Healthcare tops the list of industries with the fastest-growing expense for cybersecurity breaches. Since 2022, this cost has increased at least 8.2% for the healthcare industry, and the total average cost for healthcare data breaches in 2025 is currently at $7.42 million.
Staying ahead of compliance means adopting future-ready, automated, and integrated strategies rather than relying on outdated, reactive approaches.
It’s a true transformation, crucial to managing legal, operational, and cybersecurity risks while maintaining trust and competitive strength in healthcare. Here are just a few of the many examples of this transformation:
Why staying ahead of compliance is more important than ever
Physician licensing in the late 19th century ushered in formal healthcare safety regulations.
Medicare and Medicaid in the 1960s introduced compliance requirements for healthcare providers, and the HIPAA landmark law in the late 1990s set the first federal standards for protecting sensitive health information.
Today, healthcare facilities are operating in an environment where staffing shortages, fluctuating patient volumes, and rising acuity have made quick-fill solutions a necessity. Staffing platforms like Nursa provide a per diem staffing solution that helps address these concerns, but not all platforms help facilities manage compliance in the same way, opening up providers to potential risk.
What are some of the “gaps in the armor” that can open up risks to healthcare facilities?
Many facilities are under constant pressure to plug staffing gaps quickly, especially during census spikes, unexpected call-outs, or seasonal surges. When time is tight and coverage is urgently needed, speed can unintentionally take priority over thorough verification.
This is where risk creeps in:
- Credentials or licenses may be assumed valid rather than actively verified.
- Expired certifications—or certifications not aligned with unit requirements—may slip through.
- Onboarding steps such as facility orientation, policy review, and skills validation may be rushed or skipped altogether.
Even a single oversight can expose the facility to compliance gaps with CMS, state boards, or accrediting bodies.
What are the consequences of non-compliance?
When verification errors or documentation gaps surface, the consequences can be significant:
- Financial penalties from state and federal regulators
- Loss of reimbursement due to improper staffing documentation, especially in skilled nursing and acute care
- Accreditation risks during surveys or audits
- Reputation damage that affects patient and family trust, referral relationships, and community standing
Non-compliance comes at a high cost to both facilities and patients. For failure to comply with the US Federal Hospital Price Transparency Rule, the mean amount in hospital penalties for 2022 was $510,976, representing only the non-compliance costs related to the price transparency rule —a fraction of all non-compliance charges.
Let’s explore the top compliance concerns healthcare facilities face and what facilities can do to proactively manage these risks.
7 Top compliance risks in healthcare staffing
Healthcare staffing compliance is critical for patient safety, regulatory adherence, and reducing financial risks. Understanding these top risks helps facilities build safer, more reliable care teams while avoiding costly penalties.
1. Licensing, credentialing, and ensuring scope of practice
Credentialing risks can result in fines, legal actions, loss of accreditation, and damage to patient trust and facility reputation. Among the major healthcare compliance risks to facilities regarding licensing, credentialing, and scope of practice, these are 3 of the most common.
- Unlicensed or improperly credentialed staff, risking legal penalties and patient harm: Failure to verify and continuously monitor clinicians’ licenses and certifications is at the root of this issue.
- Practice beyond the clinician’s authorized scope, leading to malpractice liability: Inadequate documentation of credentials and scope compliance creates vulnerability to audits and enforcement.
- Delayed or incomplete reporting of credentialing or licensing issues to regulatory bodies: Lack of integration of credentialing data with electronic health records and staffing systems impacts timely reporting, as well as care and safety.
Proactive and automated credential management and scope-of-practice compliance programs are essential to mitigate these risks effectively.
For example, Nursa helps lighten the burden of schedulers and managers by automating the credentials and license verification, avoiding related risks before accepting PRN applications for each shift.
Note: Nursa performs robust background checks, license verification, and credential management for facilities. Learn more about the nurse credentialing process.
How does the risk change with 1099 clinicians?
In contrast to W-2 employees, 1099 clinicians are responsible for their own taxes, licensure, continuing education (CE), and often their own malpractice insurance.
Nonetheless, the engaging facility must still ensure that the credentials are verified and valid, and faces significant legal and financial risks for non-compliance or patient harm resulting from unqualified contractors.
2. Ongoing monitoring and exclusion risks
For both permanent and PRN staff, ongoing monitoring protects the facility and its patients. This includes checking the Office of Inspector General (OIG) exclusion list, which names the clinicians who are prohibited from practicing due to adverse actions or license disciplinary actions, such as:
- Convictions for healthcare-related fraud
- Patient abuse or neglect
- Felony convictions for controlled substance offenses
Many staffing apps don’t monitor continuously. The facility “owns” the risk, even when managing contracted per diem staff. If someone on the exclusion list works a shift, you could face penalties.
This is why Nursa re-verifies clinician licenses and re-screens against the OIG exclusion list, the National Sex Offender Registry, and other local exclusion lists each time they request a shift. Clinicians who fail these checks are banned from the app.
3. Mis-classification of employment status
Using contract workers often raises issues of whether they are considered employees (W-2), independent contractors (1099), or contracted through a vendor—this classification has legal implications and affects:
- Wages
- Hours
- Benefits
- Worker compensation
For example, if the staffing model treats someone as an independent contractor but they are functioning as an employee, that may breach labor laws. In the case of an employee, the facility controls their schedule and has broader oversight responsibilities, including performance management, training, and disciplinary actions.
Nursa helps facilities by strictly enforcing correct classification of their 1099 clinicians.
4. PRN shifts and compliance: Keeping care safe
Strong vendor oversight ensures staffing solutions provide facilities with nurses whose experience profiles align with specific shift needs, helping reduce errors, compliance risks, and third-party risk associated with external staffing partners.
A staffing solution that allows users to describe their experience in their profile can help facilities identify the highest-quality nurses available for their vacant shifts.
Short-term staffing can introduce new oversight challenges as facilities can’t always offer full onboarding for PRN nurses, but short-term staff don’t have to “go in blind.”
Nursa partners with ShiftReady, an online learning library that facilities can use to create customized courses for free for onboarding PRN clinicians, preparing them to hit the ground running when they arrive to fill a shift.
5. HIPAA, data privacy & security concerns with staffing platforms
When needed on the job, contract clinicians may access EHRs and PHI, but data breach or PHI risks may arise if supervision is lax.
Nursa acts as a marketplace and shift logistics platform, but never handles or accesses patient electronic health records (EHRs) or protected health information (PHI). This eliminates risks related to HIPAA violations or data breaches through the platform.
Facilities retain responsibility for ensuring proper clinician compliance with privacy and security protocols. However, Nursa’s design ensures HIPAA and data privacy are never concerns arising from marketplace or logistics operations.
6. Contractual risk, liability allocation, and indemnification
Contractual risk in healthcare staffing increases when contracts with agencies or platforms fail to clearly assign responsibilities like credentialing, supervision, and indemnification. Many platforms conduct initial screenings but not ongoing monitoring, exposing facilities to potential liability if unqualified PRN nurses work shifts.
Nursa screens credentials each time a clinician applies for a shift.
Clear contracts with explicit liability and compliance clauses are essential to prevent gaps, protect all parties, and ensure effective risk management in these staffing relationships.
7. Financial exposure in staffing: Credentialing and billing
Shifts must be filled by properly credentialed clinicians who are well supervised. If not, the services provided may not qualify for Medicare or Medicaid reimbursement. This can lead to denied claims, lost revenue, and increased exposure to audits and financial penalties, making credentialing a critical control for both compliance and financial protection.
Understanding these risks is the first step. The next is verifying that your staffing solutions are built to prevent them.
A facility checklist for healthcare staffing compliance
Compliance in healthcare staffing requires active oversight—not only of your internal teams but also of external partners, PRN clinicians, and staffing platforms. This checklist helps facility leaders ensure their staffing processes strengthen, rather than weaken, compliance readiness.
Use the following questions and safeguards to evaluate your staffing partners, internal workflows, and scheduling processes to understand if they adequately protect your organization from regulatory, financial, and patient-safety risks.
Questions to ask when vetting staffing solutions
A high-quality staffing partner should strengthen compliance, not introduce uncertainty. When evaluating staffing platforms or agencies, prioritize transparency, automation, and ongoing risk monitoring. Use the following example questions to guide your evaluation process:
1. What is your credentialing workflow?
Confirm that the platform or agency verifies licenses, certifications, background checks, OIG exclusion list status, adverse actions, sex-offender registries, and any state-specific requirements.
2. Do you perform ongoing monitoring or only an initial check?
Compliance risk increases when platforms rely solely on initial screenings. Continuous re-verification ensures clinicians remain in good standing for every shift they accept.
3. How does the platform ensure a clinician’s experience aligns with the shifts they request?
This includes validating unit-specific skills, prior experience, and any specialty competencies.
4. Can your platform provide records for audits or surveys?
Make sure your platform or partner can produce credentialing and verification evidence quickly if the facility faces surveyors or investigators.
Safeguards for your facility during shifts
Even with trusted staffing partners, internal controls are essential for maintaining compliance throughout each shift. These safeguards help ensure that temporary or contracted clinicians are prepared, competent, and properly documented.
Centralized onboarding checklists for all temporary staff
Maintain an onboarding checklist for per diem, PRN, travel, and agency staff that mirrors your permanent-staff requirements whenever possible. This should include:
- Mandatory facility training
- Infection control education
- EHR access and documentation training if necessary
- Code and emergency procedures
- Unit-specific workflows and safety expectations
- Charting requirements and workflows
Clear escalation pathways
Ensure both permanent and temporary clinicians know how to escalate safety concerns, documentation issues, or competency questions.
Best practices for optimizing scheduling and staffing compliance
Proactive scheduling reduces compliance risk by minimizing last-minute hires and creating space for proper onboarding, verification, and orientation. Facilities that treat staffing platforms as strategic partners see the highest return on investment for their safety and compliance.
1. Integrate platforms and agencies into long-term staffing plans
Instead of relying only on last-minute requests, incorporate PRN and agency resources into:
- Monthly staffing forecasts
- Seasonal surge planning
- Expected PTO or leave coverage
- High-acuity periods (flu season, holidays, etc.)
This reduces the need for rushed placements that bypass verification or onboarding.
2. Create scheduled orientation windows for PRN clinicians
When shifts are planned in advance, facilities can offer structured onboarding touchpoints—brief but essential—for temporary staff. Facilities that see the most success with per diem clinicians on the Nursa platform have shared best practices for orientation and onboarding, including having an easily-accessible binder with facility procedures and orientation materials.
3. Standardize expectations for external staff
Set clear policies around:
- Documentation requirements
- Patient-assignment limitations
- Supervision expectations
- Unit-specific competencies
These standards ensure safe and consistent care delivery.
Compliance staffing: A priority for trusted partners
Healthcare staffing is more complex—and more scrutinized—than ever before. With rising cybersecurity threats, ongoing workforce shortages, and an increased need for PRN and contracted clinicians, compliance can no longer be treated as a periodic checkup. It must be a continuous, proactive strategy woven into every part of workforce management.
Compliance and safety depend on you, as well as the partner you choose for staffing.
Explore how Nursa helps facilities connect with high-quality, compliance-ready clinicians to fill shifts quickly and confidently. Sign up to start posting shifts on Nursa today.
Sources:
- HPAA Journal: What is healthcare regulatory compliance?
- Average Cost of a Healthcare Data Breach Falls to $7.42 Million
- The Role of Artificial Intelligence in Modern Healthcare: Advances, Challenges, and Future Prospects
- Healthcare caught between AI promise and perils
- Explainable AI in Clinical Decision Support Systems: A Meta-Analysis of Methods, Applications, and Usability Challenges
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