If you’ve made less than 4 charting errors ever, this probably doesn’t concern you. Probably.

The California Board of Registered Nursing (BRN) has sunk to a new low in its tactics to scare registered nurses into joining the Diversion Program, or Intervention Program, or whatever it is that they are pitching it as, these days. The BRN’s contractor, Maximus, is now cold calling nurses and trying to get them to join the Diversion program over the phone, if the RN has been disciplined or terminated by their employer for charting errors. 

This is wildly problematic for a number of reasons. The first, is that often the RN is in the process of grieving the discipline with their union and the outcome is not final. Joining the Diversion program means an immediate deactivation of the RN’s license, ruining the union’s chance of employment reinstatement or discipline reduction.  The second problem is that charting errors do not always mean that the nurse is stealing the meds and shooting them into her arm in the bathroom, despite what the BRN chooses to believe. The third and most egregious is, that the Maximus contractor is not giving the nurse much of a choice and because the nurse does not know they even have a choice, they simply sign up out of a knee-jerk fear of losing their RN license!

If a nurse has been questioned about charting errors stemming from missing medication, they may eventually be terminated from their jobs. In the most recent case, the nurse had made a series of 4 charting errors over the course of a 2 ½ year period. Two were unaccounted for antibiotics. One was diabetic treatment medication about a year later. One was a Norco at the 2 ½ year mark. She was given a warning after the first two, put on an improvement plan for the third and terminated for the fourth. Sounds a bit harsh to me, but whatever – that’s not the problem. The problem is that the employer is a mandatory reporter and must report this to the BRN. The BRN sees missing meds, automatically assumes the nurse is diverting and tells Maximus to sic ‘em. 

Now, not in my wildest dreams can I imagine someone diverting 2 antibiotics or diabetes meds. The Norco… Maybe. But typically there needs to be some pattern of diversion: the same med over a period of time, usually a short period of time in order to substantiate a diversion allegation. This nurse was clearly not diverting medication. She may have been a tad sloppy in her charting, but that is it. So why the call from the Diversion Program? 

The moment that the BRN receives a report that a nurse may have misused drugs or alcohol, they offer the RN the Diversion or Intervention program. It happens in every DUI or alcohol related arrest and it happens in most medication charting reports. Up until now, they have been sending out a letter that says (and I paraphrase) “the BRN has received a report that you may have violated the nurse practice act by misusing drugs or alcohol. Please call the BRN’s diversion program for more information or the matter will be investigated.” This at least gave the poor nurse a chance to catch her breath and hopefully do a bit of research before calling (you can research more about the pros and cons of Diversion here.) But with the new cold-call, there is no time for the nurse to process the information! The nurse who called me received a call from either the BRN or Maximus, they didn’t identify themselves as one or the other. They told her that they’d received a complaint that she may have diverted medication and she should sign up for the Diversion program.  She told the caller that she didn’t drink and didn’t take any medication and didn’t need an intervention or recovery program. They then told her that if she didn’t join, she needed to call the Enforcement Division of the BRN, give them her name and license number and they would begin an investigation. AAAAAAHHHHHH!!! I’m so glad she had the wherewithal to not just take the bait and sign up at that moment. I don’t know if most nurses would fare so well under that kind of pressure.

First of all, the caller gave her absolutely false information. She unequivocally does not need to call the Enforcement Division and self-report anything, nor should she! A registered nurse is not required to report employment termination to the BRN, regardless of whether it was for medication charting or not. A Nurse is not required to report employment discipline to the BRN, regardless of whether it was for medication charting or not.  If the BRN is going to conduct an investigation into a possible violation of the nurse practice act, they will do so. It is not the nurse’s obligation to start the process for them! On top of that, anything that the nurse may have disclosed in this call to the BRN is 100% admissible and could be used against her later. For example, why would one self-report something unless they did something wrong or were required to do so?

Second of all, the Diversion program is only supposed to admit nurses who are suffering from a dependency or mental health issue that precludes them from practicing nursing safely. If this nurse was not dependent nor suffering from a mental health issue, then she would not be able to even enroll in Diversion… unless of course she said she was dependent or dealing with a mental health matter because she was so terrified of the other option of being investigated by the BRN and potentially losing her license.

Are you starting to see the big picture?

Let me paint it with a big huge brush: Maximus is a company. They make money. In fact, it will cost a nurse participant about $18,000.00 on average to complete and be released from the Diversion program. Maximus is the BRN’s exclusive provider of rehabilitation or recovery services for RNs. It is absolutely in Maximus’s financial interest to cold-call a nurse and try to strong arm her with fear mongering into joining the Diversion or Intervention program. They are now $18,000.00 richer. The BRN provides the information of suspected nurses to Maximus and no one else, so the first and only call these nurses get, is from them. It is then up to the nurse to not panic, to not enroll immediately over the phone and conduct their own research.

Hopefully, such research will bring them to me. If you are a nurse who has received a call from the BRN or Maximus, threatening… I mean offering… you the Diversion or Intervention Program and you want a little more information, please give me a call. I will listen to the details of your specific case, explain the process to you in detail and give you a very clear idea of exactly what you can expect. It may be that Diversion is the best option, but you should have the ability to get all the facts and make an informed and rational decision, not a knee- jerk reaction based on the fear of losing your precious license and your nursing career.