California BRN tells IEC to pause blanket work and narcotics requirements for intervention participants

The Board of Registered Nursing on Sept. 17 directed the Intervention Evaluation Committee (IEC) to stop automatically requiring intervention-program participants to work in direct patient care or to pass narcotics testing unless there is evidence showing a patient-safety risk.

Loretta Melby, executive officer for the Board of Registered Nursing, told the IEC that the board adopted the instruction in an August 2025 motion and asked staff to audit past recommendations and educate IEC members on applying the board’s standards. "They asked me to review for evidence to support that request," Melby said of IEC recommendations to extend participation past three years or to permit work in direct patient care or access to narcotics.

The board’s motion responds to public and stakeholder concerns, Melby said, and resulted after staff could not trace a single authoritative source that had required those measures. She cited Business and Professions Code section 2770 as the statutory framework that directs the board to identify and rehabilitate nurses whose competence may be impaired by substance use or mental illness.

Why it matters: the IEC recommends terms and conditions for nurses in the confidential intervention program, including clinical monitoring, workplace restrictions and lengths of participation. Requiring work in direct patient care or narcotics access without supporting evidence could limit rehabilitation pathways, committee members and staff said.

Melby reported that, since the board’s August motion, staff reviewed 56 IEC requests submitted for board-level review over the previous year. Of those reviews, 19 were supported by evidence sufficient to continue with restrictions or extensions; 31 did not include evidence justifying requirements for direct patient care, narcotics access, or extensions beyond three years. Staff returned the 31 cases to IECs for reevaluation and consideration of alternative measures.

Melby described the board’s approach to completion and monitoring: the IEC may initially recommend that a participant not work while undergoing evaluation and testing; as the participant progresses in treatment and demonstrates compliance — through therapy, support-group attendance and negative testing — the IEC can recommend graduated returns to practice, including eventual patient-care duties or access to controlled substances if the evidence supports it. The board’s intervention program is typically three to five years, she said, and completion is based on sustained compliance and demonstrated safe practice.

Melby acknowledged uncertainty in the evidence base for requiring work or narcotics access specifically. She pointed to national studies and board practices that show some boards permit completion without a work requirement and noted that the Board of Registered Nursing participates in an ongoing NCSBN study tracking intervention participants after program completion.

Committee members and staff also discussed operational clarifications. Melby said she will continue to attend IEC meetings for roughly a year to support implementation and to review any IEC recommendations to extend participation past three years or to reintroduce narcotics access.

During the meeting the committee also reviewed program outreach numbers and administrative updates: staff emailed 266 outreach materials to individual nurses in the quarter ending Sept. 5, 2025, and 1,561 materials during the calendar year to date.

Votes at a glance - Approval of IEC meeting minutes (March 12, 2025): Motion to approve minutes and allow BRN staff to make non‑substantive corrections passed by roll call (Yes: Maureen Gatt; Stephanie Evangelista; Liberty Macias; Laurie Berkimer). Motion mover: Maureen Gatt. Second: Liberty Macias.

Other procedural items - The committee recessed to closed session at 9:59 a.m. pursuant to Business and Professions Code section 2770.10 and Government Code section 11126(c)(2) to discuss intervention-applicant matters; closed session reconvened and the meeting adjourned in the afternoon.

What’s next: Board staff will continue outreach and education for IEC members, will accept requests from IECs for clarifying guidance, and will re-review IEC recommendations that ask for extensions past three years or narcotics access to ensure those recommendations include supporting evidence.