Must I comply with a board of registered nursing order to compel a psychological evaluation?
Executive Director, RN Guardian
If you are a registered nurse (RN) and have received a notice from the California Board of Registered Nursing called an “Order to Compel a Psychological Evaluation,” this is likely not the first interaction you have had with the BRN.
An Order to Compel a Psychological Evaluation, in my experience, only follows a BRN Investigation. They can be issued if there has been an alleged complaint of alcohol or drug or substance abuse. Orders To Compel can be issued if there has been perceived erratic behavior at work such as mood swings, crying or overwhelm. Orders to Compel Psychological Evaluations have been issued to our clients for personal emotional issues that were reported to the Board of Nursing or as the residual effect of a conviction. The LEGAL grounds for an Order to Compel a Psychological Evaluation are expressed in the Business & Professions code section 820 are as follows:
Whenever it appears that any person holding a [RN] license,
Certificate may be unable to practice his or her
profession safely because the licentiate’s ability to practice is
impaired due to mental illness, or physical illness affecting
competency, the licensing agency may order the licentiate to be
examined by one or more physicians and surgeons or psychologists
designated by the agency. The report of the examiners shall be made
available to the licentiate and may be received as direct evidence in
proceedings conducted pursuant to Section 822.
Furthermore, section 821 states that failure to comply with an order shall constitute grounds for suspension or revocation of the nurse’s license. Following are 2 examples of formal disciplinary action that resulted from a failure to comply with an Order to Compel a Psychological Evaluation. The first is an example of a failure to comply with the order and the resulting formal accusation that was filed. The accusation eventually led to a revocation of the RN’s license and over $16,000.00 in fines: http://rn.ca.gov/public/rn369601.pdf. The second is a surrender of a license as a result of an Order to Compel a Psychological Evaluation:http://rn.ca.gov/public/rn288543.pdf (the above cases are public record, available on the BRN’s Website and they are neither members of RN Guardian nor clients of the panel attorneys of Goyette & Associates, Inc.).
Either way, you can clearly see that a failure to comply with an Order to Compel a Psychological Evaluation will ultimately be damaging to the nurse, the matter will very likely become public record and any embarrassing, compromising or very personal issues that precipitated the original complaint or investigation, will be become public, as well. If you have received an Order to a Psychological Evaluation, you should comply. At this point you want to avoid the matter becoming public record and the only way to do that, is to cooperate with the BRN’s order.
HOW DO I AVOID THE ORDER TO COMPEL A PSYCHOLOGICAL EVALUATION IN THE FIRST PLACE?
Sometimes these orders are impossible to avoid, but a nurse’s best chance at avoiding an Order to Compel a Psychological Evaluation is to make sure to be represented by an administrative law attorney who specializes in Registered Nurse license defense during the initial BRN investigation. After 25 years as an attorney, our founder’s advice to all of his clients is “less is more” during an investigation. Answer truthfully, carefully and concisely. Do not embellish or ramble on; this is where clients divulge information that the investigator can use against them. Even having an attorney present during the initial investigation does not guarantee that the matter will not proceed to an order, if something has been said that leads the investigator to believe that a mental health issue could impair your ability to practice safely.
WHAT SHOULD I DO IF I HAVE RECEIVED A BOARD OF NURSING ORDER FOR A PSYCHOLOGICAL EXAM?
You will be “served” the order via certified mail. Please make sure to pick up the certified mail in a timely fashion and to have the correct mailing address on file with the Board of Registered Nursing at all times. The BRN will not accept the “I didn’t get it”, or the “I didn’t get it in time” excuse. You will only have 30 days from being served with the Order in which to comply. In order to comply, you will need to contact the Case Management Analyst which will be listed on page 2 of the STATEMENT TO RESPONDENT: NOTICE OF ORDER COMPELLING PSYCHOLOGICAL EVALUATION. It is RN Guardian’s recommendation that you also send a certified letter to the Board’s designated Case Management Analyst confirming receipt of the Order and indicating your willingness to comply. You do not need to say anything more than that (remember less is more). This way you will have proof that you complied within the required time frame, should your compliance or response date be called into question.
The second portion of the Notice from the Board of Registered Nursing, will be the actual PETITION AND ORDER COMPELLING A PSYCHOLOGICAL EVALUATION. This is the section in which the jurisdiction, statutory provisions and the cause for the order are listed. Jurisdiction states the Board has a right to issue the order. The Statutory Provision lists the laws that entitle the Board to issue the order. The Cause will be a list of incidents that “caused” the Board to believe that you may have a mental condition that impairs your ability to practice safely. Some of these causes you may completely disagree with, you may have a different version, you may have no idea what they are referring to, or you may agree. Regardless, you should submit the exam, as failure to do so will inevitably result in formal disciplinary action against your RN License.
WHAT ARE THE RESULTS OF COMPLYING WITH THE ORDER FOR PSYCHOLOGICAL EXAM?
The potential outcomes for submitting to a psychological evaluation are varied:
- 1.The evaluation may find that the Nurse is mentally competent and stable and the Board may dismiss the entire matter.
- 2.The evaluation may find that there is cause for concern, whereby a formal accusation will certainly ensue.
- 3.If the evaluation is for a drug or alcohol related matter, the examiner will need to find that the nurse is of low or no risk of future substance abuse, or the examiner will need to find that once the nurse is off a prescription medication, she is not a public health risk.
- 4.If you are already on probation and one of the terms of your probation is a psychological exam, which you fail, your probation (and therefore your license) may be revoked.
WHAT DOES THE PSYCHOLOGICAL EXAM CONSIST OF? WHAT DOES THE BRN WANT TO SEE?
The exam will likely be comprised of 2 sections. The first is an in person interview, where the Psychologist or examiner will gather information regarding your personal history and a mental status examination. Your personal history will be evaluated in the context of the incident and whether or not it played a role in your actions and to what extent.
The mental status examination will gauge the importance you place on the exam as well as how you behave during the interview. The examiner may consider how flexible you were with scheduling, the timely manner in which you scheduled the appointment, your attire, grooming and appearance. They will want to see you exhibit a range of appropriate emotions including levity and gravity, extroversion and introspection, self- analysis and self-respect. The examiner will want to see that you are oriented to person, place, and time, that your long and short term memories are intact. Your thinking should be clear and linear without indication of psychosis, loose associations, organicity, or dementia. Your speech should be at a normal rate, productive, and relevant to the topic at hand.
The examiner will expect your mood to be somewhat anxious, consistent with the importance that you place on the evaluation. Interpersonal style should be cooperative and forthright. Insight, judgment, and impulse control must all be intact.
The second portion of the exam will psychological testing and this test should take approximately one hour. The test will very likely be the The Minnesota Multiphasic Personality Inventory, known as the MMPI. The examiner evaluates the test taker’s personal characteristics by comparing the test taker’s answers to those given by various psychiatric and nonpsychiatric comparison groups. By analyzing the patterns of response to the test items, the examiner is able to draw some tentative conclusions about the client’s level of adaptation, behavioral characteristics, and personality traits. The test outcomes help the examiner to determine the test taker’s severity of impairment, outlook on life, approaches to problem solving, typical mood states, likely diagnoses, and potential problems in treatment.
The MMPI is composed of 567 true/false items. It can be administered using a printed test booklet and an answer sheet filled in by hand, or by responding to the items on a computer. It is not an academic test with “right” and “wrong” answers. The inventory items are not arranged into topics or areas on the test. The areas of personality that are measured are interspersed in a somewhat random fashion throughout the MMPI-2 booklet. Some examples of true-or-false statements similar to those on the MMPI-2 are: “I wake up with a headache almost every day”; “I certainly feel worthless sometimes”; “I have had peculiar and disturbing experiences that most other people have not had”; “I would like to do the work of a choir director.”
There are also validity scales embedded in the test questions. These sets of items, scattered randomly throughout the MMPI, allow the examiner to assess whether the respondent answered questions in an open and honest manner, or tried to exaggerate or conceal information. One means of checking for distortions in responding to the instrument is asking whether the test taker refused to admit to some less-than-ideal actions that most people probably engage in and will admit to doing. An example of this type of question would be (true or false) “If I could sneak into the county fair or an amusement park without paying, I would.” Another type of validity check that assesses honesty in responses is whether the client admits to participating in far more unusual behaviors and actions than were admitted to by both the psychiatric comparison group and the general community sample. The validity scales also identify whether the test taker responded inconsistently or randomly.
In addition to the standard validity, clinical, and content scales, numerous additional scales for the MMPI have been created for special purposes over the years by researchers. These special supplementary scale scores are often incorporated into the examiner’s interpretation of the test results. Commonly used supplementary scales include the MacAndrews Revised Alcoholism Scale, the Addiction Potential Scale, and the Anxiety Scale.[i]
In the end, a psych exam is going to be difficult to “cheat” and that is precisely why the Board of Nursing will order one if they believe that a registered nurse is mentally impaired to a degree that inhibits their ability to safely practice nursing. If the results of the exam are less than desirable and the Board moves forward with a formal accusation, the panel attorneys of RN Guardian will still be able to assist you in negotiating the terms of the discipline with the Board of Registered Nursing. Please feel free to contact me if you have any additional questions, if you’ve received an Order to Compel a Psychological Evaluation, or if you’ve received the results of the exam and would like advice regarding how to best proceed.