California Nursing Substance Abuse Alternative to Discipline Program

The California Board of Registered Nursing's “Intervention Program” provides a way for nurses with substance abuse or mental health problems to receive intensive, monitored treatment while avoiding disciplinary actions connected with those issues. The Intervention Program requires the nurse to make a substantial commitment of time and effort, and while it has proved successful for many nurses, it's not for everybody. If you are considering enrolling in the Intervention Program in California, or have been referred to the program by an employer or the Board of Registered Nursing (BRN), contact the Lento Law Firm Professional License Defense Team at 888.535.3686 or through our website contact form to discuss your situation. We can help you evaluate your options and make an informed decision about whether the IP program is your best one.  

What is the Intervention Program? 

California's Board of Registered Nursing established the Intervention Program in 1984 as a “voluntary and confidential recovery and monitoring program” for nurses who may have a “substance abuse disorder or mental illness.” It is one of several healthcare professional intervention programs established by California law “so that registered nurses so afflicted may be rehabilitated and returned to the practice of nursing in a manner that will not endanger the public health and safety.” 

The Intervention Program is voluntary. No nurse can be compelled to sign up for it, though a nurse who is referred to the program by the BRN is usually referred because of misconduct allegations that the BRN will pursue if the nurse elects not to enroll in the Intervention Program. Once enrolled, nurses may leave the program before completing it, but at the likely cost of having to face the discipline that was postponed while the nurse was enrolled in the program. Nurses who complete the Intervention Program will avoid disciplinary action for the alleged misconduct that led to the program referral.   

The Intervention Program takes a multi-pronged approach to treatment. Nurses who enroll agree to check in daily to learn if they will be required to submit to random drug testing; they must participate in weekly group and AA/NA meetings, will usually be required to attend regular therapy sessions and will be prohibited from working until approved to do so by the Intervention Program. The full program takes at least two years to complete but may go for several years beyond that, depending on the situation.  

Enrolling in the Intervention Program 

There are two ways for a nurse to be referred to the Intervention Program; the nurse can “self-refer,” or the BRN can refer the nurse in response to a misconduct complaint that is “related to controlled substance, alcohol and/or mental illness.”  

The Intervention Program has eligibility requirements. The nurse must be licensed and live in California; they must be suffering from a mental illness or have abused alcohol or drugs, and they must ask to join the program. As part of the admissions process, the nurse must agree to undergo medical and psychiatric evaluations. Nurses who have already been disciplined for substance abuse or mental illness are not generally eligible for the Intervention Program, nor are nurses who were previously in the program but were terminated for not complying with the Intervention Program's requirements.  

Nurses who ask to enroll in the Intervention Program will undergo an “Initial Intake Assessment,” where a Clinical Case Manager will interview the nurse over the phone to evaluate what the nurse's treatment needs are likely to be. The nurse will then meet with a Clinical Assessor designated by the Intervention Program. This person will be a licensed practitioner in the field of substance abuse or mental health who will gather information that will be used by the Intervention Program to develop a treatment plan (called a “Recovery Agreement”) for the nurse.  

Participating in the Intervention Program 

The nurse will sign an agreement with the Intervention Program that will specify the terms of their treatment. While those terms may vary somewhat from one nurse to another, they are likely to include each of the following components:  

  • Self-assessment. Each nurse who enters the Intervention Program must complete a one-time self-assessment of the nurse's “personal situation.” This must be completed before the initial intake assessment mentioned above.  
  • Monthly self-reports. Once enrolled in the Intervention Program, nurses must submit a monthly self-report that will include information about the nurse's activities that month, particularly those that relate to the program's requirements (meetings, therapy, drug testing, and approved work situations). 
  • Drug testing. Nurses must agree to submit to random, observed drug testing, which can happen at any time. This can take the form of urine, hair samples, or blood sample testing. As part of this, the nurse is required to submit detailed information to the program administrator about where and when the test was administered, the “Chain of Custody” number for the test, and the nurse's work schedule, if any, that day.  
  • Daily check-ins. Nurses are required to check in daily with the program administrator so that they can be notified if they have been selected to be tested that day. A missed check-in, including a check-in outside of designated check-in hours, will result in the nurse's immediate removal from nursing work (if they have been approved to work and are working), and will require the nurse to pass at least two consecutive random drug tests before they may be allowed to return.  
  • Group meetings. Nurses may be required to attend AA/NA as well as Support Group meetings as part of their Recovery Agreement. They'll be expected to submit signed meeting cards for the AA/NA meetings as proof that they have met this requirement and are also responsible for making sure that the Support Group Facilitator submits attendance reports to the Intervention Program administrator each month.  
  • Counseling. As part of their Recovery Agreement, nurses may be required to attend one-on-one counseling sessions with a licensed therapist, who will be expected to submit progress reports to the Intervention Program administrator on a regular basis.  
  • Workplace monitoring. If approved to work, the nurse's designated supervisor will be required to submit quarterly reports about the nurse to the Intervention Program administrator.    

Employment While Participating in the Intervention Program 

One of the first things that the nurse will be required to do when they begin their Intervention Program treatment will be to stop working until permitted to return to work by the program. This will be for a minimum of 30 days, but in many cases, will be for a longer period until the program staff believes that the nurse is safe to return to work. Approval is likely to come in stages; at first, the nurse may not be allowed to dispense prescription medication. Then, after a period of time where the nurse continues to successfully follow their Recovery Agreement and is doing well at work, the nurse may be allowed to work with fewer restrictions on what they can and cannot do.  

The Employment Process While Participating in the Intervention Program 

As noted, when a nurse first enrolls in the Intervention Program, they must stop working until the Intervention Program board approves the nurse's return to work. Before the nurse can return to work, they must be approved to do so by their Case Manager and then by the Intervention Program board.  

Once the nurse has found a potential job, they must complete a Return to Work request. This includes an essay that the nurse must write about their readiness to return to practice. The nurse must also identify a designated Workplace Monitor at their employer who will be responsible for supervising the nurse and submitting quarterly reports about the nurse's work. The monitor needs to be approved by the Intervention Program administrator.  

The nurse's initial return to work is likely to include certain practice restrictions that the nurse and employer will need to follow. Only after a period of months after returning to work, can the nurse request that some or all of the restrictions be lifted; whether or not that happens is entirely up to the program.  

Travel While Participating in the Intervention Program 

Because of the daily check-in requirements – and in particular, the random drug testing may happen as part of the daily check-in – traveling away from home for any period of time can be a challenge. Nurses must report any out-of-town travel that involves an overnight stay to the program administrator at least three weeks before the scheduled trip. The trip must be approved by the nurse's Case Manager or program administrator. If there is no way to arrange for suitable random drug testing at the travel destination, the trip won't be approved. This can particularly be a problem with international travel and with cruises.  

Emergency travel situations also require approval from the nurse's Case Manager and are considered on a case-by-case basis. The nurse will need to account for drug testing, meeting attendance, and other requirements of the nurse's Recovery Agreement, and the Case Manager can help with that and with securing approval for emergency travel.  

Medical Waivers 

As part of their Recovery Agreement, the nurse will have a list of medications that are prohibited while the nurse is enrolled in the Intervention Program. When a nurse has a legitimate medical reason for having to take one or more medications on the prohibited medication list, the nurse may be allowed to do so without it being considered a violation of the nurse's Recovery Agreement. However, the nurse must be under a doctor's care while taking the medications and will not be allowed to work so long as they are taking the medications. The nurse will also have to pass two drug screening tests before they'll be allowed to return to work.  

In cases where the nurse has a medical emergency that could result in the nurse being unable to comply with any part of their Recovery Agreement (check-in, availability for testing, use of prohibited medications, attendance at meetings and therapy, etc.), the nurse must contact their Case Manager as soon as possible to discuss the situation and receive information about prohibited medications that can be shared with their medical team.  

Prescription Waivers 

Nurses who have a legitimate medical reason for taking a prescribed drug that is on the prohibited medication list may be allowed to do so but will need to have the prescription approved by their Case Manager. In addition, they will not be allowed to work until they've stopped taking the medication and have passed two random drug tests.  

Exiting the Intervention Program 

Nurses who have met certain requirements may petition to transition out of the Intervention Program. That is the first step to leaving the Intervention Program and involves a period of time where the nurse's Recovery Agreement requirements are reduced. A nurse must meet the following conditions before they can enter Transition:  

  • The nurse must complete a Transition Packet, including a self-assessment, letters of recommendation, and a plan to prevent relapse 
  • At least 24 continuous months of satisfactory participation in the Intervention Program 
  • Compliance with their Recovery Agreement, including attendance at all required meetings (support group, 12-step, community group, and therapy) 
  • At least 24 months of negative drug test results 
  • No evidence that the nurse has relapsed for at least 24 months 
  • Success at their return to work, if the nurse is working 
  • The BON must approve the nurse's request to enter the Transition phase 

After a period of time in the Transition phase, the nurse may request permission to exit the Intervention Program.  

Challenges of the Intervention Program 

As you may realize, there are a number of challenges that come with enrolling in California's Intervention Program. The program's strict monitoring and participation requirements can be difficult to meet, and even an inadvertent failure to meet the requirements can result in the nurse being out of work for weeks after the infraction. Other challenges include:  

  • Immediate loss of employment. When you enroll in the Intervention Program, you must stop working and will not be allowed to resume until the program approves your request.  
  • Expenses. While your initial evaluation costs are usually covered by the program, ongoing drug testing, group meeting fees, and therapy bills are your responsibility. These can easily run to hundreds of dollars per month, depending on your situation.  
  • Daily check-in and weekly meeting requirements. You need to be prepared to check in daily with the program provider and be ready and available to be tested for banned substances that day. You must also strictly follow your Recovery Agreement's requirements for attending group meetings and individual therapy sessions. If you miss any of these, you may be required to stop work (if you've been approved to work) until you pass two consecutive random drug tests.  
  • Travel restrictions. These can limit your ability to leave your home – even if you stay within California – for any overnight travel. If you have family that lives further than a day's drive from you, it can be a challenge for you to be allowed to visit them, and in any case, it requires several weeks of advance preparation.  
  • Challenges returning to work. Because you need to coordinate any job you're offered (or are returning to) with the Intervention Program staff and requirements, it may be more difficult for you to find employment. Your new employer will need to be willing to assign you a supervisor who will file quarterly performance reports with the Intervention Program administrator.  
  • Problems if you leave the program early. If you leave the Intervention Program before you have completed your Recovery Agreement, any disciplinary investigations or proceedings that were suspended because of your enrollment in the program will be resumed.   

The numerous challenges that come with participating in California's Intervention Program may explain why so few nurses in the state take advantage of it.  

Reasons to Enroll in the Intervention Program 

Despite its challenges, the Intervention Program does offer a way for nurses with substance abuse issues who are facing serious disciplinary charges to address their issues while avoiding public discipline. The intense program requirements may be exactly what some nurses need to help them with their substance abuse problems. But it's exactly because the Intervention Program is so rigorous that it makes sense for anyone who is considering enrolling or has been referred by the BRN to learn as much about it and other possible alternatives before committing to the program's multi-year monitoring and treatment requirements.  

Alternatives to the Intervention Program 

There is no shortage of drug and alcohol treatment programs available to nurses; in some cases, employers will offer confidential and effective treatment options as part of the workplace benefits packages. The main practical advantage of the Intervention Program is that it can put an end to a disciplinary proceeding that has been brought against a nurse who enrolls in the program – but only if the nurse successfully completes the program.  

The Lento Law Firm Professional License Defense Team can help you evaluate your options in a situation where you are considering enrolling in the Intervention Program or have been referred to it by the BRN. In some cases, depending on the facts of your case, it may make more sense to contest the disciplinary proceeding, seek an alternative form of treatment, or a combination of the two.  

How the Lento Law Firm Professional License Defense Team Can Help  

The experienced attorneys from the Lento Law Firm Professional License Defense Team have helped healthcare professionals, including nurses, defend their licenses in disciplinary situations all across the country, including in California. We understand the daily challenges and pressures that nurses can face and know that you don't need the added burden of trying to defend yourself from serious misconduct allegations.  

We can help you from the point at which you're informed that a complaint has been filed against you. We'll review the complaint and the facts that support it. We can be with you when you meet with BRN investigators and, in some cases, can conduct our own investigation of the situation. We'll also communicate with BRN investigators and staff and work to resolve the misconduct allegations in a way that is agreeable to you and the BRN. Where that's not possible, we will zealously defend your rights at any hearing that takes place.  

If you've enrolled in the Intervention Program and are having issues with how your case is being managed or with decisions that the program administrators are making about your treatment or progress, our lawyers will help you evaluate your options and can negotiate on your behalf with program staff to try to resolve the matter.  

You have worked hard to earn your nurse's license; your livelihood and your reputation are both important to you. The Lento Law Firm Professional License Defense Team can help you protect it all. Call us today at 888.535.3686 or use our contact form to set up a confidential consultation to learn more about how we can help.  


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