It happens every year at most companies: Employers send out an email promising crackers and juice for those who want to get a flu shot, with a sign-up sheet and permission form attached to the e-blast.

Some opt for it, and others pass, but what if your employer requires you to get one? That’s what’s happening at many U.S. hospitals in what has become a particularly nasty flu season, according to the Associated Press.

At least 15 nurses and hospital staffers in four states have been fired for refusing a flu shot in the past two months, while in other states workers have signed petitions opposing a requirement that they get one. Opponents generally cite allergies, religious objections, and general skepticism of whether the vaccinations will help patients.

Only three states, Arkansas, Maine, and Rhode Island, dole out penalties to healthcare workers who refuse to get a flu shot, but the pressure is on nonetheless: The Centers for Medicare & Medicaid Services will start requiring hospitals to report employee flu vaccination rates, with plans to eventually post the data online to allow consumers to compare options.

Many groups, including the American Medical Association, favor mandatory shots. Others, such as the American Nurses Association, support them only if they are implemented at the state level and allow for exceptions.

On the other hand, Service Employees International Union spokesman Chas Walker said that while increasing vaccination rates among healthcare workers and the general population is important, the shots should be voluntary.

(iStockphoto/Thinkstock)