Background Checks: What Employers Should Know

by Lisette Hilton
January 20, 2004

Charles Cullen, a nurse who admitted to killing 30 to 40 patients in his 16-year career, didn’t seem to have trouble getting jobs at hospitals and nursing homes in New Jersey and Pennsylvania.

The 43-year-old Cullen had been fired or forced to resign from at least six healthcare facilities, according to an article published December 16, 2003, in The New York Times. Still, the nurse had a clean slate according to medical licensing boards in New Jersey, and though one hospital made a report to Pennsylvania authorities, it was not clear what the hospital reported or what came of it.

This case and others raise serious issues, including how employers share information with other employers about employees’ pasts. It also puts under the spotlight hiring practices and the ability to get a clear picture of a person’s character and past.

Common but Often an Imperfect Practice

It seems odd to have to check the backgrounds of nurses — a profession of people known for their caring and nurturing qualities. Ironically, Cullen justified his delivery of toxic drug doses to unknowing patients as his way of alleviating pain and suffering.

But today’s hospitals aren’t only doing background checks to prevent mistakenly hiring someone like Cullen; rather, many healthcare employers are trying to avoid the potential for medication and other errors. Conducting background checks is one way to make sure people act as responsible citizens and have the credentials they say they do.

Becky Vizzone, a human resources consultant for nursing at Children’s Memorial Hospital, Chicago, IL, thinks background checks are vital. Children’s Memorial requires references and follows up with past employers to see if a nurse candidate is eligible for rehire at previous employer institutions. Checking for "rehire eligibility" is an added measure because most employers do not divulge information about former employees’ performance, but they are more inclined to indicate whether they’d hire that employee again or not, Vizzone says.

Children’s Memorial also verifies dates of employment and checks licensing and criminal pasts.

Still, Vizzone argues that despite their best efforts, "...once an individual gets here, it’s conceivable that things can happen." To combat the possibility, the hospital does ongoing competency checks.

Gloria Cohen, RN, MPS, assistant executive director for human resources, North Shore University Hospital, Manhasset, NY, says that North Shore has been conducting criminal background checks since January 1999 on all new hires, including nurses. "We do criminal, social and reference checks...," she says. The hospital also conducts degree verifications and, for nurses who work in positions involving financial matters, the hospital will run credit checks.

Cohen finds that the two most valuable investigations of potential employees are the criminal background check and New York state license verification online. "You can go into New York State on the web and look at nurses’ licenses to make sure that they are in good standing. Sometimes, it goes back beyond seven years," she says. "The [social security check] is to make sure that the social security numbers that they are providing are correct."

North Shore uses an outside source for conducting the background checks, according to Cohen. The cost for each background check runs from $30 to $105, depending on the extent of the check, she says. But the practice is a worthwhile one because it sends the message that North Shore is going the extra mile to ensure that it employs "safe practitioners," she says.

Background Check As, Bs, and Cs

Background information can vary greatly qualitywise, according to Greg H. Mohn, CEO and president, Personnel Research Services, based in Minneapolis, MN.

"You use credit bureaus, county courthouses, federal courthouses, you have motor vehicle [data]... There are thousands of places to get that information," says Mohn. "What makes it even more complicated is you have a lot of people who buy data from different sources. They roll it all together and advertise that they have this great database. But many times, that database contains incomplete and outdated information."

Mohn’s firm has audited government databases and found that some counties don’t update the data on a regular basis and criminal databases might only contain felonies and gross misdemeanors. For example, he says, the Minnesota state database, which is advertised as a complete database, is missing from 40% to 50% of all conviction records in the state.

County courthouses, according to Mohn, tend to be reliable sources and might even include dismissed charges. The caveat is that while employers can look at dismissed charges, they cannot, by law, deny someone employment due to a dismissed record.

Must Haves for Hiring Nurses

Mohn says that employers hiring nurses should conduct social security checks, to verify that they are who they say they are; county criminal searches for the past seven years in any counties in which they’ve worked; a federal criminal search; employment verification; and an education verification. Employers hiring nurses should also refer to the National Practitioner Databank and the Office of Inspector General database.

Employers should beware that negligent hiring lawsuits are on the rise, according to Mohn. "If you hire someone with a criminal past and he or she commits a crime against an employee or customer, you are liable because you should have known. That’s not a law but there are those lawsuits and the majority of those lawsuits are being lost by employers who don’t do background checks."

Employers’ Obligations: To Tell or Not to Tell?

Barry J. Nadell, president, InfoLink Screening Services, Inc. based in Los Angeles, CA, says it’s common that former employers will not divulge vital information about former employees — even if it could result in a dangerous situation for the new employer.

Employers fear being sued for defamation of character and many are when they utter negative things about former employees. The tide might be turning, however, Nadell says. "There are some states that have started looking into this area and are passing laws that would make it easier for employers to give truthful information. The best one we’ve seen is Hawaii, and there is legislation pending in other states."

Nadell is involved in writing new legislation for California. The state of California has agreed to sponsor a bill for 2004 that would make it a lot easier for employers to be honest and give information, he says. According to Nadell, section 47 of the California civil code currently makes it a qualified privilege to give information about former employees, but the qualification is such that anyone could sue anybody. Nadell and others are suggesting that the language be changed to say that an employer who provides information or an opinion to a prospective employer about a current or former employee’s job performance is “rebuttably presumed to be acting in good faith and shall have a qualified immunity from civil liability for disclosing the information and for the consequences of the disclosure.”

"What I’m saying is the good faith presumption shall be rebuttable by showing clear and convincing evidence that the information or opinion disclosed was intentionally malicious and knowingly false or misleading," says Nadell.

In the meantime, however, there are lots of other ways to uncover something shady about potential employees’ pasts, Nadell says. "What we’ve found in doing thousands of background checks is that, generally, there is going to be something that turns up that will give you an indication of a person’s character."

That’s where employers who check previous employment dates and education claims, as well as criminal and social security data, might uncover a flat out lie or embellishment of the truth. It’s not 100% insurance policy that a hospital would avoid hiring dangerous, violent, or criminal employees. But it helps to weed out a lot of the bad apples.

Lisette Hilton is a freelance healthcare reporter, specializing in covering local, national, and worldwide news for nurses, pharmacists, physicians, and other allied health professionals.