1. Green, Lauren

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Hiring in the healthcare field isn't without its challenges. The increasing number of lawsuits brought by employees who received bad references has become a deterrent to providing an honest evaluation. Unfortunately, this is the case even when a staff member was fired or forced to resign for poor performance. Current events, including the alleged involvement of accused nurse Charles Cullen in more than 40 deaths, act as examples of the extreme damage that this practice can cause.


Donna Dorsey, RN, FAAN, MS, president of the National Council of State Boards of Nursing (NCSBN) and the executive director of the Maryland Board of Nursing, feels that the health care industry needs to do its part to prevent this type of situation.


"Boards of nursing need to get reports from employers regarding nurses that violate the nurse practice act," she says. "Licensing boards can't take action against poor performing nurses unless they receive information from employers, patients, and co-workers. Employers also need to be able to give honest references."


Hiring procedures

When you're hiring from a travel staffing company, you're relying in large part on the thoroughness of the staffing company's hiring process. Eric Broder, president of FASTAFF Nursing, Denver, Colo., sets high standards for his company's hiring practices.


"When someone applies with us, we require that they have 2 years of hospital-based experience, references from facilities they've worked at, a number of disclosures, and an inventory of their skills," he says. "We also require that they have medical clearance to work on the job." The placement process then requires another set of checks, including background checks, drug screening, and examination of any additional requirements specific to the hospital.


A difficult issue we face in our current litigious society is whether a former employer is liable for defamation or similar causes of action for giving a poor reference. When hiring from a staffing company, there's an extra layer of insulation between the hospital where the nurse will work and the nurse's work history. How can travel staffing companies be sure they're hiring qualified people? How can you, as a nurse leader using travel staffing companies, be sure that the company you work with has been thorough in their hiring process?


Dorsey feels that the legal aspect of giving an opinion regarding someone's competence is an issue. "Employers need to be confident that information they share regarding employer performance is free from liability," she says. Therefore, the former employer should have documentation to back up the information they're giving the potential employer, particularly if it's not favorable to the employee.


Beyond the reference

References can only take a travel nurse so far, even when accurate and thorough. Ensuring that a potential hire is a quality employee relies on various other aspects, such as the willingness of those who've worked with the nurse to report any warranted actions to the appropriate state board of nursing. Dorsey indicates that other actions should be taken when bringing in nurses from a staffing company.


"Nurse managers need assurance that licenses are properly verified, as well as the competencies of the nurses being hired and utilized," she says. "Employers may use licensure verification with the state board of nursing or NCSBN's Nursys system, and criminal background checks may also be performed."


Mary Heinen, RN, MSN, a nurse leader with the Martinsburg Veterans Affairs Medical Center, Martinsburg, W.V., recommends that temporary staff be carefully orientated when joining the team. "Orientation is important," she says. "They need to spend time learning programs, going over procedures. I'd never bring nurses into my staff if they hadn't been orientated." She also believes where you place the travel nurse is important. Examine the nurse's background and education and verify their license and history.


If nursing is going to take positive steps toward better ensuring the quality and capabilities of nurses, changes are in order. Broder believes that to stop unnecessary lawsuits and to ensure honest references and qualified, trustworthy employees, regulatory agencies may have to step in. He does, however, note that money could become an issue.


"There are obviously much more extensive requirements with respect to checking the background of physicians prior to their gaining staff privileges at hospitals," he says. "It may make sense to do that to some extent with respect to other people that interact with patients."


Nevertheless, physician clearances are time-consuming and cost-accruing for hospitals. "Hopefully, that process would be somewhat helped by technology if it's applied to the much greater number of nurses and other professionals that would need to be cleared," says Broder. "I think it would be a good thing to do, to some extent, as long as there are mechanisms in place to make it a process that could be done in an expeditious fashion."


Vigorous standards

In the meantime, you have common sense and powers of observation to ensure that the travel nurses you hire are performing as expected.


"Are you ever 100% sure of whom you're hiring?" asks Heinen. "No. You need supervision, observation, and the staff should ask questions."


Dorsey agrees. "Regulators, employers, and nurses need to work together to ensure patient protection is the key goal," she says. It is important to verify any newly hired nurses, from travelers to staff nurses, using the aforementioned resources.