A nurse manager recognizes a change in another nurse's behavior and suspects the nurse is practicing while chemically impaired.
After ensuring the client's safety, which of the following actions should the nurse manager take first?

Choice A rationale

Advocating for the client is a fundamental ethical responsibility of nurses, as outlined in the ANA Code of Ethics. In this scenario, reporting abuse to social services demonstrates the nurse's commitment to protecting the client's rights, well-being, and safety, especially for vulnerable individuals who may not be able to advocate for themselves.

Choice B rationale

Committing to quality client care is a broad ethical principle that encompasses many aspects of nursing practice, including providing competent care. While reporting abuse contributes to quality care by ensuring safety, "advocating for the client" more specifically describes the nurse's direct action in protecting a vulnerable individual from harm.

Choice C rationale

Honoring the client's human dignity involves treating clients with respect and preserving their inherent worth. While reporting abuse helps to restore dignity by stopping mistreatment, the direct action of intervening on behalf of the client in a protective manner is best described as advocacy.

Choice D rationale

Promoting research to advance nursing practice involves contributing to the development of new knowledge and evidence-based interventions. While important for professional growth, it is not the primary ethical provision that describes the direct act of reporting client abuse. The immediate action is focused on client protection.

Choice A rationale

Directly asking a colleague if they are impaired is not the most appropriate initial action as it can lead to defensiveness or denial and may not effectively address the safety concerns. The priority is patient safety, which requires reporting to a higher authority who can intervene objectively and professionally.

Choice B rationale

Notifying the nurse manager is the most appropriate action. The nurse manager has the responsibility and authority to address concerns about a chemically impaired colleague. They can initiate the proper procedures, including investigation, intervention, and referral to employee assistance programs, ensuring patient safety and colleague support.

Choice C rationale

Contacting risk management is not the immediate first step. While risk management might become involved later, the direct supervisor or nurse manager is the initial point of contact for personnel issues that pose a potential risk to patient safety. The manager can then involve other departments as needed.

Choice D rationale

Confronting the colleague directly about the suspicion is generally not advisable. This approach can be confrontational, potentially escalating the situation without resolving the underlying issue. It may also violate professional boundaries and lacks the formal authority needed for effective intervention.