Leadership matters: ward manager vaccination status influences nursing staff influenza vaccine uptake

BACKGROUND: Healthcare worker (HCW) influenza vaccination protects vulnerable patients but uptake remains suboptimal globally. Irish rates among public hospital staff declined from 50.8% in 2023-2024 to 45.4% in 2024-2025, falling further behind the 75% national target. While organisational culture influences vaccination behaviour, the specific relationship between ward managers' vaccination status and their staff's decisions has not been quantified. METHODS: This cross-sectional study at an Irish university teaching hospital during the 2024-2025 campaign analysed the vaccination status of 116 ward managers from 26 clinical areas and 845 nursing staff. Vaccination data were obtained from Ireland's national CoVax database. Managers were categorised as all vaccinated, mixed status, or none vaccinated. Statistical analysis used Cochran-Armitage test for trend and Kruskal-Wallis test. Multivariable logistic regression assessed whether the manager-staff association persisted after controlling for ward speciality type. RESULTS: A clear dose-response relationship existed. Staff vaccination rates were 48.0% where all managers were vaccinated, 35.5% where managers had mixed status, and 27.9% where no managers were vaccinated (Cochran-Armitage Z = -3.85, p < 0.001). Staff were 2.38 times more likely to be vaccinated under vaccinated managers (95% CI 1.44-3.94). Ward-level analysis confirmed these findings (Kruskal-Wallis H = 7.982, p = 0.018). After adjustment for ward speciality, manager vaccination status remained significantly associated with staff vaccination (adjusted OR 3.01, 95% CI 1.72-5.29, p < 0.001). CONCLUSIONS: Nursing staff vaccination rates increase significantly as ward manager vaccination rates increase. Targeting manager-level interventions early in campaigns represents a promising complementary strategy for improving HCW vaccination rates. However, even optimal manager influence (48% staff uptake) falls short of targets, emphasising the need for multi-faceted approaches.