Date of Award

Spring 5-22-2021

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor



Background: In 2015, the American Nurses Association (ANA) revised their immunization and vaccine policy statement to address the culture of vaccines that was prevalent in 2015. Due to evolving climate and growth in vaccination noncompliance as evidenced by recent outbreaks of vaccine preventable illnesses.

Purpose of Project: It is my recommendation that the ANA remove their endorsement of religious exemption from vaccinations in their policy statement, considering misapplications for which the exemption was not designed and that compromises the safety of the public. Additionally, annual medical exemption recertification signed by a qualified provider will become the recommended standard of practice.

EBP Model/Frameworks: The Iowa Based Model’s intuitive architecture helped identify a knowledge gap during the 2019 measles crisis in the United States and triggered a research project of removing all but non-medical exemptions from vaccinations as a national initiative. Designed to manage the efforts of clinicians during research after a triggering event and facilitate question development, the Iowa Model proved most suitable for project development and implementation. The time-tested design of the Iowa Model evidenced by its repetitive utilization in the nursing construct ensured project success.

Evidenced Based Interventions: Mississippi, Virginia, and California exists as evidence-based models for decreasing vaccination preventable illness after removing verbiage for religious exemptions to vaccinations at the state legislative levels demonstrating a marked decline in disease prevalence.

Evaluation/Results: The measurable increase in vaccination rates corresponding to the decrease in vaccine preventable illnesses as reported by the number of national cases by the CDC. The correlation of vaccination rates in states that allow religious and personal vaccination exemptions compared with the occurrence of preventable illnesses. Nationally, there has been a 99% decrease in measles prevalence since project implementation.

Implications for Practice: Vaccine preventable illnesses continue a downward trend until declared eradicated by the World Health Organization. Vaccination rates increase and incidence of preventable diseases decrease. Herd immunity develops to a threshold to safely protect those who cannot be vaccinated, i.e., immunocompromised individuals.

Conclusions: Removal of ANA endorsement of religious exemptions to vaccinations will propagate a culture of vaccination compliance that ensures the safety of individual patients and that of the general populace and it protects those who exempt from vaccination because they cannot become vaccinated due only to medical contradictions.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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