The use of background checks (BGC) in academic nursing education has been commonplace for nearly two decades. The rationale for performing BGC is public protection and preservation of trust in the nursing profession (Philipsen et al., 2012; Sheets & Kappel, 2007). These rationales are founded on the assumption that past behavior predicts future behavior, and by extension that more serious behavior is predictive of greater risk (Philipsen et al., 2012). Despite the importance placed on background checks, little is known about the type or severity of BGC findings in nursing students. To date, there have been no published studies that describe characteristics of BGC findings in the nursing student population. Educators face a gap in the literature, which inhibits the use BGC findings to predict public risk in admission or clinical placement decisions. The authors begin to address this gap through a study to describe the most common and most serious characteristics of BGC findings in nursing students attending large universities.

Language surrounding this topic can be stigmatizing. Labeling an individual as a “criminal” or “offender” can make it difficult for a person to put prior involvement with law enforcement in their past (Denver et al., 2017; Ewald, 2019). To avoid stigmatization, the authors will refer to record searches for prior involvement with law enforcement as “background checks” (BGC) and results of those searches as “findings”.

While BGC are widely used in nursing education, little is known about how BGC findings should be used to predict and mitigate public risk (Denver et al., 2017). As a result, academic nurse educators must use their own judgement to interpret BGC findings and determine the impact upon the admission and clinical placement process (Hughes et al., 2013). Properly interpreting BGC is complex and requires careful balance between public protection and laws that prohibit discrimination against individuals with BGC findings (D'Andrea, 2014). If a student with BGC findings is admitted to a nursing program and subsequently harms a patient, a lawsuit for negligent admission could result. Such a suit carries financial liability for the program, which is perceived by some to be greater than the risk of a fine for discrimination (Dickerson, 2008; Hughes et al., 2013). Thus, administrators may justify rejecting a student with BGC findings as “erring on the side of caution” to protect the public and the school or university. It is difficult to refute this justification, as there is little research-based risk assessment published in the education literature (Dickerson, 2008; Hughes et al., 2013). Admission and clinical placement decisions are often made based on the opinion of administrators who lack specific training in the interpretation of BGC results (Hughes et al., 2013). Instead, the opinion of administrators may be overly influenced by personal experiences, biases, and incomplete knowledge of the criminal justice system. The administrators' personal opinions are likely to vary between schools and clinical agencies, which leads to inconsistent BGC policies across nursing education (Williamson et al., 2018).

The development of BGC policies in nursing education as a means of protecting the public should be considered in its historical context. The call to conduct BGCs for nurses and nursing students began in the late 1990s in the aftermath of tragic events where individuals with BGC findings caused harm to others (Bellandi, 1998; Marrs, 1997). In one such event, a senior nursing student murdered a 20-year-old home economics student two blocks from campus. The nursing student had a prior conviction for murder but had lied about it upon admission. There was no way to know the true nature of the student's past because BGC were not part of the school's admission process. As a result, there was a call for mandatory review of BGC findings for nurses and others in healthcare to mitigate public risk (Fiesta, 1999).

In another pivotal event in the early-2000s, societal change in the United States after the September 11th attacks brought an increased call for policies focused on homeland security. One of the hijackers was in the US on a student visa (Farley, 2015). As a result, BGC for nursing students became linked to public protection and the “war on terror” (Farnsworth & Springer, 2006). While suggesting a link between nursing students and terrorism may seem difficult to justify now, it was accepted at that time: “Society's interest in safety has been heightened by the threat of terrorism and it seems prudent to protect the public by regulating those entering a profession where the need for public trust is paramount” (Tate & Moody, 2005, p. 51).

The issue of public trust and nursing's professional reputation has also been used to justify BGC. Some nurses argued that the public trust should be protected through the “stringent security” BGC would provide (Carney, 2005, p. 2). Others argued that the BGC provided “assurance that nurses have integrity…and can be trusted,” (Philipsen et al., 2012, p. 708). It was even argued that the public trust would be eroded by media coverage of “extreme cases” of nurses with BGC findings and keeping those with BGC findings out of the profession was justified as a means of preserving that trust (Shalo, 2009, p. 26). Proponents of BGC for all healthcare workers asserted that they would protect the public by excluding those convicted of serious crimes (Bellandi, 1998). Even so, there were concerns at the time that some individuals who did not pose a threat to the public would lose opportunities due to their BGC findings (Bellandi, 1998).

While it is argued that BGC protect the public, there is little empirical research to explain which BGC findings have implications for public safety (Pierce & Runyan, 2010). As a result, policies may be too inclusive or too exclusive. Policies that are too inclusive may place the public at unacceptable risk from those whose past behavior indicates they may exploit the vulnerable populations that nursing serves. Alternatively, policies that are too exclusive harm those who have learned from past mistakes and represent no greater risk than individuals without BGC findings. Students from communities underrepresented in nursing are often subject to disparate policing and may be more vulnerable to BGC policies unsupported by research (Bushway et al., 2022; Concepcion, 2012). Unjustly excluding students from underrepresented communities due to insignificant BGC findings hinders efforts to diversify the profession. Public protection should not be a rationale for excluding students with background findings unless there is empirically demonstrated evidence linking specific findings and public risk. To date, the justification that BGCs improve public protection is “[b]ased on the observation that past behavior is a predictor of future behavior…” (Philipsen et al., 2012, p. 708). Beyond this observation, there is little descriptive or predictive research to inform BGG policy in nursing education.