# A registered nurse discovers that a colleague has been diverting controlled substances from the medication dispensing system. The colleague approaches the nurse privately and admits to having a substance use disorder, expressing a desire to seek treatment. What is the most appropriate initial action for the nurse to take?

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## 문제

A registered nurse discovers that a colleague has been diverting controlled substances from the medication dispensing system. The colleague approaches the nurse privately and admits to having a substance use disorder, expressing a desire to seek treatment. What is the most appropriate initial action for the nurse to take?

## 보기

1. Maintain confidentiality and encourage the colleague to self-report to the nursing supervisor within a specified timeframe
2. Report the incident immediately to the nursing supervisor and risk management according to facility policy **✔ 정답**
3. Confront the colleague directly and demand immediate resignation to avoid further complications
4. Document the incident privately and monitor the colleague's behavior before taking any action

**정답: 2**

## 해설

Immediate reporting to supervisor and risk management is mandated by facility policies and legal requirements to ensure patient safety and proper investigation. Other options violate professional obligations by delaying action, compromising confidentiality, or failing to follow protocols.

## 심화 해설

Understanding the Ethical and Legal Obligation

This scenario presents a critical conflict between the ethical principle of fidelity (loyalty to a colleague's confidence) and the overarching legal and regulatory duty to protect the public. In nursing, the primary responsibility is always to the patient's safety and the integrity of the healthcare environment. While the colleague's admission of a substance use disorder (SUD) and desire for help is a positive step, it does not negate the immediate risk posed by their actions. The act of diverting controlled substances is a serious violation that directly jeopardizes patient welfare through potential undertreatment of pain, risk of infectious disease transmission, and exposure to an impaired provider [2]. A registered nurse who is aware of such a violation and fails to report it through proper channels can be subject to disciplinary action themselves for enabling unsafe practice.

Why Immediate Reporting is the Only Correct Action

The correct initial action is to report the incident immediately to the nursing supervisor and risk management according to facility policy. This is not an act of betrayal but a fulfillment of the nurse's professional and legal mandate. The rationale is multi-layered and supported by the structure of workplace interventions:

- Patient Safety is Non-Negotiable: Drug diversion is defined as a "significant problem in healthcare" that causes direct patient harm [2]. The immediate risk must be stopped. Waiting for the colleague to self-report, even within a specified timeframe, allows the unsafe practice to potentially continue, exposing more patients to harm.

- Formal Intervention is a Structured Process: Research on workplace interventions for nurses with SUD shows that the process is initiated by a formal report, which triggers a sequence involving a "nurse leader and employer with work ability assessment and measures" [1]. This formal mechanism is designed to both protect the public and guide the impaired nurse toward appropriate treatment and monitoring, not just punishment.

- Mitigating Systemic Risk: Healthcare institutions face significant "legal impact," "financial liability," and "loss of public trust" from diversion incidents [2]. A formal report activates the institution's protocols to investigate the scope of the diversion (e.g., tampering with medications, falsification of records) and mitigate these broader risks, which a private conversation cannot achieve.

Analysis of Incorrect Options

The other options represent common but flawed intuitive responses that fail to meet the professional standard of care.

- Option 1 (Maintain confidentiality and encourage self-report): This delays the critical safety intervention. While self-reporting is encouraged, the witnessing nurse cannot outsource their own legal and ethical duty to report a known violation. The regulatory process often involves "legislation-based measures for hearing" [1], which are triggered by a formal report, not a private agreement between colleagues.

- Option 3 (Confront and demand resignation): This is a punitive and unprofessional approach that bypasses all established safety and support mechanisms. It does nothing to protect future patients if the colleague simply moves to another facility. The goal of a formal report is to ensure a safe, structured pathway that includes a fitness-to-practice assessment, not to merely remove the individual from the immediate premises.

- Option 4 (Document privately and monitor): This places the observing nurse in an inappropriate investigative role and constitutes a failure to act on a known safety risk. A nurse is not an investigator; they are a mandatory reporter. Private monitoring does not stop the ongoing diversion and exposes the nurse to significant liability for knowing about and tacitly allowing the illegal activity to continue.

The most appropriate action integrates both accountability and support by activating the formal system. The report to the supervisor and risk management initiates a process that simultaneously secures patient safety and directs the colleague into a regulated pathway for assessment and treatment, which is the standard for managing SUD-related violations in healthcare professionals [1].References (research sources)

- [1]Workplace interventions for Finnish nurses: a retrospective document analysis of disciplinary decisions related to substance use.Research articleLuurila K, Kangasniemi M, Hult M, Häggman-Laitila A. (2025) · DOI: 10.1177/14550725251351702

- [2]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

Responding to a Colleague's Drug DiversionImmediate Reporting to Protect Patient Safety
When a nurse discovers a colleague diverting controlled substances, the primary obligation is to protect patients from harm. This overrides any sense of loyalty to the colleague. The first and only correct action is to report immediately to the nursing supervisor and risk management per facility policy.

Drug diversion creates an immediate risk of patient harm, including undertreated pain, exposure to an impaired provider, and potential infectious disease transmission. Waiting for a colleague to self-report allows this danger to continue, making the observing nurse legally and ethically complicit.

Critical Legal DutyA nurse who fails to report known diversion can face disciplinary action by the state board of nursing for enabling unsafe practice. This is a non-delegable duty; you cannot transfer the responsibility to the impaired colleague by asking them to self-report.

## 핵심 개념

- **Drug Diversion** — The unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, a significant problem in healthcare causing direct patient harm.
- **Mandatory Reporting** — A legal requirement for nurses to report unsafe, unethical, or illegal practices to the appropriate authority, prioritizing public safety over individual privacy.
- **Substance Use Disorder (SUD)** — A chronic, relapsing brain disease characterized by compulsive substance seeking and use despite harmful consequences, recognized as a treatable medical condition.
- **Fidelity vs. Nonmaleficence** — An ethical conflict where loyalty to a colleague's confidence (fidelity) is overridden by the duty to prevent harm to patients (nonmaleficence).
- **Risk Management** — A department within a healthcare facility responsible for minimizing liability and adverse events, including investigating incidents like drug diversion.

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