Read between the lines of references
Because of fears of legal risks, former employers are often reluctant to give detailed information about a clinician's performance (for more information on liability issues and hiring, see story, page 76). "It's definitely becoming more difficult to get references," notes Maryfran Hughes, RN, MSN, CEN, nurse manager of the ED at Massachusetts General Hospital in Boston. "There is such potential for liability that it's truly difficult to get information other than the date of hire." Here are some things to consider when checking an applicant's references:
Contact references. Ask for permission to contact references. "If the applicant refuses, that is very telling," says Auer. "If we get letters that say things like, `he dresses nicely,' I wouldn't hesitate to call and ask them, how do they get along with other people, or are they able to handle multiple patients?"
If references seem reluctant to elaborate, giving them objective measures to cite is helpful. "Ask them specifically if they had complaints from patients or members of medical staff on this physician," Auer recommends.
Enlist help of applicant. One way to open the lines of communication is to enlist the help of the applicant. "We hold the applicant accountable to try and contact their former supervisor and let them know they're releasing them to give a reference," says Hughes. "Even then, the institution might have a policy to only give nonspecific information. But if the applicant has a good relationship with their supervisor, that can help."
Still, if a hospital has a strict policy, it can be difficult to learn more. "If a facility's policy is to only give out dates of hire, most people won't even let you engage them in a conversation," says Hughes. "If they say, I'd like to help you out but this is our policy,, that is difficult to get around."
Try multiple facilities. If one facility has a strict policy, try another that might be more lenient. "If a hospital won't give out any information, we'll sometimes explain to the candidate that we like to have had at least one contact with somebody that would give a reference," says Hughes. "It may turn out they have worked two different hospitals in the past five years, and the other facility may be more forthcoming."
Don't put too much stock in references. "I don't check the references they give me because I know they're going to be good," says Liz Jazwiec, RN, a Crestwood-IL-based consultant specializing in hiring issues. "However, I do ask if I can speak with their former employers, and explain that I would need to do that contingent upon hire."
Informal discussions are an alternative to checking references. "You can't get accurate references anymore anyway, because people are afraid of being sued," Jazwiec notes. "You need to do it informally, through your network. You can say to the applicant, did you know Peggy so and so when you worked at that hospital? Then call that person."
If a colleague seems reluctant to say anything, that is a possible danger sign. "People tend to be closed mouthed, unless they have good things to say," says Jazwiec. "So if you don't get people willing to volunteer very good things about that person, you have to assume it's bad. If they say, yes, she worked here during those periods of time, I would say she was an adequate worker, that's not enough."
Still, it's important to note that former employers or colleagues may be afraid of lawsuits. "An applicant could say, you kept me from getting a job, they were going to hire me but you slandered me," says Dighton Packard, MD, FACEP, medical director of the ED at Baylor Medical Center in Dallas, TX. "As a result, everybody is nervous about giving references."
Seek explanations for references. References rated on a numerical scale can be misleading. "Most of the time, people rate all their docs high," notes Packard. "Sometimes people rate somebody pretty good just to get rid of them."
If a recommendation indicates a physician has an interaction problem with a nurse, that's a clear red flag, but other warning signs are more subtle. Frequently, raters are asked to explain any below average marks, so some may check `average' to avoid awkward explanations, says Packard. "It's possible they didn't give a doctor any scores under six, because they didn't want to explain. So if you see a lot of sixes, pick up the phone and call," he notes. "Say, can you give me some idea why you didn't give them a nine in this category? Sometimes you get some insight and sometimes you don't."
You may uncover a personal problem between the applicant and the physician giving the reference. "There may have been bad blood between them, over a money issue or someone holding a grudge," notes Packard. "For instance, one of our applicants had started in an internal medicine residency program and changed to emergency medicine. He got good marks from emergency medicine, but the guy in internal medicine killed him. When I contacted him, it became quite obvious after five minutes that he was really hacked off because the physician had changed his residency."
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