Regulation at 244 CMR 9.03(26)

(26) Duty to Report to the Board. A nurse who holds a valid license and who directly observes another nurse engaged in any of the following shall report that nurse to the Board in accordance with Board guidelines:

  1. abuse of a patient;
  2. practice of nursing while impaired by substance abuse;
  3. diversion of controlled substances.

Comments Applicable to the Duty to Report Standard of Conduct at 244 CMR 9.03(26)

  • Reportable conduct under 244 CMR 9.03(26) is limited:
    The conduct of a nurse which 244 CMR 9.03(26) mandates be reported is limited to abuse of a patient; the practice of nursing while impaired by chemical substances including alcohol or drugs, or both; and diversion of controlled substances.
  • Valid license:
    As defined in 244 CMR 9.02, Definitions, "valid license" means, in part, a license to practice nursing in Massachusetts which is not expired, surrendered, suspended or revoked. For the purposes of 244 CMR 9.03(26), this means that a nurse whose license has expired does not have a duty to report to the Board under 244 CMR 9.03(26).
  • Direct observation:
    The duty to report to the Board only applies when a licensed nurse personally observes reportable conduct or behavior of another nurse. A reporting nurse who did not personally observe reportable conduct cannot rely on observations made by another person when making a required report to the Board.
  • Abuse:
    As defined in 244 CMR 9.02, Definitions, "abuse" means any impermissible or unjustifiable contact or communication with a patient or resident, which in any way harms or intimidates, or is likely to harm or intimidate, a patient or resident. Abuse may be verbal or non-verbal, and may cause physical, sexual, mental or emotional harm.
  • Practice of nursing:
    The "practice of nursing" is defined in 244 CMR 9.02, Definitions. The definition refers readers to Massachusetts General Laws Chapter 112, s. 80B and to Board regulations at 244 CMR 3.00, which are available on the Board's website. The duty to report impaired practice applies only when a nurse has been observed to be impaired by substance abuse while that nurse is engaged in his or her nursing responsibilities related to the delivery of nursing services.
  • Impaired:
    As defined in 244 CMR 9.02, Definitions, "impaired" means the inability to practice nursing with reasonable judgment, skill, and safety by reason of alcohol or drug abuse, use of other substances, a physical or mental illness or condition, or by any combination of the foregoing. The duty to report does not apply to impairment resulting only from a physical or mental illness or condition. A reporting nurse must evaluate the objective signs of another nurse's impairment due to substance abuse in connection with the potential danger to patients posed by the nurse whose behavior raises a question as to his or her ability to practice with reasonable judgment, skill, and safety.
  • Substance abuse:
    As defined in 244 CMR 9.02, Definitions, "substance abuse" means a dysfunctional pattern of human response characterized by excessive, inappropriate, or unhealthy use of chemical substances including alcohol or drugs, or both.
  • Diversion:
    Diversion is defined as the unauthorized removal of a controlled substance from a patient or resident supply or care setting.
  • Controlled substance:
    As defined in 244 CMR 9.02, Definitions, "controlled substance" means a drug, substance, or immediate precursor in any schedule or class referred to in Massachusetts General Laws Chapter 94C. Any drug or medication requiring a prescription in Massachusetts is a controlled substance.
  • Duty to report is not delegable:
    A nurse's duty to report to the Board under 244 CMR 9.03(26) is not delegable. This means that a nurse who directly observes another nurse engaged in conduct described in 244 CMR 9.03(26)(a) through (c) must make a report to the Board, in addition to making a report to any other entity as required by law or regulation, such as the requirement to report child abuse under M.G.L. c. 119, s. 51A, to report elder abuse under M.G.L. c. 19A, s. 15, and to report abuse of a disabled person under M.G.L. c. 19C, s. 10. The duty to report to the Board is also in addition to any reporting requirement that a nurse may have under any employment policy, condition, or agreement.
  • Reporting honestly and in good faith:
    All reports made to the Board in compliance with 244 CMR 9.03(26) shall be made honestly and in good faith. It is the Board's expectation that a nurse who reports to the Board honestly and in good faith shall not be subject to discharge, discrimination, retaliation, or other adverse action by reason of making the required report.

Reporting Procedure for Duty to Report Standard of Conduct at 244 CMR 9.03(26)

In order to comply with 244 CMR 9.03(26), a reporting nurse shall promptly submit a written report to the Executive Director of the Massachusetts Board of Nursing at the Board's business office at 239 Causeway Street, Boston, Massachusetts 02114. The written report shall include the following information:

  • The full name and license designation(s) of RN or LPN, or both, of the reported nurse and, if known, the reported nurse's title, nursing license number(s), date of birth, address, and any other identifying information.
  • If known, the name(s) and address(es) of the reported nurse's employer(s).
  • A detailed description of the reported nurse's conduct based on the personal observation and knowledge of the reporting nurse, including date(s), time(s), location(s), and specific observations.
  • All other reasonably available information which may assist the Board in investigating and evaluating the report.
  • The full name, title, license designation(s) and license number(s), address, and telephone number of the reporting nurse.
  • A statement by the reporting nurse that she or he is submitting the report to the Board honestly and in good faith. An example of such a statement is the following: "I, [insert the full name of the reporting nurse], do hereby state that the information I have provided in this report required by 244 CMR 9.03(26) is true and complete to the best of my knowledge."
  • The signature of the reporting nurse and the date the report is written.

Clarification of Voluntary Reporting to the Board

Effective October 13, 2000, a nurse is required to report to the Board the observed conduct identified in the Duty to Report Standard of Conduct at 244 CMR 9.03(26)(a), (b) and (c). However, the Board continues to encourage nurses and others to report voluntarily to the Board other conduct of a nurse that places a patient's health, safety or welfare at risk.

Adopted: July 12, 2000
Revised: September 13, 2000


This information is provided by the Department of Public Health.