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.

[psalm, RN]

As a nurse you are a pt. advocate for pt. safety. You must have paid attention in class when that was taught. I would prob. do as you do/did, maybe in clinicals mention to your preceptor? Or charge nurse? Hopefully this student will get help and not present in such a condition, but we all face this on the floor now and then (maybe not drugs, but so tired, can't make rational safe decisions).

[caroladybelle, BSN, RN]

I wonder if the risk management or the NMs at the facility know of this "policy"?

I bet they don't, and would be really interested in hearing this theory.

[traumaRUs, MSN, APRN]

It is the instructor's problem and she needs to deal with it; swiftly and decisively! No iffs, ands, or buts. This is a pt safety issue not to mention this student needs help.

[DaFreak71]

I wonder if the risk management or the NMs at the facility know of this "policy"?

I bet they don't, and would be really interested in hearing this theory.

I agree, I bet the facilities don't know about the secret policy. My gut tells me that it would be appropriate to inform the NM if this should happen again, knowing that an instructor will pass the buck.

[DaFreak71]

It is the instructor's problem and she needs to deal with it; swiftly and decisively! No iffs, ands, or buts. This is a pt safety issue not to mention this student needs help.

I absolutely agree, thus my amazement at the instructors lack of action.

As far as the student needing help, you are dead right. Everyone in her life knows about the problem, has encouraged her to enter rehab, has called child protective services, etc. This has been going on since she was 15. She refuses to deal with it, even though she acknowledges that she has a problem (to a minimal degree). I've done what I could, and have been slapped in the face for my concerns. I'm done now. I wish I could force her to get help, but I know I cannot. Plus I'm unwilling to put myself into a situation filled with constant drama (been there, done that with my parents). At some point she has to take the responsibility to deal with it. In fact, I was quite hopeful when she actually did enter rehab a few months ago. After being there for 30 days (under threat of disciplinary action thru the national guard, where she is a member and was missing work), two days post rehab she got a job as a bartender and got pregnant and of course, is still drinking. I cannot have that in my life. It sucks for her, but ultimately we are responsible for our own lives.

Sorry if I came across as a gossip in this post. It's been troubling me for a while now and I realize that I need to know what to do in the future if this should happen in school. I'm not so much concerned about what to do on the job--for me that's an easy decision...I report to my NM immediately and call security if things get out of control. In school though, it's a different thing. I don't have any power in school to make the right calls and have them be backed up by the program. This whole chain of command is holding progress back in this particular case. :trout:

After writing this (gosh, writing can be therapeutic!) I think I now know what to do. Whatever the consequences might be with my program, if I see her drunk at clinical again I will tell my instructor. If she's not off the floor in a reasonable amount of time (like ten minutes), I will go to the NM, consequences be damned because patient safety is more important than getting in dutch with instructors. Even if they resent it at first, I think they will later realize I did the right thing. And if they don't...who cares?

Thanks for letting me get this off my chest and for responding. I feel better.

P.S. Have any of you other students had this issue come up in your program? If so, how was it dealt with?

[CT Pixie, BSN, RN]

well since the clinical instructor is ultimitaly responsible for any actions (good or bad) by her/his students, I'd think the CI would take care of the matter. I cannot fathom the rationale that its the NM's responsibility to notice and do something. Its not the NM's license on the line.

Like the other poster said, I wonder, too, if the NM knows of this schools "policy" on reporting an impaired student.

[mzjones6]

I'm sorry I had to read your post several times to see if I understood what was going on. Not only is this a serious pt. safety problem, but how is this fair to you and the other students in the program? How is ignoring a problem this serious fair to the other students in the program, who are doing what they have to do to get through clinicals?

I back your decision 150%, if it happens again you have to inform your instructor as well as the NM, since it's clear that no one else in a higher authority seems to take action. You're doing the right thing!!

[Daytonite, BSN, RN]

Since I was a nursing supervisor for some years and had to deal with this situation a few times I have some experience to draw from on this issue. First of all, you are obligated to follow the policy that it is place. For you, the policy you need to follow is the policy of the school of nursing. When you are in a clinical area, your nursing instructor who is there with you is your immediate supervisor. Your nursing instructor is the person you should be reporting a drunken student to. Then, you have done your duty. If you do not think that the instructor has done their duty, then you need to report the nursing instructor to her supervisor who would probably be the dean of the nursing department.

I would suggest that you talk with someone else in the nursing program, the dean, if possible, about this, not a clinical instructor. Ask what the policy on this is so that if it happens again you will know exactly what you are to do. If you are again told is the job of the NM at the facility to notice it, then I would not hesitate to hunt down the nurse manager, supervisor or go to the nursing office and let them know about a drunken student that the instructor was doing nothing about.

I'm surprised you weren't able to smell the alcohol on this person unless they had been drinking vodka. Our normal procedure was to escort the employee to the ER and to submit to a blood alcohol draw. If they refused they were clocked out and sent home on suspension and not allowed back to work until their nursing manager and the director of nursing dealt with the problem. The most important thing was to get the employee off the patient unit and away from patient care.

[Daytonite, BSN, RN]

Something else you could do if the school continues to ignore this student and the way she shows up drunk at clinicals is to document what has happened and report it to your state board of nursing. Name the school and the clinical instructor. Ignorance of the nursing law is not an excuse for the clinical instructor ignoring this problem. If this lady were a licensed RN, she would be in danger of losing her nursing license or having her license suspended while she was put into a rehab or diversion program by your state board of nursing.

[santhony44, MSN, RN, NP]

I'm sorry, but the clinical instructor is plain nuts! Yes, the student is under her license. I'd have had the student off the floor so fast her head would spin (more than it probably already was).

That being said, if I were the nurse manager on the floor, I'd insist that the instructor handle it immediately, and if she didn't, I'd be on the phone with both my own supervisor and the head of the nursing program. I'm sure the nurse manager that day had no clue that anything was going on or it would have been dealt with, and the instructor would have been in trouble!

[smk1, LPN]

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.