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What is the Enforcement Program?

The Board of Registered Nursing (BRN) has the primary responsibility of licensing and regulating registered nurses in California. The BRN's responsibilities come from the Nursing Practice Act, which is composed of California statutes that give the BRN, among other functions, the authority to investigate complaints and take disciplinary action against registered nurses. These investigation and disciplinary functions are handled by the Board's Enforcement Program.

The Board of Registered Nursing's Enforcement Program staff work with health care consumers and health care professionals in identifying those registered nurses who have engaged in any activity which may be unsafe and which may put the public at risk.

The Enforcement Program's responsibilities can be divided into four primary categories:

• Complaint Intake
• Investigation
• Legal Action
• Probation Monitoring

In addition to taking disciplinary action against a nurse's license, the BRN is also responsible for denying licensure to those individuals identified as potentially unsafe practitioners. If an application is denied, the applicant can appeal the denial through the same disciplinary proceeding as those indicated in the Legal Action section.

Complaint Intake

A complaint is information which alleges that a registered nurse or an applicant has violated the Nursing Practice Act by engaging in any activity or behavior which is inconsistent with professional responsibilities.

Anyone who believes a registered nurse has acted in an unsafe or unprofessional manner or that an unlicensed person is illegally providing nursing care should file a complaint as soon as possible.

The two most frequently received complaints by the BRN pertain to:

• Patient Care - The complainant believes that the registered nurse's actions were unsafe or inappropriate. Serious medication errors, patient abuse, and failure to provide care are examples of patient care complaints.
• Chemical Dependency - The complainant believes that the nurse is abusing alcohol or other drugs.

Complaints involving chemical dependency and mental illness may be referred to the BRN's Intervention Program. This is a confidential rehabilitation program. For information regarding this program, contact the BRN.

Other types of complaints include license application fraud, sexual misconduct, criminal convictions, and mental illness.

Activities and behavior not within the authority of the BRN include:

• general business practices, such as fee and billing disputes
• personality conflicts

Complaints about health care providers regulated by other agencies, such as physicians, vocational nurses, and nursing assistants, are outside the BRN's jurisdictions and are referred to the agencies that regulate them.

For your protection!

• As a health care consumer, you are entitled to quality nursing care.
• The complaint process is the primary means by which the BRN can learn of alleged violations of the Nursing Practice Act and begin appropriate disciplinary procedures.

Filing a complaint is not mandatory; however, it is critical to ensure safe quality nursing care in California.

When information or a complaint is received by the BRN, a written notification is sent to the complainant within 10 days. The information is reviewed to determine if the RN is eligible for the BRN's Intervention Program, if additional information is needed, or if the complaint should be forwarded to another agency which has jurisdiction.

The entire complaint, investigation and legal action processes may take an extended period of time depending on the complexity of the case. Complaints posing the greatest risk receive the highest priority.

Complaints, in general, are confidential and are not public record during the investigation process. However, when an accusation is filed, it becomes a matter of public record and the BRN will disclose the specific charges upon request. Once disciplinary action has been imposed, it becomes a permanent part of the nurse's record and is subject to public disclosure.

Investigation

If additional information is needed before the board makes a determination, the board may request a formal investigation. The board has an internal BRN Investigation Unit comprised of non-sworn Special Investigators. In addition to the BRN Investigation Unit, the Department of Consumer Affairs also has the Division of Investigations (DOI), consisting of sworn peace officers.

During the course of an investigation, the investigators conduct interviews, gather evidence, submit reports, and may refer cases to the District Attorney's Office if they determine a crime has been committed.

When an investigation is completed, the investigator submits a written report of the findings to the BRN for review. If no violation can be substantiated, the case is closed and the complainant is notified.

Legal Action

If the investigation finds evidence that the nurse has committed a minor violation and the violation does not warrant formal disciplinary action, the case is handled through an informal process - the BRN Citation and Fine System. Under this system, the Executive Officer is authorized to issue citations and fines for minor violations of the Nursing Practice Act. A nurse may contest the citation and fine through an informal or formal appeal process.

If the investigation finds evidence that the nurse has violated the Nursing Practice Act and the violation warrants formal disciplinary action, the case is forwarded to the Attorney General's Office for review. If there is sufficient evidence, an accusation, which is a legal document that lists the charges, is prepared and sent to the nurse. The nurse will be given an opportunity to dispute the charges at an administrative hearing. This hearing is an administrative proceeding that closely resembles a court trial. In some cases, the BRN may negotiate a stipulated agreement to resolve the case in lieu of a hearing. In this agreement, the nurse admits specific charges and agrees to the proposed disciplinary action. After the hearing, the Administrative Law Judge writes a proposed decision. The proposed decision is then sent to the nine-member Board for consideration. These members make the final decision on disciplinary matters and can either adopt, modify, or reject the proposed decision.

If the nurse against whom you have filed a complaint is found to be in violation of the Nursing Practice Act, the final decision can be:

• to revoke or suspend the license
• to accept surrender of the license (Revoking, voluntary surrendering, or suspending a license prohibits the nurse from practicing.)
• to place the nurse's license on probation
• to cite and fine

The Board of Registered Nursing's decisions are always based on the safeguards required to protect the public.

Probation Monitoring

Nurses placed on probation will be required to comply with the specific conditions of their probation. Compliance with the conditions is monitored by a BRN probation monitor. When the nurse successfully meets the conditions of probation, the license is restored without restrictions.