Healthcare reference checks: what to verify and ask
A reference check in healthcare sits beside two checks it cannot replace: license verification and exclusion screening. How the three fit together, and what to ask the people who saw a candidate’s clinical work.
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See plansKey takeaways
- Clinical hiring needs three checks: the license, the federal exclusion list and references. Each answers a different question.
- Verify licenses at the source. For nurses, NCSBN’s Nursys QuickConfirm is free for employers.
- The HHS Office of Inspector General says health care employers should check its exclusion list for new hires and current employees.
- Ask clinical references about patient safety, judgment, documentation and teamwork, and never about the candidate’s health.
A clinical hire puts someone in front of patients, often on their first shift. Three checks stand between the offer and that shift, and each answers a different question. The license tells you the person may practice. The exclusion list tells you whether federal health care programs will pay for their work. References tell you how they practice.
This guide covers all three for clinics, home health agencies, long-term care providers and other employers hiring nurses, aides, technicians and therapists.
Three checks, three questions
| Check | The question it answers | Where the answer comes from |
|---|---|---|
| License or certification | May this person practice in this role, and has a board taken public action? | The issuing board, or a national verification service where one exists |
| Exclusion screening | Is this person barred from federal health care programs? | The HHS Office of Inspector General’s exclusion list |
| References | How does this person practice, and would the people who worked with them hire them again? | Supervisors, preceptors and colleagues, with the candidate’s consent |
Verify licenses at the source
Confirm every license and certification the role requires with the body that issued it, not from a copy the candidate supplies. For nurses, NCSBN’s Nursys QuickConfirm lets employers look up RN and LPN or VN licenses, with any public discipline, from the boards that take part, free of charge. Nursys e-Notify sends employers updates about the nurses they enroll, also at no cost.
For other professions, such as pharmacy technicians, therapists and dental staff, use the issuing state board’s own lookup. Record what you checked, when, and what it showed.
Screen the federal exclusion list
The HHS Office of Inspector General keeps the List of Excluded Individuals/Entities: people and organizations barred from federal health care programs, which cannot pay for items or services an excluded person furnishes, orders or prescribes. The OIG warns that anyone who hires a person on the list may be subject to civil monetary penalties, and says health care entities should routinely check the list for new hires and current employees.
Its Special Advisory Bulletin on the effect of exclusion recommends checking the list before you hire or contract with someone, and periodically after that. The list is searchable online and updated monthly.
Who to ask for a clinical reference
- A direct clinical supervisor: a charge nurse, nurse manager, lead technician or supervising therapist from a recent position.
- A preceptor or clinical instructor for a new graduate.
- A provider or pharmacist who worked with the candidate often, for how they raise concerns.
- For agency and per diem staff, a clinical coordinator at the agency and a supervisor from a facility where they worked regularly.
What to ask
Ask about the parts of the work that keep patients safe, and ask for an example every time.
- Tell me about a time the candidate recognized a change in a patient and escalated it. What did they do, and who did they tell?
- How does the candidate keep to infection control and safety procedures when the unit is short-staffed?
- How accurate is their documentation, and what does the next shift know after their handoff?
- How do they work with the rest of the care team, including aides, providers and families?
- Would you want them back on your team? Why or why not?
For questions written for a specific role, see the sets for registered nurses, licensed practical nurses, certified nursing assistants and medical assistants.
Clinical references in one scored report
In ReferenceCheck, the candidate records consent and names their references from a secure link, each reference answers your clinical questions on their phone, and you get one scored report. Candidates and references do not need accounts.
See plans for employersQuestions to leave out
Clinical work is physical, and it is tempting to ask a reference whether a candidate can manage the lifting or the hours. Under the ADA, the EEOC’s guidance says an employer may not ask disability-related questions before making a conditional offer, and may not ask a third party any question it could not ask the applicant directly. Ask references how the candidate performed the job, not about their health, injuries, medical leave or workers’ compensation history.
Keep the record
Keep what you checked, when and what it showed: license lookups, exclusion screening and reference answers, together in the personnel file. The EEOC’s recordkeeping rule requires the employers it covers to keep employment records for at least one year, and your payers, accreditors or state may ask for more.
Common questions
Is Nursys QuickConfirm free for employers?
Yes. NCSBN describes Licensure QuickConfirm as a free service for employers and recruiters to retrieve a nurse’s licensure and any public discipline. It covers RN and LPN or VN licenses from the boards that take part, so check the issuing board directly for anything else.
How often should healthcare employers check the OIG exclusion list?
Before hiring and periodically after. The OIG’s Special Advisory Bulletin recommends checking the list before employing or contracting with someone and then periodically for current staff and contractors. The list itself is updated monthly.
Does license verification replace a reference check?
No. A license lookup tells you a person may practice and whether a board has acted. It cannot tell you how they practice: how they escalate a concern, how they chart or how they work with a team. That is what references are for.
What should you ask a clinical reference?
Ask about patient safety, clinical judgment, documentation and teamwork, with an example each time, and close by asking whether they would have the candidate back. Leave out anything about the candidate’s health or medical leave.
Sources
- National Council of State Boards of Nursing, Nursys overview. Checked October 8, 2026.
- National Council of State Boards of Nursing, Nursys e-Notify. Checked October 8, 2026.
- U.S. Department of Health and Human Services, Office of Inspector General, Exclusions (List of Excluded Individuals/Entities). Checked October 8, 2026.
- U.S. Department of Health and Human Services, Office of Inspector General, Updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (May 8, 2013). Checked October 8, 2026.
- U.S. Equal Employment Opportunity Commission, Enforcement Guidance: Preemployment Disability-Related Questions and Medical Examinations. Checked October 8, 2026.
- Legal Information Institute, Cornell Law School, 29 CFR 1602.14: Preservation of records made or kept. Checked October 8, 2026.
This article is general information, not legal advice. Confirm the requirements that apply to your organization, and in your state, with your counsel or HR policy office.
About this guide
Written and kept up to date by Never Ending Solutions, the company that builds NES ReferenceCheck. Outside facts are cited with the date we checked them, and the advice works with or without our software. Read our editorial standards.