Stumpy Meadows Lake, NorCal Photographer Gene MaGann
Two terms the Ca. BRN is now using for disciplinary actions are Intervention and Enforcement.
Nurse Practice Act
The Nursing Practice Act (NPA) is the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs. The NPA is located in the California Business and Professions Code starting with Section 2700. Regulations which specify the implementation of the law appear in the California Code of Regulations. (California Board of Registered Nursing Website) Please see link to Nurse Practice Act.
Board of Consumer Affairs:
www.dca.ca.gov/
The California Department of Consumer Affairs (DCA) is a department within the California Business, Consumer Services, and Housing Agency. DCA’s stated mission is to serve the interests of California’s consumers by ensuring a standard of professionalism in key industries and promoting informed consumer practices. The department provides the public with information on safe consumer practices, in an effort to protect the public from unscrupulous or unqualified people who promote deceptive products or services. (Wikipedia)
The Board of Registered Nursing www.rn.ca.gov/ is regulated by the Board of Consumer Affairs. It is the responsibility of the Board of Consumer Affairs to ensure that every person holding a license to provide service to the public within key industries is safe and competent to do so. Registered Nurses and Licensed Vocational Nurses are two of these industries. It is the responsibility of the Board of Registered Nursing to license and regulate Registered Nurses in California. Once a nurse, or any individual with intention to become a nurse, has violated the Nurse Practice Act, the onus probandi is upon the person to prove to the Board of Registered Nursing that they are capable and competent to provide safe care to the public.
THESE ARE THE APPOINTED CALIFORNIA BOARD OF REGISTERED NURSING MEMBERS. www.rn.ca.gov/consumers/brdmbrs.shtml
The Board of Registered Nursing is answerable to the Department of Consumer Affairs and therefore is subject to DCA decisions.
Please google California State Government – The Executive Branch Organizational Chart.
Violations of the Nurse Practice Act that occurred at any time in a person’s life are a concern to the Board of Registered Nursing. Even if the individual was not a nurse at the time and had no idea what a Nurse Practice Act was, they will still be held accountable and responsible to the Board of Registered Nursing when applying for a nursing license. The rationale for this is that poor character, bad behavior, and ill intent cause the Board to question the individual’s ability to provide safe care to the public. A person who has, for instance, had a DUI when they were 21 years old and prior to attending college to become a nurse, will not be allowed a nursing license upon graduation until they have been dealt with by the Board. They will not be given the option of participating in Intervention but rather will have the opportunity to present at a hearing before the Board. Requests to continue with a nursing career are rarely denied but the new graduate will go into the discipline of their license by being placed on public Probation. This causes the new nurse to have record of public discipline against their nursing license before they’ve ever applied for their first job. Please see the Discipline Webinar provided by the BRN.
Records that occurred as a juvenile should be sealed and not admissible for Board scrutiny.
Anything a nurse says to the Board or it’s representatives, such as investigators, will be documented and can and will be used against them. BRN hearings are a court of law.
Some nurses have found it valuable, and it is their right, to seek credible legal council with an Administrative Law Attorney on these matters prior to talking to anyone representing the Board.
To be heard before the Board, a request for hearing must be filed and reviewed by the BRN. This process is lengthy and may take anywhere from 4-18 months. If a hearing is granted, a date is set for the hearing which is an additional 3-10 months away. After the hearing, the applicant will be notified of the BRN decision approximately 3 months after the hearing date. According to the BRN Enforcement Program at the Sept 2016 meeting, the beginning of the disciplinary process has been reduced from 3 years to 2 years. The goal is 540 days.
Disclaimer: No stated lengths of time are reliable and vary dramatically. This is only to give a very rough outline of what might be expected.
Please review following report that provides the number of nurses undergoing discipline, both Intervention (Diversion) and Enforcement (Probation), throughout California as well as the case loads of Probation monitors. Problems with delays in administrative procedures are not new but are improving. Several different bureaus are involved with proceedings, each requiring information from the other, and some taking longer than others.
http://www.rn.ca.gov/pdfs/meetings/brd/brd_sep16_item9.pdf
The Board of Registered Nursing hold regular public meetings and it is encouraged to attend or be aware of matters being discussed as they affect the nursing profession.
Dates of upcoming Ca. BRN meetings. www.rn.ca.gov/consumers/meetings.shtml
The BRN has filmed disciplinary hearings which can be viewed online. Much to his credit, Raymond Mallel, previous Vice President of the BRN, adamantly verbalized protest against filming of BRN disciplinary hearings. The Board of Consumer Affairs supports the right to film and post BRN meetings based on the Bagley-Keane Open Meeting Act of January 15, 2014.
State of California Department of Justice Open Meetings:
Bagley-Keane Act. www.dca.ca.gov/publications/bagleykeene_meetingact.pdf
The Brown Act. Open meetings for Legislative Bodies pdf. http://ag.ca.gov/publications/2003_Intro_BrownAct.pdf?
BRN meetings are usually held in hotel meeting rooms throughout California and take place every few months with schedules posted online. In an attempt to process cases in a more timely manner, the BRN will hold additional meetings between those originally posted. A nurse can request to be heard at the next available hearing, which may require traveling to another part of the state or they may wait for the next available meeting in their region, which may also requiring traveling. Some nurses choose to stay the night at the hotel or nearby the meeting to prevent lateness secondary to unpredictable traffic. BRN meetings can be viewed by webcast online, nurses are encouraged to attend a meeting prior to their own. Once a meeting comes to session, the meeting becomes a courtroom with a Judge and the nurse is sworn in. When a nurse attends their own hearing before the Board they will sit at a desk in front of the Board with a microphone. The nurse may prepare something to read or notes to refer to when speaking before the Board. In view of the gravity of the situation, it is ill advised to extemporize. The nurse will be asked questions by Board members as well as a representative from the Attorney General’s office. It is the nurse’s right to have legal representation beside them. Colleges send nursing students to the meetings so there may be over 400 people in attendance. This is one of the reasons why it is important for a nurse to attend a meeting prior to their own; to know what to expect. Knowledge reduces fear of the unknown and exposure will reduce sensitivity to the event.
From the date of the initial incident to final completion of Enforcement (Probation) or Intervention (Diversion), the time frame can be up to 10 years or more.
Nurse Consultant
Employment, physician appointments, treatment programs, and education are under strict guidelines and time frames mandated by the BRN. The nurse must meet these time frames to avoid being out of compliance. Once the nurse has found employment, physicians, treatment programs, and education that meet BRN guidelines, the nurse must submit the requests to their Enforcement Monitor. The Enforcement Monitor then forwards the requests to the BRN Nurse Consultant. It is the responsibility of the BRN Nurse Consultant to review every request and make a decision on it. There is currently one part-time Nurse Consultant to review the requests of approximately 1500 California nurses in the Enforcement program. The stated length of time documented by the BRN for decision is 10-14 days. Because of the considerable workload placed upon the Nurse Consultant, decisions for requests are taking beyond a month. The extensive delay in job approval is causing prospective employers to deny employment to nurses. It is a challenge of exceeding proportions for a nurse to obtain employment while undergoing public discipline, therefore having an employer change their mind about hiring secondary to disciplinary complications is disheartening. Employment denial, as well as disapproval of other requests, places the nurse at risk for not only continual unemployment but not meeting BRN discipline mandates. Not meeting mandates is resulting in an entire additional year of Enforcement Discipline being placed upon nurses. Worse yet, the nurse’s license can be sent to the Attorney General’s Office for noncompliance with ensuing license revocation. It is the stated goal of the BRN to improve this process. Extensions of a week have been given to nurses unable to meet mandated time frames. The BRN is currently considering adding an additional part-time Nurse Consultant to assist with the heavy work load and improve time frames. The issue is not only of the Nurse Consultant workload but lack of resources and direction for nurses undergoing discipline. The terms coddling and enabling nurses have been used by Enforcement when seeking to provide resources to nurses in need. This website could not disagree more with the use of those terms. Substantial literature is available to support the link between excessive stress with substance abuse and relapse. This site firmly stands in support of nurses to succeed and thrive within these programs, to grow and become everything they were intended to be without placing any additional stress upon them than they are already bearing.
Photo by Vivian Lowe
Intervention Evaluation Committee IEC (Diversion) The Intervention Program is a voluntary, confidential program for registered nurses whose practice may be impaired due to substance use disorder or mental illness. The goal of the Intervention Program is to protect the public by early identification of impaired registered nurses and by providing these nurses access to appropriate intervention programs and treatment services. Public safety is protected by suspension of practice, when needed, and by careful monitoring of the nurse. (BRN Website)www.rn.ca.gov/intervention/whatisint.shtml
RN licenses/APN certificates are placed on inactive status once an RN enrolls in the Intervention/Diversion Program. Necessity to work has swayed many nurses to decline the Intervention Program. This declination does not ensure a nurse will be allowed to continue to work while in Probation, which is often the result of not going into the Intervention Program.
Consider confidential short-term unemployment with possible disability benefits and improved physical, mental, and spiritual health versus less support and long-term public probation record on the internet. If it is possible, it may be in the nurse’s best interest to pursue acceptance into the Intervention program.
License discipline of Enforcement or Probation remains public discipline (judgment attached to the nurse’s license) for ten years after completion of the disciplinary process.
POLICY ON INTERNET DISCIPLINE DOCUMENT RETENTION
https://www.rn.ca.gov/pdfs/enforcement/disclosure.pdf
There are currently over 1550 nurses in Enforcement/Probation
There are currently approximately 400 nurses in Intervention/Diversion
BOARD OF REGISTERED NURSING Intervention/Discipline Committee Agenda Item Summary
http://www.rn.ca.gov/pdfs/meetings/brd/brd_sep16_item9.pdf
BOARD OF REGISTERED NURSING Diversion/Discipline Committee Agenda Item Summary June 4, 2015
www.rn.ca.gov/pdfs/meetings/brd/brd_jun15_item9.pdf
The Intervention Program is a supportive and confidential program that provides stipulated requirements and resources that empower nurses to recovery. The nurse will be taken out of practice for at least six months during the beginning of Intervention. From the nurse’s standpoint, this provides the nurse a “time out” from the stress and responsibilities that may have contributed to inappropriate substance use. Although this is initially a hardship, it is highly recommended that nurses seek acceptance into the Intervention program rather than Enforcement. Enforcement or Probation discipline remains publicly attached to the nurse’s license for ten additional years beyond completion while the Intervention Program is confidential within the BRN and is more supportive.
Remember that participation in either program is a choice the nurse makes. Perception, acceptance, and willingness to grow are also choices one can make when undergoing either program.
A nurse does not have to participate in The Intervention (Previously termed Diversion) Program. If they choose not to participate, they will be given the opportunity for Enforcement (Previously termed Probation) which becomes public knowledge. If they choose not to participate in Enforcement, if they are denied Enforcement, or if they fail to give a change of address so are not aware that a hearing regarding their nursing license is being held, they can expect their RN license to be revoked for at least 3 years, which can roll into 5-6 years waiting for hearings and decisions. If a nurse does not appear for their hearing to defend themselves, their nursing license is revoked by default. When a nurse’s license is revoked, the nursing license goes to the Attorney General’s office where an accusation is made against the license and the nurse. If, after investigation, it is found that a felony has been committed, criminal charges may be imposed against the nurse.
https://www.dca.ca.gov/…/brn_enforceme…
www.rn.ca.gov/enforcement/dispaction.shtml TERMS AND DEFINITIONS OF BRN ENFORCEMENT
http://leginfo.legislature.ca.gov/ Official California Legislative Information
http://www.rn.ca.gov/pdfs/forms/sunset2016.pdf
National Council of State Boards of Nursing (NCSBN) is an independent, not-for-profit organization through which Boards of Nursing act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of nursing licensure examinations. https://www.ncsbn.org/
Expungement:
Conviction was “dismissed or set aside”. Legally the conviction is gone but the record remains as a case dismissed. It means that everything that was required as a result of the conviction has been completed, eg, DUI school, fines, etc. It is still reportable and matters to the BRN who will want to address why this occurred in the first place.
https://www.propublica.org/
In July 2009 Pro Publica, “Journalism in the Public Interest” published investigations with allegations of misconduct of nurses, stating the Board of Registered Nursing was remiss in regulating nurses, following up on complaints, etc. Schwarzenegger, who was Governor at the time, immediately replaced most of the Board members, citing it took an unacceptable amount of time, often years, to discipline nurses accused of egregious misconduct.
https://www.propublica.org/article/schwarzenegger-replaces-most-of-state-nursing-board-713
Since that time the Enforcement Program of the Ca. BRN has worked hard to enforce new laws, policies, and regulations affecting all California nurses. Some have been sorely needed while others have had consequences incommensurate to the accusation. Examining the laws and working to make policy change where it is needful can bring balance into a system that, it is trusted, seeks to deal fairly and equitably with all concerned.
Photo by Vivian Lowe. California Poppy