Reporting Requirements (abuse, communicable disease, impaired coworker 등)
A nurse observes a colleague who appears to be under the influence of alcohol during a night shift. The colleague's speech is slurred, there is a strong odor of alcohol, and the colleague has made two medication errors in the past hour. What is the nurse's most appropriate immediate action?
1Document the incident and report it to the nursing supervisor at the end of the shift
2Confront the colleague directly and ask if they have been drinking alcohol
3Continue to monitor the colleague's behavior for the remainder of the shift
4Immediately notify the charge nurse or nursing supervisor and remove the colleague from patient care✓ 정답
해설
Patient safety is the highest priority when a colleague shows signs of impairment (slurred speech, alcohol odor, medication errors). Immediate notification to the charge nurse/supervisor ensures removal from patient care and activation of protocols. Other options delay action and risk patient harm.
Correct Answer: 4. Immediately notify the charge nurse or nursing supervisor and remove the colleague from patient care
Analysis of the Clinical Scenario
This question addresses the critical nursing responsibility of ensuring patient safety when a colleague is impaired. The scenario presents clear, objective signs of impairment: slurred speech, a strong odor of alcohol, and, most critically, two medication errors in the past hour. This combination of physical signs and direct evidence of patient harm elevates the situation from a suspicion to an immediate safety emergency.
Why Immediate Removal and Reporting is the Only Correct Action
The nurse practice act and professional standards in every jurisdiction mandate that a nurse's primary duty is to protect the public. When a colleague's impairment creates an imminent threat to patient safety, the obligation is not to counsel, diagnose, or monitor the colleague, but to act decisively to safeguard patients. The presence of medication administration errors is the definitive factor here. This is not a vague suspicion; it is an active, ongoing patient safety crisis.
The systematic review by Zhao et al. (2026) provides a powerful, evidence-based context for this urgency [1]. Their work highlights that medication administration errors are a major cause of adverse events, and that even when safety systems like double-checking are in place, adherence is inconsistent and often omitted when clinical demands compete. In this scenario, the impaired colleague is not simply failing to follow a policy; their compromised cognitive and motor function has already defeated the safety net, resulting in actual errors. The review's finding that nurses' adherence to safety procedures is vulnerable to competing demands underscores why a colleague's impairment is so dangerous—it represents a complete breakdown of the individual's ability to function within the safety system. Removing the colleague from patient care is the only way to immediately halt the cascade of potential harm that the systematic review identifies as a major cause of adverse events [1].
Critique of the Incorrect Options
- Option 1: Documenting and reporting at the end of the shift. This is a dangerously passive approach. The systematic review's findings on medication errors make it clear that every moment the impaired nurse remains in a patient care role carries a high risk of a new, preventable adverse event [1]. Delaying intervention for hours is a failure to protect patients from an immediate threat.
- Option 2: Confronting the colleague directly. While direct communication is often valued in nursing, it is inappropriate in this context. A nurse under the influence may become defensive, agitated, or deny the situation, leading to a confrontation that delays the essential step of securing patient safety. The nurse's role is not to investigate or extract a confession, but to report the objective observations to a supervisor who has the authority to manage the personnel issue.
- Option 3: Continuing to monitor the colleague. This option fails to recognize that the threshold for action has already been crossed. The documentation of two medication errors is not a baseline for further observation; it is the sentinel event that demands immediate termination of the colleague's patient care duties. Continued monitoring implies a tolerance of the ongoing risk, which is ethically and legally indefensible.
Clinical and Regulatory Reasoning
The most appropriate immediate action is a two-part process: (1) ensure the colleague is removed from any direct patient care responsibilities, and (2) immediately notify the charge nurse or nursing supervisor. This sequence prioritizes patient safety above all else. The supervisor then assumes the responsibility for further investigation, securing safe transport for the colleague, and managing the legal and employment implications. The nurse's documentation of the objective observations (slurred speech, alcohol odor, specific medication errors) should occur as soon as possible after the immediate safety actions are taken, creating a clear, factual record of the events that triggered the intervention. This approach directly addresses the core problem identified in the literature: that systems and individual vigilance are both required to prevent the medication errors that cause patient harm [1].
References (research sources)
[1]
Nurses' Adherence to Double-Checking: A Systematic Review of Influencing Factors, Improvement Strategies, and Their Effectiveness.Meta-analysis/systematic reviewZhao J, Liu H, Shan A, Peng Y, Or CKL. (2026) · DOI: 10.1111/inr.70179
Clinical Practice Guide: Managing an Impaired Colleague
Immediate Actions for Suspected Impairment
Ensure Patient Safety First: If the colleague is in the process of performing a task that could cause immediate harm, intervene directly and calmly to stop the task. Remove the colleague from the patient care area immediately.
Notify the Supervisor: Contact the charge nurse or nursing supervisor directly and immediately. Do not delay reporting to gather more evidence or wait for the end of the shift. Provide a factual, objective report of your observations (e.g., slurred speech, odor of alcohol, specific medication errors).
Do Not Confront or Diagnose: Your role is not to investigate the cause of the impairment or to extract a confession. Confrontation can escalate the situation and create a safety risk for you and others.
Secure the Medication Administration Record (MAR) and Witnessed Errors: Ensure the specific medication errors are documented and the involved medications are accounted for to prevent further patient harm.
Key Indicators of an Imminent Safety Threat
Objective physical signs of impairment (slurred speech, unsteady gait, odor of alcohol or drugs).
Direct observation of unsafe practice, such as a medication error, procedural breach, or neglect.
Erratic or unusual behavior that deviates sharply from the colleague's baseline professional conduct.
Post-Incident Responsibilities
Documentation: After the immediate safety threat is neutralized, document your objective observations, the time you notified the supervisor, and the name of the person you reported to. Use an incident report per facility policy, keeping it separate from the patient's medical record.
Professional Accountability: Understand that reporting an impaired colleague is not a personal betrayal but a professional and legal obligation under the state's Nurse Practice Act to protect the public.
Support Systems: Recognize that the reporting process often leads to the colleague being offered help through a professional health program or employee assistance program, which is a constructive outcome for the nurse and the profession.
Duty to Protect — The ethical and legal obligation of a nurse to prioritize patient safety above all other concerns, including loyalty to a colleague, by intervening when unsafe practice is observed.
Chain of Command — The established line of authority and communication within a healthcare facility, which should be used to report an impaired colleague to the charge nurse or nursing supervisor for immediate action.
Imminent Threat — A situation where there is an immediate and serious risk of harm to a patient, such as an impaired nurse making active medication errors, requiring instant intervention.
Medication Administration Error — Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, serving as direct evidence of unsafe practice in this context.
Nurse Practice Act — State-level legislation that defines the scope of nursing practice and establishes the board of nursing's authority to discipline licensees, mandating that nurses report unsafe, incompetent, or impaired practice.