Question

Judy is the charge nurse in the ICU on the day shift. In the morning, she receives report from the night charge nurse. Judy has noticed lately that her coworker has a slightly slurred speech in the morning and can hardly stay awake long enough to give report. Some of the night nurses have seen the charge nurse wasting patient’s unused narcotics without a witness on several occasions. The nurses on the night shift have recently started to complain about the night charge nurse’s short absences from the unit during the night shift.

A. What legal and ethical responsibilities do the nurses have to the professional individual abusing substances?

B. Why is reporting the substance abuse important in this situation?

Answer 1

A. What legal and ethical responsibilities do the nurses have to the professional individual abusing substances?

Legal and ethical responsibilities fellow nurses and supervisors have in relation to professional individual abusing substances are clearly stated and guided by code of ethics, professional standards, and laws of the state.

Nurses have an ethical duty to protect patients, colleagues, the profession, and community. This ethical responsibility extends to nursing leaders and executives to report an impaired professional and ensure he/she receives the appropriate treatment through appropriate professional drug and rehabilitation treatment. Impaired nurses, including nurses who have admitted to unlawful behaviours, should not be allowed to practice and subject patients to potential harm.

Nursing leaders and executives have an ethical, legal, and moral obligation to preserve patient safety while maintaining the integrity of the profession to assist nursing colleagues to seek treatment for this affliction. These responsibilities are :

· to be able to recognize the signs or symptoms of substance abuse in a co-worker

· to report appropriate authority immediately of their suspicions as this is in the best interest of the nurse and the nurse’s patien.t

· to safeguard the patients by removing the nurse from patient care is essential immediately

· to act in accordance with organizations policy for employee substance abuse and law of the state.

· Nurses who divert medications are a liability to the organization as a result of theft and patient safety issues. Specific policies must be there in place to manage such instances and prevent the organization from being liable to theft

The professional nurses can find support for ethical decisions making in this situation by referring to the code of ethics for nurses by International council of Nursing (ICN), American Nurses Association or other regulatory bodies and professional organization. The code delineates the ethical principles and professional standards for nurses across all settings, levels and roles, setting expectations as well as providing guidance.

According to ICN a nurse has a number of ethical responsibilities towards people whom they provide care (client and family), practice, profession, and co-workers. ICN code of ethics in relation to ethical responsibility towards co-workers clearly states that,

”The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other fields.

The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. The nurse takes appropriate action to support and guide co-workers to advance ethical conduct.”

Other than code of ethics ethical principles that serve as a guide to the nurse in making ethical decisions. Six important principles of ethical decision making are:

Respect for persons (autonomy and self-determination)
Beneficence (doing good)
Nonmaleficence (avoiding harm)
Justice (fairness, equitability, truthfulness)
Veracity (telling the truth)
Fidelity (remaining faithful to one’s commitment)

The legal implications of nursing practice are related to licensure, laws, scope of practice and a public expectation that nurses practice at a high professional standard. It provides the framework by which nurses are expected to practice. When a nurse’s practice falls below acceptable standards of care and competence, this exposes the nurse to litigation.

The basis for legal issues can relate to malpractice; and professional negligence, failing to exercise the level of care that a reasonable, prudent nurse would maintain under similar circumstances; and errors in recording and reporting, safety in storage and use of narcotics and controlled drugs which means an act of neglect committed in the nurse’s professional role. Acts of omission and commission will subject the nurse to litigation and can also reprimand of a nurse’s license or loss of a license.

Therefore to sum up nurses have an ethical and moral duty to patients, colleagues, the profession of nursing, and the community to take action. Laws governing substance-abusing nurse vary among states. As a nurse consider the following:

· Do not ignore poor performance.

· Do not lighten or change the nurses’ patient assignment.

· Do not accept excuses.

· Do not allow yourself to be manipulated or fear confronting a nurse if patient safety is in jeopardy.

· Educate yourself on the organization’s policy and procedures for employee substance abuse and employee assistance programs.

· Careful documentation of any changes in the suspected/ impaired nurses’ behaviours is important.

· Report the suspicious behaviour.

· Confidentiality must be exercised with disclosure only to appropriate authorities.

Why is reporting the substance abuse important in this situation?

Loyalty, guilt and fear often prevent a nurse from reporting of substance abuse by a colleague to the nurse manager. Many nurses fear reporting a colleague because they worry about retaliation. Fear of reprisal may keep some nurses from action.

There are many stereotypes regarding substance abuse like health professional are more health conscious and will not indulge in such practices. Since these negative stereotypes may make it very difficult to suspect a co-worker of substance abuse.Education is the first step in creating a culture of acceptance and understanding about peers with substance use and to overcome such stereotypes. No one is immune from developing substance use disorders. It can affect anyone regardless of age, ethnicity, gender, economic circumstance or occupation.

However reporting of such behaviour or its suspicion is essential for safety and well being of patients cared by that nurse as well as in best interest of herself too.

All nurses have a professional and ethical responsibility to report substance by a fellow nurse in order to ensure the safety of patients. Prompt reporting will serve as a safeguard to prevent patient harm, and will help the nurse receive immediate care and treatment. Once a report has been made with the nurse manager, action by the manager must be taken immediately

It is not helpful to make excuses or cover for an impaired nurse. It will not only potentially harm the nurse, but his or her patients.

The nurse should be made to accept the consequences of his or her behaviours and actions. Any impaired nurse should be reported immediately to prevent any negative effects to the nurse, the nurse’s co-workers or patients.

Reporting a colleague can be a positive step as this will protect patients and support their colleagues to enter into treatment programs.

The requirements for mandatory reporting of substance abuse by nurses vary from state to state. If this is mandatory nurse is legally bound to report if she observes a colleague doing something suspicious, it is the nurse’s role to report it to a supervisor.