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I don’t think there are many jobs out there where an employer doesn’t attempt to learn a little about a person before he or she comes to work for them. Even your local burger joints require some information about one’s past. Of course, the background check plays a bigger role in some professions than others. For instance, in the healthcare industry a worker’s past can play a vital role. But how helpful and reliable is the information that’s obtained on these routine checks?

That’s the question that’s on the lips of healthcare facilities across the country. In the wake of Charles Cullen, a nurse accused of killing some 40 patients, the industry is left struggling with a reference process that is, at best, inadequate. There are two obvious problems in this story, one being that this man was able to commit murder in the first place, the second, and more alarming issue, that he was able to do it in not one, but possibly nine hospitals over a 16 year career.

What A Tangled Web We Weave
How did this happen? Apparently, we have a system that across the board — local, state, and national — is failing us miserably. It’s tragic that it took an incident like this to bring our attention to this matter. But after Cullen’s confession the hospitals where he worked in the past had no choice but to revisit his employment history. The discovery that’s quickly coming into focus is that there are serious inequities in the way hospitals hire and fire their frontline professional workers, including nurses and physicians.

As the investigation spurred by Charles Cullen goes deeper and deeper, the entire healthcare industry is being unnerved. A disturbingly fragmented employment system is being uncovered, one that is obviously plagued with gaps and disconnects. The saddest fact is the reason checks and balances are being neglected is fear of litigation. Many hospitals would rather let a nurse resign, retire or move on than take any kind of disciplinary action that could lead to a wrongful termination lawsuit.

Close Your Eyes And Hope For The Best
What’s truly horrifying is that even when hospitals did contact each other on Charles Cullen’s past the only thing they were told were his dates of employment, which was then considered a neutral reference. The reason why this happened is simple, hospitals and human resource professionals are not willing to share with other organizations anything derogatory about an individual because they fear being sued for defamation of character. Charles Cullen was hired again and again even though on more than one occasion he was fired under a cloud of suspicion.

If a hospital wanted any real “useful” information they would have had to have a written request for information along with a signed consent form from Cullen himself. This would be the only way a hospital would have learned that Cullen had a “no rehire” in his personnel file.

Something’s Gotta Give
What can be done to help this failing system? Hospitals are sticking to their story saying their fear of litigation is real. They want government protection if they are going to be sharing character information with other organizations. Can the government provide this kind of confidence?

Well, two Senators from New Jersey know one thing — they want to prevent anything similar to the Charles Cullen case from happening in the future. Sen. Jon Corzine and Frank Lautenberg are crafting a bill that would create a federal nurse database. Under their proposal, employers who share information about nurses with each other would be protected from lawsuits. State boards regulating nurses would also be notified when a nurse is being investigated.

Permission to Speak Freely
The proposed national databank would be accessible to every hospital and other employers of nurses. Overarching federal legislation would also allow states to be aware of each other’s actions against nurses. Both Senators want to make sure hospitals can pass on crucial information about a nurse’s work history without fear of being sued.

Right now, it is not clear how much congressional support the bill will generate. The American Association of Colleges of Nursing said they would support any legislation that ensures patient safety, but they feel the database should include all healthcare workers not just nurses.

Currently, hospital must check with the National Practitioners Data Bank when they hire doctors. This databank contains information about criminal convictions, license suspensions and medical fraud convictions on doctor’s records. At this time hospitals have no similar resource to check a nurse’s background. Another federal databank, the Healthcare Integrity and Protection Databank, does exist and has such information on nurses and other healthcare providers, but the information is not available to hospitals or the public.

All Hope Is Not Lost
The National Council of State Boards of Nursing launched a database in May 2003 containing information about nurses, including license verification and disciplinary actions taken against them. To date, 27 states have joined and another eight plan to join. All nurses working in these member states are entered into the database.

Even with programs like this in the works, there are still hurdles to overcome. There has to be uniform rules set on the type of information that will be mandatory for hospitals to report. Currently every state has their own standards on what they are willing to report to other organizations. Hospitals have to be willing to share information that they currently regard as confidential. The bottom line is that someone needs to address the very real fears hospitals have about being sued, so they can focus more on patient safety and worry less about disgruntled nurses. If this issue is not addressed there is a good chance that this one bad seed can infect the trust of an entire profession. Sad but true.