Current TN Nurse Feature Story

Smallpox Vaccinations: 
A Volunteer Program in the Volunteer State

 By Melanie Pafford-Failor, MSN, RN, APRN, BC

Have you heard the news? Tennessee is the leader in volunteers for the smallpox vaccination effort! As of May 2, 2003, Tennessee had vaccinated 2,429 volunteers out of the national total of 35,903. 

On January 30, the Mid-Cumberland Region began the smallpox vaccination program with public health staff volunteers. On February 10, vaccinations began for hospital worker volunteers. These volunteers are part of the public health and hospital emergency response teams in the event of a smallpox outbreak.  

The Mid-Cumberland Region of the Tennessee Department of Health includes 12 counties surrounding Davidson County. In those 12 counties, we have 11 hospitals –nine of which participated in the Pre-Event Smallpox Vaccination Program. What a great effort of preparedness and teamwork!

I am a Family Nurse Practitioner employed by the State of Tennessee as the Primary Care Director for the Mid-Cumberland Region. In December 2002, I was invited to participate in the Southeast Public Health Leadership Institute (an effort to build public health leaders). One of my assignments is to develop a leadership project to interface with my current job and the bioterrorism preparedness effort. Teambuilding is the area of focus I have chosen for my project. Soon after my first course in the Leadership Institute, my supervisor asked me to manage the Pre-Event Smallpox clinic…and we both realized that this would also fulfill the course requirement for a leadership project. What an adventure this would turn out to be. 

My personal decision to volunteer for the smallpox vaccination was an easy one to make. As the uncertainty of bioterrorism became more of an issue for Americans, it became clear to me that the United States needed to be better prepared to meet this threat. Once President Bush authorized the implementation of Phase I, I knew I wanted to be a part of it. I had no contraindications to the vaccine and had received it as a child. My risk for complications was very low. However, I must admit that I rested a bit easier after day 21 (most complications will occur by day 21). The only side effects that I experienced were fatigue/malaise for two to three days, localized site tenderness and site itching. I did not miss any days of work. 

As Smallpox Clinic Manager, my responsibilities included clinic staffing; obtaining clinic supplies; monitoring appointments of the volunteers; answering medical questions; planning, evaluating and revising clinic flow issues; serving as public information officer; and submitting weekly reports to Tennessee Department of Health officials. 

Staffing was composed of public health nurses from three different regions. Some weeks we had different staff each day. Morning staff meetings were essential to provide instruction in clinic flow, smallpox vaccination protocol, and to explain paperwork required by the CDC. The attitude of the staff was very positive and everyone worked well together–thus making my job a lot easier. 

Clinic flow began with registration at the front desk. The next stop was the video room to view a 12-minute CDC video explaining the smallpox vaccination, possible side effects and contraindications. Paperwork was also completed here with the assistance of nurses.  Next was Pre-Counseling, in which every volunteer had an opportunity to meet one-on-one with a nurse. Paperwork was reviewed, questions answered, and each volunteer was evaluated for any contraindications to the vaccine. If the volunteer was cleared to receive the vaccine, they proceeded to a clinic room to be vaccinated by a nurse. Site care instructions and extra dressing supplies were given to each volunteer. The entire process took approximately one hour. 

The role of Public Information Officer was completely new to me. My initiation was a trial by fire. On the first day of public health staff vaccinations, we had reporters from four television stations and three newspapers–all arriving at the same appointed time. In spite of a few hours of chaos in the clinic, media coverage was accurate and well done. In the meantime, I have attended media training and have a better plan in mind for the next time. 

The response of the hospital volunteers has been a good one. They have been excited to be a part of the smallpox emergency response teams. It was fun to meet these folks who are on the front lines of acute patient care. The smallpox clinic provided an opportunity for hospital workers and public health workers to meet each other, collaborate and network together. Part of bioterrorism preparedness involves inter-agency cooperation. Our clinic has been an important part of this process. 

The Pre-Event Smallpox clinic was a great experience for me.  Some of the lessons learned were:

1)      Pre-planning is important to all aspects of clinic management.

2)      Communication needs to be both clear and concise.

3)      Flexibility and a sense of humor are essential.

4)      There are many aspects to team building and this will be an ongoing process for me. 

I have enjoyed the opportunity to grow in my leadership skills and to be a participant in making public health history in Tennessee.

Melanie Pafford-Failor, MSN, RN, APRN, BC, is certified by the American Nurses Credentialing Center as  a Family Nurse Practitioner. She currently is the Primary Care Director for the Mid-Cumberland Region for the Tennessee Department of Health.