Question

A nursing student, Caitlyn, is working with her preceptor, Brenda. Brenda, an experienced nurse, appears to be fumbling with her assessment and acting a bit odd. She then accidentally pulls out the patient’s IV without noticing. When Caitlyn brings it up, Brenda blames Caitlyn for pulling it out. Caitlyn approaches her nursing instructor, Ms. Simpson, with concerns that her preceptor might be impaired.

SCENE 1: A nursing student, Caitlyn, is working with her preceptor, Brenda. Brenda, an experienced nurse, appears to be fumbling with her assessment and acting a bit odd. She then accidentally pulls out the patient’s IV without noticing. When Caitlyn brings it up, Brenda blames Caitlyn for pulling it out. Caitlyn approaches her nursing instructor, Ms. Simpson, with concerns that her preceptor might be impaired.

1. Why did the student nurse feel that Brenda may be “drunk” or chemically impaired while at work?

2. What other possible clues, not present in the scenario, could indicate that a nurse (in this case Brenda) may be chemically impaired?

3. If you were a student nurse in this situation, what would be your first priority? How would you address this priority?

SCENE 2: Caitlyn and Ms. Simpson are discussing Caitlyn’s concerns in a small conference room. Ms. Simpson asks Caitlyn to provide as much information as possible and then inquires what Caitlyn’s first immediate action should be. Caitlyn agrees to report the nurse to the nurse manager, with Ms. Simpson’s support. However, Caitlyn, who would like to get a job at the hospital after graduation, is concerned about coming off as a tattletale and possibly losing a job opportunity.

4. Do you feel that the nursing instructor (Ms. Simpson) or Caitlyn should be responsible for reporting Brenda to the nurse manager? Why?

5. Caitlyn is worried about reporting because she may want to seek a job at the hospital and does not want to be seen as a “tattletale”. How do you feel about Ms. Simpson’s response? Have you had similar concerns in your clinical setting (when you felt something was incorrect but didn’t want to “rock the boat” due to the possibility of future employment at the facility)?

6. At the end of the scene, Ms. Simpson asks Caitlyn if she is ready to report to the nurse manager. In what other ways could Ms. Simpson have helped Caitlyn prepare for giving the report?

7. How would you report the concerning behaviors to the nurse manager? What specifically would you say?

SCENE 3: The nurse manager enters the room of one of Brenda’s patients to find Brenda draped over the patient and asleep. The nurse manager awakens Brenda and tells her that she will need to be escorted by security down to the Emergency Department.

8. Why do you think the nurse manager stated that security was coming to take Brenda to the Emergency Department? Do you feel that this was appropriate?

9. What are the next steps that the nurse manager and facility will take in regard to Brenda’s chemical impairment?

10. What guidelines do you think maybe put in place when Brenda returns to work? What do you think will happen if Brenda violates those guidelines?

Answer 1

1) The student nurse feel that Brenda may be “drunk” or chemically impaired while at work because she pulled out the IV of the patient accidentally and on informing that she had pulled the IV line out ,Brenda blames the student that she took the IV out .

2) The possible clues that indicates that a nurse may be chemically impaired are :-

Severe mood swings, personality changes.

Frequent or unexplained tardiness, work absences, illness or physical complaints.

Elaborate excuses.

Underperformance.

Difficulty with authority.

Poorly explained errors, accidents or injuries.

Wearing longs sleeves when inappropriate.

3) If was the student nurse in this situation then my first priority will be to fix the IV of the patient and then report about Brenda's behaviour to the instructor .

4) Yes I think, that the nursing instructor (Ms. Simpson) or Caitlyn should be responsible for reporting Brenda to the nurse manager because then only necessary action required ( that could be treatment / and legal action if absence of disease ) will be taken against her . Not informing about her behaviour will cause further harm to the patients .