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How often can an employer require a nurse to get a chest X-ray to rule out TB?

Friday August 31, 2012
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Dear Nancy,

Last summer I chose to work as a travel nurse. Because I have had positive PPD reactions in the past, I was required to submit a current chest X-ray to show I'm free of tuberculosis. Because I had not had one done in approximately seven years, I was not concerned about providing this. (I did undergo six months of prophylactic isoniazid therapy at the start of nursing school at the advice of my primary care provider.)

Now, six months later at another hospital, I am required to have a clear chest X-ray done within 90 days of my new assignment. How often can my employer require chest X-rays, which are not without risk? While at my last permanent hospital, I was not required to have even annual chest X-rays; I simply had to fill out a form that checked for symptoms. I don't wish to overexpose myself to radiation.


Nancy Brent replies:

Dear Jennifer,

Employers are concerned not only about the health and safety of patients who seek treatment in their facilities, but also about the health and safety of their healthcare workers. Healthcare staff posing a risk to patients because of their own illnesses or conditions, such as TB, is a legitimate concern. The employer must ensure a staff member does not have an active case of TB and until that is established, the staff member cannot work until he or she no longer is contagious.

In regard to your concern about being exposed to another chest X-ray, only your physician can advise you about that risk. He or she also may have information as to other options to determine if you are not contagious or do not currently have an active case of TB. You can get some preliminary information about TB and healthcare workers on the following websites: the Centers for Disease Control and Prevention (www.cdc.gov), the Occupational Safety and Health Administration (www.osha.gov) and the National Institute of Occupational Safety and Health (www.cdc.gov/NIOSH). Type something like "Mandatory chest X-rays for health care workers to rule out active TB" in the search bar.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.