Forced Immunization

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How many pharmacists have refused to immunize although their companies dictate it is mandatory? Has anyone lost their job or quit because of forced immunizations? I understand that many pharmacists want to immunize but I am curious about the pharmacists who do not for personal reasons or otherwise. Just wondering.
 
everyone in my district was forced to get certified, those who didnt either switched to midnite shifts, left the company, or gave up their staff spot and became floaters covering middle shifts at busy busy stores

just from my limited experience
 
My friend refused to give immunizations, and he never got fired. His DM was fine with it and he is the PIC... My partner refuses to give immunizations as well, and my DM hasn't fired him since he's been with the company before they started the immunizations.
 
Well, I'm disappointing. I thought this was going to be a discussion about compulsory vaccination.

I sure hope you meant disappointed:meanie:. Based on your posts, I never found you disappointing.... Though I don't know you personally.
 
I sure hope you meant disappointed:meanie:. Based on your posts, I never found you disappointing.... Though I don't know you personally.
:laugh: I don't know, I'm sometimes disappointed by npage. :laugh:
 
Why would someone not want to give immunizations? I don't give them, I am curious.
 
Why would someone not want to give immunizations? I don't give them, I am curious.

The main problem for many people isn't in the giving of immunizations, but in having "vaccine quotas" during flu season and just forcing immunizations upon the pharmacists while they have to to a bajillion more things, all with less and less tech help and just at any time of day (15-minute gift card rule still in effect, I imagine, while pharmacist gives vaccine). If MTM ever becomes profitable enough, I'm sure the same problem will exist with that.

Get your flu shot, an MTM session and your 3 prescriptions processed in under 15 minutes or you get a gift card, what a deal!
 
Better yet, why would someone start a petition with no audience in mind?


Since pharmacists are generally the biggest pansies of the medical community, perhaps the final destination of any data cannot be determined without knowing how many will speak up. The goal to any research of this type is to first accumulate information (if it is there to be gained), and then determine the best route to a true response from a governing body.

Pharmacists love to complain about retail and all of its downfalls, but did any large group really stand up against the corporations? I haven't seen it done enough to make a statement. The chains make money off of us with vaccinations, but we see nothing in return.

Most pharmacists do not want to be forced into giving immunizations, but are coerced by having to choose between principles and employment. My class had about 5-10% that wanted to actively pursue immunizing. THe rest simply wanted nothing to do with it.

Fear of disease risk and liability are the two biggest and valid reasons people DO NOT want to give them. Other just simply hate needles and the thought of giving an injection, and did not go to pharmacy school to become nurses.
Despite what your employer may say, we are NEVER immune from civil damages in court. Sure the company provides some coverage, and sure the government protects immunizers, but we have a hospital here with a 3.5 million dollar lawsuit over an injection infection.

I am 100% ok with pharmacists having the privilege to immunize, but totally against anyone being forced to do it. I have been certified to immunize for 3 years, and eventually decided that getting HIV/Hepatitis from a bum off the street (that I have no medical chart on) just wasn't for me.
 
The main problem for many people isn't in the giving of immunizations, but in having "vaccine quotas" during flu season and just forcing immunizations upon the pharmacists while they have to to a bajillion more things, all with less and less tech help and just at any time of day (15-minute gift card rule still in effect, I imagine, while pharmacist gives vaccine). If MTM ever becomes profitable enough, I'm sure the same problem will exist with that.

Get your flu shot, an MTM session and your 3 prescriptions processed in under 15 minutes or you get a gift card, what a deal!


DITTO . they should have called it "reward your angriest and rudest customers campaign" Reward their bad behavior with $5.
Here's $5 a-hole for acting like a complete jackwagon in the pharmacy today! Thank you, come again!
 
Since pharmacists are generally the biggest pansies of the medical community, perhaps the final destination of any data cannot be determined without knowing how many will speak up. The goal to any research of this type is to first accumulate information (if it is there to be gained), and then determine the best route to a true response from a governing body.

Pharmacists love to complain about retail and all of its downfalls, but did any large group really stand up against the corporations? I haven't seen it done enough to make a statement. The chains make money off of us with vaccinations, but we see nothing in return.

Most pharmacists do not want to be forced into giving immunizations, but are coerced by having to choose between principles and employment. My class had about 5-10% that wanted to actively pursue immunizing. THe rest simply wanted nothing to do with it.

Fear of disease risk and liability are the two biggest and valid reasons people DO NOT want to give them. Other just simply hate needles and the thought of giving an injection, and did not go to pharmacy school to become nurses.
Despite what your employer may say, we are NEVER immune from civil damages in court. Sure the company provides some coverage, and sure the government protects immunizers, but we have a hospital here with a 3.5 million dollar lawsuit over an injection infection.

I am 100% ok with pharmacists having the privilege to immunize, but totally against anyone being forced to do it. I have been certified to immunize for 3 years, and eventually decided that getting HIV/Hepatitis from a bum off the street (that I have no medical chart on) just wasn't for me.

I don't necessarily agree with the conditions that immunizations must take place in, but I have no problem with an employer changing a job description to meet the changing work environment. If some pansy can't get over the use of needles, then perhaps they've got more serious issues. I had to get used to it as well, and I learned to deal with it. As for exposure to blood borne pathogens, we're not talking about lancing the arm here, or drawing blood. Getting HepB or HIV from an accidental needle stick s/p immunization, while not impossible, would be extremely low risk given the amount of fluids in play.
Most of the comments have to do with time and convenience, few have anything to do with FORCING someone to immunize. It seems nearly all people are against forcing someone inconvenience themselves. That probably won't help much regardless of the audience.
 
i know plenty of rph who went into pharmacy instead of medicine/nursing/etc b/c they cant stand looking at blood or have needles/phobia. working retail was perfect for them, but with these immunizations, they are kind of in a bind.

and its easier said than done to 'man up,' if someone faints when looking at blood, its not a easy task to decondition them
 
We received an e-mail this week from our RxS (CVS) stating that all staff pharmacists will need to be certified immunizers for next season. He also stated that those who do not wish to become immunizers may have to be relocated into a different shift/location. I think this may be location specific, but has anyone else heard about this in their CVS district?
 
i know plenty of rph who went into pharmacy instead of medicine/nursing/etc b/c they cant stand looking at blood or have needles/phobia. working retail was perfect for them, but with these immunizations, they are kind of in a bind.

and its easier said than done to 'man up,' if someone faints when looking at blood, its not a easy task to decondition them

I was in that same boat, and still have my limitations, but I went to a program where immunization was required and decided it wasn't going to hold me back from doing what I wanted to do. With experience, I must say I'm much better about it than I thought I would be. I still don't like needles going into me, but I've been able to put them into other people with no problem. I'm not saying that just because I did it everyone should be able to, but I am saying that the majority should.
 
I know some rphs that dodged it for a few years but now all of them can do it now. We had to go for unpaid training, it was a whole day. I personally dont mind doing it if it was all i had to do (say in overlap) but that never happens. I do refuse to give them if i am working by myself. I cant be on the phone with 911, giving cpr, and doing all the other crap if God forbid something did happen
 
I know some rphs that dodged it for a few years but now all of them can do it now. We had to go for unpaid training, it was a whole day. I personally dont mind doing it if it was all i had to do (say in overlap) but that never happens. I do refuse to give them if i am working by myself. I cant be on the phone with 911, giving cpr, and doing all the other crap if God forbid something did happen

Yeah, where I am, we only schedule them 10-12 and 2-4 when we know we'll have intern coverage. Benefits of on campus pharmacy, lots of intern coverage. When I did my flu shots for Sav-On, they didn't have enough immunization trained pharmacists, so they'd do a rotating all day clinic and the pharmacist would be brought in. It still took staff time to process claims, but at least the regular pharmacist didn't have to leave the pharmacy for the immunizations.
 
Immunization training was mandatory for my University -- we had two folks pass out due to fear of needles but still everyone passed the training somehow (after they woke back up) ...

It's not my problem thank goodness, I've been providing a few immunizations at my weekend intern job too and don't mind it at all. It only takes a minute or two thanks to a pretty good computer system, and if there is any adverse reaction I'm sure all the people waiting for their RXs will forgive me for doing CPR first and their scripts second. Heck, they'll probably be staring like at a car wreck.
 
I am 100% ok with pharmacists having the privilege to immunize, but totally against anyone being forced to do it. I have been certified to immunize for 3 years, and eventually decided that getting HIV/Hepatitis from a bum off the street (that I have no medical chart on) just wasn't for me.

[/QUOTE]
I agree totally. It should be a choice. There are pharmacists who cannot take the hep vaccines due to family history or other medical reasons; some can't take the flu shots due to allergic reactions or family history of neurological disorders in other family members. Now, quality pharmacists are having to risk their own lives or quality of life or lose their jobs and there are really no jobs out there and all of the major chains and grocery chains are forcing pharmacists to immunize. 😡
 
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I agree totally. It should be a choice. There are pharmacists who cannot take the hep vaccines due to family history or other medical reasons; some can't take the flu shots due to allergic reactions or family history of neurological disorders in other family members. Now, quality pharmacists are having to risk their own lives or quality of life or lose their jobs and there are really no jobs out there and all of the major chains and grocery chains are forcing pharmacists to immunize. 😡[/QUOTE]

Corporations are making tons of $ off of our backs, with no added benefit to us...if you buy into the hype, then I just continue to feel pity for our retail sector. Business is business, but the village idiot in a corporate office is completely out of touch with the ground level of what reality is.
Pharmacists went to school to be patient educators, liaisons, dispensers, medication specialists, etc....not nurses. Like I said before, I'm not opposed to those wanting to actively participate doing it, but in my pharmacy class...90% of ppl wanted nothing to do with it.

We should NOT be forced to do this. It should be a calculated professional choice. For example, A general MD can likely remove a cyst, but probably refer you to a dermatologist or outpatient day surgeon...if MDs were pushed into things like "every doctor must do everything they're legally authorized to do", I bet they'd fight back. I'm just saying that Pharmacists have lost control and are the biggest pushovers I have ever seen. I'm ashamed sometimes of being counted against a group of people who do not preserve the dignity of their profession. We allow corporations to run us over.
 
It is just sort of crazy that we have an education, we're obviously intelligent on some level, but a corporation could literally pass the word down that "everyone must eat 4 catcrap sandwiches a day" and pharmacists gobble them down faster than the next bulletin can come out on it and then ask for seconds.
:scared: omg omg did i eat that catcrap sandwich fast enough?? will i get in trouble for not eating the crust too?

we're just a fear-mongering, testicle-lacking group of "professionals" lately.
 
I agree totally. It should be a choice. There are pharmacists who cannot take the hep vaccines due to family history or other medical reasons; some can't take the flu shots due to allergic reactions or family history of neurological disorders in other family members. Now, quality pharmacists are having to risk their own lives or quality of life or lose their jobs and there are really no jobs out there and all of the major chains and grocery chains are forcing pharmacists to immunize. 😡

Corporations are making tons of $ off of our backs, with no added benefit to us...if you buy into the hype, then I just continue to feel pity for our retail sector. Business is business, but the village idiot in a corporate office is completely out of touch with the ground level of what reality is.
Pharmacists went to school to be patient educators, liaisons, dispensers, medication specialists, etc....not nurses. Like I said before, I'm not opposed to those wanting to actively participate doing it, but in my pharmacy class...90% of ppl wanted nothing to do with it.

We should NOT be forced to do this. It should be a calculated professional choice. For example, A general MD can likely remove a cyst, but probably refer you to a dermatologist or outpatient day surgeon...if MDs were pushed into things like "every doctor must do everything they're legally authorized to do", I bet they'd fight back. I'm just saying that Pharmacists have lost control and are the biggest pushovers I have ever seen. I'm ashamed sometimes of being counted against a group of people who do not preserve the dignity of their profession. We allow corporations to run us over.[/QUOTE]
I am so glad to see that there are others out there that feel the same way I do!!!!! Nicely said SheraPharmD👍
 
If you want to determine your own work activities you have to be self employed. Do you really think physicians who work for health systems don't also have employers making decisions about what services they are expected to provide?
 
Corporations are making tons of $ off of our backs, with no added benefit to us...if you buy into the hype, then I just continue to feel pity for our retail sector. Business is business, but the village idiot in a corporate office is completely out of touch with the ground level of what reality is.
Pharmacists went to school to be patient educators, liaisons, dispensers, medication specialists, etc....not nurses. Like I said before, I'm not opposed to those wanting to actively participate doing it, but in my pharmacy class...90% of ppl wanted nothing to do with it.

We should NOT be forced to do this. It should be a calculated professional choice. For example, A general MD can likely remove a cyst, but probably refer you to a dermatologist or outpatient day surgeon...if MDs were pushed into things like "every doctor must do everything they're legally authorized to do", I bet they'd fight back. I'm just saying that Pharmacists have lost control and are the biggest pushovers I have ever seen. I'm ashamed sometimes of being counted against a group of people who do not preserve the dignity of their profession. We allow corporations to run us over.

The current immunization model is essential. It allows chains to maximize profits which is neccesary due to decreased reimbursement from dispensing drugs. I am so thankful that pharmacists can immunize since it expands our scope of practice therefore providing more job security
 
If you want to determine your own work activities you have to be self employed. Do you really think physicians who work for health systems don't also have employers making decisions about what services they are expected to provide?

Exactly. If it's part of the job to immunize, you immunize. If you don't want to, there are options with chains that don't do shots or owning your own pharmacy.
 
Exactly. If it's part of the job to immunize, you immunize. If you don't want to, there are options with chains that don't do shots or owning your own pharmacy.

It should be voluntary. That is all...no one should be forced. I have been certified by acpe to do this for 3 yrs along with ACLS through AHA, but cannot understand why we just jump off cliffs without any questions whatsoever. The settings I work in retail are 400+ rxs with ONE pharmacist. It is unsafe enough without adding more duties and more risk.

Pharmacists are weak and do what they are told without thinking. Everyone jumped on this simply because they were threatened or scared of losing a job. No one ever stood up on a large scale and asked "what if we say no?". Our retail setting has no self respect.🙁
 
It should be voluntary. That is all...no one should be forced. I have been certified by acpe to do this for 3 yrs along with ACLS through AHA, but cannot understand why we just jump off cliffs without any questions whatsoever. The settings I work in retail are 400+ rxs with ONE pharmacist. It is unsafe enough without adding more duties and more risk.

Pharmacists are weak and do what they are told without thinking. Everyone jumped on this simply because they were threatened or scared of losing a job. No one ever stood up on a large scale and asked "what if we say no?". Our retail setting has no self respect.🙁

My husband is a manager for a Fortune 500 shipping company. He just took a new job within the company. There are a few duties in his new job description that he's not really fond of. Should those things be voluntary for him?
 
A general MD can likely remove a cyst, but probably refer you to a dermatologist or outpatient day surgeon...if MDs were pushed into things like "every doctor must do everything they're legally authorized to do", I bet they'd fight back.

I spent the morning of 9/11 in a plastic surgeon's office, having exactly this done. I had a marble-sized cyst on my scalp.

About 10 years ago, the place where I worked retail got a new store director who wanted us to be immunization certified. One of my colleagues had been an Army medic during the Vietnam era, and he said there was no way he would do that unless there was a physician present.
 
It should be voluntary. That is all...no one should be forced. I have been certified by acpe to do this for 3 yrs along with ACLS through AHA, but cannot understand why we just jump off cliffs without any questions whatsoever. The settings I work in retail are 400+ rxs with ONE pharmacist. It is unsafe enough without adding more duties and more risk.

Pharmacists are weak and do what they are told without thinking. Everyone jumped on this simply because they were threatened or scared of losing a job. No one ever stood up on a large scale and asked "what if we say no?". Our retail setting has no self respect.🙁




Once again I applaud you........I agree with every word!👍
 
My husband is a manager for a Fortune 500 shipping company. He just took a new job within the company. There are a few duties in his new job description that he's not really fond of. Should those things be voluntary for him?




I believe the point being made is when do we put our foot down and say enough is enough? Our concern is for our patient's safety & the pharmacist's ability to manage the role we already have in the pharmacy. The inadequate staffing, long hours, no overlap........etc,etc....... Patient safety has got to come first no matter what the economic times are currently. Guess that's my point. JMO.
 
I believe the point being made is when do we put our foot down and say enough is enough? Our concern is for our patient's safety & the pharmacist's ability to manage the role we already have in the pharmacy. The inadequate staffing, long hours, no overlap........etc,etc....... Patient safety has got to come first no matter what the economic times are currently. Guess that's my point. JMO.

The point Shera is pushing is the immunization should be voluntary. Frankly, that's just not the way things work in the working world. Our employers set our job descriptions and we choose to continue working for them or move on. I've been working in another industry for over a decade and never once have I been able to cherry-pick my job description that way.

I agree that the chains should provide adequate staffing to accomplish the tasks they set for their employees. That's the real issue here. Not immunization. It's the whole working environment that needs improvement.
 
The point Shera is pushing is the immunization should be voluntary. Frankly, that's just not the way things work in the working world. Our employers set our job descriptions and we choose to continue working for them or move on. I've been working in another industry for over a decade and never once have I been able to cherry-pick my job description that way.

I agree that the chains should provide adequate staffing to accomplish the tasks they set for their employees. That's the real issue here. Not immunization. It's the whole working environment that needs improvement.

The point about immunization is that it is inherently dangerous. A person could have an adverse reaction to the injection. You're exposed to the risk of a needle stick thus transporting all of the fun conditions that could be transmitted. You don't have a chart for the patients who come in. A lot of people don't want to take on those risks. There's a difference between forcing someone to do something essential to the job or something that is complementary to the job, and immunization hasn't been a part of pharmacy until very recently. The point is that immunization isn't an inherent part of the job of being a pharmacist. It takes away time from what a pharmacist should be doing. And risking your health and license for something that isn't part of the practice of pharmacy should be optional to those who wish to abstain.
 
The point about immunization is that it is inherently dangerous. A person could have an adverse reaction to the injection. You're exposed to the risk of a needle stick thus transporting all of the fun conditions that could be transmitted. You don't have a chart for the patients who come in. A lot of people don't want to take on those risks. There's a difference between forcing someone to do something essential to the job or something that is complementary to the job, and immunization hasn't been a part of pharmacy until very recently. The point is that immunization isn't an inherent part of the job of being a pharmacist. It takes away time from what a pharmacist should be doing. And risking your health and license for something that isn't part of the practice of pharmacy should be optional to those who wish to abstain.

Patient counseling wasn't always part of the practice of pharmacy either. There are still old school RPhs who aren't comfortable with it and don't want to make recommendations about OTCs, etc. But it's very much entrenched in the practice of pharmacy now. I think immunization (like it or not) is on its way to being similarly entrenched as a standard part of pharmacy practice. In terms of risk, I think there are other far more risky activities one can be exposed to on the job. But as with making chemo or handling anti-neoplastics or working with radiopharmaceuticals or rounding with the ID team in the ICU, the risks are minimized by adhering to proper protocol.
 
I'm in awe that people are so worried about getting a disease from giving immunizations. I've been exposed to scarier things just accepting someone's groddy, stained prescription that I thought had to be expired it looked so old, only to see it was written that day. How do people DO that?

I completely understand the workload issue. I don't understand the fear of disease.
 
Patient counseling wasn't always part of the practice of pharmacy either. There are still old school RPhs who aren't comfortable with it

One reason is that not so many years ago, patients were often not told the truth about their diagnoses. This was especially true with cancer and psychiatric disorders.
 
Patient counseling wasn't always part of the practice of pharmacy either. There are still old school RPhs who aren't comfortable with it and don't want to make recommendations about OTCs, etc. But it's very much entrenched in the practice of pharmacy now. I think immunization (like it or not) is on its way to being similarly entrenched as a standard part of pharmacy practice. In terms of risk, I think there are other far more risky activities one can be exposed to on the job. But as with making chemo or handling anti-neoplastics or working with radiopharmaceuticals or rounding with the ID team in the ICU, the risks are minimized by adhering to proper protocol.

The things that you bring up are all drug related. Pharmacists deal with drugs. Our profession evolves to let us do more drug related things (counsel, make chemo, etc). My problem is that giving vaccinations (while a great public health service) isn't drug related therefore it shouldn't be within the scope of a pharmacists practice if he/she doesn't feel comfortable.
 
The things that you bring up are all drug related. Pharmacists deal with drugs. Our profession evolves to let us do more drug related things (counsel, make chemo, etc). My problem is that giving vaccinations (while a great public health service) isn't drug related therefore it shouldn't be within the scope of a pharmacists practice if he/she doesn't feel comfortable.

The items in bold say it all. Nobody gives two sh*ts about your feelings. If you don't like the terms of employment, you can quit. Nor are you the God of Pharmacy to determine what is in the scope of practice. The practice of pharmacy will always continue to evolve just as it has for the more than 30 years I have been involved.

Just one more thing, vaccines are drugs. Open your dictionary to the word drug and you will find:


  • A substance recognized in an official pharmacopoeia or formulary.
  • A substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.
  • A substance other than food intended to affect the structure or function of the body.
  • A substance intended for use as a component of a medicine but not a device or a component, part, or accessory of a device.
What part of that definition does not apply to vaccines.
 
The items in bold say it all. Nobody gives two sh*ts about your feelings. If you don't like the terms of employment, you can quit. Nor are you the God of Pharmacy to determine what is in the scope of practice. The practice of pharmacy will always continue to evolve just as it has for the more than 30 years I have been involved.

Just one more thing, vaccines are drugs. Open your dictionary to the word drug and you will find:


  • A substance recognized in an official pharmacopoeia or formulary.
  • A substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.
  • A substance other than food intended to affect the structure or function of the body.
  • A substance intended for use as a component of a medicine but not a device or a component, part, or accessory of a device.
What part of that definition does not apply to vaccines.

So is propofol, but you don't see us administering it. By your definition we should be giving all anesthetics, injections, etc. Where is the line supposed to be drawn?

Glad to know no one gives a **** about how I feel. I guess I'm not a special little snowflake. Feel better now that you gave me an e-smackdown? I thought this was supposed to be a constructive debate between professionals. Perhaps you should open your dictionary to that page and check another definition.
 
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So is propofol, but you don't see us administering it. By your definition we should be giving all anesthetics, injections, etc. Where is the line supposed to be drawn?

Glad to know no one gives a **** about how I feel. I guess I'm not a special little snowflake. Feel better now that you gave me an e-smackdown? I thought this was supposed to be a constructive debate between professionals. Perhaps you should open your dictionary to that page and check another definition.

If your contract with a hospital (pretend you're a CC pharmacist) said that you were responsible for administering propofol to all unit patients, then you would be doing just that.

As a resident, I'm required to treat whatever patients come on my service. I can't decide not to treat the cocaine-induced chest pain patient just because I think my time would be better spent on someone I can actually help. Same with your job and whatever rules are present.

Where did the post you quoted suggest that pharmacist must administer ALL medications? On the other hand, at my hospital all drugs must obviously be screened/prepared in the pharmacy by the pharmacist.
 
So is propofol, but you don't see us administering it. By your definition we should be giving all anesthetics, injections, etc. Where is the line supposed to be drawn?

Glad to know no one gives a **** about how I feel. I guess I'm not a special little snowflake. Feel better now that you gave me an e-smackdown? I thought this was supposed to be a constructive debate between professionals. Perhaps you should open your dictionary to that page and check another definition.

Nice to bring up a straw man. I'll take your week arguments one at a time.

1. We dispense propofol just the same as we dispense other drugs. We don't administer propofol, becuase we unlike giving vaccinations, we have not been trained to administer propofol. You can't just start giving vaccinations w/o the proper training. So my friend, the line is drawn by what we are legally allowed to do.

2. Your feelings are immaterial. Nobody cares what you feel. Keep your emotions out of it. I have no problem with an argument or a discussion. Stick to facts, not feelings. Feelings are not constructive. That means it's about YOU. Stop being so narcissistic. It's not about you. It's about what society allows you to do in the scope of your practice. Independent pharmacists have been pushing this for a long time. It makes sense. There is a shortage of PCP's coming, pharmacists see more patients in a day than any other heath care professional. It's an additional source of income. Once it became common place, the chains could not cede the provision of this service to independents. So thank your independent brethren for where you are. It is now in the scope of practice for a pharmacist.
 
We received an e-mail this week from our RxS (CVS) stating that all staff pharmacists will need to be certified immunizers for next season. He also stated that those who do not wish to become immunizers may have to be relocated into a different shift/location. I think this may be location specific, but has anyone else heard about this in their CVS district?

Same thing in my district.


I think the major issue with the whole immuniztion thing is the addition to an already ever increasing, barely safe, work environment. It's very hard to devote the necessary time. Just think about any time you had a vaccine administered in a medical office setting. Even if it should "in theory" take seconds you will have waited in the office for awhile with all the paperwork, preparation, etc. That is very difficult to in a CHAIN setting.

Also, another thing is how there is a quota and how we have to upsell these. We have to "sell em" with every prescription and phone call.
 
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