Updated: Nurses on the Front Lines of Flu Epidemic


By Debra Wood, RN, contributor

As feverish, achy, coughing patients flow into clinics and emergency departments, nurses are on the front lines of recognizing these patients might have influenza, keeping themselves safe and educating patients about cough etiquette while providers prescribe appropriate antiviral therapy. 

“It’s a bad flu season, with a lot of ill people” said Crystal Heishman, MSN, RN, ONC, CIC, a member of the Association for Professionals in Infection Control and Epidemiology and an infection preventionist at University of Louisville Healthcare in Kentucky.

Influenza is widespread across the country, according to the Centers for Disease Control and Prevention (CDC). Influenza A, H3N2 continues to be the predominant strain. 

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“We are currently in the midst of a very active flu season, with much of the country experiencing widespread and intense flu activity,” said Brenda Fitzgerald, director of the CDC, during a press briefing. “When H3 viruses are predominant, we tend to have a worse flu season with more hospitalizations and more deaths.”

CDC surveillance systems show that nationally the flu season may be peaking now, but from past experience public health officials know that it will take many more weeks for flu activity to truly slow down, she said.

“In addition to being associated with increased severity, H3N2 seasons also are associated with vaccine effectiveness that is lower than what we usually see against H1NI or influenza B viruses,” added Daniel B. Jernigan, MD, MPH, (CAPT, USPHS) director of the Influenza Division of the National Center for Immunization and Respiratory Diseases at the CDC. 

As of January 13, 2018, among people 65 and older, the hospitalization rate was 136.5 per 100,000. It’s also hitting children hard. Thirty children had died since October 1, 2017 to January 13 of this year from influenza-related conditions. 

Complicating matters, the influenza vaccine is only about 30 percent effective against H3N2. Even so, CDC officials encouraged people to obtain the vaccine if they have not already done so.

“While our flu vaccines are far from perfect, they are the best way to prevent getting sick from the flu and it is not too late to get one,” Fitzgerald said. 

Nurses also can educate people that it’s not too late to be vaccinated. Adults and high medical-risk groups also should receive the two different pneumococcal vaccines.


Tactics for prevention and self-protection from the flu include practicing good hand hygiene and avoiding touching one’s face, the eyes, nose and mouth.

The CDC advises people to stay home if they are sick. That includes nurses. 

“If you are sick, you should just stay home,” Heishman said. 


Once patients start to show symptoms, they should be prescribed antiviral flu medication. 

“These drugs can lessen the symptoms and shorten the duration of illness, and there’s observational studies and other studies that have shown they prevent serious flu complications,” Jernigan said. 

Providers should not wait for confirmatory influenza testing.

“CDC recommends that people who are very sick or people with flu symptoms who are high-risk for serious flu complications should be treated as soon as possible with flu antiviral drugs,” Jernigan added. “That means people that are 65 and older. It means young children. It means people with chronic conditions like diabetes, heart disease or asthma. It means pregnant women and others more vulnerable to serious flu illness.”

While the total reported national supply of influenza antiviral drugs should be sufficient to meet this high seasonal demand, he added, some manufacturers are reporting delays in filling orders. CDC is aware of spot shortages of antiviral drugs in some places that have high influenza activity. 

Once past the 48 hours since symptoms started, the time period for which flu antivirals are most effective, many physicians will not prescribe the drugs. So the lesson is to go to the health care provider as soon as flu symptoms--fever, cough, body aches, headache, sore throat, nasal congestion--appear.

Nurses can instruct patients on good cough etiquette--to cough into the elbow while tilting one’s head down, not into the hands. When going to the provider’s office, patients should wear a mask. The CDC encourages people to seek care early for flu symptoms, not to wait.

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