# A registered nurse discovers that a colleague has been diverting controlled substances from the medication dispensing system. The colleague approaches the nurse and asks not to report the incident, claiming personal problems and promising it won't happen again. What is the most appropriate action for the nurse to take?

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> subject: Critical Care

## 문제

A registered nurse discovers that a colleague has been diverting controlled substances from the medication dispensing system. The colleague approaches the nurse and asks not to report the incident, claiming personal problems and promising it won't happen again. What is the most appropriate action for the nurse to take?

## 보기

1. Agree to keep the incident confidential and monitor the colleague's behavior closely
2. Confront the colleague directly and demand immediate cessation of the behavior
3. Wait to see if the behavior continues before taking any action
4. Report the incident to the appropriate supervisor or authority immediately **✔ 정답**

**정답: 4**

## 해설

The nurse must report suspected drug diversion immediately to protect patient safety and comply with legal and ethical obligations. Other options violate professional standards by delaying action or failing to report.

## 심화 해설

Understanding the Ethical and Legal Obligation

When a nurse discovers a colleague diverting controlled substances, the situation immediately triggers a set of non-negotiable professional, ethical, and legal duties. The core conflict is not between loyalty to a colleague and following rules; it is between the immediate safety of patients, the well-being of the impaired colleague, and the legal integrity of the healthcare institution. The narrative of "personal problems" and a promise to stop, while humanly sympathetic, is a classic feature of a substance use disorder (SUD), which is a recognized, progressive disease. Allowing the behavior to go unreported enables the disease, prolongs the risk to patients, and places both the diverting nurse and the institution in greater jeopardy.

Why Immediate Reporting is the Only Appropriate Action

Reporting the incident to a supervisor immediately is the most appropriate action because it is the only option that simultaneously addresses patient safety, provides a pathway to treatment for the colleague, and fulfills the nurse's legal and ethical responsibilities.

1. The Irreducible Priority of Patient Safety

Drug diversion directly harms patients in multiple ways. The primary harm is the undertreatment of pain and suffering when a patient does not receive their prescribed analgesic medication [1]. Beyond this, diversion creates a risk of disease transmission if a contaminated syringe or vial is used on a patient after being tampered with [1]. A healthcare provider with an active, untreated SUD also poses a risk of impaired vigilance, leading to clinical errors that can cause significant patient harm [1]. By not reporting, a nurse becomes complicit in a chain of events that has a high probability of ending in patient harm. The duty to protect the patient supersedes any personal loyalty to a colleague.

2. The Colleague's Well-being and the Nature of Addiction

Substance use disorder is a disease that is characterized by denial and an inability to stop use without structured intervention . A promise from a colleague that "it won't happen again" is not a credible safety plan; it is a symptom of the disease itself. True help does not mean concealing the problem, which enables further deterioration and potentially a fatal overdose. The appropriate workplace intervention, as described in disciplinary processes, involves actions by a nurse leader, a formal work ability assessment, and a structured pathway that often leads to treatment and monitoring rather than solely punitive measures . Reporting is the critical first step in a process that can save a colleague’s career and life through a formal, supervised recovery program.

3. Systemic and Legal Imperatives

Healthcare institutions face severe legal and financial liability for illegal routes of drug release, including sanctions and a catastrophic loss of public trust [1]. A nurse who knows of diversion and fails to report it is individually accountable and can face disciplinary action from the regulatory authority, including loss of licensure, for enabling the violation . The act of reporting is not a betrayal; it is a fundamental legal obligation of professional practice. The "legislation-based measures for hearing the matter" described in the Finnish study underscore that these are not informal, internal conflicts but formal legal and regulatory events that must be processed through the correct institutional channels . Waiting to see if the behavior continues or confronting the colleague privately bypasses these essential legal and safety mechanisms, placing the reporting nurse in a position of profound liability.References (research sources)

- [1]Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review.Research articleFitzsimons MG, de Sousa GS, Galstyan A, Quintão VC, Simões CM. (2023) · DOI: 10.1016/j.bjane.2023.07.008

## 임상 시나리오

Nurse-to-Nurse Drug DiversionImmediate Reporting Protocol
Upon discovering a colleague diverting controlled substances, the sole priority is patient safety. The immediate action is to report the incident to a supervisor or authority per facility policy and state law.

This approach initiates a non-punitive pathway to treatment for the colleague's substance use disorder while halting direct patient harm from medication theft and potential disease transmission.

CautionNever agree to keep diversion confidential. Confronting the colleague directly or delaying to observe behavior are unsafe and legally negligent actions that enable the disease and prolong patient risk.

## 핵심 개념

- **Drug Diversion** — The act of redirecting a controlled substance from its intended medical use to an illegal or unauthorized use, often by a healthcare worker.
- **Substance Use Disorder (SUD)** — A progressive, chronic disease characterized by the inability to control the use of a substance despite harmful consequences.
- **Mandatory Reporting** — A legal and ethical obligation for nurses to report certain incidents, such as impaired practice or drug diversion, to the appropriate authority immediately.

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