Avoid nightmares with temp workers — Take steps now, and avoid liability
If you hire a doctor, you can check to see if there have been any sanctions. If you need a driver for a semi, you can found out if he or she ever failed a drug and alcohol screen. Even retailers can find out if shoppers have admitted to stealing merchandise, says Jeff Wizceb, vice president of business development and account management at, HR Plus, a division of AlliedBarton Security Services in Chicago. But don't expect to find out similar information about a temporary worker you hire. Many healthcare managers don't have the tools available to know if that person presents a threat to their patients, Wizceb says.
Consider what sequence of events happened recently because a national registry of problem temp workers doesn't exist, says Diana Acuna, healthcare product manager at HireRight, a leading provider of employment background screening, drug and health screening, and employment eligibility verification programs. A temp worker, David Kwiatkowski, was arrested in July in New Hampshire on charges related to stealing drugs from a hospital. Subsequent reports indicate that he infected at least 31 people with hepatitis C through infected syringes.
"He'd been fired in 2010 from a hospital in Arizona when a co-worker reported finding him passed out in the bathroom, but he continued to be hired as a temp worker in different hospitals in several different states until July 2012 when he was arrested," Acuna says. This case provides an example of "gaps" in healthcare, she says. "It was very easy for him to go from one organization to another without anyone knowing about the previous incidents," Acuna says. "This is precisely why this is a problem and why it needs to be addressed."
There is no mandatory federal disclosure by healthcare facilities about problem workers. However, there are some states that require disclosure, depending on the incident, Acuna says.
"The challenge is that it's not consistent because there's no federal law that has a global and consistent requirement for documenting and reporting this information," she says. "As a result, there are individuals who can fall through the cracks with a long list of incidences because no employer, agency, or board has been able to compare records and put it all together."
Who reports what?
From the perspective of an outpatient surgery manager, it's difficult to determine who is supposed to report what, and what kind of documentation and evidence is required for reporting, Acuna says.
"[O]ftentimes, that leads to incidents never being reported at all," she says. Always check to determine if your state law requires reporting, sources emphasizes.
Adding to the problem is the fact that temp workers often are employees of a staffing agency, not the healthcare facility, Acuna says. If there is an indent at the facility involving a temp worker, the facility often reports it to the staffing agency.
"The healthcare organization often believes that the staffing agency will report the individual to the appropriate licensing boards, but agencies often don't," she says. "Staffing agencies aren't in the business of providing care. They're in the business of staffing, so they don't necessarily know which boards and agencies they should be reporting the employee to."
Also, the staffing agency often doesn't have access to witnesses or the full context of the incident, so that "limits their ability to file an appropriate report," Acuna says. (For tips on using a staffing agency and orienting a contract employee, see story,below.)
Take these steps now
Despite the magnitude of the problem, there are steps that outpatient surgery managers can take to minimize the potential for liability, says Acuna and other experts interviewed by Same-Day Surgery.
Wizceb says that when it comes to verifying temp workers have proper licensing and good reputations, outpatient surgery programs "have a large obligation, whether they realize it or not."
If you have an incident, you name and brand are in the spotlight, he points out. "The media, public, or patient are going to see the facility name and not going to care if it was a temporary employee or a regular employee," Wizceb says.
You must take steps to ensure temporary workers, as well as full-time employees, repair personnel, and other contractors who have access to patients, records, or other parts of the building have the proper due diligence completed on them, he says. Acuna concurs "The healthcare organization has an ethical, legal, and financial responsibility to protect its patients," she says.
• Have a process and policy in place.
Work with your legal counsel to develop a thorough background screening and reference check process and policy, Acuna advises.
"The most important step is to create a comprehensive background screening policy and conduct a thorough background check that is based on very specific criteria defined for each role and position," she says.
• Perform a thorough background check.
"[H]ave a process to conduct thorough background, licensing, and sanctions checks on all workers, including those who are temporary," Acuna says.
You can perform these checks yourself, or require the agencies or staffing firms you work with to conduct the checks, she says. "If the third-party agency is conducting the checks, it's important that the healthcare organization verifies that the checks are completed in accordance with their policies and standards," she says. "The best practice would be to include the requirements in the contract and conduct regular audits to ensure compliance..."
Before the person sets foot on your property, have specific requirements of the temp agency in conducting due diligence, Wizceb says. "The due diligence may include personality testing, criminal record checks, license verifications, employment verifications, and any other job-related screening," he says.
Be warned: Many agencies will run background checks or other type of screening only if you require it, Wizceb says. He offers a list of items he considers to be part of a best practice for healthcare background searches. (See list, below..) Always verify the license yourself, and put proof of licensure in the worker's file, says Beverly Kirchner, RN, CNOR, CASC, president of Genesee Associates, a Dallas-based independent consulting business working with ambulatory surgery centers (ASCs) and hospital systems with ASCs to improve quality of care, safety, and regulatory compliance. You are required to take this step, as you don't have an agreement with the temp agency to act as your credential agent, sources say.
Best Practices for Healthcare Background Searches
Source: Jeff Wizceb, Vice President of Business Development and Account Management, HR Plus, Chicago.
Wizceb adds, "Although the [healthcare] facility wouldn't want to see the details of the report — co-employment concerns — the agency or better yet, a third party should be able to provide a `clear' or `not clear' status back to you based on your criteria."
For accreditation purposes, the standards that apply to full-time staff also apply to temp workers, according to The Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC).
• Confirm a temp worker's reputation.
Verify a potential worker's entire application, Acuna says.
"We generally recommend that healthcare facilities check back either the last seven years of employment or the last three employers, but organizations should work with their legal counsel to determine the criteria that is best for their organization," she says. Talk with those employers, Acuna adds.
Check all the appropriate federal, state, and local licensing agencies and sanctions databases to ensure there is no record of disciplinary action, she says. "Confirm the worker's licenses and credentials are current and in good standing, and verify the individual is not on any exclusion lists that would prevent him from providing patient care."
Acuna advises that you include a comprehensive criminal history check, and check the sex offender database (http://1.usa.gov/SVeMHy).
When a temp worker behaves questionably
One of your employees catches a temp work, or another staff person, with a syringe, but doesn't witness him or her committing a crime. What should you do?
When this situation arose a few years ago at a hospital in Pittsburgh, more syringes were found on the temp radiology technician, and a drug test indicated he had taken fentanyl and other opiates, according to a media report.1 No one at the hospital called the police, and neither the hospital nor the staffing agency notified the national accreditation organization for radiology technicians, the media report says. The temp worker started a new hospital temp job in another state within a few days, and he went on to work at 10 hospitals in the next four years, the report says. Eventually, he was found to have infected at least 31 people with hepatitis C through infected syringes, the media reported.
How can managers avoid this situation arising with their workers?
"There are a few steps they should always take," says Diana Acuna, healthcare product manager at HireRight, a leading provider of employment background screening, drug and health screening, and employment eligibility verification programs. "As a best practice, these steps should be laid out in a policy, and employees and managers should be trained on what to do in the event they witness something inappropriate or suspicious."
Be certain that the incident was witnessed and not simply gossip or hearsay, Acuna emphasizes. "It's always critical to document any incidents, noting details, dates and times, and any other witnesses who were there," she says.
Approach the individual in a calm and honest manner, and discuss the incident that was observed, Acuna says. There might be a simple explanation, she points out. "If it is not resolved, then the manager should report it to the appropriate director, and the investigation should continue," Acuna says.
When the internal investigation is complete, report it to the appropriate licensing and sanctions boards or agencies, which will conduct their own investigation, she says. "These steps should be clearly defined in a written policy that's been developed with the healthcare organization's management and legal counsel," Acuna says.
The consequences of actions involving drugs should be spelled out in the employee handbook or policy so the consequences are clear to the manager or supervisor, and the employee, says Jeff Wizceb, vice president of business development and account management at, HR Plus, a division of AlliedBarton Security Services in Chicago.
"This could range anywhere from an informal discussion all the way up to a more severe disciplinary action up to and including termination, depending on the circumstances," Wizceb says. "If processes and procedures are put into place, it should make it easier to take action."
Orient temp workers to your facility
Avoiding problems with temp workers starts with using the right agency, and it continues with having proper orientation for these workers.
Conduct due diligence when contracting with a staffing agency, says Diana Acuna, healthcare product manager at HireRight, a leading provider of employment background screening, drug and health screening, and employment eligibility verification programs.
"It's important to determine if they specialize in healthcare staffing and what their familiarity is with the healthcare industry and its requirements," Acuna says.
Review the firm's screening policy, determine its comprehensiveness and effectiveness, and compare it to your organization's policies and processes, she says. "Ask the staffing agency about its process for reporting incidents to the licensing boards and sanctions agencies, and ask for examples of how the firm has handled such incidents in the past," Acuna says.
Some sources say your agreement with the temp agency should require that they conduct background checks, that they share this information with you, and that they report mandated incidents to proper authorities, as well as document for you that they have done so.
Once an agency is in place and temp workers are hired, you need a policy and procedure on the use of contract labor that includes expectations of qualifications, says Beverly Kirchner, RN, CNOR, CASC, president of Genesee Associates, a Dallas-based independent consulting business working with ambulatory surgery centers (ASCs) and hospital systems to improve quality of care, safety, and regulatory compliance. The staffing agency should be able to provide most of the education and competencies, Kirchner says.
The Centers for Medicare and Medicaid Services (CMS) wants contracted labor workers to be oriented to the facility, and it wants to ensure they can react appropriately in an emergency, Kirchner says. Have your own mini-orientation program to cover safety requirements from the Occupational Safety and Health Administration, environmental safety such as fire, cardiac arrest, disasters (internal), surgical site infection prevention, and hand hygiene. [A Contract Employee Checklist that Kirchner developed for a surgery center to use to meet CMS standards is included.] Kirchner acknowledges that her list is detailed, and she thinks most facilities could provide less information, but "my feelings are if my staff has to have this type of training and expectations to ensure patient safety and quality of care, then why would I not want someone who is filling in to meet the same standards of my employees?"
Kirchner requests that the staffing agency send a new contractor to the facility at least a day before the work assignment, at their expense, so the facility can conduct an orientation and complete a mini employee file, Kirchner says. She suggests limiting the orientation to one hour for contract labor. (An Agency Personnel Orientation Checklist is included.) Use the checklist to create a miniature version of an employee file, she advises.
Have a copy of the malpractice insurance and verify it to be accurate and covering the employee, she says.
"You might say this [process] is a cross between credentialing a provider and orienting an employee," Kirchner says.
Evaluate the contract employee's performance each day he or she works, she advises. (An Agency Personnel Performance Evaluation is included.)"The evaluation should be shared with the contracted person, their agency, and a copy placed in their mini personnel file," Kirchner says. "The evaluation does not have to be long, but should cover points like observation of care the employee provided to your patients, hand hygiene, safety, how they worked with others in the center, etc." (For a resource that can ensure vendors and reps are credentialed for your facility, see Resource, below.)