Nurse asked to document student ingested drug, but no proof

[Nurse Beth, MSN]

In this situation, the nurse is caught between the need to provide accurate documentation and administrative pressure to confirm something that isn't certain.

Here's how the nurse can navigate this ethically and professionally:

• Assess the situation thoroughly. The nurse should first assess the student's symptoms and gather any further details that can potentially confirm or rule out a marijuana-related reaction. Symptoms of cannabis ingestion can include dizziness, increased heart rate, dry mouth, confusion, and, in some cases, anxiety or paranoia. If the nurse suspects marijuana consumption, they should still rely on their clinical judgment rather than making assumptions.
• Document symptoms clearly and factually. Even if the student isn't admitting to consuming an edible, the nurse should document what is observable. For example:

"Student reports consuming a pop-tart. Presented with dizziness, mild tachycardia, and no other apparent symptoms. Denies edible marijuana consumption, though symptoms may suggest a reaction. No other substances available for assessment."

This allows the nurse to record the symptoms without definitively stating it's a marijuana-related issue unless they can confirm it, which, in this case, they cannot.

• Avoid making assumptions in the documentation. Even if the nurse suspects marijuana use, it's crucial not to make definitive claims unless confirmed. The nurse can write:

"Symptoms could be consistent with a possible reaction to edible marijuana, but the student did not confirm this."

• Follow facility policies. The nurse should follow those protocols if the school or healthcare facility has specific guidelines about handling cases where students may be suspected of consuming illegal or controlled substances. Depending on the setting, this might include informing the administration and parents or conducting drug testing.
• Addressing the Administrative Pressure: If the administration wants the nurse to write "confirm edible" despite the nurse's uncertainty, the nurse should express their concerns. It is not professional to document something that isn't true or confirmed, and doing so could create liability or ethical issues for both the nurse and the school. The nurse should consider discussing this with a supervisor or higher authority to ensure proper documentation practices are followed. The documentation should be based on evidence and clinical findings, not assumptions.

Professional advice. Suppose this situation could have legal implications (such as involving minors or school policy violations). In that case, the nurse might also want to consult with a legal or risk management advisor to ensure they follow appropriate protocols and safeguard their professional integrity and the student's safety.

In summary, the nurse should document the facts they can confirm, acknowledge the possibility of a marijuana-related reaction without confirming it, and remain professional when dealing with administrative pressure to confirm something not backed by evidence.

Best wishes,

Nurse Beth

 

[JKL33]

Nurse Beth said:

bur Admin wants the notes to say that.

Too bad for them; that's not how this works. You may have to inform them, in a professional manner, that is not how medical documentation works and that you are not going to produce false documentation. They are free to write an administrative report of their concerns but there is no situation where you will document that you have confirmed a specific fact when you haven't. [Even if there was a suspicious looking product present, the most you would be able to factually "confirm" without further testing of the product would be that the student has a product suspicious for being edible marijuana.]

When something is clearly wrong like administration's demand in this case, I have had success with just being very direct, right away. As in...this isn't going to take any time for me to ponder...it's technically illegal (falsification of record) as well as a violation of my ethical duty and I'm not going to do it.

Good advice above.