Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Laura Munoz


Teresa Acosta


Purpose: The aim of this quality improvement project was to improve the influenza vaccination rate of health care workers at an ambulatory care center to meet the national benchmark of 90%.

Background: Influenza is a communicable disease that affects over 130,000 people causing 7,000 deaths (CDC, 2017b). Over the last 3 years the influenza immunization rates at the facility of interest have been on a downward trend despite multiple interventions, resulting in 43% last season. A directive was published at the beginning of the 2017-2018 influenza season mandating each employee to either get a vaccine or decline in writing. This directive resulted in a formal grievance filed by the union causing a delay in enforcement.

Methods: An intense effort to improve the immunization rate was undertaken in collaboration with the Occupational Health employees. Staff were educated with a script that would be utilized for employees who declined the influenza immunization. Employees who were not immunized by week 1 of the project were tracked by the Occupational Health team for directive adherence and provide face-to-face communication to encourage immunization.

Results: At the end of the influenza season the health care immunization rate increased to 86% (n = 883)

Conclusion: Having a one-on-one interaction with individuals who had not made an immunization decision provided the opportunity for education and administration of the immunization if desired. With increased compliance, documentation, and education the project obtained overall success despite unexpected challenges.