BRN executive officer urges evidence-based limits on forcing nurses back into direct patient care

The Board of Registered Nursing's Intervention Evaluation Committee on Oct. 29, 2025, heard an update from Executive Officer Loretta Melby on reviews of IEC recommendations that require nurses to return to direct patient care or to demonstrate the ability to pass narcotics as a condition of completing the intervention program. Melby said the board asked her in August to do a "deep dive" into such recommendations and into cases extended beyond three years.

Melby, the board's executive officer, told the committee that her review was intended "not to overturn the request, but to see if there was evidence to support that." She said the board's motion allows IECs to require direct patient care or narcotic-passing only "if there was evidence of additional patient safety" concerns. "We can't make them go to direct patient care," Melby said, "unless you have evidence to say that you really believe that I'm gonna be at risk to the public."

Why it matters: IEC decisions on return-to-work conditions affect individual nurses' ability to complete rehabilitation and return to practice, and they bear directly on patient safety and employer decisions about training and placement.

Melby described the IEC's monitoring role: drug testing, support-group attendance, therapy, clinical evaluations, worksite reports and other feedback from clinical case managers and vendors such as Vault. She emphasized a phased approach: participants can be returned to RN duties that exclude direct patient care while monitoring continues, and only be advanced to direct patient care when the committee has reasonable evidence of safety. "You can progress them' and give them more access," Melby said, "but if you've got somebody that's been a case manager for 20 years and they were able to divert ' you don't want that person to be forced into patient care."

Melby also cautioned about logistical and competency concerns: returning someone who has been out of direct patient care for decades could require new-to-specialty training that hiring managers may not accept solely to satisfy an intervention completion condition. She noted that medical limitations may make direct patient care physically unsafe for some participants and reiterated that an RN license covers practice in many roles beyond bedside patient care.

The executive officer warned against narrow use of the phrase "access to narcotics." "Narcotics are not the only addictive medication out there," she said, giving the example of Seroquel to illustrate that non-narcotic medications can also be misused and should be considered in assessments and conditions.

Melby said the board asked her to review IEC recommendations that imposed longer-than-typical program durations; of 22 cases initially reviewed after August, she said, only one required review since that time, suggesting the board's guidance is being followed. She told the committee she will seek board action in November to allow routine review of IEC recommendations to be handled by program manager Jaspreet rather than by the executive officer, and said she will continue to provide education to IEC members.

Vice Chair Lehi Watson sought clarification about tailoring conditions to case circumstances. Melby agreed: requirements such as returning to direct patient care or passing narcotics "are not something that you would automatically" impose for conditions like a diversion-related allegation that did not include patient-safety evidence.

The committee was also briefed on outreach and program-support work: management continues to work with Premier Health Group, staff are updating outreach brochures and posters, and the board reported emailing 345 outreach materials to individual nurses in the last quarter.

Melby said she will continue to attend IEC meetings to offer education and will return to report on next steps at the board's November meeting.