Barriers to Employment
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Criminal Record / Background Check If a client is beginning a training program and has been convicted of any criminal offense, s/he must contact the organization that administers the certifying or licensing exam. Many of the governing boards will not grant certification or licensure to individuals with select criminal offenses, regardless if they have completed a training program or can pass the national or state exam. If the individual is not able to obtain a mandatory license or certificate due to a criminal offense, s/he will be unemployable in the healthcare setting in the occupation in which they completed training. All healthcare employers surveyed ask applicants to disclose information about their criminal history on an application, and the employers would not accept a resume in lieu of this application, no exceptions. Signed applications permit the employer to perform a criminal background check, and unsigned applications cannot be processed. Each employer follows different procedures for criminal background checks that are within the employer rights stipulated in the California Labor Code and an explanation of the employers background check procedure will appear on the employment application. Unlike the majority of States, California only permits employers to conduct a background search that goes back seven years. Healthcare employers are given special provisions under the law due to the nature of the services that some healthcare workers provide to patients. Healthcare employers are permitted to search for convictions of a sexual nature beyond the seven year statute for employees. All employees in the managed care setting (skilled nursing facilities, homes for the elderly and incapacitated, etc.) are subject to a full criminal background check. Individuals working in select licensed occupations may also undergo a full criminal background check. You may review the guide at the bottom of this report for more information on California regulations and the California Labor Code. Employers surveyed unanimously expressed that certain criminal convictions render clients unemployable in the healthcare sector due to patient safety concerns and the institution's insurance requirements. Clients who have been convicted of crimes of a sexual, violent or abusive nature; clients who have been convicted of an offense related to the sale or manufacturing of drugs; clients who have been convicted of fraud, hacking or high tech crime should absolutely pursue employment in another industry and should not seek training in a healthcare related field. Employer response differed, however, with regard to some more common criminal offenses. For example, while a single DUI conviction or marijuana possession conviction was considered by several employers to be a barrier to employment, a substantial portion of employers indicated that these offenses would not automatically exclude an applicant from participating in certain recruitment if the applicant was forthcoming with the information. A criminal offense may also exclude individuals from working in a particular area of the hospital. For example, an applicant with drug possession or theft convictions is unlikely to gain employment in a pharmacy. Furthermore, while multiple moving violations are typically ignored for most individuals who work in hospitals, if the applicant would be operating a vehicle while on the clock (home health provider, lab courier, equipment preparer) s/he would likely be excluded from a recruitment based on a poor driving record due to the costs of insuring the driver and the liability the organization would have to assume in hiring the individual. A gray area exists, however, with regard to certain criminal convictions. For example, shoplifting is perhaps the most common criminal offense that appears on a background check and clients may think that because it is a misdemeanor, it will not be a factor in the hiring decision. Not so! Employers are particularly reticent to hire individuals with shoplifting convictions due to the accessibility of prescription drugs, expensive equipment, cash (in certain departments), and confidential records. Employers seem to be more willing to overlook shoplifting or petty theft convictions when the offense occurred when the applicant was a youth and could be dismissed as adolescent behavior, rather than adult deviant behavior. With
the exception of the offenses that leave individuals absolutely unemployable,
employers interviewed indicated that they were looking for a pattern of
criminal activity, not a single mistake. Regardless, the presence of any
criminal offense–however minor–would still inevitably be a factor
in a hiring decision. Additional Resources Employment
Background Checks in California:
A Jobseekers' Guide. provides invaluable information on employer
background checks, California labor law, and the rights of the applicant.
This guide suggests the following tips for all job seekers: The California Attorney General maintains a program to check fingerprints electronically called Live Scan. Click the link for more information. Why
California Is Different Employment Screening Resources How to Seal Your Juvenile & Criminal Records in California: Legal Remedies to Clean Up Your Past. Nolo Press, 2000. Consumer
Credit Reporting Agencies Act (CCRAA), CA Civil Code §1785 et seq.
To access the California Civil Code, go to www.leginfo.ca.gov.
Click on California Law. Then click "Civil Code" and either
insert the section number or scroll through the entire Civil Code to find
the specific citation. |
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Obtaining permanent resident status can be a long process, and a number of individuals apply for employment with a temporary working visa. Even though the law protects certain individuals from discriminatory immigration-related employment practices--which includes refusing to employ a qualified individual based on the future expiration date of their current Employment Authorization Documents (EAD)-- being a nonresident may be a barrier to healthcare employment because it creates complications in the HR process for the following reasons: verifying employment history is challenging, particularly if the applicant previously worked in a predominately non-English speaking country; the procedure for obtaining an international criminal background check is different, if it is available at all; occupational duties and training programs vary greatly by country; and, because certificate/license/registry exams are administered on a State and/or National basis, foreign certificates or licenses are often not transferable. Applicants with working visas who are in the process of attaining permanent resident status can improve their chances of gaining employment by: passing the State and/or National license/certificate exam; providing clear contact information for the educational institutions attended; providing current contact information for all previous employers; and staying current with regard to Employment Authorization Document reapplication deadlines. Expired documents can not be used to satisy the I-9 requirement, which verifies the individual's right to work in the United States. Outside of the Registered Nursing profession, where some foreign trained workers have been recruited and guided through the naturalization process, foreign trained healthcare workers may be at a disadvantage. Because a shortage of qualified applicants for the entry level allied health occupations does not exist in the Peninsula and South Bay Area--this excludes the mandatory associate's degree prepared professions such as radiologic technologist, nursing, respiratory therapy, etc.--and large healthcare organizations typically hire interpreters independent of their healthcare staff, it is unlikely healthcare employers will specifically seek out foreign trained healthcare workers to join the healthcare workforce. However, if a foreign trained applicant has good English skills, can pass a State or National certifying exam, and has their documentation in order, they should not, in theory, be excluded from a recruitment because they are foreign-born or a conditional resident. |
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Because healthcare workers in patient care settings interact with individuals from vulnerable populations, employers are wary of job applicants and incumbent workers who exhibit signs of drug and alcohol abuse in the interest of patient safety and employer protection. For example, employers fear that an employee with an alcohol or drug problem may come to work under the influence, leading him or her to make a mistake and jeopardize a patient's safety, opening the facility up to a costly lawsuit and damaging the organization's reputation. Because patient care employees have access to controlled substances and could potentially obtain the substances for personal use or to sell illegally, employers will likely be hesitant to hire an individual with a history of drug and/or alcohol abuse in a patient care occupation. If a client has a recent conviction related to drugs or multiple convictions for possession, sale and/or use, this is a considerable barrier to employment in healthcare and the client should consider pursuing employment in another industry. Though employers can legally only look back 7 years on a criminal background check in most settings (managed care is an exception), it is important to remember that employers often obtain undesirable information from an applicant's previous employer when doing reference checks. If an individual was fired ten years ago for using drugs on the job, it is likely that the employer who fired the individual will divulge that information if contacted. This type of scenario is important to consider before pursuing training. |
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The healthcare workforce and patient population in Silicon Valley are diverse. Diversity enhances the work environment and is even thought to increase access to medical care for certain populations, but can present unique challenges to employers with regard to communication in the workplace. During employer interviews, all employers stressed that clear communication between employees, patients, and outside healthcare professionals is essential for patient safety and satisfaction. To gain employment, all employers indicated that applicants must be proficient in English, but the degree of proficiency clearly varies by facility and even by department within a healthcare facility. Nursing, laboratory and pharmacy departments tend to have more employees with communication challenges, primarily because shortages in these areas have garnered international attention. Food service, central service and environmental service also have a high number of employees with communication challenges but these employees do not have regular patient contact and therefore their communication challenges should not negatively affect patient safety. Because communication challenges are an issue in every healthcare facility, some healthcare employers provide in-house English Language Learner (ELL) training and accent-reduction courses, and several healthcare employers contract with local community colleges or private instructors for special courses. If an employee receives a patient complaint or is identified by coworkers or department management as difficult to understand, s/he may be sent through an accent reduction program that is taught by a speech therapist or speech language pathologist. These programs are often successful if the individual invests a tremendous effort in the sessions and completes the assigned work at home. The accent reduction programs are most difficult for individuals who speak their native language at home and only speak English while at work. The program may vary in length, and may involve individual and/or group training. If an employee does not have a good understanding of English or does not have a sufficient vocabulary to communicate adequately with patients or coworkers, s/he may be sent through an ELL program designed for healthcare professionals. Many individuals improve with ESL and accent reduction training, but a number of healthcare workers are displaced because they have been sent through ELL and/or accent reduction training and have been unable to improve their skills. Employers that terminate employees based on the grounds of communication challenges do so only after a documented history of communication error and coworker or patient complaints is in place, and they feel patient safety is at risk. According to several individuals interviewed, this has happened within several health organizations. Due to the cost of training and the effects of displacement on employer image and staff morale, employers are hesitant to hire applicants with heavy accents. Individuals with communication challenges should enroll in an accent reduction program or ESL course prior to applying for jobs as a heavy accent or poor English vocabulary is likely to be a substantial barrier to employment in a tight job market. Most community college training programs will make students aware of the challenges that individuals with less than perfect English skills will face in the healthcare workplace and concurrent enrollment in a community college course designed for non-native English speakers is available. However, these courses are not always offered in vocational college programs and students are not always told about realities of pursuing healthcare employment from vocational college instructors so it is essential that career advisors give clients information about accent reduction resources and ESL courses. A course entitled "ESL for Healthcare Professionals" is offered quarterly at DeAnza. This class is valuable because it teaches vocabulary related to anatomy, healthcare practices and delivery systems, and provider/patient interaction training that is not taught in traditional ESL classes. Individuals need not be enrolled in a DeAnza healthcare training program to enroll. For more information, contact Blanche Monary at 408.864.5705. Vocational ESL is also available through Sunnyvale-Cupertino Adult and Community Education. Individuals in San Mateo County may wish to enroll in Jewish Vocational Services VESL for Health Professionals Course. Contact Marc Goldberg at 415.782.6283 or mgoldberg@jvs.org for more information. If an individual has completed an ESL program but is still having difficulty with accent reduction, and he or she has the resources to pay for a consultation with an accent reduction specialist, contact the American Speech Language Hearing Association for a referral to a trained professional, www.csha.org or (916) 921-1568. If a private accent reduction program is not an option, the Speech Language Pathology Department at the Greater Baltimore Medical Center recommends the following ten tips for accent modification:
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Due to the increased wages, relatively short training requirements and perceived limitless job openings, thousands of individuals who had not previously considered a career in healthcare are suddenly flooding the healthcare market. Employers surveyed expressed that the implications of the sudden interest in healthcare careers are both positive and negative. It is positive because the incumbent workforce is rapidly aging, life expectancy has risen, healthcare organizations are expanding, certain occupations have ratios that must be met and the new graduates are satisfying this need. It is negative, however, that a rush of new graduates are entering in previously unheard of numbers because the workforce is disproportionately inexperienced. Ideally, employers prefer to have a staff that is 1/3 new graduates, 1/3 mid-career workers, and 1/3 end-career workers because it makes the most sense financially and is considered to be the most efficient model of care in the interest of patient safety. Employers and training providers suggest that it can take 2-3 years for a new graduate to gain the work experience necessary to work safely, independently, and efficiently. In this time, the new graduates rely on the mid-career workers for on-the-job training and guidance and the mid-career workers impart the knowledge they've gained from several years on the job to the new graduates. Mid-to-late career workers are often in administrative or specialty roles. If the workforce is comprised almost entirely of new graduates, a knowledge gap exists that may not be bridged. Because healthcare was not a popular or lucrative career choice in the 1990s, there is a shortage of mid-career paraprofessionals in many areas of healthcare (respiratory care, nursing, diagnostic imaging, pharmacy, clinical laboratory science, physical therapy) but because salaries have suddenly increased by more than 30% in some areas of allied health, the workforce is now disproportionately "green". In an effort to balance out their healthcare workforce, employers are now focusing on late-career employees in many occupations rather than hiring a new graduate, even though it is costly. For example, a local hospital pays a new nursing graduate approximately $38 per hour. Because new graduates often work the night or swing shift, employers must entice experienced nurses to also work night and/or swing shifts so that patient care is not compromised by having an inexperienced nursing staff in the night shift. A nurse with 20 years of critical care experience can command as much as $65 per hour picking up per diem night shifts, which is significantly more than what s/he makes per hour during the regular day shift. The bottom line is that it is more costly to hire a new graduate even though their salaries are lower, because it is imperative that a well-trained, experienced (which almost always means higher paid) nurse is available so patient care is not compromised. Some healthcare employers will set a limit of how many new graduates they will hire per recruitment, and will pay what the market demands for experienced individuals rather than compromise. Other employers indicated that if they do hire a new graduate, they always prefer to hire a new graduate that performed an externship at their facility and had a good attendance record and exhibited good soft skills. If that individual is not available, the recruitment manager will look for the applicant with the most desirable combination of transferable skills, customer service experience, volunteer experience, recognized training program, good grades and strong recommendations. Because turnover is incredible costly, employers are also wary of "job-hoppers", regardless of the industry in which the job-hopping occurred. Some healthcare employees bounce around frequently, because healthcare recruiting firms are often visible and are willing to offer several dollars more per hour. Because a number of healthcare jobs must be filled immediately so as not to disrupt the balance of the patient care team, healthcare companies often turn to travelers or temps for a quick fix, which is costly and frustrating for employers. Because each healthcare organization is different and training time is extensive, hiring professionals try to weed out job hoppers from recruitments. If an individual has a history of job-hopping, s/he may have an easier time gaining employment with a smaller medical group or independent medical practice. If s/he has stuck with something for a long period of time--for example, volunteering at a summer camp for 6 years in a row--then s/he should absolutely emphasize that experience. Because cost and consistency is the bottom line in healthcare, the applicant should expect to be questioned about their job hopping pattern and should have an answer prepared--for example, "My previous occupations have been interesting to me, but I am passionate about healthcare, see it as the career for me, and am looking for an employer that I can establish a long relationship with"--and should know that their history of job-hopping will be taken into account in a hiring decision. |
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Unprofessional Appearance or Demeanor A significant number of individuals interviewed for the Navigator project indicated that a significant percentage of applicants for the entry-level allied health occupations attend hiring events and even job interviews in unprofessional attire and do not project professionalism. Many employers indicated that they will not hire individuals who do not project a professional demeanor upon first impression. Employers and training providers also indicated that because the healthcare setting must be sanitary and many patients are apprehensive when they enter the healthcare environment, employees should have a clean and professional appearance. Multiple employers indicated that job applicants must attend recruitment events with clean hair and nails, wearing modest clothing, and with facial piercings removed and visible tattoos covered. Hiring managers also indicated that a shocking number of resumes contain grammatical errors or are not organized in a logical manner. Because accuracy is key in medical documents and patient correspondence, healthcare hiring professionals have stringent screening guidelines for health professionals' resumes, particularly for administrative recruitments. Employers indicated that soft skills and presentation are key, and because patient satisfaction most often results from good customer service received from allied health workers on the "front-line", employers are looking for applicants with a positive attitude and good communication skills. Employers overwhelmingly indicated that they would prefer to hire a less experienced candidate from a less prestigious training program, if s/he had a magnetic personality and exceptional customer service skills, primarily because, unlike some industries, healthcare work is rarely performed on an individual basis, and employees must function as team members and care providers, therefore good communication skills are essential. Though most employers would like the ideal combination of community college education, excellent soft skills, it appears that superior soft skills are the key component to getting hired in a competitive market. Some healthcare training programs are taking notice of employer preferences and including a soft skills component in the curriculum and are taking students aside and letting them know that they may encounter some trouble finding a job if they do not improve their interpersonal skills and/or hygiene, or modify their demeanor. The Navigator strongly recommends that enrolled clients go through the NOVA PEP program or a similar professional development program focused on improving soft skills. |
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The medical exam is a relative newcomer to the hiring process for many healthcare organizations, and according to a large local employer, it has been put into practice in the interest of employer protection and patient safety. The medical exam was introduced to the hiring process because on occasion, newly hired individuals would take jobs even though they were unable to perform the standard occupational duties of the position. The medical exam is similar to a physical, and looks at the sensory abilities, vital signs, ability to lift and carry a specified amount of weight, and the general health of the individual. A judgment is made as to whether the individual has any physical limitations that could potentially compromise patient safety. A drug test is also administered during the medical exam and is designed to screen for illicit substances. Protection under HIPAA guarantees that what the medical exam will not do, however, is exclude an individual from a recruitment who has common ailments that are controlled and will not interfere with an individual's ability to work; or contribute to an increased cost to the insurer, such as: high blood pressure, history of heart attack, depression, smoking, genetic disease or genetic predisposition to disease, etc. Several employers interviewed indicated that the medical exam does not eliminated a significant number of individuals from recruitments and that individuals who are screened out are rarely surprised. The most common reasons for a failed medical exam include a failed drug test or inability to lift the minimum weight specified for the recruitment. |
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It is becoming common for large healthcare employers to run credit checks on job applicants in the final stage of the hiring process. The applicant must give his or her consent and signature to the employer for the explicit purpose of the credit check. The credit check is not used to obtain information about the applicant's financial history for purposes of salary negotiations or to make inferences about an individual's wage history, it is simply used as a tool to evaluate any negative financial decisions the individual has made, to verify previous addresses, and to search for red flags such as possible gambling problems or bankruptcy. What does this mean for someone who has watched their credit rating drop and their bills mount due to a long period of unemployment? Probably nothing. Employers understand this situation and are not concerned about the medical assistant who got into trouble with credit card debt in her twenties or a newly single mom trying to keep up with the house payment and go to school. It is important for clients to be honest with employers about why their credit rating is low and what they are doing to solve the problem, such as changing spending habits, or working with a credit counselor, etc. Employers are concerned, however, with individuals in financial management roles who may have discretionary spending privileges who have a personal history of irresponsible financial management. This may be a substantial barrier to employment. Employers are also concerned with a "peaks and valleys" credit history - which indicates periods where an individual worked to restore and maintain better credit and then slipped back into old habits. But is it enough to shut someone out of a career in allied health? Almost never in the entry-level patient care positions, and if the individual can demonstrate improvement, it is unlikely to affect him or her with regard to promotions or supervisory roles. Recommended Resource |