Seeking to boost its vaccination rate, Essentia Health this week began requiring all its 15,000-plus employees across four states to get flu shots, the health system's patient quality and safety officer said.

The requirement also applies to the health system's vendors, students and volunteers who serve in the health system, said Dr. Rajesh Prabhu, who also is an infectious diseases physician at Essentia.

The compulsory element of the new vaccination effort doesn't sit well with all Essentia employees.

"There are a lot of people upset about it," said Paula Bullyan, a certified surgical technician at Essentia since 2002. "Even people who receive the flu shot, they say they don't think it's right to force people to take an injection."

But Essentia Health, which had a vaccination rate among its employees of 82 percent last year, has good reason to seek a higher rate, Prabhu said.

"It's important for multiple reasons, but primarily to protect our patients," he said. "Because we do know, and it has happened at Essentia Health ... that patients do acquire influenza while being hospitalized."

The only exceptions are for employees with medical or religious reasons, Prabhu said. Those employees must provide a statement signed by a doctor or member of the clergy.

But a spokesman for the Minnesota Nurses Association said its members who are Essentia employees can't be required to get the shots.

"They would be in violation (of the contract) if they tried to implement it without negotiation," Rick Fuentes said.

Essentia has contacted the MNA, and a negotiating session on required flu shots has been set for Nov. 7, Fuentes said.

Prabhu said he wasn't aware of that, but he noted that one-third of Essentia employees got their flu shots this week, the first week of the campaign.

It was too early to know how MNA members in the Essentia system would respond to the flu shot requirement, Fuentes said. "We're still taking the temperature of our members to see if they oppose it."

In general, MNA is concerned that if health systems require flu vaccinations, they should provide for employees to be able to take a day or two off if they suffer a bad reaction, Fuentes said.

"It does happen," he said. "They tell you this. You have to sign a waiver when you get a flu shot that you understand that people have adverse reactions."

Prabhu downplayed that possibility, saying a severe allergic reaction is "one in a million."

But Bullyan said she's willing to get a flu shot only if Essentia can guarantee no adverse reaction.

"I want full disclosure," she said. "I will conditionally accept their offer to vaccinate if they can provide verifiable proof that the vaccine will cause no harm to me or my family."

Lacking that, Bullyan said, she thinks it's a violation of human rights for an employer to require that its employees get vaccinations.

Bullyan is among Essentia employees with membership in the Steelworkers Union; others belong to the American Federation of State, County and Municipal Employees. She said she has been told those unions will be negotiating about the flu vaccinations later this month.

But if it comes to it, Bullyan said, she's willing to risk losing her job rather than submit to a flu shot.

Prabhu said Essentia already has required immunizations for employment - tetanus; measles, mumps, rubella; and hepatitis B.

"Health care workers are supposed to be role models for the community," he said. "If your role models are not doing this, then the public is not going to do this."

Last year, Essentia increased its participation by 10 percentage points by requiring employees to say whether they were getting a flu shot, Prabhu said. Requiring the shot itself is considered the next step, and it's a step many health systems have taken, he said.

According to the Centers for Disease Control and Prevention, 78.6 percent of health care personnel responding to a survey reported receiving vaccinations during the 2016-17 flu season. But that reached 96.7 percent among those whose employers required flu shots.

Sanford Health, which has hospitals in Fargo, N.D., Sioux Falls, S.D., and other locations, made flu shots mandatory for employees four years ago.

Fuentes said the MNA supports efforts to voluntarily increase flu shot participation but has reservations about mandatory requirements.

St. Luke's hospital doesn't have a mandatory flu vaccination policy, said Jane Gilbert-Howard, who oversees infection control for the hospital's quality management department. By encouraging employee participation, the hospital usually gets better than an 80 percent vaccination rate, she said.