
Front Matter
· Transmittal Letter: (pg. 362) Full block style letter (pg. 288)
· Opens with one or two sentences that explains what is being
sent and why.
· The next paragraph concisely summarizes the report’s contents
or stresses a finding or conclusion important to the audience.
May also mention special conditions under which the material
was prepared. (limitations of time or money, for instance)
· Closing paragraph may acknowledge any help received in
preparing the report or express the hope that the information
fulfills its purpose.
· Title page (pg. 365 example)
· Report Title and subtitle
· Report author
· Date Report Issued
· Report Recipient
· No page number
· Informative Abstract (Start header on this page) (pg.365-
367)(iii is your footer)
· Contains Purpose and Scope
· Methodology

· Conclusions
· Recommendations
· Table of Contents (pg. 368-369)(v is your footer)
Body
· Executive Summary (pg. 370-373)(page numbers start here in
footer)
· Write after you finish your report
· Avoid using terminology that may not be familiar to your
readers
· Spell out all uncommon symbols, abbreviations, and
acronyms.
· Introduction (pg. 374-375) (provide general information such
as why report was written)
· State the subject, purpose, scope, and the way you plan to
develop the topic. You should include background (see example
on Moodle).
· Proposal Information (377) (should include your research and
at least one visual. Here is where you can include some of the
information from your proposal)
· Conclusions (384)
· Recommendations
· Works Cited/References (385)
Back Matter Contains appendixes (if needed) and Bibliography
March 30, 2015
Mr. John Doe, Senior Lobbyist
California Advocacy Group
555 South Street
Sacramento, CA 55555

Dear Mr. Doe:
The Influenza Vaccination Watch Group has been excited
to see much of the new legislation you have been able to bring
before the state senate. We also know that we share a common
concern for diminishing the pandemic effects of vaccine
preventable illnesses. We are interested in working with your
firm. We have prepared a proposal that outlines our findings
and recommendations regarding increasing vaccination uptake
in California's health care workers. Please take the time to read
and consider our proposal. If you have any questions please call
me at (555) 555-5555. Thank you for your time and
consideration of our proposal.
Sincerely,
Director
Influenza Vaccination Watch Group
cs.ivwg.org
Enclosures (1)

555 Main Street
Northridge, CA 55555
555-555-5555
Request For Stronger Vaccination RegulationInfluenza
Vaccination Watch Group
Request for Stronger State Level Influenza Vaccination
Regulation for California’s Health Care Personnel
Director
555 Main Street

Date: April 28, 2015
Submitted to: California Advocacy Group
Request For Stronger Vaccination RegulationInfluenza
Vaccination Watch Group
Abstract
Influenza is a highly contagious disease that can have severe
complications, especially in high risk populations (CDC,
2014b). One of the best ways to help prevent the spread of flu is
to receive annual flu vaccinations. Vaccinations are especially
important for health care personnel because the populations
they work with can be highly susceptible to influenza infection.
Current legislation in California places the majority of the
burden on individual facilities to generate policies, with the
CDC issuing strong recommendations. New York is one state
with tough legislation. Additionally, there are individual
facilities with strong policies. The greater the strength of

guidelines and consequences for noncompliance, the greater the
vaccination uptake for health care personnel. California needs
to improve legislation by making it clear, strong, enforceable,
and unified.
iii
Table of Contents
Title
Page........................................................................................
..................................................i
Abstract..................................................................................
..........................................................ii
Table of
Contents..................................................................................
...........................................v
Executive
Summary.................................................................................
........................................1
Introduction............................................................................
..........................................................2
Background.............................................................................
.........................................................2
Proposal................................................................................ ..
..........................................................3
Current California
Regulation...............................................................................
...........................3
Comparison Legislation and
Policies...................................................................................
............4
National Agencies

Policies...................................................................................
...............4
Individual State
Legislation..............................................................................
...................4
Individual Facility
Policy.....................................................................................
................5
Issues With California
Regulations.............................................................................
....................6
Recommendations for
Change....................................................................................
.....................7
Conclusion..............................................................................
.........................................................8
Appendix
A............................................................................................
..........................................9
References..............................................................................
........................................................10
Bibliography...........................................................................
.......................................................12
v
Executive Summary
Influenza is a highly contagious disease that can have severe
complications, especially in high risk populations (CDC,
2014b). One of the best ways to help prevent the spread of flu is
to receive annual flu vaccinations. Vaccinations are especially
important for health care personnel because the populations
they work with can be highly susceptible to influenza infection.

Current legislation in California places the majority of the
burden on individual facilities to generate policies. This creates
a system where each county, city, and even facility can have
very different policies from the next. The minimal legislation
currently in place is not as effective as it could be. Clear
definitions and enforceable consequences could have a greater
effect on vaccination uptake. The CDC has strong
recommendations and keeps current on the most up-to-date
practices. Policies that require adoption of CDC
recommendation will keep facilities current and up to date with
innovations in health. The state of New York strengthened
legislation. They also require CDC adherence, resulting in a
quick and dramatic increase in vaccination uptake in health care
personnel. There are also individual facilities with stronger
policies that have seen almost complete adherence and uptake.
The greater the strength of policy and consequences for
noncompliance, the greater the vaccination uptake for health
care personnel. Incorporating CDC recommendations, masking
policies, and enforcement into legislation can potentially help
states improve their influenza vaccination uptake in health care
workers. California needs to improve their legislation by
making it clear, strong, enforceable, and unified.
13
Introduction
Hypocrites, one of the fathers of medicine, said that doctors
should first do no harm (USNLM [United States National
Library of Medicine], 2012). This charge still holds true today.
Most health care personnel would not choose to out rightly harm
someone, however, some are and do not even realize it.
Unvaccinated healthcare personnel have a greater risk of
spreading pathogens which can have deadly consequences.
(Catania, 2014). Because of this fact, it is important for states

to have strong legislation protecting patients from unnecessary
risks. The Influenza Vaccination Watch Group is seeking to
change California Legislation to better protect this vulnerable
population.
Background
The Centers for Disease Control (CDC) asserts that influenza is
a highly contagious disease that can have severe complications,
especially in high risk populations (CDC, 2014b). The flu is an
infection caused by a variety of viruses. The CDC states that it
has a wide range of symptoms, such as sneezing, coughing,
fever, vomiting, sore throat and headache (CDC, 2014b). The
viruses are highly contagious and can be transmitted in aerosol
or droplet form through air and surfaces; mainly entering the
body through the nose and mouth (CDC, 2014b). The Mayo
Clinic asserts that one of the best ways to help prevent the
spread of flu is to receive annual flu vaccinations. Though the
flu vaccine is not a guarantee against the flu, failing to
vaccinate leaves individuals more susceptible to flu and its
consequences (Mayo Clinic, 2014). Since the vaccine changes
each year, it is important that vaccinations are received
annually. It is recommended that everyone ages six months and
older obtain a flu vaccine (Mayo Clinic, 2014). However, even
with the evidence showing the benefits of vaccinations, many
people are still unvaccinated. An article in the Respiratory Care
and Critical Care Journal found a strong association between
intensive care unit flu related admissions and a low rate of
vaccinations (Catania, 2014). Jelena Catania, Loretta G.
Que, Joseph A. Govert, John W. Hollingsworth, and Cameron R.
Wolfe assert that people who do not receive the flu vaccination
are more susceptible to acquiring the flu virus (Catania, 2014).
Many do not realize that vaccinations not only benefit the
person who is receiving the immunization, but also the people
around them by preventing the spread of the virus. Health care

personnel (HCP) are regularly in close contact with vulnerable
and high risk populations. For young children, the elderly, and
people who are immune compromised, the flu can have very
damaging and even deadly consequences (CDC, 2014b). The flu,
along with complications such as pneumonia, is the eighth
leading cause of death in the United States, with 53,826 deaths
in 2011 (CDC, 2014b). The flu also can aggressively aggravate
asthma, chronic heart conditions, respiratory problems, and
even diabetes (CDC, 2014b). These special populations and
other vulnerable people are the ones found in many hospital
beds around the state. The California Department of Public
Health (CDPH) reveals that the vaccination coverage in health
care personnel is still at a relatively low 74 percent (CDPH,
2014).It is imperative that we limit the spread of the Influenza
Virus in our health care facilities.
Proposal
Health care facilities offer differing policies and varying levels
of stringency (Randall, 2013). The inconsistency in policy can
cause confusion and even lead some HCP to quit and seek
employment in hospitals with differing policies (Winston,
2014). In efforts to lead change in the issue of uptake (making
use of the vaccine) and create uniform policy, regulations must
be mandated at state level. The Influenza Vaccination Watch
Group proposes that the state legislature construct a clear
amendment that will provide stricter regulation and stronger
language regarding influenza vaccination uptake for HCP. We
encourage the legislative body to further investigate the
inconsistency of uptake in HCP and to quickly seek an
appropriate solution. The mark of success would be an increase
in influenza vaccination uptake among HCP and all California
health care facilities meeting the Healthy People 2020 (HP2020)
national guidelines of 90 percent HCP vaccination rates

(HP2020, 2015). With this success, California could lead the
nation on improved uptake in HCP and set an example for all
Americans.
Current California Legislation
California Senate Bill Number 739 (CSB739), approved and
filed on September 28, 2006, outlines the state requirements for
HCP to vaccinate against influenza in order to protect against
hospital acquired infections (CSB739, 2006). CSB739 first
establishes the Hospital Infections Disease Control Program,
which requires a tri-year efficacy review of hospital policy and
action on vaccination uptake and compliance. (CSB739, 2006).
The legislation has a large portion that focuses on collection of
information and statistics for use by the state. These will come
in the form of surveillance and compliance reports that are sent
to the state and federal agencies (CSB739, 2006). Individual
facilities are given the responsibility to create and enforce
policy surrounding uptake. The main legislative components
are:
· Tracking and reporting necessary uptake statistics (CSB739,
2006).
· Requiring a written declaration of refusal (CSB739, 2006).
· Offering free flu vaccinations (CSB739, 2006).
The bill places more responsibility on hospitals to create,
maintain, and evaluate their own vaccination uptake programs
and policies (CSB739, 2006). The only basic state mandated
policy requirements for facilities are the written declaration,
offering of vaccinations, and production of reports. (CSB739,
2006). CSB739 fails to clearly define HCP and who the
legislation applies to. CSB739 also leaves most of the policy
creation to the facilities and provides little instruction on
application and enforcement. The bill does not provide any
action to be taken for noncompliance by facilities or HCP. The

CDPH, in efforts to help increase compliance and uptake, is
urging all hospitals to review CDPH key findings data and to
evaluate their own programs and policies (CDPH, 2014). The
CDPH is encouraging hospitals to do their part in helping the
state reach the Healthy People 2020 national target of a 90
percent health care personal influenza vaccination rate (CDPH,
2014). See Appendix A for full comparison table.
Comparison Legislation and Policies
California is not alone in the fight against Influenza. All states
have varying regulations regarding HCP Influenza vaccination
uptake. The CDC also has produced policy recommendations for
the entire nation. Individual health care facilities also create
their own policies regarding vaccination uptake. The variety of
policies can be confusing to navigate and each has its own level
of effectiveness in increasing influenza vaccination uptake.
National Agencies Policies
The CDC produced a National Healthcare Safety Network
Manual that includes a Healthcare Personnel Vaccination
Module and Influenza Vaccination Summary (CDC,2014a). The
CDC manual, last updated in August of 2014, outlines the
national recommendations published by the agency regarding
annual influenza vaccinations for HCP. All attempt to follow
most of the CDC’s federal recommendations such as:
· Employing effective strategies
· Offering free vaccinations, training, and education
· Tracking and submitting uptake statistics
· Providing written or electronic documentation of vaccination
and declaration of refusal
· Completing annual CDC HCP Influenza vaccination survey

forms
These recommendations carry weight, but do not have legal
implications, leaving it up to the state to interpret, create,
regulate, and enforce policy. Many states like California take
cues from the CDC policies, but do not mandate that all CDC
requirements be adhered to. See Appendix A for full comparison
table.
Individual State Legislation
The New York Department of Public Health (NYDPH) instituted
statewide mandatory HCP influenza vaccination policies
(NYDPH, 2015b). The NYDPH created regulations that took
effect on July 31, 2013, which apply to all health care facilities,
including but not limited to: hospitals, nursing homes,
diagnostic and treatment centers, and adult day care facilities.
The NYDPH states that the regulations require all persons who
sign a declaration forgoing the vaccination, due to specified
objections or contraindications, to wear a mask at all times
during shifts (NYDPH, 2015b). The masks must be used through
the influenza peak season, which will be outlined each year, and
all health care personnel must comply. Exceptions will be made
for patients needing to lip read or for speech therapists
modeling words with their mouths (NYDPH, 2015b). The policy
outlines how each facility is responsible for policy creation
regarding enforcement, discipline, level of mask use (other than
regulation standard of basic surgical), use of masks in common
areas and break areas, use by non-health care employees, and
further application of the policies to non-health care personnel
(NYDPH, 2015b). The NYDPH regulation addresses a number
key topics:
· Providing written or electronic documentation of vaccination
and declaration of refusal (NYDPH, 2015b).
· Offering free vaccinations, training, and education (NYDPH,

2015b).
· Following all CDC recommendations (NYDPH, 2015b).
· Masking requirements (NYDPH, 2015b).
· Defining HCP and Extending policy to all HCP including
office workers, contract workers, students, volunteers, and
anyone with potential patient contact (NYDPH, 2015b).
·
See Appendix A for full comparison table.
Individual Facility Policies
In 2005, the Virginia Mason Medical Center (VMMC) in
Seattle, Washington, was one of the first facilities in the United
States to institute a mandatory vaccination program with strict
enforcement (Schnirring, 2010). Launched during the 2005-06
flu season and affecting 5,000 employees, Virginia Mason's
vaccination mandate states that vaccinations are a "fitness-for-
duty" condition for continued employment (Schnirring, 2010). If
HCP fail to provide documentation their employment will be
terminated (Schnirring, 2010). Vaccination rates increased from
54 percent to 97 percent the next year and then to 99 percent by
2007 (Schnirring, 2010;VMMC, 2008). The success of the
program has been shown by the dramatic increase in
vaccinations; due in part to enforcement through strong
negative consequences (Galanakis,2013). (See Chart 1) The
policy also clearly defines HCP and extends the policy to all
office workers, contract workers, students, volunteers, and
anyone with potential patient contact.
The policies include:
· Requiring documentation of vaccination or declaration of
refusal for approved reasons (Galanakis,2013).
· Offering free vaccinations, training, and education
(Galanakis,2013).

· Offering vaccinations all year and by all methods
(Galanakis,2013).
· Masking requirements (Galanakis,2013).
· Strong and clear policies and enforcement (Galanakis,2013).
Virginia Mason approved 31 exemptions during the first year of
the mandatory requirement and that number has not dramatically
increased (VMMC, 2008). Only a handful of workers have left
the hospital because of the policy (Schnirring, 2010). The
nurses union appealed to the courts, stating that the masking
policy violated their union agreements. However, the courts
upheld the policy. See Appendix A for full comparison table.
Chart 1. Vaccination rate trends of Virginia Mason Medical
Center. Chart1 shows the dramatic change after the policies
were enacted.
Source: Schnirring, 2010;VMMC, 2008
Issues With California Regulations
Critics of California's current regulations state that the law is a
"relatively permissible requirement" (Harris,2014). Harris et al.
found that on average, California’s health care personnel knew
about the policy and still many remained noncompliant. Harris
et al. noticed that there were not a significant number of HCP
being punished for blatant disregard of the policy (Harris,2014).
The California legislation has many of the same constructs as
the stricter policies in other states and facilities, however there
is little in the legislation about enforcement. It is left to the
facility to create a more comprehensive policy (Harris,2014).
Thus, the state is left with a patchwork of differing policies and
different levels of enforcement resulting in a lack of overall

success in the uptake rate. Mandatory policies need enforcement
power by means of strong negative consequences
(Galanakis,2013). The rates of influenza vaccination uptake
since the legislative action, are not statistically significant when
compared to other states (Harris,2014). California's 2006
legislation prompted a slow increase of vaccination uptake
(CDPH, 2014). In comparison, when New York's 2013
comprehensive and stringent regulations were enacted, there
was an increase in uptake that surpassed California's statistics
within a year (CDPH, 2014; NY data, 2014). There are some
that have concerns that mandatory programs can infringe on
civil liberties and be seen as coercion (Galanakis,2013). Since
current regulation has failed to meet uptake standards, the
benefits of stronger regulation outweigh the potential harm
(Galanakis,2013). See chart 2
Chart 2. Comparison of Influenza vaccination uptake trends in
New York and California. Chart shows the quick rise in New
York uptake after the new legislation.
Source: CDPH, 2014; NYDPH, 2015a
The void left by weak state legislation has left different
counties and health districts trying to close the holes. Jonathan
E. Fielding, the Director and Health Officer for Los Angeles
County, issued a letter mandating the county to follow
guidelines for health care worker (HCW) influenza
vaccinations. Fielding states the mandate is in addition to the
current California guidelines, as well as individual facility
guidelines, will be applied to the whole of Los Angeles County.
The letter orders that all HCP refusing vaccination must wear a

surgical mask for the duration of the influenza season to prevent
transmission while working in patient care areas (Fielding,
2013). Fielding clarifies that this applies to all HCP, including
paid, unpaid, contract, student, and volunteer workers who
serve in patient care areas or have direct patient contact
(Fielding, 2013). This again can lead to confusion with differing
polices within the state.
Recommendations for Change
In efforts to meet the National Healthy People Guidelines by
2020, California needs to consider the development of a
comprehensive policy that adopts new strategies and will
provide stronger enforcement. (HP2020, 2015) The Influenza
Vaccination Watch Group asserts that the following items
should be considered:
· Mandatory state wide policy
· Mandatory masking policies
· Specific state wide enforcement policy
· Investigations into hospitals not meeting guidelines
· Stronger and more specific language
· Fewer exemptions
· A strong recommendation to follow new CDC advisements
· Broader definitions of HCP and facilities
· Mandatory training and education
Conclusion
Despite the fact that vaccinations can dramatically aid in the
prevention of many illnesses, many of the vaccine preventable
illnesses still remain a major health threat (Galanakis, 2013).
HCP are at a higher risk for both contracting and transmitting
infections to high risk populations (Galanakis, 2013). Because
high risk populations entrust their care to HCP, it is morally
justified to require strong mandatory vaccination regulation. If
HCP are going to follow the charge of Hypocrites, then we need
to make sure they are doing no harm, even if it is unknowingly

(USNLM [United States National Library of Medicine], 2012).
In addition, California is falling short of the Healthy People
2020 national objectives for HCP influenza vaccinations rates.
In order to reach goals and promote health most efficiently and
effectively, we need clear and unified state wide legislation.
Strengthening the legislation regulation will not only help
California reach national goals, but will help us lead the way to
a better health care future.
Appendix A
Comparison table of policies and legislations. The table shows
regulations at different levels and with different strengths. The
state legislation comes from California and New York. The
CDC is a federal agency and the VMMC is an individual facility
level policy. These items are general policy ideas and topics and
are not exhaustive of all related policy and legislation
components.
Current California Legislation
CDC National Recommended Policies
Produce annual surveillance
Employ effective strategies
Produce annual compliance reports
Offer free flu vaccinations
Individual facility policy creation around uptake
Offer training and education
Provide annual vital statistics
Track and submit statistics
Require a written declaration of refusal
Written or electronic documentation of vaccination
Written or electronic declaration of refusal
Prepare influenza disaster plans

Completion of CDC annual HCP Influenza vaccination survey
forms
New York Legislation
Virginia Mason Medical Center Policy
Individual facility policy creation around uptake and
enforcement
Offer training and education
Require a written declaration of refusal (limited permitted
reasons)
Follow CDC recommendations
Masking requirements
Require a written declaration of refusal (limited permitted
reasons)
Masking requirements
Termination of employment as a enforcement
Extends policy to all HCP with potential patient contact
Extends policy to all HCP with potential patient contact
Offered vaccination all year and in all methods
Source: CDC,2014a; CSB739, 2006; Galanakis,2013; NYDPH,
2015b
References
Catania, J., Que, L. G., Govert, J. A., Hollingsworth, J. W., &
Wolfe, C. R. (2014). High Intensive Care Unit Admission Rate
for 2013–2014 Influenza Is Associated with a Low Rate of
Vaccination. American Journal of Respiratory and Critical Care
Medicine,189(4), 485-487. doi:10.1164/rccm.201401-0066LE
CDC, Centers For Disease Control and Prevention, Division of
Healthcare Quality Promotion. (2014a). The National
Healthcare Safety Network (NHSN) Manual Healthcare

Personnel Vaccination Module: Influenza Vaccination Summary
(pp. 1-1-A-2). Atlanta,, GA.
CDC, Key Facts about Influenza (Flu) & Flu Vaccine. (2014b,
September 09). Retrieved February 4, 2015, from
http://www.cdc.gov/flu/keyfacts.htm
CDPH, California Department of Public Health. (2014).
California Department of Public Health Influenza Vaccinations
Among Health Care Personnel in California's Hospitals for the
2013-2014 Respiratory Season Key Findings and Public Health
Actions [Press release]. Retrieved March 30, 2015, from
http://www.cdph.ca.gov/programs/hai/Documents/FLU_Vax_HC
P_KeyFindings_2012-13_Final050614.pdf
CSB739, Health and Safety Code, relating to health facilities,
Chapter 2 of Division 2, S. 739, 109R Cong. 2006
Fielding, Jonathan E. "Health Officer Order for Annual
Influenza Vaccination Programs for Healthcare Personnel."
Letter to Licensed Acute Care Hospitals, Skilled Nursing
Facilities, Long-. 02 Oct. 2013. MS. Los Angeles County, CA.
Galanakis, E., Jansen, A., Lopalco, P., & Giesecke, J. (2013).
Ethics of mandatory vaccination for healthcare workers.
Eurosurveillance, 18(45), 20627.
doi:10.2807/15607917.ES2013.18.45.20627
Harris, K., Pines, L., Han, B., Lindley, M., & Lorick, S. (2014).
The impact of influenza vaccination requirements for hospital
personnel in California: Knowledge, attitudes, and vaccine
uptake. American Journal of Infection Control, 42(3), 288-293.
doi:10.1016/j.ajic.2013.09.030
HP2020, Healthy People 2020. (2015). Retrieved March 30,
2015, from http://www.healthypeople.gov/

Mayo Clinic, Infant and toddler health. (2014, October 22).
Retrieved February 4, 2015, from
http://www.mayoclinic.org/healthy-living/infant-and-toddler-
health/expert-answers/flu-shots/faq-20058448
NYDPH, influenza Vaccination Rates for Health Care Personnel
by Facility Chart for 2013-2014 [Chart]. (n.d.). In New York
State Department of Health. Retrieved March 30, 2015a, from
https://health.data.ny.gov/browse/embed?limitTo=charts&q=infl
uenza%2Bhealth%2Bcare&sortBy=relevance&utf8=%E2%9C%9
3
NYDPH , United States, New York Department of Public
Health. (2015, January 1). Frequently Asked Questions
Regarding Title 10, Section 2.59. Retrieved March 23, 2015b,
from
http://www.health.ny.gov/diseases/communicable/influenza/seas
onal/providers/prevention_of_influenza_transmission/docs/faq_f
lu_mask_requirements.pdf
Randall, L. H., Curran, E. A., & Omer, S. B. (2013). Legal
considerations surrounding mandatory influenza vaccination for
healthcare workers in the United States. Vaccine, 31(14), 1771-
1776. doi:10.1016/j.vaccine.2013.02.002
Schnirring, L. (2010, August 03). First hospital to mandate flu
vaccination reports on challenges, success. Retrieved March 29,
2015, from http://www.cidrap.umn.edu/news-
perspective/2010/08/first-hospital-mandate-flu-vaccination-
reports-challenges-success
USNLM. (2012, February 7). U.S National Library of Medicine
(United States, National Library of Medicine). Retrieved April
16, 2015, from
http://www.nlm.nih.gov/hmd/greek/greek_oath.html

VMMC, Virginia Mason Medical Center. (2008). Best Practices
for Increasing Influenza Vaccination Levels among Healthcare
Workers [Press release]. Retrieved March 30, 2015, from
http://www.izsummitpartners.org/wp-
content/bestpractices/BP_Mason.pdf
Winston, L., Wagner, S., & Chan, S. (2014). Healthcare
Workers Under A Mandated H1N1 Vaccination Policy With
Employment Termination Penalty: A Survey to Assess
Employee Perception. Vaccine, 32, 4786-4790.
http://dx.doi.org/10.1016/j.vaccine.2014.06.001
Bibliography
Catania, J., Que, L. G., Govert, J. A., Hollingsworth, J. W., &
Wolfe, C. R. (2014). High Intensive Care Unit Admission Rate
for 2013–2014 Influenza Is Associated with a Low Rate of
Vaccination. American Journal of Respiratory and Critical Care
Medicine,189(4), 485-487. doi:10.1164/rccm.201401-0066LE
CDC, Centers For Disease Control and Prevention, Division of
Healthcare Quality Promotion. (2014a). The National
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(pp. 1-1-A-2). Atlanta,, GA.
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3
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Health. (2015, January 1). Frequently Asked Questions
Regarding Title 10, Section 2.59. Retrieved March 23, 2015b,
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considerations surrounding mandatory influenza vaccination for
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1776. doi:10.1016/j.vaccine.2013.02.002
Schnirring, L. (2010, August 03). First hospital to mandate flu
vaccination reports on challenges, success. Retrieved March 29,
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perspective/2010/08/first-hospital-mandate-flu-vaccination-
reports-challenges-success
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(United States, National Library of Medicine). Retrieved April
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VMMC, Virginia Mason Medical Center. (2008). Best Practices
for Increasing Influenza Vaccination Levels among Healthcare
Workers [Press release]. Retrieved March 30, 2015, from
http://www.izsummitpartners.org/wp-
content/bestpractices/BP_Mason.pdf
Winston, L., Wagner, S., & Chan, S. (2014). Healthcare
Workers Under A Mandated H1N1 Vaccination Policy With
Employment Termination Penalty: A Survey to Assess
Employee Perception. Vaccine, 32, 4786-4790.

http://dx.doi.org/10.1016/j.vaccine.2014.06.001
Healthcare Worker Influenza Vaccination Rates Virginia Mason
Medical Center 2002 through 2007
2002 2003 2004 2005 2006 2007 0.38000000000000145 0.54
0.29500000000000032 0.98 0.98499999999999999
0.99
Comparison of CA and NY HCP Vaccination Rates 2008-2014
NY 2008-2009 2009-2010 2010-2011 2011-2012
2012-2013 2013-2014 46 72 49 48 63.5 87
CA 2008-2009 2009-2010 2010-2011 2011-
2012 2012-2013 2013-2014 55 62.6 64.3 67.8 74 81
Percent Of HCP Vaccinated
555 Main Street
555
-
555
-
5555
March 30

, 2015
555 South Street
Dear Mr. Doe:
The Influenza Vaccination Watch Group has been excited to
see much of the new
legislation
you have been able to
bring before the state senate.
We also know
that
we share a
common concern for diminishing the pandemic effects of
vaccine preventable illnesses
.

We are
interested in working with your firm.
We have prepared a proposal that outlines our finding
s
and
recommendations regarding increasing vaccination uptake in
California's health care workers.
Please take the time to read and consider our proposal.
I
f you have any questions please call me
at (555) 555
-
5555.
Thank you for your time and consideration of our proposal.
Sincerely,
Director
cs.ivwg.org

Enclosures (1)
555 Main Street
555-555-5555
March 30, 2015
555 South Street
Dear Mr. Doe:
The Influenza Vaccination Watch Group has been excited to
see much of the new
legislation you have been able to bring before the state senate.
We also know that we share a
common concern for diminishing the pandemic effects of

vaccine preventable illnesses. We are
interested in working with your firm. We have prepared a
proposal that outlines our findings and
recommendations regarding increasing vaccination uptake in
California's health care workers.
Please take the time to read and consider our proposal. If you
have any questions please call me
at (555) 555-5555. Thank you for your time and consideration
of our proposal.
Sincerely,
Director
cs.ivwg.org
Enclosures (1)

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