Board of Registered Nursing committee reviews suspension of direct patient-care and narcotics-work requirements for intervention participants

Loretta Melby, executive officer of the Board of Registered Nursing, told the Intervention Evaluation Committee on Wednesday that the board in August 2024 moved to suspend blanket requirements that intervention-program participants be employed in direct patient care or have access to narcotics unless evidence shows patient-safety risks.

"Our Board made a motion back in August 2024 to suspend the imposition of the requirement that participants work in direct patient care and suspend the imposition that the requirement that the participants work to pass narcotics," Melby said. She described an ongoing review process of IEC recommendations to ensure each recommendation is supported by evidence rather than imposing blanket rules.

The update matters to nurses in the board's alternative-to-discipline intervention program because IEC recommendations can include limits on work duties and access to controlled substances. Melby said she has reviewed 57 IEC recommendations since August; 28 were approved and 29 were referred back to IEC panels for additional documentation or reconsideration. Between August and November 2024, she said, 22 reviews were initially sent to her for scrutiny.

"We don't mandate everybody to go into our program," Melby said, adding the program's goal is to identify and rehabilitate nurses whose competency may be impaired by mental illness or substance use so they may return to practice "in a manner that will not endanger the public health and safety," citing Business and Professions Code section 2770.

Carol Stanford, public member of the IEC, said she has participated in the program for 25 years and that a blanket requirement to return participants to direct patient care or require access to narcotics was not standard before the recent two-year change. "We never had a requirement that a person had to have patient care and or pass narcotics, in order to successfully complete as an absolute requirement," Stanford said.

Committee members debated language and standards for evaluating return-to-practice readiness. "I think competency is probably not the adequate word we should be using ... it really should be safe practice," said Humphrey Ogg, nurse member. Ogg and Melby discussed the committee's reliance on individualized plans, clinician evaluations, and progress reports from case managers rather than a single uniform tool.

Melby said the board has clarified the new vendor's role and told IEC members that direct patient-care assignments and controlled-substance access will not be imposed as blanket requirements. She also noted the board is participating in a follow-up study with the National Council of State Boards of Nursing to track participants for two years after program completion to measure recidivism and long-term public-safety outcomes.

The committee received program statistics in the update: staff emailed 266 outreach materials this quarter and 1,561 so far this calendar year, and the board continues targeted recruitment for IEC vacancies with experience in treating substance-use disorder and mental illness. Melby directed IEC members to the program application at rn.ca.gov/intervention for recruitment information.

No formal public comments were received on the item during the meeting. The committee moved on after the briefing; any IEC recommendations that would extend a participant beyond three years must include supporting evidence before staff will approve them.