Odd situation and how to handle it in the future

[DaFreak71]

Hi everyone!

I have an experience I want to share with you in hopes of getting some feedback. Firstly, this is not something that happened recently, it's something that happened last year.

During my first semester I became very good friends with a classmate. After the first semester I began to see a much darker side to her and it was obvious (even to her) that she was an alcoholic.

During our second semester at clinical one day, she staggered in while we were in pre-conference. Her eyes were bloodshot, uniform looked as though it had been slept in, hair a disaster, no make-up, pale as a ghost. I immediately knew she was hungover. Another classmate of ours knew it immediately too because he had seen her like that before in lecture (as had I).

Our instructor pulled her aside and this girl told the instructor that she had the flu (that's why she was late and looking so ragged). So the instructor took her into the back room and took her temp. Normal. During the clinical day, she was a MESS. Spent the bulk of her time at nurses station using foul language about other nurses from an area hospital, etc. When it came time for her to check off on her skill of giving eye/ear drops, the instructor asked me to come along so that I could learn by watching her do it. Let's just say it was a disaster and ended up with her snapping at our instructor in front of the patient.

After that incident, I pulled the instructor aside and said: Do we have a policy in place for drug testing students at clinical?

She replied: Why do you ask, who do you suspect of being on drugs?

I said: XX is drunker than a skunk right now.

She said: I'll take care of it.

Nothing happened though. I found out later in the week that another classmate had gone into the instructors office and reported that she was drunk that day as well. According to the instructor, if a student shows up to clinical and seems under the influence, it is the job of the NM at the facility to notice it and request a UA if they feel the need for it. Frankly, I was shocked because:

1. We all had to sign paperwork before the program even started that we could be randomly tested at any time.

2. I thought we were operating under the license of our nursing instructor and that if something happened to a patient while the student was drunk/negligent/etc, they could be held accountable. That is why I don't understand why the instructor couldn't/wouldn't do anything about it.

I will be in school with this person again in January. How should I handle the situation if faced with it again? Several instructors know about her alcoholism and her less than stellar performance. The program director also is aware. I've toyed with the idea of going to the NM at the facility next time (if it happens again) and telling her instead of the instructor. This seems like I'm jumping the chain of command, but how can I allow a drunken student to care for vulnerable patients?

If you have any ideas, fire away! This has been bugging me for quite some time now. I have even personally confronted this student and told her straight up that if I even so much as suspect she's been drinking, I will report her immediately. So she definitely knows she's on notice. But I feel like I"M the only one who considers this to be a valid concern.

[DaFreak71]

I'm wondering if the CI didn't feel that the student was currently under the influence of anything. If she went and talked to her and went so far as to take a temperature (which could be normal for any number of reasons) then I think she probably assessed the situation and deemed her competent for clinical that day. You have done your part. If you see anything amiss in the future, report her again. Other than that, you really should stay out of it until and unless you see her making mistakes that could harm the patient. (Real issues not the "oh my god that nurse didn't put on gloves" or "oh my god it took that nurse 2.2 minutes to answer that call light" stuff that we see from many of our fellow nursing students). I'ts hard when we see someone who seems like a ticking time bomb, but if her primary nurses on the floor and her CI aren't seeing fit to have her dismissed, then perhaps there isn't as big of a problem as you may think. Keep your eyes open and report when appropriate, but other than that focus on your own learning.

I appreciate your feedback. If I weren't so familiar with this student, I would question my judgment as to weather or not she was in fact under the influence. I steer clear of the petty stuff that goes on in nursing school, so it takes a bit to stir me up. I can understand your position in thinking that if the CI didn't suspect it, it might not have been as big a problem as I thought, but I can assure you that it certainly was a huge problem. The CI tried to explain to me that the school could get sued if she tested negative, unless she was displaying behaviors such as falling down, slurring words, etc.

I think there is a false perception of alcoholics. She has been drinking heavily and daily since she was 15 and she is now 26. That's eleven years of being drunk. She doesn't vomit, she doesn't stumble, she doesn't slur her words. I, on the other hand, have such a low tolerance for alcohol that I get buzzed off one wine cooler. If I (or the average person) drank the amount she drinks, we would be hospitalized for ETOH poisoning. I (and the other student who were friends with her) could tell instantly and without doubt that she was three sheets to the wind. It's subtle sometimes, but the personality changes, the rapid speech, the inappropriate speech, her appearance, and combative nature were all dead giveaways. Also, when I told her if she ever showed up drunk again I would report her, she just sort of hung her head and nodded. No denial of any sort.

Daytonite, you mentioned that unless she was drinking Vodka, the smell should have been noticeable. That is precisely her drink of choice and she has mentioned that chewing grape bubble gum can cover any odor of alcohol. Don't know if that's accurate or not, but that's what she said one day when she was telling us about how she got out of getting a DUI--grape gum. :trout:

Thanks for all your responses. I am much more confident about what I need to do if faced with this situation again. My instructors and program director honestly are great people. Despite this situation. I almost didn't want to post about this situation because I care for my instructors and director and I was worried about how it would reflect on them. It is entirely possible that they were at a loss of how to handle it but pledged to keep an open eye in the future.

Thanks for letting me vent. It's been a long time coming.

[MB37]

I've been a bartender for many years, and yes, vodka is the drink of choice for those who don't want others to know they've been drinking. However, usually you can still smell something. I've never heard of grape bubble gum being used to cover it, but it sounds like it would work. Do you think she's consuming at the hospital, or still drunk from the night before? ("still drunk" isn't better, it's just harder to catch in the act) I also drink, and enjoy it, but not the night before clinical. Any serious drinker can easily consume enough the night before to still be legally drunk the next morning and possible not even notice. It's a hard situation - you have no "proof" that she's been drinking unless youve seen it, so it's hard to get too involved - especially as a student. I think you definitely need to find out for sure what the school's policy is, from someone besides this particular instructor. If the school really places all the responsibility on the NM, you might want to print out a copy of that policy and put it in her mailbox, if you aren't comfortable talking to her in person. I couldnt' imagine my school tolerating the inappropriate behavior you described without some kind of reprimand, for a sober student! We're always told how we're supposed to be representing the school and to look and act professional at all times on hospital property. Good luck with whatever you do, and hopefully she can find help soon, for her and her baby's sake!

[DaFreak71]

I've been a bartender for many years, and yes, vodka is the drink of choice for those who don't want others to know they've been drinking. However, usually you can still smell something. I've never heard of grape bubble gum being used to cover it, but it sounds like it would work. Do you think she's consuming at the hospital, or still drunk from the night before? ("still drunk" isn't better, it's just harder to catch in the act) I also drink, and enjoy it, but not the night before clinical. Any serious drinker can easily consume enough the night before to still be legally drunk the next morning and possible not even notice. It's a hard situation - you have no "proof" that she's been drinking unless youve seen it, so it's hard to get too involved - especially as a student.

I don't believe she has ever consumed alcohol at the hospital or even at school for that matter. It was a matter of still being drunk from the night before (which she did admit to me and the other student who reported it as well). We were a "team", best friends, so I was privy to the "drama" in her life, more so than just a classmate. I spent the whole first year of our friendship trying to get her help because she would often express to me that she was afraid she was an alcoholic. I took her to the school counselor and a short while after that I took her to the doctor to be put on antabuse (her idea). Sadly, she's been a heavy alcoholic for years, starting when she was 14 or 15. I am glad that she went into rehab, but sad that nothing has changed. For my own protection (emotionally) I have cut ties with her. It was a hard choice to make, but I can't invest my time with people who aren't interested in improving themselves. The constant drama was too draining for me. It was interfering with my studies and like they say, you can lead a horse to water, but you can't make them drink. (no pun intended, lol).

You are spot on when you said that unless I have proof I shouldn't assume she was drunk. The fact that she admitted it (later) and the fact that I knew her intimately led me to be privy to her "normal" behavior versus her drunk behavior. Due to all the time we spent together outside of class, I know how she looks and acts when she's been drinking versus when she is sober. All I could do was go off what I knew to be true and report it. Friend or no, I had a responsibility to report her because if something had happened to a patient (given the wrong med, etc) I would feel just as responsible and I surely don't want or need that on my conscious.