RN impaired at work

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I work at a small hospital with an RN with 20+ years seniority on the floor. From what I've heard, she's been reported and suspended numerous times for showing up intoxicated at work. She consistently leaves the floor for an hour or more at a time, rarely is in her patients rooms, does not give her medications on time or at all, etc. managers like her because she fills in 4 hour holes when they need coverage. This morning she showed up slurring her words, swearing loudly and overall belligerent. I reported it to the nurse supervisor who, along with our manager, came to "assess", FOUR hours later. Both coming to the conclusion she was perfectly fine. I'm being made to feel guilty and am completely discouraged and disheartened by the whole situation. She needs help, and her patients are not safe if she is impaired. Any advice?

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Who's doing the talking when you say, "from what you've heard"? What was she swearing about? Do you have personal conflict with this individual? This is difficult to believe, although I suppose that it's possible.

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First off, don't go by rumors or gossip. If she came into work and you saw this behavior, you did the right thing by reporting it to the manager. That they chose to not do anything about it, I would take it up the chain of command. And you could go on your parent website and report it as well. Go to senior management.

This nurse could be mentally ill (which is a protected class) She could be a diabetic. She could be stone cold drunk. You do not know.

If you are charge nurse, that is one thing, but if you are not, then do your work, do your thing, unless you are seeing first hand and not relying on second/third/fourth hand information.

If you follow this nurse and there's meds not given (and any medication machine will say if a med was given or not) do an incident report every time.

If she comes in belligerent, call security. If she is causing patient harm, then report her to the BON. If she is leaving for an hour at a time (which in a 4 hour shift, I am not sure why one would bother to come in at all) call the BON for patient abandonment. If she is leaving you alone on the unit, call the house supervisor. Every time. And every person that has to work with her. In the meanwhile, whilst everyone is getting their ducks in a row, she should not have an assignment. Let her "float"......and methinks she will more than likely drown.

She obviously needs some help. You can't help but feel sorry for a person who is that out of control. But the patients need to be protected.

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From staff who have worked at the hospital longer than I have. I don't have personal conflict with the individual. I don't love that she received preferential treatment but I have no issues with her. Are you feeling like my story isn't believable because most institutions would have stepped in by now, after the first two or three times she showed up to work intoxicated? Everything i'm saying is 100% true.

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Specializes in Surgery.

Report her *** to HR. If it's jeopardizing patient safety it needs to reported to the next level. They can drug test or whatever and come to real conclusion.

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From staff who have worked at the hospital longer than I have. I don't have personal conflict with the individual. I don't love that she received preferential treatment but I have no issues with her. Are you feeling like my story isn't believable because most institutions would have stepped in by now, after the first two or three times she showed up to work intoxicated? Everything i'm saying is 100% true.

My first thought is always whether or not there's a personal problem ...especially with outrageous types of claims like this one and vague information. People usually don't start screaming and swearing for no reason, for example ...even when they're drunk. I'm not saying there has to be a good reason, just that some context was missing.

If there's not a personal vendetta, she should definitely be reported further up the chain of command.

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Specializes in MICU, SICU, CICU.

I do believe you.

Look up the policy for employee substance abuse and do precisely what it says. It may be mentioned in your employee handbook as well.

You have a legal obligation to report the individual. I would be in the CNOs office immediately if an employee reported to work and appeared to be under the influence of alcohol or drugs.

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I'd keep reporting up the chain of command if you witnessed this. If you do nothing and she in-fact hurts someone while under the influence and they find out you suspected a problem at one point and didn't do everything in your power to stop it, you'd be in trouble as well.

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Report her *** to HR. If it's jeopardizing patient safety it needs to reported to the next level. They can drug test or whatever and come to real conclusion.

Three years ago she was intoxicated, taken off the floor and brought to our ED for what i'm presuming was a test. She was suspended from work for two weeks. After this incident, she has been reported at least two other times that I know of. I'm feeling like i'm in the twilight zone if she was positive for alcohol and suspended, but no further action was taken.

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Specializes in Family Nurse Practitioner.

I wonder why the board of nursing wasn't notified. Isn't the hospital obligated to report this to the board of nursing? I can't imagine they would be satisfied with only a two week suspension for going to work impaired.

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From staff who have worked at the hospital longer than I have. I don't have personal conflict with the individual. I don't love that she received preferential treatment but I have no issues with her. Are you feeling like my story isn't believable because most institutions would have stepped in by now, after the first two or three times she showed up to work intoxicated? Everything i'm saying is 100% true.

Staff can gossip a great deal. Unless you see it with your own eyes, and witness it in any form yourself, do NOT get caught up in the drama.

I did not say the story was not "believable". What is troubling is why, if you have absolutely no issue with her, you would get yourself involved on gossip and hearsay.

And you may never know the "real" situation about this person. Nor why she supposedly gets "preferential treatment". But I would suggest that you never put yourself in a place where you are making sweeping judgments about a nurse and his/her livelihood over what staff say about them.

And if said nurse has been at the facility for 20 years, perhaps she has seniority at this point to be able to work shifts that suit her. Perhaps her "belligerence" is getting a little ticked that everyone is calling her a drunk and spreading gossip and rumors about her.

And I do find it hard to fathom that she leaves for an hour at a time on a 4 hour shift. Perhaps she is so tired of everyone talking smack about her that she chooses to do her charting and such elsewhere, away from the nurses station.

You are 1 year into your nursing career, OP. And it would help you to realize that often the most senior nurses are the ones that are set up to fail, set up to get so frustrated that they decide to leave, and otherwise put up with a lot more than they should at 20 years in.

Now, this nurse could be a dangerous drunk that needs to be stopped. But I don't know that. And quite frankly, neither do you.

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Who's doing the talking when you say, "from what you've heard"? What was she swearing about? Do you have personal conflict with this individual? This is difficult to believe, although I suppose that it's possible.

I don't know about this particular incident but in general, I can believe it. I have seen it a number of times. One of the places I have worked throughout my career was a company that sent us on long term assignments. One of my 9 month assignments was helping to get a Pyxis system installed and staff trained. Part of the training I provided was reviewing Pyxis reports and dealing with impaired nurses. I don't think most nurses have any idea what kinds of reports we can pull on a given nurse. It is COMMON for a fellow nurse to express a concern about another nurse. When Nurse Patty is working "X" patient is comfortable and quiet, when Nurse Gail is working the patient is screaming and moaning in pain.

Pyxis allows us to pull reports on every single move made on the pyxis machine including those numbers pushed and not finished, which patient profiles were viewed, how many seconds each profile was viewed, if it was the patient of that nurse or not. Anything done on a Pyxis can be tracked at any time.

When a nurse is impaired they start getting more and more brave. The first time they steal a Percocet they are nervous, begin sweating, shaking, paranoid, looking around them constantly.... but the 10th time she steals a percocet she's very at ease, she didn't get caught the first 9 times, she won't get caught this time.

I remember one case just like that, this was in the ED. A nurse pulled two Vicodin tablets, RIGHT IN FRONT of me she popped one in her mouth, put the other in a med cup, and per the Pyxis, she gave the patient two tablets. She was so used to doing it that she didn't even think twice about it anymore. The more they do it the more at ease they are doing it in the future.

Clearly, I stopped her dead in her tracks. She left the hospital in handcuffs that day.

I wonder why the board of nursing wasn't notified. Isn't the hospital obligated to report this to the board of nursing? I can't imagine they would be satisfied with only a two week suspension for going to work impaired.

Little hospitals are known for not making a fuss out of things, they don't want it to get around that the incident happened and they don't want to lose a 20 year vet. Sad, yet many times true.

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