X-ray for pre-employment screen?

Nurses General Nursing

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After a lot of searching I got a job offer. They want me to submit to a back x-ray among the pre-employment screening of my health. I feel like declining the offer for two reasons:

A) I take x-rays for medical reasons, not to satisfy legal departments that want to screen out the rare case that takes a job while injured for subsequent worker's comp claim.

B) My prospective employer doesn't trust me to be in a position of trust (RN) to the extent that they want not my word and medical history report, but an x-ray.

How would you react to what I call this ultimatum?

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Specializes in Complex pedi to LTC/SA & now a manager.

The only justifiable x-ray I could/would submit to would be a chest x-ray required as a result of a positive TB skin or blood test as this is the standard of care to show no active TB infection

It sounds like the potential for them to discriminate against potential employees covered by the EEOC and/or the American's with Disabilities Act. What if I have a mild scoliosis that does not impact my ability to successfully be a nurse and my treating physicians feel that I am fit for full duty. The potential employer sees this on a pre-employment screening x-ray.

I would decline, specifically stating the x-ray as the reason and that my personal physician is in agreement that taking unnecessary screening x-rays risks out weigh the benefits (and she does).

Its bad enough that some employers now inquire if you have ever filed a worker's compensation claim. Its my understanding that they are looking for those who habitually get hurt on the job, file a claim, then sue for damages not the random incident (like when a patient went nutso and nearly fractured my wrist with a death grip) but still since technically it was a workers compensation claim (to pay for treatment)....it could cost me a future job due to no fault or error of my own. Now they want to expose you to radiation for no reason other than a screening back x-ray. Aside from the fact that screening back x-rays are no way the standard of care...

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Specializes in Intermediate care.

i had to submit to a chest x-ray...mainly for TB reasons. That was when i was hired as a CNA several years ago in a pulmonary unit. I was hired over a year ago as an RN in the same unit and i guess they don't do that anymore and say that TB test are satisfactory enough. (as they should be), but yea i even had to do pulmonary function tests and drug screening.

not sure how i felt about it- i would NOT be ok with my medical records being sent to them. That with me is crossing the line. they never asked, but i had to fill out questionairs (have you been exposed to TB? How much veggies do you eat a day? Do you have regular menstral cycles?...etc.). Some were very personal questions, but they have a NP look over them and address anything that needs further work up. So it isn't all that bad, and i was ok with this because it gave me the option with every question "i prefer not to answer" type thing. But if they ASKED for my medical records....hella no. I do have personal things on there i prefer nobdoy to ever know.

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Specializes in Critical Care.

Employers are limited in what they can request prior to a conditional offer being made, but once a conditional offer is made they can do just about whatever they want; screening physicals, drug tests, asking what medications you take, etc.

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Specializes in ICU, ER, EP,.

a chest x-ray to rule out TB is one thing. A spine is another. Just as smoking and obesity are now coming into play with hiring... potential for back injury is ... i guess another.

The option to opt out is most likely a decline upon hiring.

Contact their HR department to ensure your rights are protected if you decline.

We are moving into a new world with hiring "at risk" employees... and the courts in time will protect us... or screw us. Until then, choose wisely. If you have NO reason to have a back injury, I suggest doing the x-ray as it will be a long time before the courts protect us or leave us screwed.

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Specializes in Critical Care, Education.

MunoRN is absolutely correct. It is not discrimination if the exam is based on "bonafide occupational qualifications".. and they do the same thing for all job descriptions that share the same or similar BOQs.

You can't actually tell very much from a plain old xray... other than gross skeletal abnormalities and really obvious disc problems. However, some organizations continue to use xrays because they do reveal if you have had past myelograms or other tests that leave residual traces of the contrast materials. If you have not disclosed any previous back problems as a reason for limiting your physical ability - this may be grounds for termination based on falsification of the employment application.

Health care provider organizations are really under the gun to decrease back injuries. Most organizations are (finally) modifying job descriptions and implementing more lifting technology in order to integrate research-based evidence... that it is unsafe to lift more than 35 lbs if you are dealing with people (not inert objects). The research has been out there for a long time so it's a little mind-boggling that it has taken so long.

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Thanks for all the input here. !0 years ago the Irish courts outlawed this practice:

X-ray exams: new rules you need to know - irishhealth.com

One can argue the health risks, but no one can deny there are none. The message is: you wanna work for us? then you better obey. Is this supposed to be healthcare or is it joining a gang of sorts?

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Specializes in PICU, Sedation/Radiology, PACU.

This isn't really new behavior. Employers have been pushing the envelope and increasing their conditions of employment for years.

BMI too high? Not hired. Smoker? Not hired? Can't lift 40 pounds? Not hired. Cholesterol too high? Not hired. Previous back injury? Not hired. No Influenza vaccine? Not hired.

Almost all employers now require that you pass a pre-employment physical: height, weight, blood tests, physical exam, urine test, drug screen. I'm not at all surprised that some hospitals are starting to require pre-employment x-rays. I'm expecting that soon we will start to see a wider range of blood tests done, some physical exercise, and turnover of medical records and family history.

Just more proof that there is not a nursing shortage. There are so many applicants willing to accept a job, no matter what the conditions, that employers can be as selective as they want to, and place as many pre-employment conditions as they can. It's about the bottom line for them- choosing the healthiest employees (on paper) will (hypothetically) reduce their insurance costs.

Unless you're in Ireland, it doesn't appear this practice is illegal in the US. I would definitely explain your concerns to the HR department and ask if it is possible for you to decline the x-ray without losing your offer. It's very possible they will say No, you need to do the x-ray in order to be hired. If that's the case, you have to decide whether one x-ray is worth losing this job offer.

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