Meet Erin:
Erin and Judy are registered nurses (RN) who work in a labor and delivery unit in an acute care tertiary hospital. Erin and Judy work opposite shifts.
Erin has noted that over the last six months, Judy had been consistently late for her shift, making Erin late leaving work. Erin has also had to work additional hours when Judy has called in sick at the last minute, leaving their unit manager with limited time to find a replacement. The narcotic counts have also been off after some of Judy’s shifts.
On top of this, Erin has noted a change in Judy’s behaviour. Judy has been drowsier than usual, especially after her night shifts. Erin has considered that Judy might be misusing a substance, but she doesn’t want to jump to conclusions.
Erin is concerned but is unsure of her accountability to follow up on these concerns with Judy or her unit manager because she does not have any specific evidence that Judy has misappropriated the drugs.
Later that week, another RN colleague named Alison witnesses Judy misappropriating narcotics and self-administering the medications at work. Alison and the unit manager report Judy to NANB and now Judy is off work on a leave of absence.
Erin is not sure about what she should have done differently in this situation. Should she have reported Judy? Should Alison have reported Judy? How can Erin learn from Alison in the future? How should she react the next time she works with Alison?
Reflecting on the 2019 RN Standards of Practice:
Erin knows that she is obligated to meet the 2019 Standards of Practice for Registered Nurses. Standard 1, indicator 1.7 states: “recognizes and addresses violations of practice, incompetence, professional misconduct, conduct unbecoming the profession, and/or incapacity of nurses and/or other health care providers and complies with duty to report”.
At the time, Erin was unsure of her obligation to this indicator. She had suspicions but no concrete evidence that Judy was misusing a substance.
How Can Erin Learn From this Situation?
Erin did notice a change in Judy’s behavior and that she seemed to be struggling with her professional obligations.
When there was no concrete evidence but only a suspicion of problematic substance use, Erin may have considered approaching Judy to discuss her concerns.
This type of conversation can be difficult because individuals who have a problem with substance use may deny that a problem exists and may react negatively to the concerns. If Erin had decided that a conversation was not possible, she needed to ensure client safety and have a conversation with her manager regarding the concerns.
After the fact, Erin learned that Alison did speak with Judy who admitted to misappropriating the narcotics, but Judy had assured Alison that she had her substance use under control. Alison understood that she had an accountability according to Standard 1, indicator 1.7 to report these concerns.
As a result, Alison met with the manager and focused the conversation on the specific issues related to Judy’s misappropriating as well as her suspicion that Judy was using narcotics while at work. Alison had also documented her observations of Judy’s behaviours, doing so in an objective and factual way by including information such as times, dates, locations, details of the events, names of witnesses, identification of any clients involved, and actions taken. She provided her manager with a copy of her documentation.
After taking some time to self-reflect on her actions and meeting with her manager to discuss the situation, Erin understands that both she and Alison have a professional obligation as self-regulating RNs to meet these standards.
To know more about problematic substances use or duty to report, please refer to Practice Guideline: Duty to Report.
For more information on Responsibility and Accountability, continue to explore Standard 1 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca.