1. Hader, Richard RN, PhD, CNA, CHE, CPHQ, Editor-in-Chief

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Accused critical-care nurse Charles Cullen confessed to killing as many as 40 people in 10 health care facilities in New Jersey and Pennsylvania, yet reference checks following at least 5 firings for suspected wrongdoing failed to prevent him from being hired at successive hospitals. This horrific case has created public outcry to prevent its recurrence and is forcing health care leaders to review and refine hiring procedures.


Nursing's past

Many of us have terminated a nurse because of poor clinical practice or unethical behavior, only to learn within a few days that the same nurse has gained employment at a nearby facility. Instinctively, we want to alert the facility's administrators of the prior problems encountered with the nurse, but inconclusive evidence against the nurse keeps us from doing so.


When human resources personnel perform employee reference checks, they'll likely only receive neutral references and verification of employment dates. Given the nature of the nursing shortage and high vacancy rates, we may feel compelled to hire a nurse if he or she meets a position's minimum requirements.


No systematic state or federal regulation process exists to determine a health care worker's employment and performance history. Although the Joint Commission on Accreditation of Healthcare Organizations' new requirement for criminal background checks on all health care employees is a fine minimum standard, it lacks the scrutiny required because performance issues are rarely criminal. Even when hiring managers apply this standard, a health care employee still has the ability to shift work settings, leaving a covert trail of adverse effects.


Our future

Current data banks, such as the Healthcare Integrity and Protection Data Bank and the National Practitioner Data Bank, provide information on practitioners only if they've been convicted of a crime or if their license is sanctioned. 1 We need federal legislation that provides research funding to create a national data bank that houses performance and work history information for all health care employees. Such a data bank has received support from U.S. senators Jon S. Corzine (D-N.J.) and Frank R. Lautenberg (D-N.J.). In a Statehouse conference, Corzine and Lautenberg called the nation's system of screening health care professionals "shockingly flawed."


It's essential to require health care facilities to report all disciplines and terminations to guarantee the data bank's completeness and the ongoing integrity of our health care delivery system. It's truly unfortunate that we have to consider such a system, but our patients' safety deserves our utmost attention and consideration. To champion a national health care employee screening system, contact your state's U.S. senators at




1. Fact Sheet on the Healthcare Integrity and Protection Data Bank. Available online: [Context Link]