Impaired Colleague

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Specializes in ER/ICU, CCL, EP.

I work in a procedural area that administers moderate sedation. One of my coworkers is extremely unhealthy, takes many medications, and falls asleep at work constantly. Like....ALL THE TIME. Like while she is sedating a patient. While she is charting, while she is running our specialized devices.

I had an intervention with her. I told her what she was doing and suggested she see her physician. I tried to express that I cared about her and that I didn't want to see anything bad happen. She cried, promised to get better, got new medications, etc. Did not work.

I finally told my manager about it. Multiple times. In writing. She has avoided dealing with the situation. I can only see two choices and they are both bad:

1. Tell my manager that I refuse to work in the area until she gets another nurse who is not impaired.

2. Go over my manager's head. She is extremely vindictive.

Any suggestions?

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Specializes in MICU, SICU, CICU.

A staff nurse should not have to become involved in the disciplinary process for a nurse who sleeps on the job. Her narcolepsy, anxiety or substance abuse issues are management issues that obviously can not be ignored.

Send the following text to your immediate supervisor: we have an employee who is sound asleep while on duty. Every single time. It is extremely dangerous for a nurse to fall asleep while giving and monitoring concious sedation. Why haven't the MD or manager addressed this?

File an adverse event report every single time. If you have a relationship with someone in risk management, let him or her know about this extremely unsafe situation.

In the meantime, if this person is sleeping outside of the procedure room, loudly tell her to wake up and even kick the wheels on her chair. If you can not awaken her or she is unresponsive call a rapid response.

I would be highly suspicious that she is diverting waste from the meds given during concious sedation. Be cautious about co-signing any waste. Keep your distance and keep notes about every incident. Impaired nurses are highly manipulative, use tears and excuses. They will even deflect blame on to others, mainly their nice, helpful, unsuspecting coworkers.

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Specializes in Pediatrics, Emergency, Trauma.
A staff nurse should not have to become involved in the disciplinary process for a nurse who sleeps on the job. Her narcolepsy, anxiety or substance abuse issues are management issues that obviously can not be ignored.

Send the following text to your immediate supervisor: we have an employee who is sound asleep while on duty. Every single time. It is extremely dangerous for a nurse to fall asleep while giving and monitoring concious sedation. Why haven't the MD or manager addressed this?

File an adverse event report every single time. If you have a relationship with someone in risk management, let him or her know about this extremely unsafe situation.

In the meantime, if this person is sleeping outside of the procedure room, loudly tell her to wake up and even kick the wheels on her chair. If you can not awaken her or she is unresponsive call a rapid response.

I would be highly suspicious that she is diverting waste from the meds given during concious sedation. Be cautious about co-signing any waste. Keep your distance and keep notes about every incident. Impaired nurses are highly manipulative, use tears and excuses. They will even deflect blame on to others, mainly their nice, helpful, unsuspecting coworkers.

This.

It is unfortunate that management is not taking care of this-if an adverse event happens, I wonder if they would jump then...

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Does your facility have a compliance hotline? Reports are anonymous (supposed to be).

This vindictive manager will get 'caught' with a file full of your complaints. I hate to rock boats myself, but if you can steel yourself, you might get your colleague the help she needs (or whatever) and a new manager, which your unit needs.

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Check and see if your state requires you to report suspected impaired nurses.

Some do and you may be putting your license at risk by not fulfilling your duty to report-especially since there is a paper trail where you spoke with your manager.

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Specializes in SICU, trauma, neuro.

I wasn't aware that it varies by state, but I do remember being taught in my final semester of NS that we were obligated to report impaired colleagues. "No need to decide what to do, you just have to report."

You can find out very quickly if your state has a monitoring program for impaired professionals. You can report anonymously without involving the BON, and she can get the help she needs, if she does have chemical health issues. My state's program is linked from the BON website, but you could also find it w/ a Google search.

Whether she is chem dependent, has narcolepsy, has antidepressant s/e's or is that extremely sleep deprived, she is not practicing safely. She needs help, and you have an obligation to protect your pts.

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Can someone clarify: hasn't the OP fulfilled any "duty to report" by reporting to her manager? The duty to report doesn't extend to "duty to assure action" which of course we can't... But is there a further duty besides reporting to the manager? Does it have to be somewhere more specific?

Don't get me wrong, it sounds like a very unsafe situation and an anonymous compliance line seems ideal to avoid blowback. I'm not advocating not reporting.. Just wondering what constitutes sufficient "reporting."

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Can someone clarify: hasn't the OP fulfilled any "duty to report" by reporting to her manager? The duty to report doesn't extend to "duty to assure action" which of course we can't... But is there a further duty besides reporting to the manager? Does it have to be somewhere more specific?

Don't get me wrong, it sounds like a very unsafe situation and an anonymous compliance line seems ideal to avoid blowback. I'm not advocating not reporting.. Just wondering what constitutes sufficient "reporting."

It is state specific. Here is an example:

5. Whether a nurse should report another nurse to an employer before, or instead of, reporting to the board of nursing.

Example: Oregon law explains when to report to a superior and when to report to the Board of Nursing: "Anyone knowing of a licensed nurse whose behavior or nursing practice fails to meet accepted standards for the level at which the nurse is licensed, shall report the nurse to the person in the work setting who has authority to institute corrective action. Anyone who has knowledge or concern that the nurse's behavior or practice presents a potential for, or actual danger to the public health, safety and welfare, shall report or cause a report to be made to the Board of Nursing."[14]Many states do not provide such direction. Michigan requires a licensee "who has reasonable cause to believe that a licensee is impaired must report that fact to the Department [of Consumer and Industry Services]."[12] There is no mention of discussing the matter with a supervisor before reporting in the Michigan regulation.

http://www.medscape.org/viewarticle/585562_4

So in Michigan the OP would be in violation of the law while if the OP was from Oregon the duty to report would have been met when discussed with the manager. That is why it is necessary to know your state practice act.

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[COLOR=#000000]Your manager may not be avoiding the situation, she may be gathering evidence. But I am not there and do not know the specifics of the situation. I would continue to present your manager with evidence of impairment, while keeping copies of any documentation for yourself.

I admire your willingness to confront and/or help your coworker. In my opinion, interventions with medical practitioners can be tricky. The best outcome is the person gets help, becomes a competent practitioner again, and no patients are injured. I know of two cases where interventions were conducted for a nurse and then the nurse was allowed to go home unsupervised. In these two cases the nurses both went home and committed suicide. People, especially nurses and doctor's who have access to powerful narcotics, should never be left alone after an intervention. I am sure the OP did the best he/she could and this is in no way meant to be judgmental about the OP's actions.

Sadly, many impaired doctors are escorted to treatment by their employers, but many impaired nurses are escorted to prison by their employers.

OP, please keep us updated. I hope your employer does the right thing.

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You have a duty to report.

Do it anonymously to your Compliance officer.

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Specializes in Psych, Addictions, SOL (Student of Life).

As a formerly impaired nurse whose life was saved by the colleague who reported me. I would say you should report her to the BON in her state. I had considered that colleague a friend and hated her for what she did but she quite litereally changed my life, actually saved it. I have no doubt that I would be dead today had I not been reported. I am now sober 11 years and still a nurse who is highly respected in my field. I went through hell getting sober but I am greatful that that nurse had the courage and integrity to do what she did.

Hppy

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
This.

It is unfortunate that management is not taking care of this-if an adverse event happens, I wonder if they would jump then...

They would shake their head in feigned disbelief. "I had no idea! How can I intervene if no one tells me what's going on?" That's why you keep careful records of every time you reported the problem to management. Incident reports for each incident is a good suggestion, too.

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